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Keller F, Ludwig U, Huber-Lang M. Enemy or friend: the personal and the factual patient-physician relationship. Front Med (Lausanne) 2023; 10:1098305. [PMID: 37305141 PMCID: PMC10248471 DOI: 10.3389/fmed.2023.1098305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Physicians are expected to place the patient's interests above their own. Such prioritization has worldwide consent. It constitutes the difference between medicine and other professions. The present conceptual opinion paper summarizes the authors' clinical experience with patient care and student teaching during the last 45 years. The authors comment on their own conception by referring to present debates and prominent statements from the past. Fundamental changes in medicine have taken place over the last five decades. New diseases have emerged while diagnostic and therapeutic options for patients have grown steadily - along with healthcare costs. At the same time, economic and legal constraints for physicians have increased, as has moral pressure. The interaction of physicians with patients has gradually shifted from a personal to a factual relationship. In the factual, more formal relationship, the patient and physician represent equal partners of a legal contract, which jeopardizes the prioritization of the patient's interests. The formal relationship implies defensiveness. By contrast, in the personal relationship, the physician adopts an existentialist commitment while simultaneously enabling and respecting the patient's autonomous decision-making. The authors argue for the personal relationship. However, the patient and physician are no friends. Consequently, the physician in effect competes with the patient from a knowledge-based but opposite position. Both need to make efforts to consent and maintain the relationship even when they dissent. This implies that the physician does not simply comply with the patient's wishes.
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Affiliation(s)
- Frieder Keller
- Institute of Experimental and Clinical Pharmacology, Toxicology and Pharmacology of Natural Products, University Hospital, Ulm, Germany
| | - Ulla Ludwig
- Department of Internal Medicine, University Hospital, Ulm, Germany
| | - Markus Huber-Lang
- Institute for Clinical and Experimental Trauma Immunology, University Hospital, Ulm, Germany
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Jobe I. Reflections of the collaborative care planning as a person-centred practice. Nurs Philos 2022; 23:e12389. [PMID: 35322917 PMCID: PMC9285900 DOI: 10.1111/nup.12389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 01/05/2022] [Accepted: 03/13/2022] [Indexed: 12/04/2022]
Abstract
The ageing population is increasing worldwide with an increase in chronic disorders. At the same time, person‐centred care has become a policy within both health and social care. To facilitate coordination and collaboration and integrate the older adult's perspective in the decision‐making process the collaborative care planning process with the development of a written care plan can be used. In this study, the result of an interpreted analysis of four empirical studies of the collaborative care planning as a person‐centred practice will be discussed and reflected on. A framework based on the French philosopher Paul Ricoeur's little ethics was used in the synthesis of the studies. The findings revealed two common threads: personhood and power asymmetry. Both challenges in achieving a person‐centred collaborative care planning. Ricoeur's dialogical thinking and description of a person served as an underpinning in discussing and reflecting upon the findings of the interpreted synthesis. Collaborative care planning is a complex process. However, Ricoeur's philosophy contributed to a greater understanding of the collaborative care planning as a person‐centred practice and accentuated that ethics, human values, and the older adults and care partners perspectives need to be given the same importance and considerations as the medical and social sciences perspectives for the collaborative care planning process to truly become person‐centred.
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Affiliation(s)
- Ingela Jobe
- Department of Health Science, Luleå University of Technology, Luleå, Sweden
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Osborn E, Ritha M, Macniven R, Agius T, Christie V, Finlayson H, Gwynn J, Hunter K, Martin R, Moir R, Taylor D, Tobin S, Ward K, Gwynne K. "No One Manages It; We Just Sign Them Up and Do It": A Whole System Analysis of Access to Healthcare in One Remote Australian Community. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:2939. [PMID: 35270632 PMCID: PMC8910080 DOI: 10.3390/ijerph19052939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/22/2022] [Accepted: 02/28/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To assess the accessibility, availability and utilisation of a comprehensive range of community-based healthcare services for Aboriginal people and describe contributing factors to providing effective healthcare services from the provider perspective. SETTING A remote community in New South Wales, Australia. PARTICIPANTS Aboriginal and non-Aboriginal health and education professionals performing various roles in healthcare provision in the community. DESIGN Case study. METHODOLOGY The study was co-designed with the community. A mixed-methods methodology was utilised. Data were gathered through structured interviews. Descriptive statistics were used to analyse the availability of 40 health services in the community, whilst quotations from the qualitative research were used to provide context for the quantitative findings. RESULTS Service availability was mapped for 40 primary, specialised, and allied health services. Three key themes emerged from the analysis: (1) there are instances of both underservicing and overservicing which give insight into systemic barriers to interagency cooperation; (2) nurses, community health workers, Aboriginal health workers, teachers, and administration staff have an invaluable role in healthcare and improving patient access to health services and could be better supported through further funding and opportunities for specialised training; and (3) visiting and telehealth services are critical components of the system that must be linked to existing community-led primary care services. CONCLUSION The study identified factors influencing service availability, accessibility and interagency cooperation in remote healthcare services and systems that can be used to guide future service and system planning and resourcing.
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Affiliation(s)
- Eloise Osborn
- Centre for Global Indigenous Futures, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Marida Ritha
- Centre for Global Indigenous Futures, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia
| | - Rona Macniven
- Centre for Global Indigenous Futures, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia
- Faculty of Medicine and Health, School of Population Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Tim Agius
- Durri Aboriginal Corporation Medical Service, Kempsey, NSW 2440, Australia
| | - Vita Christie
- Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW 2006, Australia
| | | | - Josephine Gwynn
- Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Kate Hunter
- The George Institute for Global Health, The University of New South Wales, Sydney, NSW 2052, Australia
| | - Robyn Martin
- Mid North Coast Local Health District, Coffs Harbour, NSW 2450, Australia
| | - Rachael Moir
- Poche Centre for Indigenous Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Donna Taylor
- Pius X Aboriginal Medical Service, Moree, NSW 2400, Australia
| | - Susannah Tobin
- Honorary Faculty of Medicine and Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Katrina Ward
- Brewarrina Aboriginal Medical Service, Brewarrina, NSW 2839, Australia
| | - Kylie Gwynne
- Centre for Global Indigenous Futures, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, NSW 2109, Australia
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Viftrup DT, Nissen R, Søndergaard J, Hvidt NC. Four aspects of spiritual care: a phenomenological action research study on practicing and improving spiritual care at two Danish hospices. Palliat Care Soc Pract 2021; 15:26323524211050646. [PMID: 34708208 PMCID: PMC8543636 DOI: 10.1177/26323524211050646] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/16/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In Denmark and internationally, there has been an increased focus on strengthening palliative care by enhancing spiritual care. Dying patients, however, do not experience their spiritual needs being adequately met. METHODS Through an action research study design with four consecutive stages, namely, observation in practice, reflection-on-praxis, action-in-praxis, and evaluation of the action research process involving patients and hospice staff from two hospices in Denmark, two research questions were explored: (1) How do patients and staff perceive, feel, live, practice, and understand spiritual care at hospice? and (2) How can spiritual care be improved in hospice practice? The data material presented comprised 12 individual interviews with patients and nine focus group interviews with the staff. RESULTS We found four aspects of spiritual care through which patients and staff seemed to perceive, feel, live, practice, and understand spiritual care at hospice, and from where spiritual care may be improved in hospice practice. These aspects constituted four themes: (1) relational, (2) individualistic, (3) embodied, and (4) verbal aspects of spiritual care. CONCLUSION Staff realized immanent limitations of individual aspects of spiritual care but learned to trust that their relational abilities could improve spiritual care. Embodied aspects seemed to open for verbal aspects of spiritual care, but staff were reluctant to initiative verbal dialogue. They would bodily sense values about preserving patients' boundaries in ways that seemed to hinder verbal aspects of spiritual care. During action-in-praxis, however, staff realized that they might have to initiate spiritual conversation in order to care for patients' spiritual needs.
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Affiliation(s)
- Dorte Toudal Viftrup
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, 5000 Odense C, Denmark
| | - Ricko Nissen
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
| | - Niels Christian Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
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Chahrour WH, Hvidt NC, Hvidt EA, Viftrup DT. Learning to care for the spirit of dying patients: the impact of spiritual care training in a hospice-setting. BMC Palliat Care 2021; 20:115. [PMID: 34273974 PMCID: PMC8286591 DOI: 10.1186/s12904-021-00804-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 05/17/2021] [Indexed: 11/21/2022] Open
Abstract
Background Patients approaching the end of their life do not experience their existential and spiritual needs being sufficiently met by the healthcare professionals responsible for their care. Research suggest that this is partly due to a lack of insight about spiritual care among healthcare professionals. By developing, implementing, and evaluating a research-based educational course on spiritual care targeting hospice staff, we aimed to explore the perceived barriers for providing spiritual care within a hospice setting and to evaluate the post-course impact among staff members. Methods Course development and evaluation was based on primary exploratory action research and followed the UK Medical Research Council’s framework for complex intervention research. The course was implemented at two Danish hospices and comprised thematic days that included lectures, reflective exercises and improvised participatory theatre. We investigated the course impact using a questionnaire and focus group interviews. The questionnaire data were summarized in bar charts and analysis of the transcribed interviews was performed based on Interpretative Phenomenological Analysis. Results 85 staff members participated in the course. Of these, 57 answered the evaluative questionnaire and 15 participated in 5 focus group interviews. The course elements that the participants reported to be the most relevant were improvised theatre unfolding existential themes and reflexive group activities. 98% of participants found the course relevant, answering either “relevant” or “very relevant”. 73,1% of participants answered “to a considerable extent” or “to a great extent” when asked to what extent they assessed the content of the course to influence their work in hospice. The focus group data resulted in 3 overall themes regarding perceived barriers for providing spiritual care: 1. Diverse approaches is beneficial for spiritual care, but the lack of a shared and adequate spiritual language is a communicative barrier, 2. Existential conversation is complicated by patients’ overlapping physical and existential needs, as well as miscommunication, and 3. Providing spiritual care requires spiritual self-reflection, self-awareness, introspection, and vulnerability. Conclusions This study provides insights into the barriers facing spiritual care in a hospice setting. Furthermore, the course evaluations demonstrate the valuable impact of spiritual care training for health care professionals. Further course work development is warranted to enhance the “science” of spiritual care for the dying. Supplementary Information The online version contains supplementary material available at 10.1186/s12904-021-00804-4.
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Affiliation(s)
- Wafie Hussein Chahrour
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense J. B. Winsløwsvej 9A, 5000, Odense C, Denmark.
| | - Niels Christian Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense J. B. Winsløwsvej 9A, 5000, Odense C, Denmark
| | - Elisabeth Assing Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense J. B. Winsløwsvej 9A, 5000, Odense C, Denmark
| | - Dorte Toudal Viftrup
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense J. B. Winsløwsvej 9A, 5000, Odense C, Denmark
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Sandu RD. Worthy and able: How helping relationships alter the trajectories of young people who face severe and multiple disadvantages. JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 49:321-342. [PMID: 33053224 DOI: 10.1002/jcop.22460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 09/20/2020] [Accepted: 09/21/2020] [Indexed: 06/11/2023]
Abstract
Relationships with professional helpers, partly resembling family relationships, have the potential to help young people facing severe and multiple disadvantages. The aim of this study was to document how relationships alter the trajectories of young people in these circumstances. Young people (n = 30) and support workers (n = 35) were identified by the leaders of 11 UK and 5 US not-for-profit organisations providing support for this population. Thematic analysis of the semi-structured interviews revealed that relationships helped young people feel positive about themselves, disrupted their maladaptive patterns of thinking, and fostered a sense of agency in themselves. The result was a self that was worthy and able. Findings provided an in-depth exploration of the notion of support in the context of adversity.
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Affiliation(s)
- Rebeca D Sandu
- Department of Psychology, University of Cambridge, Cambridge, UK
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7
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Hvidt NC, Nielsen KT, Kørup AK, Prinds C, Hansen DG, Viftrup DT, Assing Hvidt E, Hammer ER, Falkø E, Locher F, Boelsbjerg HB, Wallin JA, Thomsen KF, Schrøder K, Moestrup L, Nissen RD, Stewart-Ferrer S, Stripp TK, Steenfeldt VØ, Søndergaard J, Wæhrens EE. What is spiritual care? Professional perspectives on the concept of spiritual care identified through group concept mapping. BMJ Open 2020; 10:e042142. [PMID: 33372078 PMCID: PMC7772306 DOI: 10.1136/bmjopen-2020-042142] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES The overall study aim was to synthesise understandings and experiences regarding the concept of spiritual care (SC). More specifically, to identify, organise and prioritise experiences with the way SC is conceived and practised by professionals in research and the clinic. DESIGN Group concept mapping (GCM). SETTING The study was conducted within a university setting in Denmark. PARTICIPANTS Researchers, students and clinicians working with SC on a daily basis in the clinic and/or through research participated in brainstorming (n=15), sorting (n=15), rating and validation (n=13). RESULTS Applying GCM, ideas were identified, organised and prioritised online. A total of 192 unique ideas of SC were identified and organised into six clusters. The results were discussed and interpreted at a validation meeting. Based on input from the validation meeting a conceptual model was developed. The model highlights three overall themes: (1) 'SC as an integral but overlooked aspect of healthcare' containing the two clusters SC as a part of healthcare and perceived significance; (2) 'delivering SC' containing the three clusters quality in attitude and action, relationship and help and support, and finally (3) 'the role of spirituality' containing a single cluster. CONCLUSION Because spirituality is predominantly seen as a fundamental aspect of each individual human being, particularly important during suffering, SC should be an integral aspect of healthcare, although it is challenging to handle. SC involves paying attention to patients' values and beliefs, requires adequate skills and is realised in a relationship between healthcare professional and patient founded on trust and confidence.
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Affiliation(s)
- Niels Christian Hvidt
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
- Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense, Denmark
| | - Kristina Tomra Nielsen
- Department of Occupational Therapy, University College of Northern Denmark (UCN), Aalborg, Denmark
- The ADL Unit, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Denmark
| | - Alex K Kørup
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
- Department of Mental Health Service Kolding-Vejle, Region of Southern Denmark, Vejle, Denmark
| | - Christina Prinds
- Clinical Institute, Syddansk Universitet Det Sundhedsvidenskabelige Fakultet, Odense, Denmark
- Research, University College South - Campus Haderslev, Haderslev, Denmark
| | - Dorte Gilså Hansen
- IRS, Center for Shared Decision Making, Lillebaelt Hospital, University of Southern Denmark, Vejle, Denmark
| | - Dorte Toudal Viftrup
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Elisabeth Assing Hvidt
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Erik Falkø
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Flemming Locher
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, JELLING, Denmark
| | - Hanne Bess Boelsbjerg
- Interacting Minds Centre, Department of Clinical Medicine, Aarhus Universitet, Aarhus, Denmark
- Elective Surgery Center, Silkeborg Regional Hospital, Silkeborg, Midtjylland, Denmark
| | - Johan Albert Wallin
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Karsten Flemming Thomsen
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Katja Schrøder
- Department of Public Health, Syddansk Universitet, Odense, Denmark
| | - Lene Moestrup
- Health Science Research Center, University College Lillebaelt - Campus Odense, Odense, Denmark
| | - Ricko Damberg Nissen
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Sif Stewart-Ferrer
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Tobias Kvist Stripp
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Jens Søndergaard
- Research Unit of General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Eva Ejlersen Wæhrens
- The Research Initiative for Activity studies and Occupational Therapy, Research Unit of User Perspectives, Institute of Public Health, University of Southern Denmark, Odense, Denmark
- The ADL unit, Frederiksberg Hospital Parker Institute, Frederiksberg, Hovedstaden, Denmark
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Bergman D, Bethell C, Gombojav N, Hassink S, Stange KC. Physical Distancing With Social Connectedness. Ann Fam Med 2020; 18:272-277. [PMID: 32393566 PMCID: PMC7213990 DOI: 10.1370/afm.2538] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Revised: 03/22/2020] [Accepted: 03/24/2020] [Indexed: 11/09/2022] Open
Abstract
In light of concerns over the potential detrimental effects of declining care continuity, and the need for connection between patients and health care providers, our multidisciplinary group considered the possible ways that relationships might be developed in different kinds of health care encounters.We were surprised to discover many avenues to invest in relationships, even in non-continuity consultations, and how meaningful human connections might be developed even in telehealth visits. Opportunities range from the quality of attention or the structure of the time during the visit, to supporting relationship development in how care is organized at the local or system level and in the use of digital encounters. These ways of investing in relationships can exhibit different manifestations and emphases during different kinds of visits, but most are available during all kinds of encounters.Recognizing and supporting the many ways of investing in relationships has great potential to create a positive sea change in a health care system that currently feels fragmented and depersonalized to both patients and health care clinicians.The current COVID-19 pandemic is full of opportunity to use remote communication to develop healing human relationships. What we need in a pandemic is not social distancing, but physical distancing with social connectedness.
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Kitzmüller G, Mangset M, Evju AS, Angel S, Aadal L, Martinsen R, Bronken BA, Kvigne K, Bragstad LK, Hjelle EG, Sveen U, Kirkevold M. Finding the Way Forward: The Lived Experience of People With Stroke After Participation in a Complex Psychosocial Intervention. QUALITATIVE HEALTH RESEARCH 2019; 29:1711-1724. [PMID: 30862270 DOI: 10.1177/1049732319833366] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Stroke patients' well-being is threatened after stroke. A psychosocial intervention was developed for Norwegian stroke patients living in the community. Eight individual sessions between people with stroke and a trained health care professional were conducted 1 to 6 months post-stroke with one group of participants and 6 to 12 months post-stroke with another group. Subsequently, 19 of these stroke patients were interviewed to gain an in-depth understanding of their lived experience of the influence of the intervention on their adjustment process. Interview texts were analyzed using Ricoeur's interpretation theory. Two participants did not personally find the intervention useful. The remaining participants greatly appreciated dialogues with the empathetic intervention personnel, feeling free to discuss their fears and worries. The intervention raised these participants' awareness of their needs and resources. They were guided to resume their everyday life and adopt a future-oriented attitude. The intervention facilitated their meaning-making endeavors and post-stroke adjustment.
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Affiliation(s)
| | | | - Anne S Evju
- UiT The Arctic University of Norway, Narvik, Norway
| | - Sanne Angel
- Aarhus University, Aarhus, Denmark
- Molde University College, Molde, Norway
| | - Lena Aadal
- Aarhus University, Aarhus, Denmark
- Hammel Neurorehabilitation Centre and University Research Clinic, Hammel, Denmark
| | - Randi Martinsen
- Inland Norway University of Applied Sciences, Elverum, Norway
| | - Berit A Bronken
- Inland Norway University of Applied Sciences, Elverum, Norway
| | - Kari Kvigne
- Inland Norway University of Applied Sciences, Elverum, Norway
- Nord University, Sandnessjøen, Norway
| | - Line K Bragstad
- Oslo University Hospital, Oslo, Norway
- University of Oslo, Oslo, Norway
| | | | - Unni Sveen
- Oslo University Hospital, Oslo, Norway
- Oslo Metropolitan University, Oslo, Norway
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Healy P. Rethinking the doctor-patient relationship: toward a hermeneutically-informed epistemology of medical practice. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2019; 22:287-295. [PMID: 30414062 DOI: 10.1007/s11019-018-9875-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Although typically implicit, clinicians face an inherent conflict between their roles as medical healers and as providers of technical biomedicine (Scott et al. in Philos Ethics Humanit Med 4:11, 2009). This conflict arises from the tension between the physicalist model which still predominates in medical training and practice and the extra-physicalist dimensions of medical practice as epitomised in the concept of patient-centred care. More specifically, the problem is that, as grounded in a "borrowed" physicalist philosophy, the dominant "applied scientist" model exhibits a number of limitations which severely restrict its ability to underwrite the effective practice of care. Moreover, being structural in character, these problems cannot be resolved by piecemeal modifications of the existing model, nor by an appeal to evidence-based medicine (Miles in J Eval Clin Pract 15(6):887-890, 2009; Miles in Folia Med 55(1):5-24, 2013; Miles et al. in J Eval Clin Pract 14(5):621-649, 2008). Hence, the need for medical theorists to "partner with experts in the humanities to build a sui generis philosophy of medicine" (Whatley in J Eval Clin Pract 20(6):961-964, 2014, p. 961). In response, the present paper seeks to vindicate the merits of hermeneutically-informed template in providing the requisite grounding. While capable of correcting for the limitations of the applied scientist model, a hermeneutically-informed template is a "both/and" approach, which seeks to complement rather than exclude the physicalist dimension, and thereby aspires to reconcile technical mastery with patient-centred care, rather than eschew one in favour of the other. As such, it can provide a cogent philosophical template for current best practice, which does justice to the art as well as the science of medical care.
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Affiliation(s)
- Paul Healy
- Faculty of Health, Arts, and Design, Swinburne University of Technology, John Street, Hawthorn, VIC, 3122, Australia.
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11
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Understanding compassion in family medicine: a qualitative study. Br J Gen Pract 2019; 69:e208-e216. [PMID: 30692087 DOI: 10.3399/bjgp19x701285] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 09/10/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Patients and physicians have traditionally valued compassion; however, there is concern that physician compassion has declined with the increasing emphasis on science and technology in medicine. Although the literature on compassion is growing, very little is known about how family physicians experience compassion in their work. AIM To explore family physicians' capacity for and experiences of compassion in practice. DESIGN AND SETTING This was a qualitative study designed using a phenomenological approach in rural and urban Ontario, Canada. METHOD In-depth interviews were audiotaped and transcribed verbatim, followed by independent and team coding. An iterative and interpretive analysis was conducted using immersion and crystallisation techniques. Purposive sampling recruited 22 participants (nine males and 13 females aged 26-64 years) that included family medicine residents from Western University (n = 6), and family physicians practising <5 years (n = 7) or >10 years (n = 9) in Ontario, Canada. RESULTS From the data, the authors derived the Compassion Trichotomy as a theoretical model to describe three interrelated areas that determine the evolution or devolution of compassion experienced by family physicians: motivation (core values), capacity (energy), and connection (relationship). CONCLUSION The Compassion Trichotomy highlights the importance and interdependence in physician compassion of motivation (personal reflection and values), capacity (awareness and regulation of energy, emotion, and cognition), and connection (sustained patient-physician relationship). This model may assist practising family physicians, educators, and researchers to explore how compassion development might enhance physician effectiveness and satisfaction.
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Katz JD. At the intersection of self and not-self: finding the locus of 'self' in autoimmunity. MEDICAL HUMANITIES 2018; 44:137-139. [PMID: 29436480 PMCID: PMC6087542 DOI: 10.1136/medhum-2017-011364] [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] [Accepted: 01/02/2018] [Indexed: 06/08/2023]
Abstract
Individuals with chronic autoimmune disease experience a sense of vulnerability. In part, this relates to the struggle for finding the meaning of the illness. The consequent existential distress may manifest in an unseated sense of personhood. Insight into the mechanism of this state of powerlessness and of perceived loss of agency is central to establishing a supportive clinician-patient relationship. This present exposition underscores the concept of autoimmunity as one that represents a demarcation in the psyche: one that is not just a threat to our sense of self-hood but also to our humanity. Autoimmunity exposes the challenge imposed on the relating of the self to one's own self and hence is an ontological challenge. The breach of the boundary between self and not-self that is caused by the autoimmune process culminates in feelings of alienation.
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Abstract
The purpose of this study was to investigate the living experience of feeling peaceful. Parse's research method was used to answer the question: What is the structure of the living experience of feeling peaceful? Twelve participants living in a community consented to partake in the study. The central finding of the study is the structure: feeling peaceful is contentedness amid tribulation, as unburdening surfaces with devout involvements. The findings are discussed in relation to the humanbecoming school of thought and extant literature.
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Affiliation(s)
- Thomas J Doucet
- 1 Assistant Professor, Université de Moncton, Moncton, NB, Canada
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Hamm JA, Buck KD, Gonzalvo JD. Clinical Application of Patient-Centered Diabetes Care for People With Serious Mental Illness. Clin Diabetes 2017; 35:313-320. [PMID: 29263574 PMCID: PMC5734178 DOI: 10.2337/cd17-0041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IN BRIEF Patients with serious mental illness (SMI) have markedly higher mortality rates than those without SMI. A large portion of this disparity is explained by higher rates of diabetes and cardiovascular illness, highlighting the need for people with diabetes and SMI to have access to the highest quality diabetes care. This article applies principles of patient-centered diabetes care to those with SMI, exploring a novel approach to diabetes care embedded within a community mental health setting.
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Affiliation(s)
- Jay A. Hamm
- Eskenazi Health, Midtown Community Mental Health, Indianapolis, IN
- Purdue University, College of Pharmacy, West Lafayette, IN
| | - Kelly D. Buck
- Richard L. Roudebush VA Medical Center, Indianapolis, IN
| | - Jasmine D. Gonzalvo
- Eskenazi Health, Midtown Community Mental Health, Indianapolis, IN
- Purdue University, College of Pharmacy, West Lafayette, IN
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Sueiras P, Romano-Betech V, Vergil-Salgado A, de Hoyos A, Quintana-Vargas S, Ruddick W, Castro-Santana A, Islas-Andrade S, Altamirano-Bustamante NF, Altamirano-Bustamante MM. Today´s medical self and the other: Challenges and evolving solutions for enhanced humanization and quality of care. PLoS One 2017; 12:e0181514. [PMID: 28759585 PMCID: PMC5536364 DOI: 10.1371/journal.pone.0181514] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2016] [Accepted: 07/03/2017] [Indexed: 11/18/2022] Open
Abstract
Background Recent scientific developments, along with growing awareness of cultural and social diversity, have led to a continuously growing range of available treatment options; however, such developments occasionally lead to an undesirable imbalance between science, technology and humanism in clinical practice. This study explores the understanding and practice of values and value clusters in real-life clinical settings, as well as their role in the humanization of medicine and its institutions. The research focuses on the values of clinical practice as a means of finding ways to enhance the pairing of Evidence-Based Medicine (EBM) with Values-based Medicine (VBM) in daily practice. Methods and findings The views and representations of clinical practice in 15 pre-CME and 15 post-CME interviews were obtained from a random sampling of active healthcare professionals. These views were then identified and qualitatively analyzed using a three-step hermeneutical approach. A clinical values space was identified in which ethical and epistemic values emerge, grow and develop within the biomedical, ethical, and socio-economic dimensions of everyday health care. Three main values—as well as the dynamic clusters and networks that they tend to form—were recognized: healthcare personnel-patient relationships, empathy, and respect. An examination of the interviews suggested that an adequate conceptualization of values leads to the formation of a wider axiological system. The role of clinician-as-consociate emerged as an ideal for achieving medical excellence. Conclusions By showing the intricate clusters and networks into which values are interwoven, our analysis suggests methods for fine-tuning educational interventions so they can lead to demonstrable changes in attitudes and practices.
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Affiliation(s)
- Perla Sueiras
- Grupo Transfuncional en Etica Clínica, Centro Médico Nacional Siglo XXI, IMSS, Doctores, Ciudad de México, Mexico
| | - Victoria Romano-Betech
- Grupo Transfuncional en Etica Clínica, Centro Médico Nacional Siglo XXI, IMSS, Doctores, Ciudad de México, Mexico
| | - Alejandro Vergil-Salgado
- Grupo Transfuncional en Etica Clínica, Centro Médico Nacional Siglo XXI, IMSS, Doctores, Ciudad de México, Mexico
| | - Adalberto de Hoyos
- CIECAS, Instituto Politécnico Nacional, Lauro Aguirre 120, Agricultura, Miguel Hidalgo, Ciudad de México, México
| | - Silvia Quintana-Vargas
- Instituto de Salud Pública del Estado de Guanajuato, Tamazuca 4, Centro, Guanajuato, México
| | - William Ruddick
- Center for Bioethics, New York University, New York, NY, United States of America
| | - Anaclara Castro-Santana
- National Research Council for Science and Technology (CONACYT), Ciudad de México, México
- Instituto Nacional de Pediatría, Secretaría de Salud, Insurgentes Sur 3700, Insurgentes Cuicuilco, Ciudad de México, México
| | - Sergio Islas-Andrade
- Grupo Transfuncional en Etica Clínica, Centro Médico Nacional Siglo XXI, IMSS, Doctores, Ciudad de México, Mexico
- Unidad de Investigación de Enfermedades Metabólicas, Centro Médico Nacional Siglo XXI, IMSS, Doctores, Ciudad de México, México
| | - Nelly F. Altamirano-Bustamante
- Instituto Nacional de Pediatría, Secretaría de Salud, Insurgentes Sur 3700, Insurgentes Cuicuilco, Ciudad de México, México
- * E-mail: (NFAB); (MMAB)
| | - Myriam M. Altamirano-Bustamante
- Grupo Transfuncional en Etica Clínica, Centro Médico Nacional Siglo XXI, IMSS, Doctores, Ciudad de México, Mexico
- Unidad de Investigación de Enfermedades Metabólicas, Centro Médico Nacional Siglo XXI, IMSS, Doctores, Ciudad de México, México
- * E-mail: (NFAB); (MMAB)
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Buck KD, Buck BE, Hamm JA, Lysaker PH. Martin Buber and evidence-based practice: Can the lion really lie down with the lamb? PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2015. [DOI: 10.1080/17522439.2015.1055783] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Strang S, Henoch I, Danielson E, Browall M, Melin-Johansson C. Communication about existential issues with patients close to death-nurses' reflections on content, process and meaning. Psychooncology 2013; 23:562-8. [DOI: 10.1002/pon.3456] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2013] [Revised: 10/25/2013] [Accepted: 11/01/2013] [Indexed: 11/06/2022]
Affiliation(s)
- Susann Strang
- Sahlgrenska Academy, Institute of Health and Care Sciences; University of Gothenburg; Gothenburg Sweden
| | - Ingela Henoch
- Sahlgrenska Academy, Institute of Health and Care Sciences; University of Gothenburg; Gothenburg Sweden
| | - Ella Danielson
- Sahlgrenska Academy, Institute of Health and Care Sciences; University of Gothenburg; Gothenburg Sweden
- Department of Health Sciences; Mid Sweden University; Östersund Sweden
| | - Maria Browall
- Department of Neurobiology, Care Science and Society, Division of Nursing; Karolinska Institute; Solna Sweden
- School of Life Sciences; University of Skövde; Skövde Sweden
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Pargament KI. Conversations with Eeyore: Spirituality and the generation of hope among mental health providers. Bull Menninger Clin 2013; 77:395-412. [DOI: 10.1521/bumc.2013.77.4.395] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Vernon LT, Demko CA, Webel AR, Mizumoto RM. The feasibility, acceptance, and key features of a prevention-focused oral health education program for HIV+ adults. AIDS Care 2013; 26:763-8. [PMID: 24134855 PMCID: PMC3943585 DOI: 10.1080/09540121.2013.845291] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 09/12/2013] [Indexed: 10/26/2022]
Abstract
Poor oral health is common in HIV+ adults. We explored the feasibility, acceptance, and key features of a prevention-focused oral health education program for HIV+ adults. This was a pilot substudy of a parent study in which all subjects (n = 112) received a baseline periodontal disease (PD) examination and provider-delivered oral health messages informed by the Information-Motivation-Behavioral Skills (IMB) Model. Forty-one parent study subjects were then eligible for the substudy; of these subjects, a volunteer sample was contacted and interviewed 3-6 months after the baseline visit. At the recall visit, subjects self-reported behavior changes that they had made since the baseline. PD was reassessed using standard clinical assessment guidelines, and results were shared with each subject. At recall, individualized, hands-on oral hygiene coaching was performed and patients provided feedback on this experience. Statistics included frequency distributions, means, and chi-square testing for bivariate analyses. Twenty-two HIV+ adults completed the study. At recall, subjects had modest, but nonsignificant (p > 0.05) clinician-observed improvement in PD. Each subject reported adopting, on average, 3.8 (± 1.5) specific oral health behavior changes at recall. By self-report, subjects attributed most behavior changes (95%) to baseline health messages. Behavior changes were self-reported for increased frequency of flossing (55%) and toothbrushing (50%), enhanced toothbrushing technique (50%), and improved eating habits (32%). As compared to smokers, nonsmokers reported being more optimistic about their oral health (p = 0.024) at recall and were more likely to have reported changing their oral health behaviors (p = 0.009). All subjects self-reported increased knowledge after receiving hands-on oral hygiene coaching performed at the recall visit. In HIV+ adults, IMB-informed oral health messages promoted self-reported behavior change, subjects preferred more interactive, hands-on coaching. We describe a holistic clinical behavior change approach that may provide a helpful framework when creating more rigorously designed IMB-informed studies on this topic.
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Affiliation(s)
- Lance T. Vernon
- Department of Biological Sciences, Case Western Reserve University School of Dental Medicine, Cleveland, OH, USA
| | - Catherine A. Demko
- Department of Community Dentistry, Case Western Reserve University School of Dental Medicine, Cleveland, OH, USA
| | | | - Ryan M. Mizumoto
- Department of Biological Sciences, Case Western Reserve University School of Dental Medicine, Cleveland, OH, USA
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Westerhof GJ, van Vuuren M, Brummans BHJM, Custers AFJ. A Buberian approach to the co-construction of relationships between professional caregivers and residents in nursing homes. THE GERONTOLOGIST 2013; 54:354-62. [PMID: 23840020 DOI: 10.1093/geront/gnt064] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
This article demonstrates the value of a Buberian approach to relationships between professional caregivers and residents in nursing homes. Extant research on relationships between professional caregivers and residents typically distinguishes between task-centered and person-centered communication yet tends to privilege either the perspective of professionals or residents. To address this issue, we develop an approach that addresses the co-construction of I-It and I-Thou relationships, based on Martin Buber's social existentialist philosophy. In turn, we show the merit of this approach by using it to analyze interactional data from an observational study on morning care in Dutch nursing homes. As these examples illustrate, our analytical perspective is useful because it highlights how different caregiver-resident relationships are co-created and unfold over time. Thus, by revealing how these relationships are worked out in everyday interactions through subtle shifts between task-centered and person-centered communicative practices, this article offers important insights for improving the quality of care in nursing homes.
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Affiliation(s)
- Gerben J Westerhof
- *Address correspondence to Gerben J. Westerhof, Department of Psychology, University of Twente, Health and Technology, PO Box 217, 6500AE Enschede, The Netherlands. E-mail:
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Abstract
BACKGROUND Governments around the world are looking at means to improve health care services and health outcomes for their communities within a sustainable expenditure framework. There is a general agreement that strengthening primary health care is the way for the future. Primary health care organizations (PHCOs) are seen as a means to achieving more effective and efficient health care. RESULTS AND CONCLUSIONS This paper proposes a complex adaptive framework for PHCOs, taking account of health and illness being subjective experiences, health care being 'whole person'-focused, and PHCOs focusing on all of a community's health determinants and community-based health care needs. Such approach would foster building healthy local communities as much as seamless integration of health services for all. However, despite the expressed intensions towards patient-centred health care reform the bureaucratic mindset of Australian health policy makers risks true reform by imposing highly structured - rather than 'simple'- policy and operational rules.
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Sauer S, Lynch S, Walach H, Kohls N. Dialectics of mindfulness: implications for western medicine. Philos Ethics Humanit Med 2011; 6:10. [PMID: 21586129 PMCID: PMC3117801 DOI: 10.1186/1747-5341-6-10] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Accepted: 05/17/2011] [Indexed: 05/30/2023] Open
Abstract
Mindfulness as a clinical and nonclinical intervention for a variety of symptoms has recently received a substantial amount of interest. Although the application of mindfulness appears straightforward and its effectiveness is well supported, the concept may easily be misunderstood. This misunderstanding may severely limit the benefit of mindfulness-based interventions. It is therefore necessary to understand that the characteristics of mindfulness are based on a set of seemingly paradoxical structures. This article discusses the underlying paradox by disentangling it into five dialectical positions - activity vs. passivity, wanting vs. non-wanting, changing vs. non-changing, non-judging vs. non-reacting, and active acceptance vs. passive acceptance, respectively. Finally, the practical implications for the medical professional as well as potential caveats are discussed.
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Affiliation(s)
- Sebastian Sauer
- Generation Research Program, Ludwig-Maximilians-University, Munich, Germany
- Peter-Schilffarth-Institute, Bad Toelz, Germany
| | - Siobhan Lynch
- School of Social Sciences, The University of Northampton, Northampton, UK
- Institute of Psychiatry, King's College London, London, UK
| | - Harald Walach
- Institute of Transcultural Health Studies, European University Viadrina, Frankfurt (Oder), Germany
- Brain, Mind and Healing Program, Samueli Institute, Alexandria, USA
| | - Niko Kohls
- Generation Research Program, Ludwig-Maximilians-University, Munich, Germany
- Peter-Schilffarth-Institute, Bad Toelz, Germany
- Brain, Mind and Healing Program, Samueli Institute, Alexandria, USA
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