‘The view from here’ - Anxiety and defences against anxiety in the provision of maternity care to one mother and baby

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 car

ICU Bridge Program: Working with staff towards no family members feeling like "the elephant in the room"

The intensive care unit (ICU) provides specialized care to critically ill patients. Given the traumatic nature of critical illness and its treatments, up to 75% of family members of ICU decedents and survivors experience long-term psychological consequences, termed post-intensive care syndrome family (PICS-F). Anxiety, PTSD, and depression are common manifestations that significantly impact families’ quality of life and the recovery of those dependent on their caregiving. Although PICS-F can be mitigated by engagement with ICU staff, critical care workers are at risk of burnout and requesting closer liaisons with families is unfeasible. Bridging visitors and the ICU health care team would ensure that family members never feel like “the elephant in the room”.The ICU Bridge Program (ICUBP) is a unique volunteering and shadowing initiative designed and run by university students. Bridge Program volunteers are assigned to hospital ICUs in Montreal to be the first point of contact for visitors. This program addresses PICS-F by humanizing the ICU experience through compassionate human contact, continuous support, and an open line of communication. The diverse applicants are carefully selected and trained to maximize soft skills, such as emotional intelligence and active listening, which ensures that families feel welcome and understood in this tense environment. Furthermore, the ICUBP’s self-sufficient structure off-loads administrative responsibilities from resource-constrained hospitals and makes its implementation feasible and cost-efficient. By continuously monitoring its effect on patients, families, and staff, the ICUBP aims to improve and expand its contribution to whole-person care in the ICU

Reframing perceptions: A phenomenological inquiry into students’ written reflections on learning about mindfulness

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).&nbsp

Challenges and opportunities of relationship centred care in health care settings. My journey and the evolution of my approach

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

The early encounter: shallow looking and the manifest presence in medical education

If the pressure of patient flow limits a doctor’s visit to fifteen minutes, the importance of the early encounter is increasing. My proposal is dedicated to the first moment of the intersubjective encounter (with art or otherwise), that defined by the unconscious assessment a priori to conscious interpretation, its authority in the clinical encounter, and how to address this moment in medical education.The dynamics between observer and artwork occur in two stages. First, the observer’s senses are attacked, indeed overwhelmed, by the work. Our adaptive unconscious uses reflexive techniques (e.g. thin-slicing) to triage and resolve this information to a more manageable load. Because pattern collection, discovery, and comparison are under unconscious control, the question arises concerning accountability for snap judgments. By studying the patterns that thin-slicing utilizes and our immediate reaction given these patterns, the conscious self can predict—or at least become more accountable—for these judgments.Second, uncomfortable as the victim of a sensory attack, the observer dominates the artwork through the act of interpretation. The observer’s intellect and desire to interpret (both under conscious control) dissolve the uncertainty of the encounter by categorizing it into a comfortable system. Once attuned to this conscious power reversal, we can restrain the unconscious desire prompting the reversal and maintain space in the intersubjective encounter.As visual art is a strong vehicle to discuss the theory behind the dynamics of the early encounter, it is also the appropriate method by which to coach medical students through the early medical encounter

Into the looking glass on cultural and religious competent care: optimizing healthcare for Haredi individuals with mental illness

Previous research has shown that minority groups tend to underuse healthcare services. One community whose experiences remain particularly under-researched in the Western world is Haredi Jews- a diverse group of individuals committed to traditional Talmudic and Halakhah teachings and observances.  This presentation aims to enhance participants' understanding of mental health-seeking behaviours and challenges faced by Haredi individuals. We conducted a qualitative study that involved in-depth interviews with 24 adults who identified as Haredi and used mental health services, as well as informal consultations with local rabbis and community leaders. Interviews were transcribed and analyzed using thematic analysis techniques. Analysis revealed several important themes, including:   (1) Strength of religious practices, community, and relationship with God as a factor determining mental well-being.   (2) Implications of devotion to religion within the patient-physician encounter.   (3) Stigma and acknowledged lack of awareness surrounding mental health in Haredi communities. These themes will be explored in the presentation, which will aim to bring light to participants’ lived experiences. We hope to address the proverbial "elephant in the room" often ignored or overlooked, as encountered by Haredi community members and their interactions with the healthcare system. We will present the unique strengths and challenges related to mental health encountered by Haredi Jews in our study, while discussing potential measures that can produce better health outcomes and culturally sensitive care for Haredi individuals. &nbsp

Invitations to think and feel in forensic nursing; the role of clinical supervision and reflective practice

Providing nursing care to people who have experienced child sexual abuse, assault and rape is a highly specialised and psychologically demanding task.  Necessarily much focus is on the technical aspects of the task of providing care to patients.  The specialist administrative and nursing team in the Sexual Assault and Treatment Units (SATUs) in Ireland provide complex treatment to a particularly vulnerable group of people from various backgrounds in Irish Society. The service is open to all genders and gender identities, aged 14 and over. The care is free and it is a recognised safe place to go to if you have been raped or sexually assaulted. In the Department of Health’s Policy Review of the SATUs in Ireland they recognised the challenging nature of the work and recommended the provision of high quality emotional supports for all staff (core and on-call). This paper considers the provision of reflective practice to members of the SATU team, with a particular emphasis on their emotional and psychological experience at work. The introduction of reflective practice into a nursing setting will be discussed including opportunities and challenges that emerged, and how the service gained momentum over a year. The paper will reflect on one case example in the form of a supervisee/supervisor relationship in an effort to deepen and broaden our understanding of the need for professional spaces in which to consider ones experience at work.&nbsp

Reflections on teaching mindfulness to teenagers: from research to clinic

Increased stress reactivity during adolescence has been associated with vulnerability for psychiatric disorders in adulthood and mindfulness-based interventions (MBI) seem to be an option to stress. However, there is still debate on how to best teach MBI to teenagers. For the last 6 years, authors have been proposing the “Mindfulteen” (MT) to teenagers between 12 and 19 years in Geneva. The MT was first applied in different clinical trials and in a qualitative study and, as the results were encouraging, is now proposed in a clinical context at the University Hospital. Authors aim to share here some lessons learned from this experience: 1. Motivation and curiosity are key to engagement, and this is particularly important in school settings; 2. Even if adaptation is needed for different age groups, the program’s core remains easily the same; 3. Short formal practices with not much silence are needed, and metaphors can help; 4. Clarifying the intention of each practice can improve engagement, and the same explicit attitude can be brought into inquiry; 5. A trauma-sensitive approach is crucial, especially in clinical settings; 7. Proposing different versions of the same practice facilitates home practice; 8. Even if participants are not practicing between sessions, it doesn’t mean that they are not integrating mindfulness into their lives; 9. Creative and playful activities can provide rich mindful moments. In conclusion, there are open questions about teaching mindfulness to adolescents and authors believe that sharing and exchanging experiences is important to find some of the answers.&nbsp