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Martinez NG, Seidman DL, Briscoe H, Hayes CM, Ojukwu EI, Paltin D, Roberts SCM. Patients, colleagues, systems, and self: Exploring layers of physician emotions in caring for pregnant people who use substances and their newborns. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 164:209432. [PMID: 38857826 DOI: 10.1016/j.josat.2024.209432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 04/24/2024] [Accepted: 06/04/2024] [Indexed: 06/12/2024]
Abstract
INTRODUCTION Pregnant people who use substances experience significant stigma, including in healthcare settings, where physicians make high-stakes decisions about treatment plans, resource allocation, and even a person's ability to parent. Previous psychology research has demonstrated the influence of emotions on decision-making, as well as on the development and expression of stigma. Yet the specific content of physician emotions, as well as approaches to processing these emotions, has been relatively under-examined. We sought to better understand the emotional experiences of physicians who practice in safety-net labor and delivery/inpatient settings to inform strategies to facilitate more humanizing, equitable care. METHODS From March 2021 to June 2022, the study team conducted semi-structured interviews with 24 San Francisco Bay Area-based physicians (obstetrics-gynecology, pediatrics, family medicine) caring for pregnant people who use substances and/or their newborns. We used deductive and inductive coding and identified themes regarding the nature, etiology, and processing of physician emotions. RESULTS Physicians described experiencing a range of emotions related to interpersonal (patients, colleagues), systems-level, and internal dynamics. Emotions such as anger, sadness, frustration, and helplessness resulted from their deep care and empathy for patients, witnessing stigmatizing colleague behaviors, disagreement with punitive systems, and recognition of their own limitations in effecting change. Few participants identified strategies for processing these emotions, and several described efforts to disengage from their emotional experience to preserve their sense of well-being and professionalism. CONCLUSIONS Physicians caring for pregnant people who use substances and their newborns experienced intense, multi-layered emotions. This study posits that additional efforts to support physician emotional processing and structural competency could improve healthcare experiences and outcomes for pregnant people who use substances.
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Affiliation(s)
- Noelle G Martinez
- VA San Diego Healthcare System, 3350 La Jolla Village Drive, La Jolla, CA 92161, United States of America; Department of Family and Community Medicine, University of California, San Francisco, 1001 Potrero Avenue, San Francisco, CA 94110, United States of America.
| | - Dominika L Seidman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, 1001 Potrero Avenue, San Francisco, CA 94110, United States of America
| | - Heather Briscoe
- Department of Pediatrics, University of California, San Francisco, 1001 Potrero Avenue, San Francisco, CA 94110, United States of America
| | - Crystal M Hayes
- School of Social Work, Sacred Heart University, 5151 Park Avenue, Fairfield, CT 06825, United States of America
| | - Ekene I Ojukwu
- San Quentin Rehabilitation Center, 100 Main Street, San Quentin, CA 94964, United States of America
| | - Dafna Paltin
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, 6363 Alvarado Court, Suite 102/103, San Diego, CA 92120, United States of America
| | - Sarah C M Roberts
- Advancing New Standards in Reproductive Health, Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco, 1330 Broadway Street, Suite 1100, Oakland, CA 94612, United States of America
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Siminoff LA, Alolod GP, McGregor H, Hasz RD, Mulvania PA, Barker LK, Gardiner HM. Developing online communication training to request donation for vascularized composite allotransplantation (VCA): improving performance to match new US organ donation targets. BMC MEDICAL EDUCATION 2024; 24:77. [PMID: 38254115 PMCID: PMC10802059 DOI: 10.1186/s12909-024-05026-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024]
Abstract
BACKGROUND Approaching families of dying or newly deceased patients to donate organs requires specialized knowledge and a mastery of relational communication. As the transplantation field has progressed, Donation Professionals (DPs) are also leading conversations with family decision makers (FDMs) about the donation of uncommon anatomical gifts, such as face, hands, genitalia, referred to as Vascularized Composite Allotransplants (VCA) without much training or experience. To address the need for training, we adapted and beta tested an evidenced-based communication training program for donation discussions to VCA requests. The overarching goal of Communicating Effectively about Donation for Vascularized Composite Allotransplantation (CEaD-VCA) is to increase the number of VCA authorizations and to improve the socioemotional outcomes of FDMs. METHODS We developed CEaD-VCA, an online, on-demand training program based on the previously tested, evidenced-based communication skills training program designed to train DPs to have conversations about solid organ donation. The training was modified utilizing data from a national telephone survey with DPs and results of 6 focus groups conducted with members of the general public. The survey and focus groups assessed knowledge, attitudes, and barriers to VCA donation. The training was shaped by a partnership with a leading industry partner, the Gift of Life Institute.™ RESULTS: Using the results as a guide, the existing CEaD training program, consisting of interactive eLearning modules, was adapted to include technical information about VCA, foundational communication skills, and two interactive example VCA donation request scenarios to facilitate active learning. Forty-two DPs from two partner Organ Procurement Organizations (OPOs) participated in the beta test of CEaD-VCA. Pre- and post-test surveys assessed the impact of the training. CONCLUSIONS The training was scored highly by DPs in effectiveness and ease of use. This project created a standardized, accessible, and comprehensive training for DPs to communicate about VCA donation. CEaD-VCA is an example of how to develop a communication skills training for difficult conversations utilizing input from stakeholders, guided by communication theory. It also demonstrates how gaps in communication skills during medical education can be filled utilizing advanced online Learning Management Systems. The training specifically addresses new CMS rules concerning OPO performance metrics.
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Affiliation(s)
- Laura A Siminoff
- Department of Social and Behavioral Sciences College of Public Health, Temple University, Philadelphia, PA, USA.
| | - Gerard P Alolod
- Department of Social and Behavioral Sciences College of Public Health, Temple University, Philadelphia, PA, USA
| | - Hayley McGregor
- Department of Social and Behavioral Sciences College of Public Health, Temple University, Philadelphia, PA, USA
| | | | | | - Laura K Barker
- Department of Social and Behavioral Sciences College of Public Health, Temple University, Philadelphia, PA, USA
| | - Heather M Gardiner
- Department of Social and Behavioral Sciences College of Public Health, Temple University, Philadelphia, PA, USA
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Barlow M, Watson B, Jones E, Morse C, Maccallum F. The application of communication accommodation theory to understand receiver reactions in healthcare speaking up interactions. J Interprof Care 2024; 38:42-51. [PMID: 37702325 DOI: 10.1080/13561820.2023.2249939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 07/28/2023] [Indexed: 09/14/2023]
Abstract
Speaking up for patient safety is a well-documented, complex communication interaction, which is challenging both to teach and to implement into practice. In this study we used Communication Accommodation Theory to explore receivers' perceptions and their self-reported behaviors during an actual speaking up interaction in a health context. Intergroup dynamics were evident across interactions. Where seniority of the participants was salient, the within-profession interactions had more influence on the receiver's initial reactions and overall evaluation of the message, compared to the between profession interactions. Most of the seniority salient interactions occurred down the hierarchy, where a more senior professional ingroup member delivered the speaking up message to a more junior receiver. These senior speaker interactions elicited fear and impeded the receiver's voice. We found that nurses/midwives and allied health clinicians reported using different communication behaviors in speaking up interactions. We propose that the term "speaking up" be changed, to emphasize receivers' reactions when they are spoken up to, to help receivers engage in more mutually beneficial communication strategies.
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Affiliation(s)
- Melanie Barlow
- Faculty of Health Sciences, Australian Catholic University, Banyo, Australia
- School of Psychology, University of Queensland, St Lucia, Australia
| | - Bernadette Watson
- School of Psychology, University of Queensland, St Lucia, Australia
- Department of English and Communication, Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Elizabeth Jones
- School of Psychology, Monash University Malaysia, Bandar Sunway, Malaysia
| | - Catherine Morse
- College of Nursing & Health Professions, Drexel University, Philadelphia, Pennsylvania, USA
| | - Fiona Maccallum
- School of Psychology, University of Queensland, St Lucia, Australia
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Shikino K, Mito T, Ohira Y, Yokokawa D, Katsuyama Y, Ota T, Sato E, Hirose Y, Yamashita S, Suzuki S, Noda K, Uehara T, Ikusaka M. Frequency of Difficult Patient Encounters in a Japanese University Hospital and Community Hospitals: A Cross-sectional Study. Intern Med 2023; 62:533-537. [PMID: 35793958 PMCID: PMC10017258 DOI: 10.2169/internalmedicine.0085-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Objective Difficult patient encounters (DPEs) are defined as encounters with patients causing strong negative feelings in physicians. In primary care settings, DPEs account for approximately 15% of visits among outpatients. To our knowledge, this is the first epidemiological study of DPEs in Japan. Methods We conducted a survey of 8 physicians (5.0±2 years of clinical experience) who examined first-visit patients ≥15 years old with clinical symptoms at the Department of General Medicine in Chiba University Hospital and 4 community hospitals over a 2-month period since December 2015. Materials We evaluated 10-Item Difficult Doctor-Patient Relationship Questionnaire (DDPRQ-10) scores (DPE ≥31 points; non-DPE ≤30 points) and patient age, sex, and presence of psychological or social problems. Results The valid response rate was 98.9% (94/95) and 98.4% (189/192) in the university and community hospitals, respectively. The percentage of DPEs was 39.8% (37/93) and 15.0% (26/173) in the university and community hospitals, respectively; the percentage of DPEs was significantly higher at the university hospital than at the community hospitals (p<0.001). The proportion of patients with psychosocial problems was significantly higher in the DPE group than in the non-DPE group (93.7% vs. 40.4%, p<0.001). Conclusion Our findings were similar to those reported in primary care settings in other countries in community hospital outpatient and general internal medicine departments, where patients are mostly non-referrals, although the values were higher in university hospital general medicine departments, where patients were mostly referrals. Patients involved in DPEs have a high rate of psychological and social problems.
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Affiliation(s)
- Kiyoshi Shikino
- Department of General Medicine, Chiba University Hospital, Japan
- Department of Community-based Medical Education, Graduate School of Medicine, Chiba University, Japan
| | - Tsutomu Mito
- Department of General Medicine, Chiba University Hospital, Japan
| | - Yoshiyuki Ohira
- Department of General Medicine, Chiba University Hospital, Japan
- Department of General Medicine, International University of Health and Welfare Narita Hospital, Japan
| | - Daiki Yokokawa
- Department of General Medicine, Chiba University Hospital, Japan
| | - Yota Katsuyama
- Department of General Medicine, Chiba University Hospital, Japan
- Department of Community-based Medical Education, Graduate School of Medicine, Chiba University, Japan
- Department of General Medicine, Sanmu Medical Center, Japan
| | - Takahiro Ota
- Department of General Medicine, Chiba University Hospital, Japan
| | - Eri Sato
- Department of General Medicine, Chiba University Hospital, Japan
| | - Yuta Hirose
- Department of General Medicine, Chiba University Hospital, Japan
| | - Shiho Yamashita
- Department of General Medicine, Chiba University Hospital, Japan
| | - Shingo Suzuki
- Department of General Medicine, Chiba University Hospital, Japan
- Department of Internal Medicine, Chiba Central Medical Center, Japan
| | - Kazutaka Noda
- Department of General Medicine, Chiba University Hospital, Japan
| | - Takanori Uehara
- Department of General Medicine, Chiba University Hospital, Japan
| | - Masatomi Ikusaka
- Department of General Medicine, Chiba University Hospital, Japan
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Lip A, Pateman M, Fullerton MM, Chen HM, Bailey L, Houle S, Davidson S, Constantinescu C. Vaccine hesitancy educational tools for healthcare providers and trainees: A scoping review. Vaccine 2023; 41:23-35. [PMID: 36437208 PMCID: PMC9688224 DOI: 10.1016/j.vaccine.2022.09.093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 11/27/2022]
Abstract
In the era of vaccine hesitancy, highlighted by the current SARS-CoV2 pandemic, there is an acute need to develop an approach to reduce and address apprehension towards vaccinations. We sought to map and present an overview of existing educational interventions for healthcare providers (HCPs) on strategies to engage in effective vaccine discussion. We applied the Joanna Briggs Institute methodology framework in this scoping review. We searched five relevant databases (MEDLINE, CINAHL, EMBASE, PsycInfo, and SCOPUS) and grey literature through the Google search engine using keywords and subject headings that were systematically identified. We identified 3384 citations in peer-reviewed literature and 41 citations in grey literature. After screening for our inclusion criteria, we included 28 citations from peer reviewed literature and 16 citations from grey literature for analysis. We identified a total of 41 unique education interventions. Interventions were available from multiple disciplines, training levels, clinical settings, and diseases/vaccines. Interventions predominantly centered around two foci: knowledge sharing and communication training. Most interventions identified from peer-reviewed literature were facilitated and were applied with multiple modes of delivery. Interventions from grey literature were more topical and generally self-directed. We identified several gaps in knowledge. Firstly, accessibility and generalizability of interventions was limited. Secondly, distribution of interventions did not adequately address nursing and pharmacy disciplines, and did not cover the breadth of medical specialties for whom vaccine discussions apply. Thirdly, no interventions addressed self monitoring and the clinicians' recognition and management of emotions during difficult conversations. There is a need to address this gap and provide available, credible and comprehensive educational interventions that will support our healthcare providers in effective communication with vaccine hesitant patients.
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Affiliation(s)
- A Lip
- Division of Respirology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - M Pateman
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada; 19 to Zero Inc., Rocky Mountain House, Alberta, Canada
| | - M M Fullerton
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada; 19 to Zero Inc., Rocky Mountain House, Alberta, Canada
| | - H M Chen
- 19 to Zero Inc., Rocky Mountain House, Alberta, Canada
| | - L Bailey
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - S Houle
- School of Pharmacy, Faculty of Science, University of Waterloo, Waterloo, Ontario, Canada
| | - S Davidson
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - C Constantinescu
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Pediatric Infectious Diseases, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Gonella S, Di Giulio P, Berchialla P, Bo M, Cotogni P, Macchi G, Campagna S, Dimonte V. The Impact of Health and Social Care Professionals' Education on the Quality of Serious Illness Conversations in Nursing Homes: Study Protocol of a Quality Improvement Project. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:725. [PMID: 36613049 PMCID: PMC9819581 DOI: 10.3390/ijerph20010725] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/23/2022] [Accepted: 12/26/2022] [Indexed: 06/17/2023]
Abstract
Health and social care professionals (HCPs) who work in nursing homes (NHs) are increasingly required to sustain serious illness conversations about care goals and preferences. Although these conversations may also be challenging for experienced HCPs and the literature recognizes high-quality communication as key to providing patient-centered care, so far, no specific educational program has been developed for the NH setting to improve HCPs' communication skills. Our study aims to test the feasibility and potential effectiveness of an innovative, blended communication skills training program (Teach-to-Communicate) targeting the HCPs who work in NHs. This program includes classroom-based theory, experiential learning, and e-learning, and relies on interdisciplinary contexts and several didactic methods. The study consists of two phases: phase I is the development of written resources that employ focus group discussion involving field experts and external feedback from key stakeholders. Phase II consists of a multicenter, pilot, pre-post study with nested qualitative study. The Teach-to-Communicate training program is expected to enhance the quality of communication in NH and HCPs' confidence in sustaining serious illness conversations, reduce family carers' psycho-emotional burden and improve their satisfaction with the care received, and increase advance care planning documentation. Our protocol will provide insight for future researchers, healthcare providers, and policymakers and pave the way for blended educational approaches in the field of communication skills training.
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Affiliation(s)
- Silvia Gonella
- Direction of Health Professions, City of Health and Science University Hospital of Torino, Corso Bramante 88-90, 10126 Turin, Italy
- Department of Public Health and Pediatrics, University of Torino, via Santena 5 bis, 10126 Turin, Italy
| | - Paola Di Giulio
- Department of Public Health and Pediatrics, University of Torino, via Santena 5 bis, 10126 Turin, Italy
| | - Paola Berchialla
- Department of Clinical and Biological Sciences, University of Torino, via Santena 5 bis, 10126 Torino, Italy
| | - Mario Bo
- Section of Geriatrics, Department of Medical Sciences, University of Torino, City of Health and Science University Hospital of Turin, Corso Bramante 88-90, 10126 Turin, Italy
| | - Paolo Cotogni
- Pain Management and Palliative Care, Department of Anesthesia, Intensive Care and Emergency, University of Torino, City of Health and Science University Hospital of Turin, Corso Bramante 88-90, 10126 Turin, Italy
| | - Giorgia Macchi
- Pain Management and Palliative Care, Department of Anesthesia, Intensive Care and Emergency, University of Torino, City of Health and Science University Hospital of Turin, Corso Bramante 88-90, 10126 Turin, Italy
| | - Sara Campagna
- Department of Public Health and Pediatrics, University of Torino, via Santena 5 bis, 10126 Turin, Italy
| | - Valerio Dimonte
- Direction of Health Professions, City of Health and Science University Hospital of Torino, Corso Bramante 88-90, 10126 Turin, Italy
- Department of Public Health and Pediatrics, University of Torino, via Santena 5 bis, 10126 Turin, Italy
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Carminati L, Héliot YG. Between Multiple Identities and Values: Professionals' Identity Conflicts in Ethically Charged Situations. Front Psychol 2022; 13:813835. [PMID: 35529578 PMCID: PMC9068603 DOI: 10.3389/fpsyg.2022.813835] [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: 11/12/2021] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
This study explored identity conflict dynamics in interpersonal interactions in professionals facing ethically charged situations. Through semi-structured interviews (N = 47), we conducted a qualitative study among doctors and nurses working for the English National Healthcare Service and analyzed the data with grounded theory approaches. Our findings reveal that identity conflict is triggered by three micro processes, namely cognitive and emotional perspective taking, as well as identifying with the other. In these processes, identity conflict is signaled by emotions and recognized as a clash not only between identities and their values, but also within one identity and its multiple values. Behavioral and psychological outcomes of identity conflict involve seeking peer support, doing reflective practices and identity growth. This article contributes to identity literature by providing a multilevel approach of identity conflict dynamics able to account for both interpersonal and intrapsychic processes, deeply hold values and emotions, as well as crucial behavioral and psychological consequences.
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Affiliation(s)
- Lara Carminati
- Faculty of Behavioral, Management and Social Sciences, University of Twente, Enschede, Netherlands
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End-of-Life Decision-Making in Pediatric and Neonatal Intensive Care Units in Croatia—A Focus Group Study among Nurses and Physicians. Medicina (B Aires) 2022; 58:medicina58020250. [PMID: 35208575 PMCID: PMC8879945 DOI: 10.3390/medicina58020250] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/29/2022] [Accepted: 02/03/2022] [Indexed: 11/24/2022] Open
Abstract
Background and Objectives: Working in pediatric and neonatal intensive care units (ICUs) can be challenging and differs from work in adult ICUs. This study investigated for the first time the perceptions, experiences and challenges that healthcare professionals face when dealing with end-of-life decisions in neonatal intensive care units (NICUs) and pediatric intensive care units (PICUs) in Croatia. Materials and Methods: This qualitative study with focus groups was conducted among physicians and nurses working in NICUs and PICUs in five healthcare institutions (three pediatric intensive care units (PICUs) and five neonatal intensive care units (NICUs)) at the tertiary level of healthcare in the Republic of Croatia, in Zagreb, Rijeka and Split. A total of 20 physicians and 21 nurses participated in eight focus groups. The questions concerned everyday practices in end-of-life decision-making and their connection with interpersonal relationships between physicians, nurses, patients and their families. The constant comparative analysis method was used in the analysis of the data. Results: The analysis revealed two main themes that were the same among the professional groups as well as in both NICU and PICU units. The theme “critical illness” consisted of the following subthemes: the child, the family, myself and other professionals. The theme “end-of-life procedures” consisted of the following subthemes: breaking point, decision-making, end-of-life procedures, “spill-over” and the four walls of the ICU. The perceptions and experiences of end-of-life issues among nurses and physicians working in NICUs and PICUs share multiple common characteristics. The high variability in end-of-life procedures applied and various difficulties experienced during shared decision-making processes were observed. Conclusions: There is a need for further research in order to develop clinical and professional guidelines that will inform end-of-life decision-making, including the specific perspectives of everyone involved, and the need to influence policymakers.
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Psychological Distress in Healthcare Workers between the First and Second COVID-19 Waves: The Role of Personality Traits, Attachment Style, and Metacognitive Functioning as Protective and Vulnerability Factors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182211843. [PMID: 34831598 PMCID: PMC8623543 DOI: 10.3390/ijerph182211843] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 12/17/2022]
Abstract
The COVID-19 pandemic has impacted the mental health of healthcare workers (HCWs) since its outbreak, but little attention has been paid to person-level vulnerability and protective factors. This study aims to determine the prevalence of both general and pandemic-related psychological distress among HCWs between the first and second COVID-19 waves in Italy and analyze associations between psychological distress and personality traits, attachment style, and metacognitive functioning. Between June and October 2020, 235 Italian HCWs completed questionnaires concerning psychological stress, personality traits, attachment style, and metacognitive functioning; 26.5% of respondents presented with moderate to extremely severe levels of general psychological distress and 13.8% with moderate to extremely severe levels of pandemic-related psychological distress. After controlling for demographic and occupational variables, significant associations emerged among high emotional stability as a personality trait and both general (aOR: 0.58, 95% CI: 0.41–0.79) and pandemic-related psychological stress (aOR: 0.62, 95% CI: 0.41–0.90). Additionally, higher scores regarding one’s ability to understand others’ emotional states were associated with lower odds of developing psychological distress (aOR: 0.78, 95% CI: 0.63–0.93). Lastly, when comparing those with fearful attachment styles to those with secure attachments, the aOR for psychological distress was 4.73 (95% CI: 1.45–17.04). These results highlight the importance of conducting baseline assessments of HCWs’ person-level factors and providing regular screenings of psychological distress.
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Monden KR, Hidden J, Eagye CB, Hammond FM, Kolakowsky-Hayner SA, Whiteneck GG. Relationship of patient characteristics and inpatient rehabilitation services to 5-year outcomes following spinal cord injury: A follow up of the SCIRehab project. J Spinal Cord Med 2021; 44:870-885. [PMID: 33705276 PMCID: PMC8725682 DOI: 10.1080/10790268.2021.1881875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To examine associations of patient characteristics and treatment quantity delivered during inpatient spinal cord injury (SCI) rehabilitation with outcomes at 5 years post-injury and compare them to the associations found at 1 year post-injury. DESIGN Observational study using Practice-Based Evidence research methodology in which clinicians documented treatment details. Regression modeling was used to predict outcomes. SETTING Five inpatient SCI rehabilitation centers in the US. PARTICIPANTS Participants were 792 SCIRehab participants who were >12 years of age, gave informed consent, and completed both a 1-year and 5-year post-injury interview. OUTCOME MEASURES Outcome data were derived from Spinal Cord Injury Model Systems (SCIMS) follow-up interviews at 5 years post-injury and, similar to the 1-year SCIMS outcomes, included measures of physical independence, societal participation, life satisfaction, and depressive symptoms, as well as place of residence, school/work attendance, rehospitalization, and presence of pressure ulcers. RESULTS Consistent with 1-year findings, patient characteristics continue to be strong predictors of outcomes 5-years post-injury, although several variables add to the prediction of some of the outcomes. More time in physical therapy and therapeutic recreation were positive predictors of 1-year outcomes, which held less true at 5 years. Greater time spent with psychology and social work/case management predicted greater depressive symptomatology 5-years post-injury. Greater clinician experience was a predictor at both 1- and 5 -years, although the related positive outcomes varied across years. CONCLUSION Various outcomes 5-years post-injury were primarily explained by pre-and post-injury characteristics, with little additional variance offered by the quantity of treatment received during inpatient rehabilitation.
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Affiliation(s)
- Kimberley R. Monden
- Craig Hospital, Englewood, Colorado, USA
- Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | | | | | - Flora M. Hammond
- Department of Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana, USA
- Rehabilitation Hospital of Indiana, Indianapolis, Indiana, USA
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Brown JB, Reichert SM, Valliere Y, McLachlan C, Webster-Bogaert S, Ratzki-Leewing A, Ryan BL, Harris SB. Health Care Providers' Emotional Responses to Their Patients' Hypoglycemic Events: Qualitative Findings From the InHypo-DM Study, Canada. Diabetes Spectr 2021; 34:388-393. [PMID: 34866872 PMCID: PMC8603122 DOI: 10.2337/ds20-0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Hypoglycemia can cause psychological distress in people with diabetes; however, less is understood about the emotional impact of hypoglycemia on their health care providers (HCPs). This article focuses on the experiences and emotions of HCPs caring for patients with diabetes. METHODS This was a descriptive qualitative study from the InHypo-DM research program. Purposive sampling was used to recruit 20 HCPs from a variety of professions for 30- to 45-minute semi-structured interviews. An iterative analysis was conducted to identify the overarching themes. RESULTS Three overarching themes encompassed the responses of participants when their patients experienced hypoglycemia. The first was a sense of professional responsibility, as participants felt they must have failed or inadequately fulfilled their professional duties. The second was a more personal range of emotions such as sadness and guilt. The final theme was how these emotions created a "call to action," prompting participants to identify potential strategies to prevent future hypoglycemic events. CONCLUSION This qualitative study highlights the emotional impact of patients' hypoglycemia on HCPs. Although it may have been expected that HCPs have a strong sense of professional responsibility, it was unexpected that these responses often became personal emotions. To ameliorate the negative impact of these responses on patient care, HCPs should engage in activities that enable them to anticipate and manage their own emotional responses. In addition, strategies to optimize hypoglycemia detection and prevention should be promoted.
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Affiliation(s)
- Judith Belle Brown
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Centre for Studies in Family Medicine, Western University, London, Ontario, Canada
- Corresponding author: Judith Belle Brown,
| | - Sonja M. Reichert
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Centre for Studies in Family Medicine, Western University, London, Ontario, Canada
| | - Yashoda Valliere
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Centre for Studies in Family Medicine, Western University, London, Ontario, Canada
| | - Cecelia McLachlan
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Centre for Studies in Family Medicine, Western University, London, Ontario, Canada
| | - Susan Webster-Bogaert
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Centre for Studies in Family Medicine, Western University, London, Ontario, Canada
| | - Alexandria Ratzki-Leewing
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Centre for Studies in Family Medicine, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Bridget L. Ryan
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Centre for Studies in Family Medicine, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Stewart B. Harris
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine and Dentistry, Centre for Studies in Family Medicine, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
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12
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Carminati L. Emotions, Emotion Management and Emotional Intelligence in the Workplace: Healthcare Professionals' Experience in Emotionally-Charged Situations. FRONTIERS IN SOCIOLOGY 2021; 6:640384. [PMID: 33889607 PMCID: PMC8055814 DOI: 10.3389/fsoc.2021.640384] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/08/2021] [Indexed: 06/12/2023]
Abstract
This perspective article is grounded in a cognitive and context-dependent view on emotions. By considering emotions as socially embedded and constructed, the different but related concepts of Emotion Management and Emotional Intelligence can be introduced. Yet, research juxtaposing and applying them within the healthcare sector to explain healthcare professionals' multifaceted emotional experiences at work is still scarce. Hence, this article contributes to the literature on emotions by offering an overarching perspective on how the juxtaposition of Emotion Management and Emotional Intelligence may help healthcare professionals to bridge the developmental transition between these two crucial abilities which, in turn, can help them overcome emotional difficulties in complex situations. Such integration would positively influence individuals' behavioral and mental health, as well as the overall quality of the healthcare system.
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Affiliation(s)
- Lara Carminati
- Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
- Surrey Business School, University of Surrey, Guildford, United Kingdom
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Twelve Years of the Italian Program to Enhance Relational and Communication Skills (PERCS). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18020439. [PMID: 33429873 PMCID: PMC7826793 DOI: 10.3390/ijerph18020439] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/22/2020] [Accepted: 01/05/2021] [Indexed: 11/17/2022]
Abstract
To describe the experience of the Italian Program to Enhance Relations and Communication Skills (PERCS-Italy) for difficult healthcare conversations. PERCS-Italy has been offered in two different hospitals in Milan since 2008. Each workshop lasts 5 h, enrolls 10–15 interdisciplinary participants, and is organized around simulations and debriefing of two difficult conversations. Before and after the workshops, participants rate their preparation, communication, relational skills, confidence, and anxiety on 5-point Likert scales. Usefulness, quality, and recommendation of the program are also assessed. Descriptive statistics, t-tests, repeated-measures ANOVA, and Chi-square were performed. A total of 72 workshops have been offered, involving 830 interdisciplinary participants. Participants reported improvements in all the dimensions (p < 0.001) without differences across the two hospitals. Nurses and other professionals reported a greater improvement in preparation, communication skills, and confidence, compared to physicians and psychosocial professionals. Usefulness, quality, and recommendation of PERCS programs were highly rated, without differences by discipline. PERCS-Italy proved to be adaptable to different hospital settings, public and private. After the workshops, clinicians reported improvements in self-reported competencies when facing difficult conversations. PERCS-Italy’s sustainability is based on the flexible format combined with a solid learner-centered approach. Future directions include implementation of booster sessions to maintain learning and the assessment of behavioral changes.
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14
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Special High-Risk Populations in Dentistry: The Adolescent Patient, the Elderly Patient, and the Woman of Childbearing Age. Dent Clin North Am 2020; 64:585-595. [PMID: 32448461 DOI: 10.1016/j.cden.2020.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Comprehensive and compassionate treatment of vulnerable patients is an important service to the community, although dental treatment of special populations can represent a challenge. The dental provider must be able to recognize the issues surrounding substance use and abuse, coordinate care with medical providers, and build a trusting provider-patient relationship to achieve success. Open conversations regarding expectations of pain, and the risks, benefits, and alternatives to opioids are important aspects of the best care of these patients.
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15
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The application of psychologically informed practice: observations of experienced physiotherapists working with people with chronic pain. Physiotherapy 2020; 106:163-173. [DOI: 10.1016/j.physio.2019.01.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 01/13/2019] [Indexed: 11/17/2022]
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Taylor DJ, Jones L, Binns AM, Crabb DP. 'You've got dry macular degeneration, end of story': a qualitative study into the experience of living with non-neovascular age-related macular degeneration. Eye (Lond) 2020; 34:461-473. [PMID: 31118490 PMCID: PMC7042256 DOI: 10.1038/s41433-019-0445-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 03/25/2019] [Accepted: 04/04/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND/OBJECTIVES To investigate the impact of non-neovascular (dry) age-related macular degeneration (AMD) on the person with respect to diagnosis, vision loss and coping strategies. SUBJECTS/METHODS Volunteers with dry AMD with a range of disease severity were given an eye examination and asked to describe aspects of their experience with dry AMD in a semi-structured interview. Interviews were audio-recorded, transcribed, and subjected to Framework analysis. Overarching themes were pre-defined, whilst subthemes were derived from the data. RESULTS Twenty-seven participants (81% female), with early (n = 3), intermediate (n = 16) and advanced dry AMD (GA; n = 8) were interviewed. Median (interquartile range) age (years), logMAR binocular visual acuity and Pelli-Robson contrast sensitivity were 76 (71, 80), 0.2 (0.18, 0.40) and 1.65 (1.35, 1.93), respectively. Overarching themes (and subthemes) were: diagnosis (relationship with healthcare professional, psychological impact of diagnosis, and knowledge of AMD, both pre- and post-diagnosis), impact of visual loss (functional and psychological) and coping strategies (help from others and personal strategies). Many participants reported feelings of distress at the time of diagnosis and, particularly noteworthy, several reported a constant fear of their condition worsening. CONCLUSIONS Dry AMD, for which there is currently no treatment, can have a significant impact on individuals, even in its early stages, before significant functional vision loss is manifest, as well as in its intermediate and advanced stages. Results from this study offer important insight into the experience of living with dry AMD not previously explored. Moreover, the results have the potential to serve as an educational resource for eyecare professionals.
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Affiliation(s)
- Deanna J Taylor
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, UK
| | - Lee Jones
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, UK
| | - Alison M Binns
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, UK
| | - David P Crabb
- Division of Optometry and Visual Science, School of Health Sciences, City, University of London, Northampton Square, London, EC1V 0HB, UK.
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Calati R, Cohen LJ, Schuck A, Levy D, Bloch-Elkouby S, Barzilay S, Rosenfield PJ, Galynker I. The Modular Assessment of Risk for Imminent Suicide (MARIS): A validation study of a novel tool for suicide risk assessment. J Affect Disord 2020; 263:121-128. [PMID: 31818767 DOI: 10.1016/j.jad.2019.12.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/16/2019] [Accepted: 12/01/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Reliable diagnostic tools for the short-term suicide risk assessment are needed. The recently developed multi-informant Modular Assessment of Risk for Imminent Suicide (MARIS) includes four modules: two are patient-rated and two clinician-rated. The patient-rated modules assess a proposed pre-suicidal cognitive/emotional state (Module 1) as well as patients' attitudes towards suicide (Module 2). The clinician-rated modules assess traditional suicide risk factors (Module 3) and clinicians' emotional responses to the patient (Module 4). METHODS With the aim of extending our previous preliminary proof of concept findings, the MARIS was administered to 618 psychiatric patients (167 inpatients, 451 outpatients) and their clinicians (N = 115). Patients were assessed with a battery including the Columbia-Suicide Severity Rating Scale. Four outcomes were considered: lifetime and past month suicidal thoughts and behaviors (STB) (0-10 point scale) and suicidal behaviors (SB) (0-5 point scale). Reliability and concurrent, convergent/divergent and incremental validity were assessed. RESULTS Good internal consistency was found for modules 1 and 4 (Cronbach's α: 0.87 and 0.86, respectively) but not for the others. Module 1's total score positively correlated with lifetime STB/SB and past month STB (all p ≤ 0.003). Module 4's total score positively correlated with all four outcomes (all p < 0.001). Modules 1 and 4 showed additional capacity to detect patients' lifetime and past month STB/SB beyond other associated factors. LIMITATIONS Lack of prospective assessment. Inpatients were evaluated at discharge, whereas outpatients at intake. CONCLUSIONS These findings supported the utility of multiple data sources to identify patients at imminent suicide risk, and in particular clinicians' emotional responses.
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Affiliation(s)
- Raffaella Calati
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA; Department of Psychology, University of Milan-Bicocca, Milan, Italy; Department of Adult Psychiatry, Nîmes University Hospital, Nîmes, France.
| | - Lisa J Cohen
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Allison Schuck
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, USA
| | - Dorin Levy
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, USA; Department of Psychiatry, Mount Sinai St. Luke's and Mount Sinai West, USA
| | - Sarah Bloch-Elkouby
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shira Barzilay
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Paul J Rosenfield
- Department of Psychiatry, Mount Sinai St. Luke's and Mount Sinai West, USA
| | - Igor Galynker
- Department of Psychiatry, Mount Sinai Beth Israel, New York, NY, USA; Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Shikino K, Ito S, Ohira Y, Noda K, Asahina M, Ikusaka M. Usefulness of a short training seminar on how to handle difficult patients in simulated education. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2019; 10:483-491. [PMID: 31372084 PMCID: PMC6630360 DOI: 10.2147/amep.s209573] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 06/17/2019] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To evaluate a short-time simulation training seminar on how to handle difficult patients using professional simulated patients (SPs) such as actors. PARTICIPANTS Sixty-three second-year residents at Chiba University Hospital between 2015 and 2017 who only attended the seminar once. INTERVENTION The participants were divided into small groups, each of which was assigned a supervisory doctor as facilitator. Those who were playing the doctor's role enacted a medical interview with an SP. After the interview, the facilitator, the SP, and the observing residents participated in a debriefing while watching a recorded video of the interview. OUTCOME MEASURES Pre- and post-seminar questionnaires using a 7-point Likert scale (from 1: strongly disagree to 7: strongly agree) were used to examine the differences in "confidence in ability to handle difficult patients" and "learning motivation to handle difficult patients". The two items examined by both pre- and post-seminar questionnaires, were analyzed by a paired t-test. The residents were also surveyed on their satisfaction with the seminar, acquisition of new knowledge, and impressions and comments (free-text answers). RESULTS The findings of the questionnaire showed a significant post-seminar increase in confidence (3.1±1.6 to 4.0±1.5 [p<0.01]) and learning motivation (5.3±1.8 to 5.8±1.5 [p<0.01]) as well as high levels of satisfaction (5.8±1.1) with the seminar and acquisition of knowledge (5.7±1.3). Some residents further reported that the seminar led to self-review and was valuable for their future clinical practice. CONCLUSION Our seminar on how to handle difficult patients was perceived as effective, as evaluated by the questionnaire, despite the short duration of the session. Factors potentially contributing to this effectiveness include the use of actors as SPs and the post-interview debriefing with feedback from the SP, colleagues, and facilitator.
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Affiliation(s)
- Kiyoshi Shikino
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
- Health Professional Development Center, Chiba University Hospital, Chiba, Japan
| | - Shoichi Ito
- Health Professional Development Center, Chiba University Hospital, Chiba, Japan
- Office of Medical Education, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Yoshiyuki Ohira
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Kazutaka Noda
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
| | - Mayumi Asahina
- Health Professional Development Center, Chiba University Hospital, Chiba, Japan
- Office of Medical Education, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Masatomi Ikusaka
- Department of General Medicine, Chiba University Hospital, Chiba, Japan
- Health Professional Development Center, Chiba University Hospital, Chiba, Japan
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Weilenmann S, Schnyder U, Parkinson B, Corda C, von Känel R, Pfaltz MC. Emotion Transfer, Emotion Regulation, and Empathy-Related Processes in Physician-Patient Interactions and Their Association With Physician Well-Being: A Theoretical Model. Front Psychiatry 2018; 9:389. [PMID: 30210371 PMCID: PMC6121172 DOI: 10.3389/fpsyt.2018.00389] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 08/02/2018] [Indexed: 01/10/2023] Open
Abstract
Physicians experience many emotionally challenging situations in their professional lives, influencing their emotional state through emotion contagion or social appraisal processes. Successful emotion regulation is crucial to sustain health, enable well-being, foster resilience, and prevent burnout or compassion fatigue. Despite the alarmingly high rate of stress-related disorders in physicians, affecting not only physician well-being, but also outcomes such as physician performance, quality of care, or patient satisfaction, research on how to deal with emotionally challenging situations in physicians is lacking. Based on extant literature, the present article proposes a theoretical model depicting emotions, emotion regulation, and empathy-related processes and their relation to well-being in provider-client interactions. This model serves as a basis for future research and interventions aiming at improving physician well-being and professional functioning. As a first step, interviews with 21 psychiatrists were conducted. Results of qualitative and initial quantitative analyses provided detailed descriptions of the model's components confirming its usefulness for detecting mechanisms linking emotion regulation and well-being in psychiatrist-patient interactions. Additionally, results lend preliminary support for the validity of the model, suggesting that successful regulation of emotions (i.e., achieving a desired emotional state) elicited by cyclical transfer processes in provider-client interactions is associated with both short- and long-term well-being and resilience. Furthermore, empathy-related emotions and their regulation seem to be linked to well-being. Based on the results of the present study, a prospective longitudinal study is under preparation, which is intended to inform effective interventions targeting emotion transfer, empathy-related processes, and emotion regulation in physicians' professional lives. The model and results are also potentially applicable to other health care and social services providers.
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Affiliation(s)
- Sonja Weilenmann
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | | | - Brian Parkinson
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Claudio Corda
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
| | - Roland von Känel
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
- Medical Faculty, University of Zurich, Zurich, Switzerland
| | - Monique C. Pfaltz
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich, Zurich, Switzerland
- Medical Faculty, University of Zurich, Zurich, Switzerland
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Care for Dying Children and Their Families in the PICU: Promoting Clinician Education, Support, and Resilience. Pediatr Crit Care Med 2018; 19:S79-S85. [PMID: 30080815 DOI: 10.1097/pcc.0000000000001594] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To describe the consequences of workplace stressors on healthcare clinicians in PICU, and strategies for personal well-being, and professional effectiveness in providing high-quality end-of-life care. DATA SOURCES Literature review, clinical experience, and expert opinion. STUDY SELECTION A sampling of foundational and current evidence was accessed. DATA SYNTHESIS Narrative review and experiential reflection. CONCLUSIONS The well-being of healthcare clinicians in the PICU influences the day-to-day quality and effectiveness of patient care, team functioning, and the retention of skilled individuals in the PICU workforce. End-of-life care, including decision making, can be complicated. Both are major stressors for PICU staff that can lead to adverse personal and professional consequences. Overresponsiveness to routine stressors may be seen in those with moral distress, and underresponsiveness may be seen in those with compassion fatigue or burnout. Ideally, all healthcare professionals in PICU can rise to the day-to-day workplace challenges-responding in an adaptive, effective manner. Strategies to proactively increase resilience and well-being include self-awareness, self-care, situational awareness, and education to increase confidence and skills for providing end-of-life care. Reactive strategies include case conferences, prebriefings in ongoing preidentified situations, debriefings, and other postevent meetings. Nurturing a culture of practice that acknowledges the emotional impacts of pediatric critical care work and celebrates the shared experiences of families and clinicians to build resilient, effective, and professionally fulfilled healthcare professionals thus enabling the provision of high-quality end-of-life care for children and their families.
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Kenyon K, Hebron C, Vuoskoski P, McCrum C. Physiotherapists' experiences of managing upper limb movement impairments due to breast cancer treatment. Physiother Theory Pract 2018; 36:71-84. [PMID: 29877744 DOI: 10.1080/09593985.2018.1480077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Background: Physiotherapy is recommended for upper limb movement impairments (ULMI) following breast cancer treatment. There is limited research into the pathophysiology and management of ULMI. Care is provided in different health-care contexts by specialist and nonspecialist physiotherapists, with referrals set to increase. This study explores physiotherapists' experiences of managing ULMI. Design: Qualitative study using a hermeneutic phenomenological approach. Method: We interviewed six physiotherapists from various UK treatment settings. The data were analyzed using interpretative phenomenological analysis. Findings: Four master themes were identified: (1) lack of confidence surrounds various aspects of practice, influenced by limited evidence to guide treatment of ULMI, fear of causing harm, and working in a less-established area of physiotherapy; (2) increasing confidence in practice develops with experience, reinforcing perceptions of the benefits of physiotherapy; (3) physiotherapy is understood to empower and enable patients to regain their sense of self and quality of life; and (4) provision of care is perceived to be subject to many barriers. Conclusion: Physiotherapy for ULMI has professional challenges but is seen as beneficial, encompassing psychosocial and physical effects. Experiences in this area of practice suggest a need for increased professional support, further research to guide treatment, and better patient and health professional awareness of ULMI and the role of physiotherapy.
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Affiliation(s)
- Karen Kenyon
- Physiotherapy Department, East Sussex Healthcare NHS Trust, Eastbourne, UK
| | - Clair Hebron
- School of Health Sciences, University of Brighton, Brighton, UK
| | | | - Carol McCrum
- Physiotherapy Department, East Sussex Healthcare NHS Trust, Eastbourne, UK
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Mishra A, Browning D, Haviland MJ, Jackson ML, Luff D, Meyer EC, Talcott K, Kloek CE. Communication Skills Training in Ophthalmology: Results of a Needs Assessment and Pilot Training Program. JOURNAL OF SURGICAL EDUCATION 2018; 75:417-426. [PMID: 28870710 DOI: 10.1016/j.jsurg.2017.08.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Revised: 07/30/2017] [Accepted: 08/05/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To conduct a needs assessment to identify gaps in communication skills training in ophthalmology residency programs and to use these results to pilot a communication workshop that prepares residents for difficult conversations. DESIGN A mixed-methods design was used to perform the needs assessment. A pre-and postsurvey was administered to workshop participants. SETTING Mass Eye and Ear Infirmary, Harvard Medical School (HMS), Department of Ophthalmology. PARTICIPANTS HMS ophthalmology residents from postgraduate years 2-4 participated in the needs assessment and the workshop. Ophthalmology residency program directors in the United States participated in national needs assessment. METHODS Ophthalmology program directors across the United States were queried on their perception of resident communication skills training through an online survey. A targeted needs assessment in the form of a narrative exercise captured resident perspectives on communication in ophthalmology from HMS residents. A group of HMS residents participated in the pilot workshop and a pre- and postsurvey was administered to participants to assess its effectiveness. RESULTS The survey of program directors yielded a response rate of 40%. Ninety percent of respondents agreed that the communication skills training in their programs could be improved. Fifteen of 24 residents (62%) completed the needs assessment. Qualitative analysis of the narrative material revealed four themes; (1) differing expectations, (2) work role and environment, (3) challenges specific to ophthalmology, and (4) successful strategies adopted. Nine residents participated in the workshop. There was a significant improvement post-workshop in resident reported scores on their ability to manage their emotions during difficult conversations (p = 0.03). CONCLUSIONS There is an opportunity to improve communication skills training in ophthalmology residency through formalized curriculum.
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Affiliation(s)
- Anuradha Mishra
- Department of Ophthalmology, Mass Eye and Ear, Boston, Massachusetts
| | - David Browning
- Department of Ophthalmology and Visual Sciences, Institute for Professionalism and Ethical Practice, Landmark Center, Boston, Massachusetts
| | - Miriam J Haviland
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Mary Lou Jackson
- University of British Columbia Eye Care Centre (VGH), Boston Children's Hospital, Vancouver, British Columbia
| | - Donna Luff
- Department of Ophthalmology and Visual Sciences, Institute for Professionalism and Ethical Practice, Landmark Center, Boston, Massachusetts
| | - Elaine C Meyer
- Department of Ophthalmology and Visual Sciences, Institute for Professionalism and Ethical Practice, Landmark Center, Boston, Massachusetts; Department of Psychiatry at Boston Children's Hospital, Boston, Massachusetts
| | - Katherine Talcott
- Department of Ophthalmology, Mass Eye and Ear, Boston, Massachusetts
| | - Carolyn E Kloek
- Department of Ophthalmology, Mass Eye and Ear, Boston, Massachusetts.
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Toivonen AK, Lindblom-Ylänne S, Louhiala P, Pyörälä E. Medical students' reflections on emotions concerning breaking bad news. PATIENT EDUCATION AND COUNSELING 2017; 100:1903-1909. [PMID: 28602567 DOI: 10.1016/j.pec.2017.05.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 04/29/2017] [Accepted: 05/30/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To gain a deeper understanding of fourth year medical students' reflections on emotions in the context of breaking bad news (BBN). METHODS During the years 2010-2012, students reflected on their emotions concerning BBN in a learning assignment at the end of the communications skills course. The students were asked to write a description of how they felt about a BBN case. The reflections were analysed using qualitative content analysis. RESULTS 351 students agreed to participate in the study. We recognized ten categories in students' reflections namely empathy, insecurity, anxiety, sadness, ambivalence, guilt, hope, frustration, gratefulness and emotional detachment. Most students expressed empathy, but there was a clear tension between feeling empathy and retaining professional distance by emotional detachment. CONCLUSIONS Students experience strong and perplexing emotions during their studies, especially in challenging situations. A deeper understanding of students' emotions is valuable for supporting students' professional development and coping in their work in the future. PRACTICE IMPLICATIONS Medical students need opportunities to reflect on emotional experiences during their education to find strategies for coping with them. Emotions should be actively discussed in studies where the issues of BBN are addressed. Teachers need education in attending emotional issues constructively.
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Affiliation(s)
| | - Sari Lindblom-Ylänne
- Centre for University Teaching and Learning, Faculty of Educational Sciences, University of Helsinki, Finland.
| | - Pekka Louhiala
- Clinicum, Department of Public Health, University of Helsinki, Finland.
| | - Eeva Pyörälä
- Medipeda, Centre for University Teaching and Learning, University of Helsinki, Finland.
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24
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Luff D, Martin EB, Mills K, Mazzola NM, Bell SK, Meyer EC. Clinicians' strategies for managing their emotions during difficult healthcare conversations. PATIENT EDUCATION AND COUNSELING 2016; 99:1461-1466. [PMID: 27423178 DOI: 10.1016/j.pec.2016.06.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 06/07/2016] [Accepted: 06/16/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES To examine strategies employed by clinicians from different disciplines to manage their emotions during difficult healthcare conversations. METHODS Self-report questionnaires were collected prior to simulation-based Program to Enhance Relational and Communication Skills (PERCS) workshops for professionals representing a range of experience and specialties at a tertiary pediatric hospital. In response to an open-ended prompt, clinicians qualitatively described their own strategies for managing their emotions during difficult healthcare conversations. RESULTS 126 respondents reported emotion management strategies. Respondents included physicians (42%), nurses (29%), medical interpreters (16%), psychosocial professionals (9%), and other (4%). Respondents identified 1-4 strategies. Five strategy categories were identified: Self-Care (51%), Preparatory and Relational Skills, (29%), Empathic Presence (28%), Team Approach (26%), and Professional Identity (20%). CONCLUSIONS Across disciplines and experience levels, clinicians have developed strategies to manage their emotions when holding difficult healthcare conversations. These strategies support clinicians before, during and after difficult conversations. PRACTICE IMPLICATIONS Understanding what strategies clinicians already employ to manage their emotions when holding difficult conversations has implications for educational planning and implementation. This study has potential to inform the development of education to support clinicians' awareness of their emotions and to enhance the range and effectiveness of emotion management during difficult healthcare conversations.
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Affiliation(s)
- Donna Luff
- Institute for Professionalism and Ethical Practice, Boston Children's Hospital,,Boston,,USA; Department of Anesthesia, Harvard Medical School, Boston, USA.
| | - Elliott B Martin
- Institute for Professionalism and Ethical Practice, Boston Children's Hospital,,Boston,,USA; Department of Psychiatry, Newton-Wellesley Hospital/Tufts University School of Medicine, Newton, USA
| | - Kelsey Mills
- Institute for Professionalism and Ethical Practice, Boston Children's Hospital,,Boston,,USA; Simmons College, 300 The Fenway, Boston, USA
| | - Natalia M Mazzola
- Institute for Professionalism and Ethical Practice, Boston Children's Hospital,,Boston,,USA; FernUniversität in Hagen, Institut für Psychologie, Hagen, Germany
| | - Sigall K Bell
- Institute for Professionalism and Ethical Practice, Boston Children's Hospital,,Boston,,USA; Department of Medicine, Beth Israel Deaconess Medical Center, Boston, USA
| | - Elaine C Meyer
- Institute for Professionalism and Ethical Practice, Boston Children's Hospital,,Boston,,USA; Department of Psychiatry, Harvard Medical School, Boston, USA
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Kerasidou A, Horn R. Making space for empathy: supporting doctors in the emotional labour of clinical care. BMC Med Ethics 2016; 17:8. [PMID: 26818248 PMCID: PMC4728886 DOI: 10.1186/s12910-016-0091-7] [Citation(s) in RCA: 75] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 01/22/2016] [Indexed: 11/23/2022] Open
Abstract
Background The academic and medical literature highlights the positive effects of empathy for patient care. Yet, very little attention has been given to the impact of the requirement for empathy on the physicians themselves and on their emotional wellbeing. Discussion The medical profession requires doctors to be both clinically competent and empathetic towards the patients. In practice, accommodating both requirements can be difficult for physicians. The image of the technically skilful, rational, and emotionally detached doctor dominates the profession, and inhibits physicians from engaging emotionally with their patients and their own feelings, which forms the basis for empathy. This inhibition has a negative impact not only on the patients but also on the physicians. The expression of emotions in medical practice is perceived as unprofessional and many doctors learn to supress and ignore their feelings. When facing stressful situations, these physicians are more likely to suffer from depression and burnout than those who engage with and reflect on their feelings. Physicians should be supported in their emotional work, which will help them develop empathy. Methods could include questionnaires that aid self-reflection, and discussion groups with peers and supervisors on emotional experiences. Yet, in order for these methods to work, the negative image associated with the expression of emotions should be questioned. Also, the work conditions of physicians should improve to allow them to make use of these tools. Summary Empathy should not only be expected from doctors but should be actively promoted, assisted and cultivated in the medical profession.
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Affiliation(s)
- Angeliki Kerasidou
- Researcher in Global Health Ethics, The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK. .,The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Old Road Campus, Oxford, OX3 7LF, UK.
| | - Ruth Horn
- Ethics and Society Wellcome Trust Fellow & Reseacher in Ethics, The Ethox Centre, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
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Cameron KA, De Haes HJC, Hulsman RL. Health communication in science, teaching and clinical practice: Selected papers from the Amsterdam EACH 2014 Conference. PATIENT EDUCATION AND COUNSELING 2015; 98:1169-1171. [PMID: 26319361 DOI: 10.1016/j.pec.2015.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Kenzie A Cameron
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Northwestern University, Feinberg School of Medicine, 750 N. Lake Shore Drive, 10th Floor, Chicago, IL 60611, United States
| | - Hanneke J C De Haes
- Department of Medical Psychology, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands
| | - Robert L Hulsman
- Department of Medical Psychology, Academic Medical Centre, University of Amsterdam, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands.
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