The International Journal of Whole Person Care
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‘The view from here’ - Anxiety and defences against anxiety in the provision of maternity care to one mother and baby
Get PDFBeing emotionally open in a maternity setting is a necessary part of the job of the midwife and consultant doctor. In fact it is recognised as a key aspect of relationship-based work. However, it can be complex and uncertain, particularly in the face of a mother and baby who are separated through death at birth or serious illness at birth.
This paper is interested in exploring the necessary conditions for relating and reflecting in maternity settings when babies are born with life threatening illnesses. With particular emphasis on one case example from personal experience this paper offers wisdom from the margins in the hope that it might contribute positively to thinking and learning about these experiences in frontline hospital settings. It will focus on how the intensity of the work with one mother and baby and the strength of emotion associated with that work disrupted the nurses capacity to think.
Drawing on the classic work of Isabel Menzies Lyth (1968) and lat er Sebastian Kraemer (2015), the paper will consider the types of anxiety and defences present in the encounter and in the ongoing treatment of this mother and baby. The paper will explore how treatment and care was received by the mother and what might have enhanced that provision of car
“I get to know them as a whole person”: family physician stories of proximity to patients experiencing social inequity
Get PDFCanadians’ health outcomes are inextricably tied to social inequities. While family medicine is aptly situated to provide care that addresses social factors through longitudinal knowledge of patients and their contexts, family physicians have come under increased pressure to do more for their patients with less time and resources due to financial and resource demands within primary care.
Nursing scholar Ruth Malone has argued that remaining proximal, or close to patients, is a form of resistance to these demands. Using a critical narrative methodology, we conducted 36 interviews with 20 family physicians working with persons experiencing health needs related to social inequity in Ontario, Canada, whose stories expressed and expanded upon Malone’s proximity. Notions of proximity were invoked through descriptions of the role of family physicians in: i) generating physical proximity based on the patients’ needs for more time, space, and care; ii) developing narrative proximity through storytelling over time, both between colleagues and patient communities; and iii) engaging in moral proximity, or recognizing the vulnerabilities of their patients, by going “above and beyond” in their care and advocacy roles inspired by the needs of their patients.
The findings add theoretical depth to proximity, extending this conceptualization into a new clinical context. These stories also complement current health services and health policy research that advocates for collaborative primary care approaches, as elements of these approaches are conducive to establishing proximity with patients who need care the most
Clinical vs social approaches to pediatric patient care: the benefits and resistance of therapeutic recreation
Get PDFThis presentation outlines the work I did as a Service Aid at the Montreal Children’s Hospital (MCH) from January 2022 to May 2022. I discuss the benefits and setbacks of the work I did with adolescent patients in the MCH psychiatry ward as the “art and play lady”. I also discuss the staff resistance I experienced in this role of offering therapeutic recreation with an embedded social (as opposed to more traditionally clinical) approach.
As a teacher with an MA in art education, I also talk about how I was not treated as a professional by a number of the staff who told me I was “just a teacher”. This is not formal research but is instead an anecdotal and narrative account of my experiences in a role with a less traditional, socially based, patient-centered approach to patient care. The presentation also offers interesting examples of patient artwork that resulted from this experience.
Overall, my story points toward the need for greater shifts in the hospital culture to occur to make it more feasible for therapeutic recreation to be available to patients. My story also suggests that more funding and education are needed to make social approaches to patient care more accepted by hospital systems
Survey on the current status of undergraduate education on self-care in university medical schools and medical colleges in Japan
Get PDFA survey on the current status of undergraduate education on self-care was conducted in university medical schools and medical colleges in Japan. This survey was planned and conducted by the Professionalism Subcommittee of the Japan Society for Medical Education. Prior approval was given by the Ethics Committee of Showa University.
Self-care education was defined as education to enhance the well-being (physical and mental health) of medical students. Of the 82 universities invited to participate, 65 universities responded to the survey, giving a response rate of 79.3%. Of these 65 universities, 32 universities (49.2%) indicated that they were implementing self-care education programs. Stress management, mindfulness, self-awareness, resilience, and improvement of self-affirmation were the most common topics, and many of the faculty in charge of the topics were psychiatrists, psychologists, and medical education faculty members. Although about half of the universities implemented self-care education programs, the educational content has not yet been standardized, suggesting the need for standardization of self-care education in the future.
The survey was conducted in all medical year levels, and the results showed that self-care education is given to first- and second-year medical students. It was suggested that it is necessary to provide more education to upper-year medical students who undergo clinical practice and experience increased stress. The need for self-care education for medical students has become even more important since 2020 and onwards, partly because of the impact of the COVID-19 pandemic
Minds unravelling
Get PDFThis is a poem about dealing with the traumatic aftermath of covid19. The poem is written on 4 sheets that collectively form the poster. The motifs are pressed flowers and flora with some graphing paper and blurry photographs of flowers. The colour scheme is beige and cream with bright earthy tones for the flowers. The poem is as follows:
Our minds unravelAs we peer through PPESee the quiet veilOf another historyThat couldn’t be.What do you want from me?
Pulling my cerebellumLike a cordOf chordatesOf apes.A sweater’s woven mysteryOf a loverVery unkind to me.
You speak to meFrom useless misery.You see meAs an infinite legacy.For other generationsTo take that liningAnd weaveIts silver specksWithin our identity
Mindfulness and therapeutic relationships: insights from a phenomenological study of occupational therapists' practices
Get PDFBackground
A well-established body of literature highlights the importance of the therapeutic relationship when working with children and youth. A growing body of literature points to the potential of mindfulness to enhance the quality of relationships, including the therapeutic relationship. To date, little attention has been paid to this topic within the profession of occupational therapy.
Aim
The aim of this study was to inquire into paediatric occupational therapists’ experiences of mindfulness in the therapeutic relationship with children and youth.
Methods
Heideggerian-informed hermeneutic phenomenology was employed as the methodological approach. Two key Heideggerian concepts of being-with and care served as theoretical underpinnings of the study. Semi-structured interviews were completed with eight North American occupational therapists to elicit their first-hand accounts of mindfulness in the therapeutic relationship with their paediatric clients. Interviews were transcribed verbatim and analyzed using a phenomenological approach.
Results
Four key themes were identified and include: fostering a safe space, enhancing presence, being authentic, and cultivating acceptance.
Conclusions
The findings offer insights regarding the potential affordances of mindfulness to support clinicians as they form of therapeutic relationships with children and youth. This study highlights research priorities for future inquiry. 
Medical students as whole persons – tending to the elephants in clinical practice training
Get PDFBackgroundFor years, we have known that many medical students lose empathy and experience burn out during the last part of their undergraduate education, despite starting with high motivation and above average mental health. The most powerful learning environment is the clinic, where students in the final stages of their program interact with real patients and practice doctor’s skills in authentic environments. We wondered how students at this stage are cared for as learners and novice professionals. We tried to identify explicit and hidden professional norms and competence goals that students are measured by, and sanctioned for not conforming with, in daily practice. We asked: Is there a mismatch between what medical students need to manage in their professional lives and the affordances inherent to the workplace environment where learning takes place? Can we intervene to mitigate any gaps?
MethodInspired by the Consolidated Framework for Implementation Research (CFIR), we engaged leaders, physicians, residents, and medical students at a small Norwegian hospital in a three-year project aiming to improve students’ motivation, participation, and clinical learning, by strengthening pedagogical and affective support during an 8-week practice period.
ResultsMedical students and residents identified needs for preparation and orientation, continuity, and secure relationships where learners are acknowledged as unique individuals. A simple model of learning needs was developed, where educational goals can be arranged on three levels: 1) social survival, 2) medical knowledge and skills, and 3) clinical wisdom
Resilience in adolescent chronic pain: an exploration of coping mechanisms and personal growth
Get PDFAdolescents living with chronic pain (CP) are vulnerable to negative outcomes such as disability and impaired quality of life. They often miss opportunities for social engagement and suffer from anxiety and depression. Central to all accounts is a sense of interrupted life—phrases with negative connotations such as “couldn’t do” and “had to stop” are repeatedly used to express feelings of loss of control.
To regain control over their situation, participants create within themselves a positive internal dialogue whereby they reconstruct the meaning of normalcy, practice acceptance, make downward social comparisons, and engage in daily positive affirmations. They also create a positive external environment, surrounding themselves with compassionate individuals as well as advocating for proper accommodations at school. While CP disrupts their personal and academic trajectories, the experience of living with pain has instilled in them the pursuit of significance.
This pursuit is propelled by the imagery of a fulfilled life and seems to be particular to this age group. Ironically, some participants are grateful for their pain for granting them intuitive empathy for the suffering of others and the emotional credibility to help others