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Cilluffo S, Bassola B, Pucciarelli G, Vellone E, Clari M, Dimonte V, Lusignani M. Mutuality between nurses and patients with chronic illnesses: A cross-sectional descriptive study. Scand J Caring Sci 2024; 38:487-495. [PMID: 38459748 DOI: 10.1111/scs.13251] [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: 09/29/2023] [Revised: 01/16/2024] [Accepted: 02/24/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND AND AIM Mutuality is a process in which the patient participates and is involved in decision-making and care interventions. The aim of this study was to measure mutuality in the relationship between nurses and chronic illness patients. METHODS This study had a cross-sectional design; the sample included 249 patients and 249 nurses. Mutuality was measured with the Nurse-Patient Mutuality in Chronic Illness scale. RESULTS Patients had higher scores in almost all items (p < 0.001). Patients demonstrate high reciprocity towards nurses and the ability to express and share their emotions. Patients consider nurses their point of reference and share with them their health goals. Nurses show more difficulty in being mutual with the patient, especially in the aspects related to the sharing of emotions, objectives, and planning. The egalitarian relationship score was low in both patients and nurses. CONCLUSION These findings are important to consider at clinical, educational, organisational, and policy levels. Nurse education and organisation must push towards respect for the wishes of patients, the possibility of expressing their choices, and their involvement in the care plan. PRACTICE IMPLICATIONS In clinical practice, it is necessary to put the patients more at the centre, involving them in the identification of objectives and in making decisions.
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Affiliation(s)
- Silvia Cilluffo
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
- School of Nursing, Niguarda Hospital, University of Milan, Milan, Italy
| | - Barbara Bassola
- School of Nursing, Niguarda Hospital, University of Milan, Milan, Italy
| | - Gianluca Pucciarelli
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
- Department of Nursing and Obstetrics, Wroclaw Medical University, Wroclaw, Poland
| | - Marco Clari
- Department of Public Health and Pediatrics Sciences, University of Turin, Turin, Italy
| | - Valerio Dimonte
- Department of Public Health and Pediatrics Sciences, University of Turin, Turin, Italy
| | - Maura Lusignani
- School of Nursing, Niguarda Hospital, University of Milan, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Chan WS, Funk L, Thompson G. A Social Capital Perspective on Social-Medical Collaboration in Community End-of-Life Care in Hong Kong. OMEGA-JOURNAL OF DEATH AND DYING 2024; 89:57-72. [PMID: 34991381 PMCID: PMC11017689 DOI: 10.1177/00302228211066678] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Recent developments in Hong Kong end-of-life (EOL) care have shifted some caring work for dying people and their families to cross-disciplinary collaboration in community settings. Social-medical collaboration becomes especially important. This study aims to use social capital as an analytical lens to examine the processes and mechanisms of social-medical collaboration in EOL care and elucidate practice implications for engaging in the care of dying people and their families. Qualitative data were collected using in-depth interviews. Three major conceptual categories were generated through grounded theory methodology. They are (a) establishing trust through keeping clear and simple boundaries, (b) cultivating mutuality in the multi-disciplinary meeting, and (c) fostering social-medical collaboration in EOL care. Each new stage is based on the social capital accumulated in the previous one through the social interactions between professionals. Such theorization also provides insights into how to achieve effective social-medical collaboration in this context.
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Affiliation(s)
- Wing-sun Chan
- Department of Sociology and Criminology, University of Manitoba, Winnipeg, MB, Canada
| | - Laura Funk
- Department of Sociology and Criminology, University of Manitoba, Winnipeg, MB, Canada
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Cilluffo S, Bassola B, Lyons KS, Lee CS, Vellone E, Pucciarelli G, Clari M, Dimonte V, Lusignani M. The role of nurse-patient mutuality on self-care behaviours in patients with chronic illness. J Clin Nurs 2024. [PMID: 38685742 DOI: 10.1111/jocn.17181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 03/11/2024] [Accepted: 04/10/2024] [Indexed: 05/02/2024]
Abstract
AIM To examine the role of nurse-patient mutuality on three self-care behaviours in chronic illness patients. DESIGN A cross-sectional multi-centre study was conducted. METHODS Mutuality was measured with the Nurse-Patient Mutuality in Chronic Illness scale which has the dimensions of developing and going beyond, being a point of reference and deciding and sharing care, and self-care was measured with the Self-care of Chronic Illness Inventory (SC-CII). Multivariable linear regression analyses were used to assess the contribution of three dimensions of mutuality on self-care maintenance, monitoring and management behaviours controlling for patient gender, age, education, number of medications, and presence of a family caregiver. RESULTS The sample included 465 inpatients and outpatients with at least one chronic illness. The three dimensions of mutuality had different roles in their influence on the three dimensions of self-care. Developing and going beyond was significantly associated with self-care maintenance and self-care monitoring behaviours. Point of reference was significantly associated with self-care maintenance behaviour. Deciding and sharing care was significantly associated with self-care monitoring and self-care management behaviours. CONCLUSION The mutuality between nurse and patient may be a novel area of research to support and improve patient self-care behaviours with implications for clinical practice and education. IMPLICATION FOR PROFESSION AND PATIENT CARE Mutuality between nurse and patient increases patient engagement, symptom recognition, decision-making process and patient-centred approach favouring the development of self-care behaviours. IMPACT Mutuality between nurse and patient is a new concept and its association with the patient outcomes could bring relevance to the nursing profession. Self-care behaviours are important in the management of chronic diseases, but are difficult to perform. Mutuality between nurse and patient influences the three different behaviours of self-care in chronic illness, for this reason it is important to increase the level of mutuality in this dyad. REPORTING METHOD STROBE checklist for cross-sectional studies was followed in this study. PATIENT OR PUBLIC CONTRIBUTION Patients were involved in the sample of the study.
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Affiliation(s)
- Silvia Cilluffo
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
- School of Nursing, Niguarda Hospital, University of Milan, Milan, Italy
| | - Barbara Bassola
- School of Nursing, Niguarda Hospital, University of Milan, Milan, Italy
| | - Karen S Lyons
- Connell School of Nursing, Boston College, Boston, Massachusetts, USA
| | - Christopher S Lee
- Connell School of Nursing, Boston College, Boston, Massachusetts, USA
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
- Department of Nursing and Obstetrics, Wroclaw Medical University, Wroclaw, Poland
| | - Gianluca Pucciarelli
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Marco Clari
- Department of Public Health and Paediatrics Sciences, University of Turin, Turin, Italy
| | - Valerio Dimonte
- Department of Public Health and Paediatrics Sciences, University of Turin, Turin, Italy
| | - Maura Lusignani
- School of Nursing, Niguarda Hospital, University of Milan, Milan, Italy
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Shalev A, Ringel JB, Riegel B, Vellone E, Stawnychy MA, Safford M, Goyal P, Tsui E, Franzosa E, Reckrey J, Sterling M. Does Connectedness Matter? The Association Between Mutuality and Job Satisfaction Among Home Health Aides Caring for Adults With Heart Failure. J Appl Gerontol 2023; 42:747-757. [PMID: 36541188 PMCID: PMC9992152 DOI: 10.1177/07334648221146772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Home health aides (HHAs) provide care to many adults with heart failure (HF) in the home. As the demand for HHAs increases, there is a need to promote HHAs' job satisfaction and retention. In this cross-sectional community-partnered study, we examined whether mutuality (e.g., quality of the HHA-patient relationship), is associated with job satisfaction among HHAs caring for adults with HF. Mutuality was assessed with the Mutuality Scale, which measures overall mutuality and its four domains (reciprocity, love and affection, shared pleasurable activities, and shared values). Our final sample of 200 HHAs was primarily female. The mean overall mutuality score was 2.92 out of 4 (SD 0.79). In our final model, overall mutuality and each of the four domains were associated with increased job satisfaction; however, only the shared pleasurable activities domain was significant (aPR: 1.15 [1.03-1.32]). Overall, mutuality may play a role in promoting job satisfaction among HHAs.
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Affiliation(s)
- Ariel Shalev
- 12295Weill Cornell Medical College, New York, NY, USA
| | | | - Barbara Riegel
- 16142University of Pennsylvania School of Nursing, Philadelphia, PA, USA
| | - Ercole Vellone
- University of Rome Tor Vergata, Italy; Wroclaw Medical University, Poland
| | | | | | - Parag Goyal
- 12295Weill Cornell Medical College, New York, NY, USA
| | - Emma Tsui
- CUNY Graduate School of Public Health & Health Policy, New York, NY, USA
| | - Emily Franzosa
- 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Silvia C, Barbara B, Paolo I, Maura L. Development and validation of two versions of the Nurse-Patient Mutuality in Chronic Illness scale. J Adv Nurs 2023. [PMID: 36794730 DOI: 10.1111/jan.15594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 12/09/2022] [Accepted: 01/31/2023] [Indexed: 02/17/2023]
Abstract
AIMS The aim of the study was to develop and psychometrically test the Nurse-Patient Mutuality in Chronic Illness (NPM-CI) scale in two versions, one for nurses and one for patients. METHOD A multiphase methodological study was conducted. In the first phase, a qualitative investigation was conducted through interviews and an analysis of the content; inductively, the items of two instruments were generated, one for nurses and one for patients. In the second phase, the content and face validity were assessed through the expert consensus method. In the third phase, exploratory factor analysis (EFA), Cronbach's alpha test, intraclass correlation and Pearson correlation coefficients were conducted to estimate construct, criterion validity and instrument reliability. For each phase, the sample included nurses and patients recruited from a large hospital in Northern Italy. Data collection was conducted between June and September 2021. RESULTS Nurse and patient versions of the NPM-CI scale were developed. Two rounds of consensus reduced the items from 39 to 20; content validity index ranged between 0.78 and 1, content validity ratio was 0.94. Face validity indicated clarity and comprehensibility of the items. EFA identified three latent factors for both the scales. Internal consistency was satisfactory, with Cronbach's alphas ranging between .80 and .90. Test-retest stability was suggested, with an intraclass correlation coefficient of .96 (nurse scale) and .97 (patient scale). Predictive validity was established, with a Pearson correlation coefficient of .43 (nurse scale) and 0.55 (patient scale) between the mutuality scales and satisfaction in providing and receiving care. CONCLUSION The results suggest that the NPM-CI scales are sufficiently valid and reliable for the clinical practice among chronic illness patients and the nurses caring for them. A more in-depth exploration of this construct in the context of nursing and patient outcomes is warranted. PATIENT OR PUBLIC CONTRIBUTION Patients were involved in all study phases. IMPACT Mutuality is fundamental in the relationship between nurse and patient, based on trust, equality, reciprocity, and mutual respect. The NPM-CI scale was developed and psychometric estimated through a multiphase study in both nurse and patient versions. The NPM-CI scale measures the factors of 'developing and going beyond', 'being the point of reference' and 'deciding and sharing care'. The NPM-CI scale allows us to measure mutuality in clinical practice and research. Expected outcomes and influencing factors for patients and nurses could be associated.
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Affiliation(s)
- Cilluffo Silvia
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.,School of Nursing, Niguarda Hospital, University of Milan, Milan, Italy
| | - Bassola Barbara
- School of Nursing, Niguarda Hospital, University of Milan, Milan, Italy
| | - Iovino Paolo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.,Faculty of Health Science, School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Victoria, Melbourne, Australia
| | - Lusignani Maura
- School of Nursing, Niguarda Hospital, University of Milan, Milan, Italy.,Department of Biomedical Science for Health, University of Milan, Milan, Italy
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Bissonette S, Tyerman J, Chartrand J. Mutuality in nurse-caregiver relationships in pediatric nursing: A concept analysis. J Pediatr Nurs 2023; 70:26-33. [PMID: 36796301 DOI: 10.1016/j.pedn.2023.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/26/2023] [Accepted: 01/29/2023] [Indexed: 02/16/2023]
Abstract
PROBLEM Mutuality is often used in literature in the context of family-centered care and therapeutic relationship building. A therapeutic relationship is necessary to deliver family-centered care, strengthen family health and function, increase patient and family satisfaction, reduce anxiety, and empower decision-makers. Despite mutuality being such an important concept, it is not well defined in the literature. ELIGIBILITY CRITERIA The Walker and Avant method for concept analysis was used. The databases Medline, PSYCHInfo, CINHAL and Nursing & Allied Health were searched for texts in English from 1997 to 2021 using specific search terms. SAMPLE Of the 248 results, 191 articles were screened and 48 met inclusion criteria. RESULTS Mutuality was found to be a process of dynamic reciprocity whereby the partners contribute uniquely to their shared goals, values, or purposes. CONCLUSION Mutuality is an important aspect of family-centered care and is used throughout nursing and advanced nursing practice. IMPLICATIONS The concept of mutuality should be incorporated into family-centered care policies, as without it, family-centered care cannot be established. Further research should be done to develop methods or educational techniques to establish and maintain mutuality in advanced nursing practice.
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Affiliation(s)
- Sarah Bissonette
- University of Ottawa, Faculty of Health Sciences, School of Nursing, 451 Smyth Road, Room 3251, Ottawa, Ontario K1H 8M5, Canada; Children's Hospital of Eastern Ontario, Ontario, Canada.
| | - Jane Tyerman
- University of Ottawa, Faculty of Health Sciences, School of Nursing, 451 Smyth Road, Room 3251C, Ottawa, Ontario K1H 8M5, Canada
| | - Julie Chartrand
- University of Ottawa, Faculty of Health Sciences, School of Nursing, 451 Smyth Road, Room 3236B, Ottawa, Ontario K1H 8M5, Canada; Children's Hospital of Eastern Ontario, Research Institute, Ontario, Canada
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Chan WS, Funk L. Cultivating mutuality: A qualitative study of community end-of-life care in Hong Kong. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:1189-1198. [PMID: 33852734 DOI: 10.1111/hsc.13391] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 02/24/2021] [Accepted: 03/21/2021] [Indexed: 06/12/2023]
Abstract
In Hong Kong, death and dying are identified as a crucial public health issue, and as the healthcare system has developed, there has been a shift of some care for dying people and their families to cross-disciplinary collaboration in community settings. This shift enhances the salience of social relationships in non-medical forms of community-based end-of-life (EOL) care. The purpose of this paper is to contribute to knowledge about relational development in this regard. Abductive grounded theory methodology was used to examine the complex dynamics and mechanisms involved in cultivating mutuality between dying people (and their families) and volunteers and professionals in two community-based EOL social service agencies in Hong Kong. Qualitative data were collected between June and December 2019 using in-depth interviews with 14 agency practitioners and two theoretically sampled service users. Theoretical coding followed open coding to reach theoretical saturation. Cultivating mutuality was found to entail processes of finding social commonalities (and hiding differences), immersing in routines, supporting actualisation (granting the wishes of dying persons and their families) and engaging with clients' emotions (encouraging emotional release, demonstrating emotional involvement and actively listening). Findings offered a novel symbolic interactive and relational understanding of community EOL care practice. Contributions include theorising social processes in an intermediate stage of social capital and compassionate community development.
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Affiliation(s)
- Wing-Sun Chan
- Department of Sociology and Criminology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Laura Funk
- Department of Sociology and Criminology, University of Manitoba, Winnipeg, Manitoba, Canada
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Emmamally W, Erlingsson C, Brysiewicz P. In-hospital interventions to promote relational practice with families in acute care settings: A scoping review. Health SA 2022; 27:1694. [PMID: 35281289 PMCID: PMC8905429 DOI: 10.4102/hsag.v27i0.1694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 10/29/2021] [Indexed: 11/05/2022] Open
Abstract
Relational practice is characterised by genuine interaction between families and healthcare professionals that promotes trust and empowerment. Positive clinical outcomes have been associated with relational practice. To assess and examine in-hospital interventions designed to promote relational practice with families in acute care settings of emergency departments, intensive care units and high care units. The preferred reporting Items for Systematic Reviews and Meta-Analyses guidelines informed the design of this scoping review. To identify relevant studies, databases (Academic Search Complete; CINAHL; PubMed; PsyInfo) and the search engine Google Scholar were searched using terms for core elements of relational practice and family engagement. Of the 117 articles retrieved, eight interventional studies met the search criteria. The interventions focused on relational practice elements of collaborating with and creating safe environments for families, whilst only one addressed healthcare professionals being respectful of families’ needs and differences. In relation to the nature of engagement of families in interventions, the focus was mainly on improving family functioning. Family engagement in the interventions was focused on involving families in decision-making. The scoping review revealed a limited number of in-hospital interventions designed to promote relational practice with families in acute care settings. Further research is encouraged to develop such interventions.
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Affiliation(s)
- Waheedha Emmamally
- Discipline of Nursing, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Christen Erlingsson
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
| | - Petra Brysiewicz
- Discipline of Nursing, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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Cilluffo S, Bassola B, Pucciarelli G, Vellone E, Lusignani M. Mutuality in nursing: A conceptual framework on the relationship between patient and nurse. J Adv Nurs 2021; 78:1718-1730. [PMID: 34873740 DOI: 10.1111/jan.15129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 10/12/2021] [Accepted: 11/27/2021] [Indexed: 11/27/2022]
Abstract
AIMS To describe and develop a conceptual framework for the process of mutuality between nurse and patient. DESIGN This was a qualitative study with a grounded theory (GT) design following the constructivist approach of Charmaz (SAGE handbook of research, 2014). METHODS A sample of 33 patients with one or more chronic diseases and 35 nurses were interviewed between July and October 2020. Comparative and simultaneous data analyses were conducted. Theoretical sampling and saturation of categories were used to define the sample size. RESULTS A conceptual framework for mutuality between nurse (mean age 42 SD ±7 years, 89% female) and patient (mean age 63 SD ±8 years, 42% female) was developed, including the mutuality process, potential influencing factors for both nurses and patients, and outcomes. The mutuality process was characterised by three dimensions: developing and going beyond, being a reference, and deciding and sharing care. Influencing factors for nurses were personal characteristics and professional organisation, while for patients these were age and past experiences. Nurse outcomes were satisfaction and quality of life; patient outcomes were improved self-care and reduction of hospitalisation and emergency admissions. CONCLUSION This study described a new conceptual framework for mutuality between nurse and patient, which could improve our understanding of the relationship between nurses and patients, thus enhancing both nurse and patient outcomes.
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Affiliation(s)
- Silvia Cilluffo
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy.,School of Nursing, Niguarda Hospital, University of Milan, Milan, Italy
| | - Barbara Bassola
- School of Nursing, Niguarda Hospital, University of Milan, Milan, Italy
| | - Gianluca Pucciarelli
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Maura Lusignani
- School of Nursing, Niguarda Hospital, University of Milan, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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Caring for care: Online feedback in the context of public healthcare services. Soc Sci Med 2021; 285:114280. [PMID: 34358947 DOI: 10.1016/j.socscimed.2021.114280] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 07/07/2021] [Accepted: 07/27/2021] [Indexed: 01/30/2023]
Abstract
People increasingly provide feedback about healthcare services online. These practices have been lauded for enhancing patient power, choice and control, encouraging greater transparency and accountability, and contributing to healthcare service improvement. Online feedback has also been critiqued for being unrepresentative, spreading inaccurate information, undermining care relations, and jeopardising professional autonomy. Through a thematic analysis of 37 qualitative interviews, this paper explores the relationship between online feedback and care improvement as articulated by healthcare service users (patients and family members) who provided feedback across different online platforms and social media in the UK. Online feedback was framed by interviewees as, ideally, a public and, in many cases, anonymous 'conversation' between service users and healthcare providers. These 'conversations' were thought of not merely as having the potential to bring about tangible improvements to healthcare, but as in themselves constituting an improvement in care. Vital to this was the premise that providing feedback was an enactment of care - care for other patients, certainly, but also care for healthcare as such and even for healthcare professionals. Ultimately, feedback was understood as an enactment of care for the National Health Service (NHS), as symbolically encompassing all of the above. Putting these findings in dialogue with STS scholarship on care, we argue that, in this context, the provision of online feedback can be understood as a form of care that is, simultaneously, both directed at healthcare (in the round, including patients, professionals, services, organisations, and, of course, health itself) and part of healthcare. We conceptualise this as 'caring for care'. This conceptualization moves beyond dominant framings of online feedback in terms of 'choice' and 'voice'. It embeds online feedback within pre-existing healthcare systems, relations and moral commitments, foregrounds the mutuality of care relations, and draws attention to the affective labour of feedback practices.
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11
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Martin A, Chilton J, Paasche C, Nabatkhorian N, Gortler H, Cohenmehr E, Weller I, Amsalem D, Neary S. Shared Living Experiences by Physicians have a Positive Impact on Mental Health Attitudes and Stigma among Medical Students: A Mixed-Methods Study. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2020; 7:2382120520968072. [PMID: 33195803 PMCID: PMC7594232 DOI: 10.1177/2382120520968072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 09/24/2020] [Indexed: 05/16/2023]
Abstract
INTRODUCTION Medical culture can make trainees feel like there is neither room for mistakes, nor space for personal shortcomings in the makeup of physicians. A dearth of role models who can exemplify that it is acceptable to need support compounds barriers to help-seeking once students struggle. We conducted a mixed-methods study to assess the impact of physicians sharing their living experiences with medical students. METHODS Second-year medical students participated, through synchronized videoconferencing, in an intervention consisting of 3 physicians who shared personal histories of vulnerability (e.g. failure on high-stakes exams; immigration and acculturation stress; and personal psychopathology, including treatment and recovery), followed by facilitated, small-group discussions. For the quantitative component, students completed the Opening Minds to Stigma Scale for Health Care Providers (OMS-HC) before and after the intervention. For the qualitative component, we conducted focus groups to explore the study intervention. We analyzed anonymized transcripts using thematic analysis aided by NVivo software. RESULTS We invited all students in the class (n = 61, 46% women) to participate in the research component. Among the 53 participants (87% of the class), OMS-HC scores improved after the intervention (P = .002), driven by the Attitudes (P = .003) and Disclosure (P < .001) subscales. We conducted 4 focus groups, each with a median of 6 participants (range, 5-7). We identified, through iterative thematic analysis of focus group transcripts, active components before, during, and after the intervention, with unexpected vulnerability and unarmored mutuality as particularly salient. CONCLUSIONS Sharing histories of personal vulnerability by senior physicians can lessen stigmatized views of mental health and normalize help-seeking among medical students. Synchronous videoconferencing proved to be an effective delivery mechanism for the intervention in a 'virtual wellness' format. Candid sharing by physicians has the potential to enhance students' ability to recognize, address, and seek help for their own mental health needs.
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Affiliation(s)
- Andrés Martin
- Child Study Center, Yale School of
Medicine, New Haven, CT, USA
- Standardized Patient Program, Teaching
and Learning Center, Yale School of Medicine, New Haven, CT, USA
- Tel-Aviv University Faculty of Medicine,
Ramat-Aviv, Israel
| | - Julie Chilton
- Child Study Center, Yale School of
Medicine, New Haven, CT, USA
| | | | | | - Hilary Gortler
- Tel-Aviv University Faculty of Medicine,
Ramat-Aviv, Israel
| | | | - Indigo Weller
- Narrative Medicine Program, Columbia
University School of Professional Studies, New York, NY, USA
| | - Doron Amsalem
- Tel-Aviv University Faculty of Medicine,
Ramat-Aviv, Israel
- Sheba Medical Center, Tel-Aviv,
Israel
| | - Stephanie Neary
- Physician Assistant Online Program, Yale
School of Medicine, New Haven, CT, USA
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Abstract
In this article, we examine the process of recovery in people who have undertaken treatment for mental health problems, based on interviews with 34 participants. We describe their experiences through the lens of social capital, focusing on the social networks and relationships within which they are embedded and which they utilise to give purpose and meaning to their lives. The accounts give sense of movement from relationships, institutions and networks which were provided through their engagement with services towards relationships outside the health care system which were more freely chosen and which provided a sense that they were able to achieve recognition and make a contribution. The latter included activities such as art, theatre and sport. The relationships and institutions with which they were engaged via the statutory services were described as burdensome and inappropriate, whereas those which were freely chosen appeared more emancipatory and positively constitutive of identity. We have called this latter experience one of 'intentional social capital' because the participants were deliberately choosing and orienting to these networks and were able to derive pleasure and a sense of self from them. The findings have implications for how we see the situation of people recovering from mental health problems inasmuch as professional attitudes and practices could usefully be extended to more fully recognise and encourage wider patterns of social engagement and fulfilment occurring outside the limited contribution of clinical definitions and clinical interventions.
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Dalgarno M, Oates J. The meaning of co-production for clinicians: An exploratory case study of Practitioner Trainers in one Recovery College. J Psychiatr Ment Health Nurs 2018; 25:349-357. [PMID: 29763995 DOI: 10.1111/jpm.12469] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 05/04/2018] [Accepted: 05/08/2018] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT Analysis of co-production in mental health and specifically Recovery Colleges has not previously considered the impact on clinicians and their clinical practice. Co-production as a concept is open to multiple interpretations. Core components of co-produced work are as follows: a focus on assets, mutuality, peer support and the use of a facilitative approach. WHAT THIS PAPER ADDS TO EXISTING KNOWLEDGE?: Senior clinicians who have chosen to become Practitioner Trainers describe the experience of collaboration with service users in an educational rather than clinical context. Working together in this educational environment led to some shifts in their perceptions of professional power and authority, in some cases leading to personal disclosures about their mental health. This study suggests the mechanisms by which co-production may transform professional practice: being in an educational rather than clinical context, the experience of being supported, the challenge of negotiating multiple roles (including that of being a colleague to someone with mental health needs) and experiencing a gradual shift of role emphasis as co-trainer relationships develop. The practical challenge of holding a simultaneous role as clinician for and co-trainer with Peer Trainers has been articulated, with the caveat that mental health support may be a feature of collegiate as well as clinical roles. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Being a Practitioner Trainer could be a professionally transformative experience. Ground rules for how to support colleagues' mental health needs should be established and refined during co-produced working. Negotiating personal disclosure and professional role identity must be explored further in both co-production research and practice. ABSTRACT Introduction Co-production between service users and clinicians is a desirable element of recovery-oriented practice in mental health, but the effect of co-production on clinicians has not been explored thoroughly. Aim To explore the meaning of co-production for clinicians based on their experience of co-production in a Recovery College. Method Thematic analysis of eight semi-structured interviews with clinicians who have co-produced and co-delivered workshops with a Recovery College Peer Trainer. Results The "meaning of co-production" had four themes: definitions, power dynamics, negotiating roles and influence on practice. Clinicians' experience of co-production meant a reassessment of their expert role and power. They said that this altered their clinical practice, particularly the language they used and the personal information they shared. Discussion Role negotiation between Practitioner and Peer Trainers is an iterative process, whereby clinicians may revise their perspectives on personal disclosure, professional identity and collegiate support. The Peer and Practitioner Trainer relationship is characterized by reciprocity and mutuality, and there is some evidence that Practitioner involvement in a co-produced activity has the potential to transform service user and provider relationships beyond the Recovery College setting. Implications for practice Engaging in co-produced educational workshops can alter clinicians' perspectives on roles, power and clinical expertise. Findings from this case study must be tested against research on other Recovery Colleges.
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Affiliation(s)
- Mark Dalgarno
- SLAM Recovery College, Maudsley Hospital, London, UK
| | - Jennifer Oates
- Florence Nightingale Faculty of Nursing, Midwfery & Palliative Care, King's College London, London, UK
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Abstract
Purpose
This paper aims to describe the evolution of Sanokondu, highlighting the rationale, achievements and lessons learnt from this initiative. Sanokondu is a multinational community of practice dedicated to fostering health-care leadership education worldwide. This platform for health-care leadership education was conceived in 2014 at the first Toronto International Summit on Leadership Education for Physicians (TISLEP) and evolved into a formal network of collaborators in 2016.
Design/methodology/approach
This paper is a case study of a multinational collaboration of health-care leaders, educators, learners and other stakeholders. It describes Sanokondu’s development and contribution to global health-care leadership education. One of the major strategies has been establishing partnerships with other educational organizations involved in clinical leadership and health systems improvement.
Findings
A major flagship of Sanokondu has been its annual TISLEP meetings, which brings various health-care leaders, educators, learners and patients together. The meetings provide opportunities for dialog and knowledge exchange on leadership education. The work of Sanokondu has resulted in an open access knowledge bank for health-care leadership education, which in addition to the individual expertise of its members, is readily available for consultation. Sanokondu continues to contribute to scholarship in health-care leadership through ongoing research, education and dissemination in the scholarly literature.
Originality/value
Sanokondu embodies the achievements of a multinational collaboration of health-care stakeholders invested in leadership education. The interactions culminating from this platform have resulted in new insights, innovative ideas and best practices on health-care leadership education.
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15
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Larsson I, Jormfeldt H. Perspectives on power relations in human health and well-being. Int J Qual Stud Health Well-being 2017; 12:1358581. [PMID: 28831852 PMCID: PMC5590626 DOI: 10.1080/17482631.2017.1358581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Affiliation(s)
- Ingrid Larsson
- a School of Health and Welfare , Halmstad University , Halmstad , Sweden
| | - Henrika Jormfeldt
- a School of Health and Welfare , Halmstad University , Halmstad , Sweden
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Atanasova D, Koteyko N, Brown B, Crawford P. Representations of mental health and arts participation in the national and local British press, 2007–2015. Health (London) 2017; 23:3-20. [DOI: 10.1177/1363459317708823] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
We analysed news articles published in national and local British newspapers between 2007 and 2015 to understand (1) how mental health and arts participation were framed and (2) how the relationships between participants in arts initiatives were conceptualised. Using corpus-assisted qualitative frame analysis, we identified frames of recovery, stigma and economy. The recovery frame, which emphasised that mental illness can be treated similarly to physical illness, positioned arts participation as a form of therapy that can complement or substitute medication. The stigma frame presented arts participation as a mechanism for challenging social conceptions that mentally ill individuals are incapable of productive work. The economy frame discussed the economic burden of mentally ill individuals and portrayed arts participation as facilitating their return to employment. Using thematic analysis, which paid attention to the representation of social actors, we found that service users were identified as the prime beneficiaries of arts initiatives, and arts participation was conceptualised as a way to bring people with mental health issues together. We discuss these findings against existing research on media representations of mental health and the concept of ‘mutual recovery’ and suggest what wider concurrent developments in the areas of mental health and the media may account for the uncovered frames and themes.
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