The International Journal of Whole Person Care

    Transforming the Intensive Care Culture Using the Palliative Approach

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    Introduction: Although the ultimate goal of the intensive care unit (ICU) is to save and prolong human life, the integration of palliative care approach in this fast-paced highly technologic environment is increasingly recognized as a means of restoring the global nature of care and enhances the integrity of the person. In this perspective, a recent study showed that three conditions promote the integration of palliative care in the ICU: sharing a common vision, a collaborative decision-making process and a proper environment.Objective: In light of these findings, this study proposes to develop, implement and evaluate an intervention to integrate these previously identified conditions. The purpose of this communication is to present our approach and its main results.Method: Based on the premise that research and action can coexist to improve practice, a qualitative inquiry of action research was chosen for this study. Valuing the consensual decision-making process, this research method provides an organizational structure allowing success and sustainability of this intervention.Results: The intervention aims to improve the quality of interdisciplinary communication and consisted of two main components. The first propose to enhance the skills and leadership of nurses through interactive training and the second focused on the improvement of intra and inter disciplinary intervention plan.Conclusions: The integration of the palliative care approach in the ICU is definitely an innovative strategy to transform the mission of the ICU caregivers and improve the care of the whole person

    Finding My Voice in Residency: Reflections on Integrative Family Medicine

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    The author discusses how self awareness and healing play a key role within the evolving field of integrative family medicine

    Promoting Resilience with the Mindfulness-Based Stress Reduction Program in Patients With Chronic Illness

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    Objectives: Twenty-first century patients need to take a proactive stance with regard to their health in order to cope well with chronic illness.  Mindfulness-Based Stress Reduction (MBSR) is an 8-week structured group program that encourages patients to take responsibility for their health and teaches them to cope with stressors inherent in living with illness.Methods: Patients with chronic illnesses (e.g., breast cancer, chronic pain, multiple sclerosis) participated in the MBSR program from 2006-2012.  They completed questionnaires pertaining to depression, medical symptoms, stress, coping, sense of coherence, and mindfulness pre- and post-MBSR.  They filled out a follow-up questionnaire that asked them to rate the program and its components. A self-care index was created from 5 items.Results: Of the 126 patients, 85.7% were woman, breast cancer was the most common illness (46.8%), and the average age was 52.3 (SD = 13.3). There were significant improvements on the following outcomes: depression, stress, and medical symptoms. With regard to process measures, there were significant increases in: mindfulness, sense of coherence (comprehensibility, manageability, and meaningfulness of life), as well as significant decreases in emotional coping.  Patients rated the program with a mean of 8.94 (1 to 10 scale) for importance. They rank ordered the program components in terms of helpfulness with awareness of breath, the silent retreat day, and yoga practice as the highest of 10 items.  There was a significant positive correlation between self-care index at the end of the course and its perceived importance. Moreover, self-care was positively and significantly correlated with post-MBSR mindfulness and viewing life as meaningful.Conclusions:  Patients who took the MBSR program reported mental and physical health benefits. Furthermore, being mindful enabled them to cope better, take care of themselves, and view life as more coherent such that they became more stress resilient

    Incorporation of spiritual care as a component of healthcare and medical education: comparison of Sub-Saharan African and Northern European viewpoints

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    This study addresses cultural differences regarding views on the place for spirituality within healthcare training and delivery. A questionnaire was devised using a 5-point ordinal scale, with additional free text comments assessed by thematic analysis, to compare the views of Ugandan healthcare staff and students with those of (1) visiting international colleagues at the same hospital; (2) medical faculty and students in United Kingdom. Ugandan healthcare personnel were more favourably disposed towards addressing spiritual issues, their incorporation within compulsory healthcare training, and were more willing to contribute themselves to delivery than their European counterparts. Those from a nursing background also attached a greater importance to spiritual health and provision of spiritual care than their medical colleagues. Although those from a medical background recognised that a patient’s religiosity and spirituality can affect their response to their diagnosis and prognosis, they were more reticent to become directly involved in provision of such care, preferring to delegate this to others with greater expertise. Thus, differences in background, culture and healthcare organisation are important, and indicate that the wide range of views expressed in the current literature, the majority of which has originated in North America, are not necessarily transferable between locations; assessment of these issues locally may be the best way to plan such training and incorporation of spiritual care into clinical practice

    Beyond Resilience and Burnout: The Need for Organizational Change to Promote Humanistic Practice and Teaching in Healthcare

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    Rapid changes in healthcare organization and practice environments, increasingly driven by business models and commercial interests, are associated with widespread burnout and dissatisfaction among healthcare professionals and pose barriers to humanistic relationship-centered quality care. Studies show burnout and significant stress currently affect over half of US physicians and nurses. Clinicians’ ability to provide compassionate care is significantly challenged. Most solutions to date have included individual interventions designed to enhance well-being and promote resilience. We examined organizational factors that inhibit or promote humanistic practice by faculty physicians in today’s healthcare environment. In this qualitative study, physician faculty who completed a one-year faculty development program in humanism at eight US academic medical centers provided written answers to two open-ended questions: a) What institutional or specific organizational unit-related factors promote humanism for you and others? b) What institutional or specific organizational unit-related factors inhibit or pose barriers, to humanism for you and others? 74% (68/92) of the physicians participated. The constant comparative method was used to analyze responses. We found that organizational culture was the central theme. Motivators of humanism included leadership supportive of humanistic practice, responsibility to role model humanism, organized activities promoting humanism, and practice structures that facilitate humanism. Factors that inhibited humanism included “top down” organizational culture, non-supportive leadership, time and bureaucratic pressures, and non-facilitative practice structures. Our findings suggest that organizational culture is, at a minimum, equally important as individual interventions. We describe features of organizational culture that reinforce humanistic practice and care in healthcare institutions and offer recommendations for organizational change that support the primacy of humanistic, compassionate, high quality patient care. 

    A Call for Compassion and Culture Change for Addicted Doctors

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    There is a code of silence regarding addicted doctors in medicine. While the doctor is minimizing or denying the problem, often her or his co-workers look the other way. Colleagues may be concerned but hold back from “denouncing” one of their own. Yet, ethical and legal issues are real. Patient care may be compromised. This presentation will engage listeners by asking several reflective questions. The 4 C’s of addiction will be reviewed. Signs of addiction will be enumerated. Why doctors become entangled in substances will be examined. Is addiction different from burnout? If so, how? The adverse consequences of addiction will be reviewed. How can compassion be offered for a problem that triggers blame and shame?Impaired doctors are usually referred to Physician Health Programs. What do they offer? Can the Buddhist view of addiction contribute to Western therapies? Addiction recovery will be examined through a mindfulness lens.This, however, still puts the onus on the individual who struggles with addiction. What about the medical culture may contribute to the problem? Can this be changed? If so, how? Addicted doctors are not alone, and the problem is more than personal. Rather than simply review the literature, this presentation will engage the audience so that the taboo of addiction can be tackled. It is intended to break the silence such that upon return to work, participants may notice a colleague who shows signs of addiction and then open their hearts to offer support

    Music, Brain and Health

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    Music, like language, is a uniquely human experience, ubiquitous across human cultures and across the human life span.Musical capacity appears early in evolution and it seems to be innate to most of the human population. Neurobiological studies of music perception and music performance profoundly affect the brain, in an acute and chronic way, by modulating networks involved in cognition, sensation, emotion, reward, and movement corresponding to the empirical findings why people listen to music: pleasure, self-awareness, social relatedness, and arousal and mood regulation.Most intriguing is “salutogenic” effect of musical activities, such as instrumental and choral “musicking” (particularly in non-professional musicians), both on the individual level and in populations. Musical training can promote the development of non-musical skills as diverse as language development, attention, visuospatial perception, and executive functions.Music is also a prophylactic resource, it improves the bonding of mother and child. There is a wide range of therapeutic domains and disorders where musical interventions improve the outcome. As an example, familiar music has an exceptional ability to elicit memories, movements, motivation and positive emotions from adults affected by dementia.Considering that one of the most important problems in biomedicine is “understanding what is to be human” then “music should be an essential part of this pursuit” – of an understanding of the whole person. Despite evidence of significant effects of music on health and well-being - music is not well present in current re-humanization of medicine

    Life with COVID-19: Learning to “Breeze in and Breeze out” in Japan

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    Gender Differences in Mindfulness, Self-Compassion, and Drinking to Cope in Undergraduates with Problematic Consumption

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    Undergraduate students show the highest rates of problematic alcohol consumption compared to any other non-clinical category of individuals, and coping-motivated drinking has been consistently shown to be the most problematic. The present study examines associations between mindfulness facets, self-compassion, and coping-motivated drinking, and how these associations differ by gender. Undergraduate problematic drinkers (N = 146) completed self-report measures assessing their motives for drinking (coping-depression, coping-anxiety, enhancement, social, conformity) and levels of dispositional mindfulness (observing, describing, acting with awareness, non-judging, non-reactivity) and self-compassion. Regression analyses revealed that for both genders, mindfulness facets and self-compassion were statistically significantly negatively associated with coping-depression, but not coping-anxiety. Non-judging was uniquely associated with coping-depression in women, but in men, non-reactivity was the sole unique association. Unexpectedly, describing was negatively associated with conformity-motivated drinking in women. Mindfulness and self-compassion based programs for undergraduate problematic drinkers may be most effective if they target students who drink to cope with depression and emphasize different skills depending on the student’s gender

    Making Sense of Collaborative Practices: Practice as a Social and Scientific Phenomenon

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    Workshop Description (objectives, methods, results, conclusions): The concept of “practice” has received little attention in healthcare literature. This is an important oversight as practitioners tend to equate the dominant scientific discourse with practice. This covers over the social nature of individual and team-based practices. Social theorists argue that human nature is ‘helplessly’ social and interdependent. This failure to recognize the social construction of knowledge and knowing influences our ability to engage in collaborative practice and provide whole person care.  We cannot see where “hidden practices” (the practice equivalent to 'hidden curriculum') influence what we can see and what remains hidden, what we can say and what we must keep silent about, or which actions are encouraged and which are constrained. We will explore the paradox of the co-existence of rational science and social constructionist views of knowledge and knowing and propose that practices are complex, responsive, processes of relating that are informed by, and in turn, challenge and further inform science. Using a mix of presentation, personal reflection, and case studies in small groups, this 90 minute workshop we will explore the social nature of practice, the theory/practice (science/experience) paradox, and consider how this “two-eyed” understanding could facilitate the provision of whole person care.Specific Objectives: Participants will be able to:1. Define collaborative practice2. Elaborate and understand their own experience of collaborative practice3. Differentiate between social and scientific paradigms and explain the differences and implications4. Explain the concept and implications of the practices of particular communities and of first- and second-order breakdowns5. Understand the nature of collaboration and distinguish it from included and related concepts of communication, coordination, cooperation, and co-location6. Articulate personal definitions of and strategies for and identify personal commitments to collaborative practice related to whole person care
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