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Mindfulness and therapeutic relationships: insights from a phenomenological study of occupational therapists' practices 正念与治疗关系:职业治疗师实践现象学研究的启示
Pub Date : 2024-01-29 DOI: 10.26443/ijwpc.v11i1.400
K. Smith, E. Kinsella, Sheila Moodie, Lisa McCorquodale, Gail Teachman
Background A well-established body of literature highlights the importance of the therapeutic relationship when working with children and youth. A growing body of literature points to the potential of mindfulness to enhance the quality of relationships, including the therapeutic relationship. To date, little attention has been paid to this topic within the profession of occupational therapy. Aim The aim of this study was to inquire into paediatric occupational therapists’ experiences of mindfulness in the therapeutic relationship with children and youth.  Methods Heideggerian-informed hermeneutic phenomenology was employed as the methodological approach. Two key Heideggerian concepts of being-with and care served as theoretical underpinnings of the study. Semi-structured interviews were completed with eight North American occupational therapists to elicit their first-hand accounts of mindfulness in the therapeutic relationship with their paediatric clients. Interviews were transcribed verbatim and analyzed using a phenomenological approach. Results Four key themes were identified and include: fostering a safe space, enhancing presence, being authentic, and cultivating acceptance. Conclusions The findings offer insights regarding the potential affordances of mindfulness to support clinicians as they form of therapeutic relationships with children and youth. This study highlights research priorities for future inquiry. 
背景已有大量文献强调了与儿童和青少年合作时治疗关系的重要性。越来越多的文献指出,正念具有提高人际关系(包括治疗关系)质量的潜力。迄今为止,职业治疗行业对这一主题的关注还很少。目的 本研究旨在探究儿科职业治疗师在与儿童和青少年的治疗关系中对正念的体验。 方法 采用海德格尔诠释现象学作为研究方法。海德格尔的两个关键概念 "与存在 "和 "关怀 "是本研究的理论基础。研究人员对八名北美职业治疗师进行了半结构式访谈,以了解他们在与儿科客户的治疗关系中运用正念的第一手资料。访谈内容逐字记录,并采用现象学方法进行分析。结果 确定了四个关键主题,包括:营造安全空间、增强存在感、真实感和培养接受能力。结论 研究结果为临床医生与儿童和青少年建立治疗关系提供了正念的潜在支持。本研究强调了未来探索的研究重点。
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引用次数: 0
Surrounded by text: the meaning of health represented through the texts of life. An interpretative process 被文字包围:通过生活中的文字体现健康的意义。解释过程
Pub Date : 2024-01-29 DOI: 10.26443/ijwpc.v11i1.416
Richard B. Hovey
Our omnipresent reflective worlds invite interpretation through the incalculability and types of text that surrounds us during our daily lives. We as human beings have no choice but to acknowledge this bombardment of texts as our obligatory and oblivious day-to-day engagements or be in denial of them because, as their meaning has not become relevant and interpreted within our lives. These texts of life will continue to appear regardless of whether through an interpersonal encounter within our taken-for-granted lives, as researcher through the recounting of a research a research participant’s lived experience of something, or of a form of “art” that uniquely somehow “speaks to us”. Patients, clinicians, and researchers are offered windows, images, narratives, metaphors, or other creative expression into the complex experiences that can be explored and interpreted to help understanding complex health conditions. Chronic pain and cancer an example of these but the text associated with these transcend their medicalization to include the ontological pain associated with the day-to-day distress these can create. This presentation offers the personal and academic reflections as a researcher and a person who lives with chronic pain and is currently undergoing a second round of chemotherapy for cancer. By finding a common ground of understanding the clinical and life experiences of living with chronic health conditions becomes mutually more accessible and may enhance the treatment of the person. The first step it to help create awareness that text and interpretation skills can benefit the clinician, the patient, and researchers.
在我们的日常生活中,无处不在的反思世界邀请我们通过不可估量、种类繁多的文本进行解读。作为人类,我们别无选择,只能承认这些文本的轰炸是我们义不容辞、视而不见的日常接触,或者对它们予以否认,因为它们的意义并没有在我们的生活中得到相关的诠释。不管是通过我们习以为常的生活中的人际交往,还是通过研究者讲述研究参与者的生活经历,抑或是通过某种 "与我们对话 "的独特 "艺术 "形式,这些生活文本都将继续出现。病人、临床医生和研究人员可以通过窗口、图像、叙述、隐喻或其他创造性表达方式了解复杂的经历,这些经历可以被探索和解释,从而帮助理解复杂的健康状况。慢性疼痛和癌症就是其中的一个例子,但与之相关的文本超越了医学范畴,包括了与日常痛苦相关的本体论痛苦。作为一名研究人员和一名生活在慢性疼痛中并正在接受第二轮癌症化疗的人,本演讲提供了个人和学术反思。通过寻找共同点来理解慢性病患者的临床和生活经历,可以使双方更容易沟通,并可加强对患者的治疗。第一步是帮助人们认识到,文本和口译技能可以使临床医生、患者和研究人员受益。
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引用次数: 0
Medical students as whole persons – tending to the elephants in clinical practice training 医学生作为完整的人--在临床实践培训中照顾大象
Pub Date : 2024-01-29 DOI: 10.26443/ijwpc.v11i1.411
J. D. Boudreau, Edvin Schei, E. Valestrand, Hannah Gillespie, Beth Whelan, E. Kinsella, Hilde Grimstad, Monika Kvernenes, Terese Stenfors
BackgroundFor years, we have known that many medical students lose empathy and experience burn out during the last part of their undergraduate education, despite starting with high motivation and above average mental health. The most powerful learning environment is the clinic, where students in the final stages of their program interact with real patients and practice doctor’s skills in authentic environments. We wondered how students at this stage are cared for as learners and novice professionals. We tried to identify explicit and hidden professional norms and competence goals that students are measured by, and sanctioned for not conforming with, in daily practice. We asked: Is there a mismatch between what medical students need to manage in their professional lives and the affordances inherent to the workplace environment where learning takes place?  Can we intervene to mitigate any gaps? MethodInspired by the Consolidated Framework for Implementation Research (CFIR), we engaged leaders, physicians, residents, and medical students at a small Norwegian hospital in a three-year project aiming to improve students’ motivation, participation, and clinical learning, by strengthening pedagogical and affective support during an 8-week practice period. ResultsMedical students and residents identified needs for preparation and orientation, continuity, and secure relationships where learners are acknowledged as unique individuals. A simple model of learning needs was developed, where educational goals can be arranged on three levels: 1) social survival, 2) medical knowledge and skills, and 3) clinical wisdom.
背景多年来,我们一直知道,许多医科学生在本科教育的最后阶段会失去同情心,出现职业倦怠,尽管他们一开始的学习动机很强,心理健康水平也高于平均水平。诊所是最有力的学习环境,在这里,处于课程最后阶段的学生可以与真实的病人互动,在真实的环境中练习医生的技能。我们想知道,在这一阶段,学生作为学习者和专业新手是如何得到照顾的。我们试图找出显性和隐性的专业规范和能力目标,这些规范和目标是学生在日常实践中的衡量标准,如果不符合则会受到制裁。我们问道医科学生在职业生活中需要处理的问题与开展学习的工作场所环境固有的能力之间是否存在不匹配? 我们能否进行干预,以缩小差距?方法在实施研究综合框架(CFIR)的启发下,我们让挪威一家小型医院的领导、医生、住院医师和医学生参与了一个为期三年的项目,旨在通过在为期 8 周的实习期内加强教学和情感支持,提高学生的学习动力、参与度和临床学习能力。结果医学生和住院医师确定了对准备和定位、连续性和安全关系的需求,在这些方面,学习者被视为独特的个体。我们建立了一个简单的学习需求模型,将教育目标分为三个层次:1)社会生存;2)医学知识和技能;3)临床智慧。
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引用次数: 0
Reframing perceptions: A phenomenological inquiry into students’ written reflections on learning about mindfulness 重塑认知:对学生学习正念的书面反思进行现象学调查
Pub Date : 2024-01-29 DOI: 10.26443/ijwpc.v11i1.408
E. Kinsella, Allison Chrestensen, Kirsten Sarah Smith
Introduction Mindfulness practices offer approaches to reflection that have been argued to contribute to positive outcomes for students in the health professions. Despite calls for more phenomenological investigations in the field, few studies examine the lived experience of learning about mindfulness in professional schools.  Objective The objective of this study was to inquire into first-hand written accounts of students’ experiences of learning about mindfulness.  Methods This study reports on occupational therapy health professions students’ phenomenological reflections written during and following a 5 week, 15 hour, mindfulness elective course offered at a Canadian University. The study adopts a hermeneutic phenomenological methodology and is informed by theoretical frameworks of embodiment and practice theories. An indepth thematic analysis of twenty-one students' written reflections on the experience of integrating mindfulness practices into their lives was undertaken.  Results Predominant themes identified in students’ written reflections include: reframing perceptions, ‘being’ while ‘doing’, witnessing the struggle, and compassion for self and others.  Conclusions This research contributes richly textured accounts that advance understandings about the affordances of mindfulness education in the lives of future health care practitioners. The results also hold implications for educational design in higher education professional school contexts, considerations of mindfulness practices in future professional practitioners’ everyday and workplace occupations, and identification of promising avenues for future research. This study is funded by the Social Science and Humanities Research Council of Canada (SSHRC). 
导言:正念实践提供了反思的方法,被认为有助于为健康专业的学生带来积极的成果。尽管人们呼吁在这一领域开展更多的现象学调查,但很少有研究探讨在专业学校学习正念的生活体验。 目标 本研究旨在探究学生学习正念的第一手书面记录。 方法 本研究报告了职业治疗健康专业学生在加拿大一所大学开设的为期 5 周、15 小时的正念选修课程期间和之后所写的现象学反思。本研究采用诠释现象学方法,并参考了体现理论和实践理论框架。对 21 名学生关于将正念实践融入生活的书面反思进行了深入的主题分析。 结果 在学生的书面反思中发现的主要主题包括:重构认知、在 "做 "的同时 "存在"、见证斗争以及对自己和他人的同情。 结论 这项研究提供了丰富的内容,促进了人们对正念教育在未来医疗从业人员生活中的作用的理解。研究结果还对高等教育专业学校的教育设计、未来专业从业人员在日常和工作场所的正念实践的考虑以及确定未来研究的可行途径产生了影响。本研究由加拿大社会科学与人文研究理事会(SSHRC)资助。
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引用次数: 0
Considering life through death - introduction to lessons of life 从死亡中思考生命--生命教训导论
Pub Date : 2024-01-29 DOI: 10.26443/ijwpc.v11i1.391
Yusuke Takamiya
I am a palliative care physician for 30 years. And I have been teaching " Lessons of Life " to medical students and elementary, junior high, and high school students for 30 years. Based on the words left behind by the deceased patient, these are classes to think about life through death. I would like to introduce some of the lectures at this conference. When I took care of a 23-year-old female terminal cancer patient, her pain of bone metastasis, which could not be removed, was relieved by a wedding ceremony. I was taught that pain is relieved not by drugs but by supporting the hopes and dreams of patients. A 21-year-old woman with cancer of unknown primary cancer, who had not been told of her prognosis, realized that she was dying and left a letter for her mother. She wrote, "I am glad I was born as your daughter” with gratitude. A 17-year-old high school male student, who had a brain tumor, left a diary. In the diary, he wrote, "If I were to die tomorrow, what would I do today? All I can do now is to live my life to death as I am.”An 18-year-old woman, battling rhabdomyosarcoma,said,“Walking, talking, seeing, hearing, laughing, crying, and living. You may think it’s normal as someone who always takes it for granted, but that’s not the case.” Through the words and actions left behind by my patients, I learn that we are living a day that is irreplaceable.  
我是一名从事姑息治疗 30 年的医生。30 年来,我一直在为医学生、小学生、初中生和高中生讲授 "生命之课"。这些课程以逝去的病人留下的话语为基础,通过死亡来思考生命。我想介绍一下本次会议的一些讲座内容。我在照顾一位 23 岁的癌症晚期女病人时,她因无法切除的骨转移而痛苦不堪,但通过婚礼仪式,她的痛苦得到了缓解。她告诉我,减轻痛苦的方法不是药物,而是支持病人的希望和梦想。一位 21 岁的不明原发性癌症女性患者在未被告知预后的情况下,意识到自己生命垂危,给母亲留下了一封信。她满怀感激地写道:"我很高兴生为您的女儿"。一名患有脑瘤的 17 岁高中男生留下了一本日记。他在日记中写道:"如果我明天就死了,我今天会做什么?我现在所能做的,就是像我现在这样,向死而生。"一位与横纹肌肉瘤作斗争的 18 岁女性说:"走路、说话、看东西、听东西、笑、哭、活着。作为一个总是认为这是理所当然的人,你可能认为这很正常,但事实并非如此。从病人留下的言行中,我了解到我们所过的每一天都是不可替代的。
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引用次数: 0
Using the serious illness conversation guide to improve the quality of life of hematology-oncology patients: a pilot study 使用重病对话指南提高血液肿瘤科患者的生活质量:一项试点研究
Pub Date : 2024-01-29 DOI: 10.26443/ijwpc.v11i1.389
Victoria Korsos, Saima Ahmed, Sheena Heslip, Chantal Cassis, Vasiliki Bitzas, S. Assouline
Introduction: Hematology-oncology patients are more likely to receive high intensity care (HIC), including ICU admission and active cancer treatment, than solid cancer patients near end of life (EOL). This prevents patients and their families from realistically planning for the future, and diminishes quality of life (QOL). We previously conducted a retrospective study to understand factors influencing HIC outcomes at EOL in hematology patients at McGill-affiliated hospitals. While non-curative goals, early level of intervention (LOI) discussions and palliative care (PC) involvement lowered the likelihood of HIC at EOL, the median time of LOI discussion and PC involvement to death was 22 and 9 days respectively. We hypothesize that a timely discussion aligning patient perspectives and goals with their treating team could improve QOL at EOL. Methods: We are conducting a pilot study looking at the impact of using the Serious Illness Conversation Guide (SICG), a validated conversation tool in the general oncology population, on the QOL of hematology patients. Participants are identified by their treating doctor or nurse practitioner to be at risk of dying in the next year. The primary aim is to decrease death in acute care. Secondary aims include reporting other HIC outcomes, time from LOI discussion and PC consult to death, and the short term benefit to QOL. In addition, qualitative analysis will explore participant perspectives on benefits of the SICG and areas to improve, and explore EOL QOL topics relevant to hematology patients. We have currently enrolled 2 patients. Interim analysis is projected for September 2023.  
简介与接近生命终点(EOL)的实体癌患者相比,血液肿瘤患者更有可能接受高强度护理(HIC),包括入住重症监护病房和积极的癌症治疗。这阻碍了患者及其家属对未来进行现实的规划,并降低了生活质量(QOL)。我们曾进行过一项回顾性研究,以了解影响麦吉尔附属医院血液病患者生命末期 HIC 治疗效果的因素。虽然非根治性目标、早期干预水平(LOI)讨论和姑息治疗(PC)参与降低了患者在临终前发生 HIC 的可能性,但从讨论 LOI 和 PC 参与到死亡的中位时间分别为 22 天和 9 天。我们推测,及时与治疗团队讨论患者的观点和目标,可改善患者临终前的生活质量。方法:我们正在进行一项试点研究,探讨使用重病对话指南(SICG)这一在普通肿瘤人群中经过验证的对话工具对血液病患者 QOL 的影响。参加者由其主治医生或执业护士确定在未来一年内有死亡风险。主要目的是减少急症护理中的死亡人数。次要目标包括报告其他 HIC 结果、从 LOI 讨论和 PC 咨询到死亡的时间,以及对 QOL 的短期益处。此外,定性分析将探讨参与者对 SICG 的益处和有待改进之处的看法,并探讨与血液病患者相关的 EOL QOL 主题。我们目前已招募了 2 名患者。中期分析预计将于 2023 年 9 月进行。
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引用次数: 0
Culturally-adapted resilience-building curriculum for medical students: a comprehensive approach at Showa University School of Medicine, Japan 针对医学生的适应文化的复原力培养课程:日本昭和大学医学院的综合方法
Pub Date : 2024-01-29 DOI: 10.26443/ijwpc.v11i1.413
Shizuma Tsuchiya, Edward Barroga, Atsuko Furuta, Makiko Arima, Hiroaki Ogata, Eriko Goto, Tsuyoshi Oshiro, Miki Izumi
The growing prevalence of psychological morbidity, depersonalization, and low personal accomplishment among medical students underscores the need for resilience-enhancing programs tailored to their specific needs. Incorporating cultural perspectives and societal context into these interventions is crucial to ensure their effectiveness and relevance. In response, Showa University School of Medicine in Japan has pioneered a culturally-adapted, resilience-based curriculum for medical students from their first through sixth years since 2020. This presentation will outline the comprehensive framework of the resilience-focused curriculum, including course objectives, content, learning resources, timetables, and pedagogical approaches. Key components of the curriculum encompass self-assessment and reflection, stress management strategies, effective communication and conflict resolution skills, and fostering a growth mindset. Additionally, interdisciplinary collaborations with psychology and social work departments provide individual supports and resources for students. Emphasizing the distinct challenges faced by medical students, such as academic stressors, relationships with senior clinical educators, patient and family interactions, and managing errors and burnout, the presentation will highlight the classes on the curriculum, support systems and mentorship programs in promoting mental well-being and resilience. The experiences and outcomes of the 2020-2022 cohorts will be shared, offering valuable insights into the effectiveness of the resilience-building curriculum in the Japanese context. Lessons learned from the implementation process, including challenges faced and strategies employed, will provide practical examples for other medical schools seeking to develop similar programs.
医学生的心理疾病、人格解体和个人成就感低的情况越来越普遍,这突出表明需要针对他们的具体需求制定增强复原力的计划。将文化视角和社会背景融入这些干预措施对于确保其有效性和相关性至关重要。为此,日本昭和大学医学院自2020年起率先为一年级至六年级的医学生开设了适应文化、以抗挫力为基础的课程。本讲座将概述以抗逆力为重点的课程综合框架,包括课程目标、内容、学习资源、时间表和教学方法。课程的主要内容包括自我评估和反思、压力管理策略、有效沟通和解决冲突的技巧,以及培养成长心态。此外,与心理学和社会工作系的跨学科合作为学生提供了个人支持和资源。演讲将强调医科学生面临的独特挑战,如学业压力、与资深临床教育者的关系、与患者和家人的互动,以及处理错误和职业倦怠等,并重点介绍课程、支持系统和导师计划在促进心理健康和抗压能力方面的作用。此外,还将分享 2020-2022 届学员的经验和成果,就日本抗挫折能力建设课程的有效性提供有价值的见解。从实施过程中汲取的经验教训,包括面临的挑战和采用的策略,将为其他寻求开发类似课程的医学院提供实用范例。
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引用次数: 0
Anatomy of the elephant in Quebec family practice 魁北克家庭医生的大象剖析
Pub Date : 2024-01-29 DOI: 10.26443/ijwpc.v11i1.401
Mark Yaffe
Background Whole person care has been a foundation of the modern practice of family medicine, and therefore one might expect that such an approach by family practitioners   would evolve and mature over time. Some of these clinicians, however, currently question their ability to provide such holistic care because of external factors they perceive as negative, and over which they have little or no control. Objectives This presentation will explore perceived inhibiting factors affecting family doctors ability to provide whole person care within the publicly-funded health care system of the Canadian province of Quebec. Method The presenter, an academic and clinician scientist with forty-four years of   experience practicing family medicine, will present personal perspectives, along with those gathered informally from a broad cadre of colleagues working in different settings. Using the idiom of “elephant in the room” to identify problems or obstacles that may not be voiced, this talk will start with consideration of elephant anatomy as being comprised of thirteen distinct anatomical parts that contribute to a functional whole. An analogy will be developed in which thirteen distinct factors are presented as likely impeding or discouraging whole person care by family physicians. Conclusion Some agendas and policies of health care planners and administrators, either alone or collectively, and intentionally or unintentionally, may decrease opportunity or ability of family physicians to provide whole person care.
背景 全人护理一直是现代家庭医疗实践的基础,因此人们可能会认为家庭医生的这种方法会随着时间的推移而不断发展和成熟。然而,其中一些临床医生目前对自己提供这种全人护理的能力表示怀疑,因为他们认为这些外部因素是负面的,而且他们几乎无法控制这些因素。目的 本讲座将探讨影响家庭医生在加拿大魁北克省公费医疗系统内提供全人医疗服务能力的已知抑制因素。方法 主讲人是一位拥有 44 年家庭医疗实践经验的学者和临床科学家,他将介绍个人观点,以及从在不同环境中工作的广大同事那里非正式收集到的观点。本讲座将使用 "房间里的大象 "这一成语来识别可能未被提及的问题或障碍,首先考虑大象的解剖结构,即由 13 个不同的解剖部位组成一个功能性整体。以此类推,十三个不同的因素可能会阻碍或妨碍家庭医生的全人护理。结论 医疗保健规划者和管理者的一些议程和政策,无论是单独的还是集体的,有意的还是无意的,都可能减少家庭医生提供全人护理的机会或能力。
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引用次数: 0
Minds unravelling 思想解体
Pub Date : 2024-01-29 DOI: 10.26443/ijwpc.v11i1.421
Kathleen Lefevre
This is a poem about dealing with the traumatic aftermath of covid19. The poem is written on 4 sheets that collectively form the poster. The motifs are pressed flowers and flora with some graphing paper and blurry photographs of flowers. The colour scheme is beige and cream with bright earthy tones for the flowers. The poem is as follows: Our minds unravelAs we peer through PPESee the quiet veilOf another historyThat couldn’t be.What do you want from me? Pulling my cerebellumLike a cordOf chordatesOf apes.A sweater’s woven mysteryOf a loverVery unkind to me. You speak to meFrom useless misery.You see meAs an infinite legacy.For other generationsTo take that liningAnd weaveIts silver specksWithin our identity.
这是一首关于处理 covid19 创伤后遗症的诗歌。这首诗写在四张纸上,共同构成了海报。图案是压制的花朵和植物,还有一些绘图纸和模糊的花朵照片。配色方案为米色和奶油色,花朵为明亮的大地色调。诗歌内容如下当我们透过 PP 看到另一段不可能存在的历史的静谧面纱时,我们的思绪被解开了。你想从我这里得到什么?你想从我这里得到什么?拉扯我的小脑,就像拉扯猿类脊索动物的绳索。你从无用的苦难中对我说话,你把我看成是无穷的遗产,让其他世代把那衬里和银色斑点编织在我们的身份中。
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引用次数: 0
Death and the Shovel Lady 死亡与铲女
Pub Date : 2024-01-29 DOI: 10.26443/ijwpc.v11i1.404
Peter Dorward
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引用次数: 0
期刊
The International Journal of Whole Person Care
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