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Narrative medicine and narrative practice: partners in the creation of meaning 叙事医学和叙事实践:创造意义的伙伴
Pub Date : 2024-01-29 DOI: 10.26443/ijwpc.v11i1.403
Miriam Colleran, C. Donohoe, Anna Beug, Corina Bruekel, John Launer
Background Narrative medicine has emerged as an approach to whole person care and to support the clinician-patient therapeutic relationship. Although training in narrative medicine is usually based on the study of literary or artistic works, the same attitude of close reading can also be applied in conversations with patients or learners.MethodWe held a two-day narrative medicine workshop, incorporating two approaches: 'Conversations Inviting Change' (CIC) and humanities-based narrative medicine as taught by Columbia University. The workshop was primarily experiential, with theoretical components of both approaches. Participants brought active concerns for confidential breakout sessions and engaged in text-based and reflective writing exercises. Participants generated metaphors to describe these approaches to narrative medicine.Results Participants included a mix of community and hospital-based practitioners, pre-dominantly doctors. Participants considered the two approaches to be compatible and enhance each other. One metaphor generated was that Columbia style narrative medicine is ’like an individual lens which allows you to see things clearer’, it allows practitioners a different perspective on their patients and that CIC teaching ‘is a frame of glasses in which the lenses could be placed to enhance the ease of use’. Another metaphor was that the former ‘is like learning from a cadaver in the anatomy lab’, while the latter ‘is like running a clinical simulation’.Conclusion We believe this was the first workshop integrating these approaches to narrative medicine. They appear to be highly complementary. Both approaches lead to enhanced attention to narratives which has clear applicability to clinical practice.
背景叙事医学作为一种全人护理方法和支持临床医生与患者之间治疗关系的方法而出现。尽管叙事医学的培训通常基于对文学或艺术作品的研究,但同样的细读态度也可应用于与患者或学习者的对话中:我们举办了为期两天的叙事医学工作坊,融合了两种方法:"邀请改变的对话"(Conversations Inviting Change,CIC)和哥伦比亚大学教授的以人文为基础的叙事医学。工作坊以体验为主,同时包含两种方法的理论内容。与会者为保密分组讨论带来了积极关注的问题,并参与了基于文本和反思的写作练习。结果 参加者中既有社区医生,也有医院医生,其中以医生为主。参与者认为这两种方法相互兼容、相互促进。其中一个比喻是,哥伦比亚式叙事医学 "就像一个独立的镜片,让你看事情更清晰",它让从业者从不同的角度看待病人,而 CIC 教学 "就像一个眼镜框,可以把镜片放在里面,以提高易用性"。另一个比喻是,前者 "就像在解剖实验室向尸体学习",而后者 "就像在进行临床模拟"。它们似乎是高度互补的。这两种方法都能加强对叙事的关注,这对临床实践具有明显的适用性。
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引用次数: 0
Ethical challenges for children undergoing surgery: Evaluation of graduate nursing students' learning 接受手术的儿童面临的伦理挑战:护理研究生的学习评估
Pub Date : 2024-01-29 DOI: 10.26443/ijwpc.v11i1.406
Ariane Gautrin, A. Tsimicalis, Yi Wen Wang, Raíssa Passos dos Santos, Franco A. Carnevale, Amanda Cervantes, Katherine Logue
Background Multiple barriers can impede the holistic care of children and their meaningful involvement in their healthcare in the context of surgery. These include lack of clinician knowledge of the ethical concerns impacting children and scarce educational resources. Our team created an open-access training module (https://childsxethics.net) to enhance clinicians’ understanding of ethical challenges for children undergoing surgery.  Objective To evaluate the level of Bloom’s Taxonomy cognitive, affective, and psychomotor learning reached by graduate nursing students after completing the module.  Methods A qualitative descriptive study was conducted. Data sources comprised of participants’ course assignments. Data were analysed inductively and deductively using Bloom’s Taxonomy and the Childhood Ethics Framework. Results Nineteen participants wrote online reflections and peer responses. Two subgroups completed group assignments. The module and associated class assignments successfully promoted high levels of cognitive and affective learning of ethical challenges impacting children undergoing surgery. The type of assignment influenced participants’ level of learning and achievement of learning objectives. Cognitive and affective learning processes were enhanced when integrating reflections and fostering dialogue/interaction among peer learners.  Implications Study findings will be used to improve the module. Future iterations will include collaborations with international clinicians to enhance the global relevance of the module contents, which will be evaluated with other clinicians/trainees. Providing educational resources for clinicians on ethical challenges in children’s surgery will help facilitate the recognition of children as active moral agents and improve their surgical experiences by promoting holistic patient care.
背景 在外科手术中,多种障碍可能会阻碍对儿童的整体护理以及儿童对其医疗保健的有意义参与。这些障碍包括临床医生对影响儿童的伦理问题缺乏了解以及教育资源匮乏。我们的团队创建了一个开放访问的培训模块 (https://childsxethics.net),以提高临床医生对接受手术的儿童所面临的伦理挑战的理解。目标 评估护理研究生在完成该模块后在布卢姆分类法认知、情感和心理运动学习方面达到的水平。方法 进行定性描述研究。数据来源包括参与者的课程作业。使用布卢姆分类法和儿童伦理框架对数据进行归纳和演绎分析。结果 19 名学员撰写了在线反思和同行回复。两个小组完成了小组作业。该模块和相关的课堂作业成功地促进了对影响接受手术儿童的伦理挑战的高水平认知和情感学习。作业类型影响了参与者的学习水平和学习目标的实现。在整合反思和促进同伴间的对话/互动时,认知和情感学习过程得到了加强。 启示 研究结果将用于改进该模块。未来的迭代将包括与国际临床医生的合作,以提高模块内容的全球相关性,并与其他临床医生/学员一起进行评估。为临床医生提供有关儿童外科伦理挑战的教育资源,将有助于促进对儿童作为积极的道德主体的认识,并通过促进全面的患者护理来改善他们的手术体验。
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引用次数: 0
Whole Person Care in philanthropy - healing & giving 慈善事业中的全人关怀--治疗与捐赠
Pub Date : 2024-01-29 DOI: 10.26443/ijwpc.v11i1.407
Glen Komatsu
Static reimbursement, rising expenses and decreasing margins for hospice and palliative care programs in the US, limit funding for innovative and creative education, care-giver well-being and resilience efforts and workforce development.  Whole Person Care in philanthropy can lead to healing not only of grateful patients, families and friends but can also be a source of healing, connectiveness and meaning for donors, board members, foundations and the community.  This presentation will share leadership practices which engage grateful patients, families, prospective donors, board members, foundations and the community to raise significant funds for innovative education and program development.  Conversely, the presentation will share innovative education and program development which engages and excites patients, families, donors, board members, foundations and the community to give significant philanthropic gifts.  A small but excellent hospice foundation staff (5 people) with the help and support of the clinical leadership team raised over 4 million dollars in 2022 for a community-based hospice serving over 300 patients/day and community-based palliative programs serving over 600 patients/day, both adults and children.
美国临终关怀和姑息关怀项目的报销额度不稳定、支出增加、利润减少,限制了对创新性和创造性教育、关怀者的福祉和恢复力以及劳动力发展的资助。 慈善事业中的 "全人关怀 "不仅能治愈病人、家属和朋友的心灵,还能为捐赠者、董事会成员、基金会和社区带来治愈、联系和意义。 本讲座将分享领导力实践,让感恩的病人、家属、潜在捐助者、董事会成员、基金会和社区参与进来,为创新教育和项目发展筹集大量资金。 反过来,演讲也将分享创新的教育和项目发展,吸引并激发病人、家属、捐赠者、董事会成员、基金会和社区捐赠大量慈善资金。 在临床领导团队的帮助和支持下,一个规模不大但非常出色的安宁疗护基金会工作人员(5 人)在 2022 年为一个每天为 300 多名病人提供服务的社区安宁疗护项目和每天为 600 多名病人(包括成人和儿童)提供服务的社区姑息治疗项目筹集了 400 多万美元。
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引用次数: 0
‘The view from here’ - Anxiety and defences against anxiety in the provision of maternity care to one mother and baby 从这里看风景"--为一名母亲和一名婴儿提供产科护理时的焦虑和焦虑防御
Pub Date : 2024-01-29 DOI: 10.26443/ijwpc.v11i1.423
Nicola O'Sullivan
Being emotionally open in a maternity setting is a necessary part of the job of the midwife and consultant doctor. In fact it is recognised as a key aspect of relationship-based work.  However, it can be complex and uncertain, particularly in the face of a mother and baby who are separated through death at birth or serious illness at birth. This paper is interested in exploring the necessary conditions for relating and reflecting in maternity settings when babies are born with life threatening illnesses. With particular emphasis on one case example from personal experience this paper offers wisdom from the margins in the hope that it might contribute positively to thinking and learning about these experiences in frontline hospital settings.  It will focus on how the intensity of the work with one mother and baby and the strength of emotion associated with that work disrupted the nurses capacity to think. Drawing on the classic work of Isabel Menzies Lyth (1968) and lat  er Sebastian Kraemer (2015), the paper will consider the types of anxiety and defences present in the encounter and in the ongoing treatment of this mother and baby. The paper will explore how treatment and care was received by the mother and what might have enhanced that provision of care
在产科环境中保持情感开放是助产士和顾问医生工作的必要组成部分。事实上,它被公认为是以关系为基础的工作的一个重要方面。 然而,这可能是复杂和不确定的,尤其是面对因出生时死亡或出生时患重病而分离的母婴。本文旨在探讨当婴儿出生时患有危及生命的疾病时,在产科环境中进行关系和反思的必要条件。本文特别强调了个人经历中的一个案例,提供了来自边缘的智慧,希望能为一线医院环境中对这些经历的思考和学习做出积极贡献。 本文将重点论述与一位母亲和婴儿相关的工作强度以及与该工作相关的强烈情感如何扰乱了护士的思考能力。本文将借鉴伊莎贝尔-孟席斯-莱斯(Isabel Menzies Lyth,1968 年)和塞巴斯蒂安-克雷默(Sebastian Kraemer,2015 年)的经典论著,考虑在与这对母婴的接触和持续治疗中存在的焦虑和防御类型。本文将探讨这位母亲是如何接受治疗和护理的,以及怎样才能更好地提供护理。
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引用次数: 0
The empathy imperative in whole person care - for patients and physicians 全人护理中的同理心要求--对患者和医生而言
Pub Date : 2024-01-29 DOI: 10.26443/ijwpc.v11i1.396
Anita Nowak, Milan Sen
Clinical empathy is associated with improved patient satisfaction, treatment compliance, and better health. At the same time, empirical evidence shows that strong empathic connections between physicians and patients increase job satisfaction and decrease malpractice complaints. Plus, doctors with higher levels of empathy also experience less stress, cynicism, and burnout. Empathy in healthcare should be the norm. Unfortunately, that’s not the case. Physicians encounter emotionally taxing situations—illness, trauma, suffering, and dying—on a frequent or ongoing basis. Which might explain why they may miss or dismiss signs of patient distress. But there’s a growing body of evidence that points to overwork and a lack of self-care as a major problem. In fact, relative to the general population, doctors suffer from higher rates of compassion fatigue, burnout, depression, and suicide. The long hours, administrative workload, and financial imperatives of today’s medical practice means that many physicians struggle to prioritize self-care, including a lack of sleep, exercise, and healthy eating habits. All of this was further exacerbated by the pressure of the recent COVID pandemic. Yet physicians are not permitted to appear vulnerable or weak because doing so is inconsistent with the culture of medicine.This session will explore why empathy and self-empathy are both imperative to whole person care - for physicians and their patients. And will suggest several strategies and practices to combat empathy fatigue.
临床移情与提高患者满意度、治疗依从性和改善健康状况有关。同时,经验证据表明,医生与患者之间强烈的同理心联系会提高工作满意度,减少渎职投诉。此外,具有较高同理心的医生还能减少压力、愤世嫉俗和职业倦怠。在医疗保健领域,移情应该是一种常态。遗憾的是,事实并非如此。医生会经常或持续地遇到情绪紧张的情况--疾病、创伤、痛苦和死亡。这也许可以解释为什么他们可能会错过或忽视病人痛苦的迹象。但越来越多的证据表明,过度劳累和缺乏自我保健是一个主要问题。事实上,与普通人相比,医生的同情疲劳、职业倦怠、抑郁和自杀率更高。当今医疗实践的工作时间长、行政工作量大、财务要求高,这意味着许多医生难以优先考虑自我保健,包括缺乏睡眠、锻炼和健康的饮食习惯。而最近 COVID 大流行所带来的压力又进一步加剧了这一切。然而,医生却不能表现得脆弱或软弱,因为这样做不符合医学文化。本节课将探讨为什么同理心和自我同理心对于医生及其患者的全人护理都至关重要。本讲座将探讨为什么共情和自我共情都是全人护理的必要条件--对医生和患者都是如此,并将提出几种消除共情疲劳的策略和做法。
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引用次数: 0
Challenges and opportunities of relationship centred care in health care settings. My journey and the evolution of my approach 医疗机构中以关系为中心的护理所面临的挑战和机遇。我的历程和方法的演变
Pub Date : 2024-01-29 DOI: 10.26443/ijwpc.v11i1.414
Maeve Hurley
Understanding the complexities of relating in a health care context invites practitioners to anticipate and identify challenges and opportunities as they arise in their practice. This experiential paper will attempt to explore and illustrate some of the complexities of adopting a relationship centred  approach in healthcare settings, from the perspective of one practitioner.  This paper will consider how the organisational culture can impact on the practitioners ability to interact with patients. In this context the  influence of the organisational culture with its emphasis on task, diagnosis and treatment of disease, functioned to undermine this practitioners capacity to relate and take up a relationship centred approach. This paper, with reference to clinical material, will highlight the tension that exists between task and relationship  in healthcare settings. Special reference will be made  to how in some situations the wish to relate interrupted the task focused work, causing co  nfusion and great challenge for the practitioner . The invitation to adopt  relationship centred practice , while  still attending  to the task in hand  restored the practitioners belief in the medical consultation’s potential to create  a receptive , responsive  and relationship centred space . Finally, this paper will conclude by considering how to navigate this complex context and to achieve a balance which includes relationship centred care , using these  opportunities as they arise to  ensure  optimum health care outcomes for both practitioner and patients.
了解医疗保健环境中关系的复杂性,有助于从业人员预测和识别实践中出现的挑战和机遇。这篇经验论文将从一名从业者的角度出发,尝试探索和说明在医疗环境中采用以关系为中心的方法的一些复杂性。 本文将探讨组织文化如何影响从业人员与患者互动的能力。在这种情况下,强调任务、疾病诊断和治疗的组织文化的影响,削弱了该从业人员与患者建立关系和采取以关系为中心的方法的能力。本文将参考临床材料,强调医疗机构中任务与关系之间存在的紧张关系。本文将特别提到,在某些情况下,建立关系的愿望是如何干扰以任务为中心的工作,从而给从业者带来混乱和巨大挑战的。在完成手头任务的同时,邀请从业者采用以关系为中心的做法,恢复了从业者的信念,即医疗咨询有可能创造一个接受、响应和以关系为中心的空间。最后,本文将通过思考如何驾驭这种复杂的环境并实现平衡,其中包括以关系为中心的护理,利用这些出现的机会,确保为从业者和患者提供最佳的医疗保健结果。
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引用次数: 0
“He told me my pain was in my head”: Testimonial injustice in patient-physician relationships "他说我的疼痛是我自己造成的":医患关系中的证词不公
Pub Date : 2024-01-29 DOI: 10.26443/ijwpc.v11i1.398
Marie Vigouroux, Angela Morck, Richard B. Hovey
Women living with chronic pain are more likely than men to experience pain dismissal, receive nonspecific diagnostics, receive fewer follow-ups, have their condition undertreated, and be told that it results from a psychological condition. This is particularly concerning for adolescent girls living with scoliosis, who, given the progressive nature of their condition, require timely diagnosis to allow for less invasive treatment options to be explored. This population is also significantly more likely to have their condition progress to a curve angle where treatment such as bracing or spinal fusion surgery is required, both of which are associated with chronic pain. However, timely diagnosis depends on clinicians taking patients’ testimony regarding their health concerns seriously and investigating their claims. This presentation will dive into the gender gap in care for adolescent girls living with chronic pain caused by scoliosis, focusing on their experiences of pain dismissal and its negative short and long-term effects. Leveraging the concept of intersectionality, the authors argue that adolescent girls may suffer a testimonial injustice when their pain is dismissed by clinicians. This presentation will also explore gender-specific peer support groups as a possible mitigating factor to testimonial injustice and other negative outcomes from chronic pain and pain dismissal. The researchers interviewed members from scoliosis peer support group Curvy Girls using open-ended questions, gathering narrative data about their experiences that was subsequently analyzed using an applied philosophical hermeneutics approach, along with intersectionality and testimonial injustice as part of their framework.
与男性相比,患有慢性疼痛的女性更有可能遭遇疼痛被忽视、接受非特异性诊断、接受较少的随访、病情未得到及时治疗,以及被告知这是心理疾病所致。对于患有脊柱侧弯症的少女来说,这种情况尤其令人担忧,因为她们的病情具有渐进性,需要及时诊断,以便探索创伤性较小的治疗方案。这部分人群的病情也更有可能发展到需要支具或脊柱融合手术等治疗的曲线角度,而这两种治疗方法都会带来慢性疼痛。然而,及时诊断取决于临床医生是否认真对待患者关于其健康问题的证词并对其主张进行调查。本讲座将深入探讨因脊柱侧弯导致慢性疼痛的少女在护理方面的性别差距,重点关注她们的疼痛被忽视的经历及其短期和长期的负面影响。作者利用交叉性的概念,认为当临床医生忽视青春期女孩的疼痛时,她们可能会遭受证词上的不公正。本报告还将探讨针对不同性别的同伴支持团体,以减轻证词不公以及慢性疼痛和疼痛被忽视造成的其他负面影响。研究人员使用开放式问题采访了脊柱侧弯同伴互助小组 "曲线女孩 "的成员,收集了关于她们经历的叙述性数据,随后使用应用哲学诠释学方法对这些数据进行了分析,并将交叉性和证词不公正作为其框架的一部分。
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引用次数: 0
Ends of the Earth…Ever Been There? 地球的尽头……你去过吗?
Pub Date : 2023-06-20 DOI: 10.26443/ijwpc.v10i2.378
Cory Ingram
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引用次数: 0
On Lifesaving Care and the Necessity of Dignity 论救生护理与尊严的必要性
Pub Date : 2023-06-19 DOI: 10.26443/ijwpc.v10i2.387
Alexander Stoljar Gold
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引用次数: 0
Apathy Sets in During the Third Year 第三年开始变得冷漠
Pub Date : 2023-06-19 DOI: 10.26443/ijwpc.v10i2.386
Lucie Dubes
{"title":"Apathy Sets in During the Third Year","authors":"Lucie Dubes","doi":"10.26443/ijwpc.v10i2.386","DOIUrl":"https://doi.org/10.26443/ijwpc.v10i2.386","url":null,"abstract":"","PeriodicalId":348245,"journal":{"name":"The International Journal of Whole Person Care","volume":"93 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"120842704","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
The International Journal of Whole Person Care
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