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Epstein RM. Mechanics and gardeners: The role of mindfulness in medical education. CLINICAL TEACHER 2022. [DOI: 10.1111/tct.13495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Ronald M. Epstein
- Family Medicine, Oncology and Medicine
- American Cancer Society Clinical Research
- Center for Communication and Disparities Research
- Mindful Practice in Medicine
- School of Medicine and Dentistry University of Rochester Rochester NY USA
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Abstract
Palliative care is defined as ‘an approach that improves the quality of life of patients and their families who are facing problems associated with life-threatening illness. It prevents and relieves suffering through identification, assessment and treatment of pain and other problems, whether physical, psychosocial or spiritual’. As a palliative care physician, I aim to explore and meet the needs of my patients and their loved ones. As I am specifically trained as a specialist in assessing and treating ‘pain and other physical symptoms’, in psychological, social and spiritual issues, I am a generalist. Two approaches are described to assess spiritual needs in palliative care: The first is adjoining the analytic concept of the four dimensions of palliative care: using an instrument, measuring spiritual well-being or spiritual needs, and measuring the quality of life, with specific attention to spiritual issues. Second, a holistic approach is promoted, with openness to the patients’ narrative of their life, disease and suffering. In the integrity of the clinical encounter, medical, ethical and spiritual issues may be discussed. Broadening our clinical language with ethical, psychosocial, and spiritual vocabulary is mandatory, and self-reflection, interdisciplinary collaboration and specific interdisciplinary training may be supportive to develop such a clinical language.
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Cadge W, Lewis M, Bandini J, Shostak S, Donahue V, Trachtenberg S, Grone K, Kacmarek R, Lux L, Matthews C, McAuley ME, Romain F, Snydeman C, Tehan T, Robinson E. Intensive care unit nurses living through COVID-19: A qualitative study. J Nurs Manag 2021; 29:1965-1973. [PMID: 33930237 PMCID: PMC8236976 DOI: 10.1111/jonm.13353] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 12/25/2022]
Abstract
Aims To understand how nurses experience providing care for patients hospitalized with COVID‐19 in intensive care units. Background As hospitals adjust staffing patterns to meet the demands of the pandemic, nurses have direct physical contact with ill patients, placing themselves and their families at physical and emotional risk. Methods From June to August 2020, semi‐structured interviews were conducted. Sixteen nurses caring for COVID‐19 patients during the first surge of the pandemic were selected via purposive sampling. Participants worked in ICUs of a quaternary 1,000‐bed hospital in the Northeast United States. Interviews were transcribed verbatim, identifiers were removed, and data were coded thematically. Results Our exploratory study identified four themes that describe the experiences of nurses providing care to patients in COVID‐19 ICUs during the first surge: (a) challenges of working with new co‐workers and teams, (b) challenges of maintaining existing working relationships, (c) role of nursing leadership in providing information and maintaining morale and (d) the importance of institutional‐level acknowledgement of their work. Conclusions As the pandemic continues, hospitals should implement nursing staffing models that maintain and strengthen existing relationships to minimize exhaustion and burnout. Implications for Nursing Management To better support nurses, hospital leaders need to account for their experiences caring for COVID‐19 patients when making staffing decisions.
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Affiliation(s)
- Wendy Cadge
- Department of Sociology, Brandeis University, Waltham, MA, USA
| | - Mariah Lewis
- Department of Sociology, Brandeis University, Waltham, MA, USA
| | - Julia Bandini
- Institute for Patient Care, Massachusetts General Hospital, Boston, MA, USA.,RAND Corporation, Boston, MA, USA
| | - Sara Shostak
- Department of Sociology, Brandeis University, Waltham, MA, USA
| | - Vivian Donahue
- Blake 8 Cardiac Surgical Intensive Care Unit, Massachusetts General Hospital, Boston, MA, USA
| | | | - Katelyn Grone
- Neuroscience Intensive Care Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Robert Kacmarek
- Respiratory Care Department, Massachusetts General Hospital, Boston, MA, USA
| | - Laura Lux
- Blake 12 Intensive Care Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Cristina Matthews
- Lunder 7 Neuroscience Unit, Massachusetts General Hospital, Boston, MA, USA
| | | | - Frederic Romain
- Respiratory Care Department, Massachusetts General Hospital, Boston, MA, USA.,Ethics Service, Massachusetts General Hospital, Boston, MA, USA
| | - Colleen Snydeman
- Patient Care Services Office of Quality & Safety, Massachusetts General Hospital, Boston, MA, USA
| | - Tara Tehan
- Neuroscience Intensive Care Unit, Massachusetts General Hospital, Boston, MA, USA
| | - Ellen Robinson
- Ethics Service, Massachusetts General Hospital, Boston, MA, USA.,Patient Care Services Office of Quality & Safety, Massachusetts General Hospital, Boston, MA, USA
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Narrative Medicine perspectives on patient identity and integrative care in neuro-oncology. J Neurooncol 2017; 134:417-421. [PMID: 28669013 DOI: 10.1007/s11060-017-2542-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 06/26/2017] [Indexed: 10/19/2022]
Abstract
Narrative Medicine sessions can encourage patients to rediscover personal identity and meaning by telling or writing their stories. We explored this process to improve care and quality of life for brain cancer patients in an academic neuro-oncology program. Brain cancer and its treatments may threaten a patient's quality of life and sense of self in many ways, including impaired cognitive skills, loss of memory, reduced coordination, and limited capacity for self-expression. The impact of symptoms and side effects on quality of life must be evaluated in terms of each patient's identity and may be understood in terms of each patient's story. Insights from Narrative Medicine visits may also be helpful for the treatment team as they seek to assess patient needs, attitudes, and abilities. We provide case-based histories demonstrating applications of Narrative Medicine in the care of patients with brain tumors whose sense of self and quality of life are challenged. The cases include managing frontal lobe syndrome of loss of initiative and pervasive emotional apathy with his wife and young children, regaining a meaningful activity in a patient, re-establishing self-identity in a young woman with ependymoma, and improving spells with coexistent epilepsy and psychogenic non-epileptic seizures (PNES).
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