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Butchart L, Parsa S. Narrative Medicine Theory and Practice: the Double Helix Model. MEDICAL HUMANITIES 2024; 50:153-161. [PMID: 37852746 DOI: 10.1136/medhum-2023-012648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/26/2023] [Indexed: 10/20/2023]
Abstract
The genesis of the medical humanities as a discrete academic discipline engendered a need for a theoretical framework, a function taken on by the growing narrative medicine movement. More recently, scholars have begun to develop a critical medical humanities, an analytical movement that emphasises the fundamental enmeshment of the sciences and humanities. Building on Helene Scott-Fordsmand's work on reversing the medical humanities, this paper develops an alternative to the current version of narrative medicine. We propose a new interpretive heuristic, the Double Helix Model, and place it in critical dialogue with the Columbia School's close reading based-approach. Through this new conceptual frame, we suggest that critical narrative medicine may empower clinicians to contribute to the reorientation of the roles of the sciences and humanities, benefiting providers, scholars and patients.
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Affiliation(s)
- Liam Butchart
- Center for Medical Humanities, Compassionate Care, and Bioethics, Stony Brook University Renaissance School of Medicine, Stony Brook, New York, USA
| | - Shabnam Parsa
- Stony Brook University Renaissance School of Medicine, Stony Brook, New York, USA
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2
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Chong Y, Wang C, Min H, Zhang L, Zhi T, Wu X, Wang Y. Physical Restraint Experience of Patients with Mental Disorders in Mainland China: A Qualitative Study. J Multidiscip Healthc 2024; 17:431-444. [PMID: 38314012 PMCID: PMC10838508 DOI: 10.2147/jmdh.s438269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 01/16/2024] [Indexed: 02/06/2024] Open
Abstract
Introduction The use of physical restraint (PR) is considered a controversial practice and research in Western countries has demonstrated negative physical and psychological consequences for patients, as well as staff, family members/carers, organisations and society as a whole. However, there are few research reports on restraint experiences of patients with mental disorders in non-Western countries, especially in mainland China. Aim This study aims to explore the subjective experiences and perceptions of patients with psychiatric disorders who have experienced PR in mainland China. Methods Semi-structured interviews were conducted with 8 inpatients with mental disorders in convalescence at a specialized mental health hospital in Shanghai. Interviews were recorded on audiotape and transcribed verbatim. Transcripts were analyzed using thematic analysis. Results Five themes emerged: "perception and understanding of PR", "response to PR", "negative physical and psychological experiences", "unmet care needs during PR" and "changes after PR", which together characterize patients' perceptions, experiences, feelings, and needs in PR. Conclusion The use of PR involves ethical issues and brings negative experiences to patients with mental disorders that cannot be ignored and should be used as a last resort. Different patients have different attitudes and reactions to PR. During PR, patients' physical and psychological needs are not adequately met. Medical staff should give more attention to patients in PR, meet their physical and psychological needs, and actively seek PR alternatives and reduction options based on evidence-based resources on restraint reduction available in the West and the national context and culture of China.
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Affiliation(s)
- Yue Chong
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People's Republic of China
| | - Can Wang
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People's Republic of China
| | - Haiying Min
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People's Republic of China
| | - Lei Zhang
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People's Republic of China
| | - Tingting Zhi
- Shanghai Baoshan Mental Health Center, Shanghai, 201900, People's Republic of China
| | - Xiaoning Wu
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People's Republic of China
| | - Yanbo Wang
- Clinical Research Center for Mental Disorders, Shanghai Pudong New Area Mental Health Center, School of Medicine, Tongji University, Shanghai, 200124, People's Republic of China
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Jensen MAE, Mørch CD, Yilmaz MN, Feilberg C, Pedersen B. A new self-understanding as chemo sufferer - a phenomenological study of everyday life with chemotherapy induced neuropathy among survivors after colorectal cancer. Int J Qual Stud Health Well-being 2022; 17:2049437. [PMID: 35315728 PMCID: PMC8942531 DOI: 10.1080/17482631.2022.2049437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To explore the essential meaning of how sensory disturbances caused by Oxaliplatin influence self-understanding and freedom to live an everyday life among survivors after colorectal cancer. METHODS Data was generated by means of a semi-structured individual interview with eight survivors after colorectal cancer who continued to experience chemotherapy-induced peripheral neuropathy at least one year after completing chemotherapy with Oxaliplatin. Data analysis was guided by existential phenomenology and descriptive life-world research. RESULTS The essential meaning was structured by four constituents. 1) An unpleasant fluctuating sensation which is impossible to ignore, 2) Breaking through of noise and pain despite struggling to keep them at bay, 3) Continuously feeling ill despite being cured, and 4) Bodily constraints that impact self-understanding and limit enjoyment of life. CONCLUSION The survivors used distraction to keep the sensory disturbances at bay but were forced to adapt to a new self-understanding as sufferers after chemotherapy despite being cured of their cancer disease. This way of being-in-the-world was understood by survivors, their families and healthcare professionals as a necessary price to pay to be alive. However, marked as sufferer after chemotherapy, the participants' everyday style of experience and life revealed as an ill health condition, which limited their ability to accomplish everyday activities as before and their freedom to realize their potential-the "I can".
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Affiliation(s)
- Marlene AE. Jensen
- Department of Oncology, Clinic for Surgery and Cancer treatment, Aalborg University Hospital, Denmark
| | - Carsten D. Mørch
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Mette N. Yilmaz
- Department of Oncology, Clinic for Surgery and Cancer treatment, Aalborg University Hospital, Denmark; Clinical Cancer Research Centre, Aalborg University Hospital, Denmark
| | - Casper Feilberg
- Department of Communication and Psychology, Aalborg University, Aalborg, Denmark
| | - Birgith Pedersen
- Department of Oncology, Clinic for Surgery and Cancer treatment, Aalborg University Hospital, Denmark; Clinical Nursing Research Unit, Aalborg University Hospital, Denmark; Clinical Cancer Research Centre, Aalborg University Hospital, Aalborg, Denmark
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Crocker RM, Tan T, Palmer KNB, Marrero DG. The patient's perspective of diabetic foot ulceration: A phenomenological exploration of causes, detection and
care seeking. J Adv Nurs 2022; 78:2482-2494. [PMID: 35285035 PMCID: PMC9283226 DOI: 10.1111/jan.15192] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 11/29/2021] [Accepted: 02/09/2022] [Indexed: 01/13/2023]
Abstract
AIMS Diabetic foot ulceration can contribute to lowered life expectancy and quality of life for people with diabetes, and yet, scant attention has been given to improving preventive and educational measures. This article uses a phenomenological approach to explore individuals' lived experiences of diabetic foot ulcerations to explore factors that can be harnessed to achieve improved outcomes. DESIGN This was a qualitative study using semi-structured interviews grounded in a phenomenological framework to explore how patients perceive and understand their foot problems. METHODS Study participants were recruited from February 2020 to February 2021 from a tertiary referral centre that treats foot problems in persons with diabetes. A total of 15 Hispanic, Native American and White patients participated in the study. We conducted in-depth semi-structured interviews which were audio recorded with the participant's consent. Interview data were transcribed and analysed with Dedoose data management software. RESULTS Analysis revealed findings in two primary domains: (1) how patients perceive foot ulceration, with themes around limited understandings of foot ulceration, close sensory observation of foot problems and barriers to ulcer perception and (2) how patients experience the timing of foot ulceration, with themes on how time perceptions shifted as foot problems became more serious, which correlated closely to how patients responded to their foot problems. CONCLUSION Despite the close sensory observation of their feet, people with diabetes face an array of barriers to recognizing and understanding the implications of diabetic foot ulceration, which can lead to delayed care seeking. Nurses can play a critical role in promoting patient education and improving patient self-management of foot ulcers. IMPACT This phenomenological study offers important lessons to guide nurses and other providers in enhancing patient self-management of DFUs and improving care outcomes by expanding an understanding of DFU early warning signs, the imperative to seek medical care quickly, and addressing possible barriers.
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Affiliation(s)
- Rebecca M. Crocker
- Center for Border Health Disparities University of Arizona Health Sciences Tucson Arizona USA
| | - Tze‐Woei Tan
- Division of Vascular and Endovascular Surgery University of Arizona College of Medicine‐ Tucson, Southern Arizona Limb Salvage Alliances (SALSA) Tucson Arizona USA
| | - Kelly N. B. Palmer
- Center for Border Health Disparities University of Arizona Health Sciences Tucson Arizona USA
| | - David G. Marrero
- Center for Border Health Disparities University of Arizona Health Sciences Tucson Arizona USA
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Oh Y. A New Perspective on Human Rights in the Use of Physical Restraint on Psychiatric Patients-Based on Merleau-Ponty's Phenomenology of the Body. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910078. [PMID: 34639380 PMCID: PMC8508529 DOI: 10.3390/ijerph181910078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 09/08/2021] [Accepted: 09/24/2021] [Indexed: 11/16/2022]
Abstract
(1) Background: Physical restraint in psychiatric settings must be determined by health care professionals for ensuring their patients’ safety. However, when a patient cannot participate in the process of deciding what occurs in their own body, can they even be considered as a personal self who lives in and experiences the lifeworld? The purpose of this study is to review the existential capability of the body from Merleau-Ponty’s phenomenology to explore ways of promoting human rights in physical restraint. (2) Methods: A philosophical reflection was contemplated regarding notions of the body’s phenomenology. (3) Results: Merleau-Ponty’s body phenomenology can explain bodily phenomena as a source of the personal subject, who perceives and acts in the world, and not as a body alienated from the subject in health and illness. Patients, when they are physically restrained, cannot be the self as a subject because their body loses its subjecthood. They are entirely objectified, becoming objects of diagnosis, protection, and control, according to the treatment principles of health care professionals. (4) Conclusions: The foundation of human rights, human being’s dignity lies in the health professionals’ genuine understanding and response to the existential crisis of the patient’s body in relation to its surrounding environment.
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Affiliation(s)
- Younjae Oh
- College of Nursing, Research Institute of Nursing Science, Hallym University, Hallymdaehakgil 1, Chuncheon 24252, Gangwon-do, Korea
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Ellingsen S, Moi AL, Gjengedal E, Flinterud SI, Natvik E, Råheim M, Sviland R, Sekse RJT. "Finding oneself after critical illness": voices from the remission society. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2021; 24:35-44. [PMID: 33029693 DOI: 10.1007/s11019-020-09979-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 06/11/2023]
Abstract
The number of people who survive critical illness is increasing. In parallel, a growing body of literature reveals a broad range of side-effects following intensive care treatment. Today, more attention is needed to improve the quality of survival. Based on nine individual stories of illness experiences given by participants in two focus groups and one individual interview, this paper elaborates how former critically ill patients craft and recraft their personal stories throughout their illness trajectory. The analysis was conducted from a phenomenological perspective and led to the meaning structure; a quest to find oneself after critical illness. In this structure, illness represented a breakdown of the participants' lives, forcing them to develop a new understanding of themselves. Despite acute illness, they felt safe in hospital. Coming home, however, meant a constant balancing between health and illness, and being either in or out of control. To gain a deeper understanding of the participants' narratives of survival, the meaning structure was developed from a phenomenological life world perspective, Heidegger's concept of homelikeness and Arthur Frank's typologies of illness narratives. In conclusion listening to and acknowledging the patients' lived experiences of critical illness may support the patient efforts to establish the newly defined self and hence be vital for recovery. Phenomenology is one approach facilitating care tailored to the patients' lived experience of critical illness and its aftermaths.
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Affiliation(s)
- S Ellingsen
- Faculty of Health Studies, VID Specialized University, Bergen, Norway.
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - A L Moi
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Plastic, Hand and Reconstructive Surgery, National Burn Centre, Haukeland University Hospital, Bergen, Norway
| | - E Gjengedal
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - S I Flinterud
- Centre of Diaconia and Professional Practice, VID Specialized University, Bergen, Norway
| | - E Natvik
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Førde, Norway
- The Centre for Health Research, District General Hospital of Førde, Førde, Norway
| | - M Råheim
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - R Sviland
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - R J T Sekse
- Faculty of Health Studies, VID Specialized University, Bergen, Norway
- Department of Obstetrics and Gynaecology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
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Wirth M. Phenomenology and its relevance to medical humanities: the example of Hermann Schmitz's theory of feelings as half-things. MEDICAL HUMANITIES 2019; 45:346-352. [PMID: 30206101 DOI: 10.1136/medhum-2018-011464] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/15/2018] [Indexed: 06/08/2023]
Abstract
One leitmotif that medical humanities shares with phenomenology and most contemporary medical ethics is emphasising the importance of appreciating the patient as a whole person and not merely as an object. With this also comes a focus on marginalisation and invisibility. However, it is not entirely clear what exactly patient-centred care means. What both phenomenology and medical humanities contribute to a 'more humane health-care encounter' (Goldenberg 2010, p 44) is offering not only a first-person perspective, but a dialogue between the third-person perspective and evidence-based medicine. Therefore, one main aim of medical humanities and phenomenology is to pay attention to the lived body (Leib) while adding this to the science of the objective body (Körper). In this study, I will discuss this connection through the lens of Hermann Schmitz's phenomenology. Finally, in light of this dialogue between phenomenology and medical humanities some proposals for medical practice shall be suggested.
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Affiliation(s)
- Mathias Wirth
- University of Bern, Faculty of Theology, Bern, Switzerland
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Roldán-Chicano MT, Fernández-Rufete J, Hueso-Montoro C, García-López MDM, Rodríguez-Tello J, Flores-Bienert MD. Culture-bound syndromes in migratory contexts: the case of Bolivian immigrants. Rev Lat Am Enfermagem 2017; 25:e2915. [PMID: 28699998 PMCID: PMC5511005 DOI: 10.1590/1518-8345.1982.2915] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 04/18/2017] [Indexed: 11/22/2022] Open
Abstract
Objective: to describe the culture-bound syndromes maintained by Bolivian immigrants in the
new migratory context and analyze the care processes of these health problems.
Method: qualitative research with an ethnographic methodological approach. Sample: 27
Bolivian immigrants. In-depth interviews and participatory observation were the
strategies used for data collection. Data were classified and categorized into
logical schemes manually and using the ATLAS-ti program v.5. Results: susto, “wayras”, amartelo, pasmo de sol, pasmo de luna and pasmo de sereno are
some of the folk illnesses that affect the Bolivian immigrants and that they have
to treat in the new migratory context. Conclusions: in the new environment, the group under study preserves culture-bound syndromes
that are common in their country of origin. The care strategies used for these
health problems are adapted to the resources of the new context and based on
interactions with the domestic environment, biomedicine and traditional medicine.
It was observed the need for the health professionals to realize that the efficacy
of certain therapies occurs within the scope of cultural beliefs and not in that
of the scientific evidence.
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Affiliation(s)
| | | | | | | | - Javier Rodríguez-Tello
- MSc, RN, Hospital General Universitario Santa Lucía, Servicio Murciano de Salud, Cartagena, Murcia, Spain
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