First International Congress on Whole Person Care

What would it be like to participate in a conference that nurtured you, stimulated you, educated you, and sent you home with a new sense of what the practice of healthcare could be, and how you can begin to bring these insights into your own work as a physician, nurse or other healthcare professional?

We are in the grip of an approach to clinical practice that can leave individual practitioners feeling isolated and sometimes burned out, and patients dissatisfied with their care. This Congress, developed by the first university center specifically focused on whole person care and bringing together acknowledged experts from around the world, will put you at the cutting edge of what it means to practice whole person care.

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Presentations

A01-A

Staying Present to Youth with an Unknown Future 

Meaghen Johnston1, Camara Van Breemen2, Susan Poitras2

1. Mount Royal University, Calgary, Alberta, Canada 

2. Canuck Place Children's Hospice, Vancouver, British Columbia, Canada 

The intention of this workshop is to provide an opportunity to explore the various dimensions of clinical practice known to support and enhance coping in adolescents living with a life-threatening illness.   The objectives are to: 1) Present recent research findings related to the future thinking activities of adolescents in pediatric palliative care; 2) Acknowledge that these findings stretch us as clinicians  to “sit with” and \"create time for\" the youth’s exploration of future in the context of an anticipated shortened life; 3) Discuss several cases and provide experiential activities that can prepare the clinician in ‘being with’ and ‘staying present’ to youth who are exploring their future that remains unknown by virtue of the trajectory of illness.

The workshop will be broken down into three parts.  In the first 30 minutes the findings from a doctoral study aimed at examining the future thinking of adolescents living with a progressive life-threatening neurodegenerative illness will be presented and discussed.  Secondly, consideration will be given to how clinicians can mindfully prepare themselves for supporting adolescents and to consider aspects of the clinical self in our work with this population and finally, through both storytelling and the facilitation of active experiential activities, the presenters will share stories and ideas that have been integrated into existing practices.

 

A01-B

Understanding Patient Perspectives of Self-Care in the Management of Chronic Disease 

Jean Burgess1, Roberta Clark2, Keith De'Bell3

1. University of New Brunswick, Fredericton, New Brunswick, Canada 

2. University of New Brunswick, Saint John, New Brunswick, Canada 

3. St. Francis Xavier University, Antigonish, Nova Scotia, Canada 

This workshop will provide participants with an understanding of how appreciative inquiry based methods can help us learn from patient experience, develop self-care plans and identify the roles of various support groups within those plans, and develop a framework for chronic  disease management which is based on lessons learnt from patient experience.

Understanding patient experience with and perspectives on what supports on-going self care to manage chronic disease is critical to a whole person approach to chronic disease care. While the individual’s experience of chronic disease self-management may vary from individual to individual, our recent work demonstrates that appreciative enquiry is an effective tool for understanding the key support structures for effective management of self-care. This work also points to appreciative inquiry as an effective tool for patients and care-givers in developing approaches to individual self-care plans.

After a brief presentation of our recent findings, workshop participants will have an opportunity to use a modified appreciative inquiry approach to consider aspects of chronic disease care and particularly to discuss those factors that support chronic disease management. Appreciative Inquiry, as a positive form of narrative inquiry will elicit stories that make these supportive factors more concretely visible and comprehensible. Workshop participants will also be provided with a brief overview of thematic analysis as a way of identifying common themes in the appreciative inquiry data and developing a model of self-care support.

 

A02

Transforming Challenging Patients into Interesting People - Creative Writing as Burnout Prevention for Health Professionals 

Hilton Koppe, North Coast GP Training, Lennox Head, New South Wales, Australia 

And now for something completely different…..
As health practitioners, we are involved in writing “stories” every day.  The patient record is our interpretation of our patients’ stories (History) and a summary of our response to this (Examination and Management Plan).
This record does not allow for much creativity on the part of the writer, and is very limited in its ability to assist the health practitioner in making sense of what has gone on for them at a personal level.
To assist in remedying this problem, this workshop will use creative writing as a tool to assist in burnout prevention. 
The workshop will allow participants an opportunity to experience the use of stories and creative writing as a means of helping them to better manage some of the more challenging aspect of their working life, and to better make sense of what it means to be a health practitioner.
Practical writing exercises across a range of styles will assist participants in reflecting on the effect their clinical practice has on their lives with the goal of increasing their enjoyment of work, and of life in general.
These simple writing exercises will magically transform challenging patients into interesting people.
No previous writing experience is required.
Most of all, it will be an opportunity for some light hearted fun with colleagues.
Learning Objectives: By the end of the workshop, participants will have had the opportunity to
1.  Learn knew skills in creative writing
2.  Reflect on what it means to be a health practitioner through the use of structured writing exercises
3.  Develop skills in using reflective writing as a way of personal debriefing about experiences at work
4.  Reignite previously lost passions for creativity
5.  Marvel at the brilliance of their colleagues
6.  Share some of their creative brilliance with colleagues, if they choose to

 

A03-A

Doing 'Technological' Time in a Pediatric Hemodialysis Unit 

Hilde Zitzelsberger1, Elizabeth Peter2, Patricia McKeever2, Adrienne Chambon2, Kathryn Morgan2, Karen Spalding3

1. University of Ontario Institute of Technology, Oshawa, Ontario, Canada 

2. University of Toronto, Toronto, Ontario, Canada 

3. Ryerson University, Toronto, Ontario, Canada 

Study objectives: For Canadian children living with end-stage renal disease, hemodialysis is a common intervention and usually received in a specialized ambulatory hospital-based unit. Although children spend up to 12 hours a week receiving hemodialysis, little is known about how they perceive and respond to hospital-based hemodialysis. The study’s purpose is to describe and interpret the children’s embodied situatedness in the temporal, spatial and technological regimes and relations of a pediatric hospital-based hemodialysis unit.

Methods: An ethnography was undertaken at a Canadian urban pediatric hospital. Time, space, and technology are viewed as significant interrelated aspects of the hemodialysis unit and the unit is conceived as nested in the broader contexts of the children’s everyday lives. The theoretical framework merges concepts of human embodiment and contemporary human geographical perspectives and philosophy of technology.
 
Results: The dominant theme emerging from the study findings is the notion of the children doing ‘technological’ time. The pervasiveness and reach of hemodialysis technologies upon the children profoundly textures their situations, shapes their perspectives, evaluations and expectations and impacts how they are seen by caregivers in the unit.

Conclusions: Crucial changes in practices are essential to envision ways to create with children an overall positive place that merges and balances technological care with child focused care. The inclusion of children’s views is critical because many settings typically occupied by children have been designed and designated by authoritative or professional adults as “places for children” (Rasmussen, 2004, p. 155) without children being involved. Exploration of the findings may contribute to the ways that healthcare providers, funders, administrators and policy-makers can facilitate the inclusion of children in the design and care provision of hemodialysis units as well as other high-tech hospital-based units.

REFERENCES
Rasmussen, K. (2004). Places for children – children’s places. Childhood, 11(2), 155-173.

 

A03-B

The Intimate Partner Violence Nurse Specialist Role in a UK Emergency Department: Transcending Traditional Cultures of Care 

Julie McGarry , University of Nottingham, Derby, U.K. 

Background: Significant numbers of people attend emergency departments (ED) as a direct result of intimate partner violence (IPV) or through IPV related admissions, for example self harm (Boyle et al, 2006). While ED is a ‘vital source of assistance’ to those who have experienced IPV many ‘pass through the healthcare system unnoticed’ (Corbally, 2001). Practitioners in ED are often on the front line with individuals who have experienced abuse but the traditional biomedical culture of ED presents a barrier to effective support (Olive, 2007). As such, one regional ED department in the UK developed a specialist IPV nurse role with the specific remit of supporting staff in the development of effective identification and management of IPV.

Objective: The overall objective of this research was to explore and evaluate this role from the perspectives of ED clinical staff.

Methods: A qualitative approach incorporating semi-structured interviews with a range of clinical staff (n=16). An aide-memoir was developed to guide the interviews. Interviews were audio-recoded and transcribed. Data collection and analysis was contemporaneous, involving an iterative approach whereby emerging themes were explored in subsequent interviews.

Results (findings):
Three main themes emerged and form the basis of the presentation:
•           Time constraints: taking things on face value
•           Education and training: a very visible service
•           Professional and personal support: somewhere to go

Conclusions: The study highlighted that the specialist nurse was highly valued and perceived to be beneficial to the development of practice within emergency work. The context of emergency care is often focused on the acute biomedical event and the complex issues that arise from IPV do not conform to the ‘traditional’ ED patient. The ED is ideally suited to identify IPV survivors but is not institutionally organised in a way that prioritises a whole person approach to care. This role is one way that this issue can be addressed.

References:
Boyle, A, Jones, P, Lloyd, S. (2006) The association between domestic violence and self harm in emergency medicine patients. Emergency Medicine Journal. 23, 604-607
Corbally, M. (2001) Factors affecting nurse attitudes towards the screening and care of battered women in Dublin A and E departments: a literature review. Accident and Emergency Nursing. 9, 27-37
Olive, P. (2007) Care for emergency department patients who have experienced domestic violence: a review of the evidence base. Journal of Clinical Nursing. 16, 1736-1748

 

A03-C

The Expectations of Low and High Risk Pregnant Women Who Seeking Obstetrical Care in a Highly Specialized Hospital 

Roxana Behruzi1, Marie Hatem2, Lise Goulet2, William Fraser2

1. McGill University, Montréal, Québec, Canada 

2. Université de Montréal, Montréal, Québec, Canada 

Background:  In the context of a highly specialized hospital, birth care might be is expected to be more medicalized and technocratic for both low and high risk pregnant women.

Objective: This study aimed to explore the expectation of low and high risk pregnant women who seeking an obstetrical care in a highly specialized hospital. 

Methods: A single case study design was chosen for this study. The case under study was a tertiary and university affiliated hospital in Montreal, Canada. The data were collected through semi-structured interviews, field notes, participant observations and self-administered questionnaire. An inductive qualitative content analysis was used. 

Results: As a whole 157 women were participated in the study. The analysis of data showed that both high and low risk women felt more satisfied with the care they received if they were provided with informed choices, had the right to participate in the decision-making process and were surrounded by competent care providers and obstetric technology. The presence of an attentive care provider during labour who humanly cared for women and her family considered as essential component of birth care by women participant.

Conclusion: A birth care provider in a tertiary hospital setting should aim to meet both physiological and psychological aspects of birth care, including respect of the fears, beliefs, values, and needs of women and their families. Integration of competent and caring professionals, as well as the use of obstetric technology, could enhance the level of certainty and assurance in both high-risk and low risk women in a tertiary hospital.

 

A03-D

Transforming the Intensive Care Culture Using the Palliative Approach 

Diane Guay1, Cécile Michaud1, Luc Mathieu2, Jacinthe Pepin2

1. Université de Sherbrooke, Sherbrooke, Québec, Canada 

2. Université de Montréal, Montréal. Québec, Canada 

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.

 

A04-A

Workshops in Healing for Senior Medical Students:  A 5 Year Experience 

John Kearsley1,2, Elizabeth Lobb3,4,5

1. University of New South Wales, Kensington, New South Wales, 2033 Australia 

2. St George Hospital, Kogarah, New South Wales, 2217 Australia 

3. Calvary Healthcare Sydney, Kogarah New South Wales 2217 Australia 

4. Cunningham Centre for Palliative Care, Darlinghurst, New South Wales 2010 Australia 

5. University of Notre Dame, Sydney, Darlinghurst, New South Wales 2010 Australia 

Objectives:  To provide a 5-year (2008-2012) overview and appraisal of a novel course for senior undergraduate medical students (Workshops in Healing) at the University of New South Wales, Sydney, Australia within the context of a traditional 6-year curriculum.  In these innovative workshops, 8-12 self-selected students per year participate over 6 hours in two sessions, several days apart.  The sessions use artwork and other evocative images, poetry, music, statues and classic/contemporary literature to illustrate points of discussion relating to suffering, healing and the doctor-patient relationship.   

Methods: A written open-ended reflection was requested from 48 students in the final year of their 6-year medical course within a few weeks of the second workshop.  The study employed an emergent qualitative design.  Open coding involved repeated reading of the sections of the student’s feedback and a line-by-line analysis of this data.  Selective coding was then used to link data together and develop the themes.

Results:  Students identified the following benefits from the workshops:  1)  the opportunity to re-affirm their commitment to their chosen career path;  2)  the value of listening to other students share their stories;  3)  the importance of the timing of the Workshops to occur after exams;  4)  the use of various mediums such as art,  music and literature to present concepts of suffering and healing;  and 5) the creation of a safe and confidential space.

Conclusions:  Students reported that the workshops gave them a renewed sense of drive and enthusiasm for their chosen career.  They highlighted the importance of addressing an aspect of Medicine (healing) not covered in the traditional medical curriculum.  For many students the workshops provided a broader understanding of the meaning of concepts such as suffering and healing, and helped them to rediscover a deeper meaning to Medicine, and their roles as healthcare professionals.

 

A04-B

Challenging Conversations in Healthcare: Simulation-Based Interprofessional Learning 

Elizabeth A. Rider1,2, David M. Browning1,2, Sigall Bell1,2, Giulia Lamiani3, Robert D. Truog1,2, Elaine C. Meyer1,2

1. Harvard Medical School, Boston, MA, USA 

2. Institute for Professionalism  and  Ethical Practice, Boston Children's Hospital, Boston, MA, USA 

3. Università degli Studi di Milano, Milan, Italy 

Introduction: Interprofessional education is central to the mission of the Institute for Professionalism and Ethical Practice, based at Boston Children's Hospital and affiliated with Harvard Medical School. The Institute’s Program to Enhance Relational and Communication Skills (PERCS) offers simulation-based interprofessional workshops designed to help trainees and practitioners engage in challenging healthcare conversations across situations such as critical care, primary care, parent presence during resuscitation, spiritual distress, adverse medical outcomes, informed consent, organ donation, and others.

Objective: To describe the pedagogy, recruitment statistics and sustained participant outcomes of the Program to Enhance Relational and Communication Skills (PERCS)

Methods: The pedagogical framework is based on creating safety for learning, emphasizing moral and relational aspects of care, suspending hierarchy to support interprofessional learning, honoring multiple perspectives, and valuing reflection and self-discovery. Programs bring together physicians, nurses, social workers, psychologists, chaplains and other healthcare professionals for a wide range of innovative educational offerings. Core learning occurs through live enactments of challenging conversations with professional actors portraying patients and family members, followed by guided debriefings that support individual and group reflection.

Results: Approximately 2500 local, national and international professionals have participated since the program’s inception in 2002. PERCS workshop participants have reported a greater sense of preparation, confidence, improved communication and relational skills, and decreased anxiety when holding challenging healthcare conversations immediately following training and up to 12 months later. Benefits of the training were not related to discipline, level of experience or previous educational opportunities.

Conclusions: Participants reported enhanced communication and relational skills. The program strives to develop relational competence in the healthcare world, including qualities of compassion, trust, and respect between clinicians and patients, and increased attention to interprofessional collaboration and knowledge sharing.

 

A04-C

Caring for the Lived Experience:  An Exercise in Teaching Whole Person Care 

Cory Ingram1,2

1. Mayo Clinic, College of Medicine, Mankato, Minnesota, USA 

2. Mayo Clinic Health System, Mankato, Minnesota, USA

Common medical professions’ education for whole person care of seriously ill people and their family is often lacking.  The balance of educational attention to the biology of disease often far outweighs similar attention to the lived experience of the illness and personal caring.  In an attempt to test and teach the lived experience a written essay survey instrument has been created and administered to new palliative care staff and family medicine residents.

A summary of the participant’s responses to questions concerning ethical principles, dignity, health care desires, compassion, existential suffering, hope, grief, mindfulness, attunement, and end of life care will be shared in narrative fashion accompanied with teaching points used with participants.  Third year family medicine residents’ reflections will be shared to reflect the impact of the teaching of whole person care.

 

A04-D

Person-Centered Care In Mental Health Education and Practice Through Arts-Informed Narrative Inquiry 

Jasna Schwind1, Gail Lindsay2, Sue Coffey2, Debbie Morrison3, Barb Mildon4

1. Ryerson University, Toronto, Ontario, Canada 

2. University of Ontario Institute of Technology, Oshawa, Ontario, Canada 

3. Durham College, Oshawa, Ontario, Canada 

4. Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada 

Objectives: We conceptualize person-centred care (PCC) as whole person care that is enacted through the relationship between caregivers and care-receivers. This understanding bridges education and practice, nursing students and nurses, and methodological approaches. The objective of our Associated Medical Services Phoenix Call to Caring funded research is to explore how students and nurses in mental health construct and enact person-centred care.

Methods: Our participants include students and nurses in mental health education and practice. We meet with them in integrated groups of nurses and students. Our research process engages participants in four arts-informed narrative inquiry sessions: stories of giving and receiving PCC, use of metaphors to access tacit knowing, collages and mandalas to explore embodied experience of PCC .  Our research is multi-method through the addition of pre and post caring scales to document changes in participant attitudes and behaviours. A follow-up telephone call three months after the fourth session provides an evaluation of the significance of this exploration to PCC in their practice.

Results: Dimensions of enacting PCC are revealed including personal, regulatory, professional and institutional forces that shape students’ and nurses’ choice to be person-centred in their practice. Nurses and students increase self-awareness and critical thinking about the value and enactment of PCC in their practice, also shaping the healthcare environment.  The significance of arts-informed narrative methods to illuminate knowledge construction is revealed. 

Conclusions: PCC includes the practitioner and student as knowledge maker, in partnership with a patient and family. PCC involves choosing how to be in relationship as a whole person as well as conceptualizing patients as whole persons. PCC involves practitioner self-awareness and courage to advocate for personal integrity of patients and self-as-caregiver. Arts-informed narrative inquiry provides nurses (established and emergent) processes for continuing reflection and professional development.

 

B02

Bringing Our Whole Person to Whole Person Care: Fostering Reflective Capacity with Interactive Reflective Writing in Health Professions Education 

Grayson A. Armstrong1, Aaron Kofman1, Joanna J. Sharpless1, David Anthony1, Hedy S. Wald1

1.  Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA

Reflective learning and practice foster personal, professional, and interprofessional identity development within health professions education to encourage humanistic, competent patient care. Reflection on experience nurtures mindful presence and adaptive expertise/”practical wisdom,” enabling the health care professional to recognize and address patients’ and families’ emotional, psychosocial, cultural, and spiritual needs for optimizing whole person care (WPC). By heightening awareness of strengths, values, biases, and/or limitations, reflection also helps the provider bring more of his/her “whole person” to WPC, strengthening the provider-patient therapeutic relationship (reciprocity for healing). The use of reflective writing (RW) to augment reflective practice is well documented. RW in the small group setting fosters narrative competence (hearing/responding to a patient’s story, awareness of one’s own stories), self-assessment, moral sensitivity, empathy, emotional processing, and provider well-being. At Alpert Med, we have implemented an “interactive reflective writing” (IRW) paradigm of guided individualized feedback from interdisciplinary faculty to students’ RW in a Doctoring course and Family Medicine clerkship (with small group peer-based narrative sharing and collaborative feedback). Frameworks for enhancing educational value of feedback (BEGAN and REFLECT-reflective level evaluation rubric) were developed, incorporated into student and faculty guides, and applied in faculty development.

INTERACTIVE WORKSHOP OBJECTIVES: 1) Participants will be familiarized with constructs of reflective learning/practice and IRW, 2) Participants will apply BEGAN and REFLECT to a student’s reflective essay as exemplar, 3) Participants will engage in interactive dialogue with medical student presenters on positive learning outcomes of IRW for WPC 4) Participants will consider and share merits, limitations, and possible utility of presented curricula/evaluative tools for their settings. 

FORMAT/ACTIVITIES:

1.  Didactic - Reflective Learning/Practice for WPC

2.  Participants provide feedback to student’s RW

3.  Discussion

4.  Introduce BEGAN/REFLECT frameworks

5.  Participants re-craft feedback with frameworks/Discuss

6.   Student/faculty presenters share experiences of IRW pedagogy for fostering reflection and WPC

7.  Wrap-up/Q and A.

 

B03-A

Group Art Therapy Program for Women Living with Breast Cancer 

Katherine Laux1, Virginia Lee2, Sarkis Meterissian3, Gwynneth Gorman1, Sharon Wexler1

1. Cedars CanSupport, Montréal, Québec, Canada 

2. McGill University Health Centre Cancer Care Mission, Montréal, Québec, Canada 

3. Cedars Breast Clinic, McGill University Health Centre, Montréal, Québec, Canada

Background/Objective: A 9-week group art therapy program for women living with breast cancer is a new initiative to bring comprehensive cancer care to oncology patients and caregivers at our host institution, a major university health center.  The development of this program was supported by a mixed-methods research study which explored the impact of art therapy on the psychosocial needs of women in treatment for breast cancer.  Over 60 women were recruited for this study (control and intervention groups). The art therapy program offers tangible meaning-making opportunities through art-making in a therapeutic frame.  Participants incorporated their artworks in group discussions and individual reflections of how they benefited from art-making.

Methods: Sources of data include the artwork and group discussions, an upcoming exhibit, narrative-based interviews, and quantitative questionnaires.  The data will be analyzed qualitatively to elicit the major themes that the participants addressed in their art-making and group experiences, and in their narratives about their journey with cancer as a whole.

Results: The program’s 9 weekly topics will be presented and the qualitative results will be discussed. The topics  include addressing a changing mind/body, processing challenging emotions/thoughts/relationships, highlighting one’s strengths and capabilities, building talismans and amulets (protection), and increasing one’s self-awareness of the realities of living with cancer. Some of the major themes from a preliminary data analysis include the development of one’s personal artistic language/symbolism; a place just for me; discovering and building connections; at a crossroads; and transformations. 

Conclusion: This study highlights the importance and benefit of complementary therapies such as art therapy. We propose that creative arts therapies should be considered as an important contributor to the provision of whole person care in oncology clinics and wellness centres. The implications of group art therapy will be discussed in light of its feasibility in routine cancer care.

 

B03-B

When One is Sick and Two Need Help: Caring for the Caregiver

Susan Law1,2

1. St Mary's Hospital, Montréal, Québec, Canada 

2. McGill University, Montréal, Québec, Canada

Objectives: To increase public and professional understanding of caregiving experiences of people who care for adults with chronic physical illness; to promote the use of caregivers’ lived experiences in the education of healthcare professionals.

Methods: Part 1: 40 qualitative audio/video recorded interviews were conducted with adult caregivers in a maximum variation sample from across Canada. Data collection and analysis is via rigorous qualitative research. 25 topics or themes are identified reflective of the participants’ concerns, meanings and priorities.  Results including video, audio or text clips, and evidence-informed resources are published on www.healthexperiences.ca. The methods are adopted from the award-winning website (www.healthtalkonline.org) from Oxford University, UK. Part 2: collaboration with healthcare professionals, educational experts, researchers and caregivers to design educational modules to be piloted in University setting for healthcare professional education.

Results: Caregivers described their experiences with the healthcare system as part of their role. They provide advice to health care professionals about issues such as access to information and services, attitude and behaviours, the impact of caregiving on their own well-being , and reflections on their role. Participants emphasize the importance of recognition for their role as part of the care team for patients with chronic physical illnesses. Some described the need for the healthcare system to consider caregivers as an important component in the ‘a circle of care’ around the patient. If caregivers suffer physical or mental illness, burn-out or lack of resources, the support system for the patient falls away. Educational modules featuring video and audio clips of caregivers’ stories are powerful educational tools in developing healthcare professional sensitivity to these issues in patient care.

Conclusion: The www.healthexperiences.ca / www.experiencessante.ca sites are unique in Canada in the field of patient experiences and healthcare communication. It is a great resource to educate health care professionals about the caregivers’ perspective on caring for adults with chronic physical illness.

 

B03-C

Is the Whole Greater Than the Sum of Its Parts? Self-Rated Health and Transdisciplinarity

Martin Picard1, Robert-Paul Juster2, Catherine M Sabiston3

1. CMEM - Children’s Hospital of Philadelphia and UPenn, Philadelphia, PA, USA 

2. Department of Neurology and Neurosurgery, McGill University, Montréal, Québec, Canada 

3. Faculty of Kinesiology and Physical Education, University of Toronto, Ontario, Canada

How individuals rate their general health – self-rated health, SRH – predicts future morbidity and mortality. Evidence shows that this prospective association hold true across age groups, patient populations and ethnicities, and is independent of existing illness or biomedical conditions. The reason why such subjective self-perception of one’s health (the whole) is a valid and powerful predictor of health outcomes, beyond traditional disease biomarkers and risk factors (the parts), has remained unclear. One possibility is that the experience of Health transcends the biological domain, and that psychological, social, behavioral and spiritual factors are integrated in unique ways among each individual/patient to shape “true” health. Each domain bears different relative importance for different individuals. Thus, self-rated health, by virtue that it arises from a completely non-leading and non-directed question, may capture an emergent holistic experience that best represents health, and which translates more directly than other focused assessments into healthspan and lifespan. By reviewing epidemiological, clinical and qualitative research findings about self-rated health, this presentation will adopt a transdisciplinary stance to explore new knowledge that can be derived from the study of self-rated health, as well as its limitations. We will also discuss a practical approach to “profile” self-rated health as a means to identify therapeutic windows and orient person-centered care. Integrating individuals’ self perceptions of health into healthcare practice should enhance patient satisfaction with care, strengthen the therapeutic alliance, and promote empowerment and sustainable care.

 

B03-D

Mind the Gaps

Graeme Kidd1,2,3

1. Howick House Surgery, Auckland, NZ 

2. Eastern Bays Hospice, Auckland NZ 

3. Totara Hospice, Auckland  NZ

Objective: Reflection on 35 years in family medical practice - from home births to home deaths. My own wider understanding of "medical practise" through my personal growth.

THE GAPS

1) ISAAC NEWTON vs ALBERT EINSTEIN
Matter versus energy.
Current medical practise is still largely perceived through a Newtonian mindset .In recent years the "repair shop" mentality has intensified as we find more sophisticated techniques for managing the ailing human body. We still practise in a reductive world where we believe that we can determine outcomes entirely by understanding the parts . Even a scant understanding of wave  particle interactivity can help interpret a more holistic view of disease processes.  Metastatic cancer is an enormous challenge and I believe outcomes are related to far more than the conventional invasive treatments.

2) LOUIS PASTEUR vs CLAUDE BERNARD
Germ theory versus milleu.
The debate these two men initiated 170  years ago continues today - even though it is rumoured on his deathbed Louis was heard to say he thought Claude was right.  We still practise medicine as if we are fighting an enemy and give scant regard to the milleu that we allow the "enemy" to inhabit.
As the mystics and the scientists draw closer together through our quantum understanding, the milleu of our human system appears more complex and more connected to the world that we inhabit.

Although I practise conventional family medicine, I use metaphysics, metaphor and an interpretation of energy medicine to help patients  understand their disease and enable them to use an holistic approach to intergrate both conventional and complimentary therapies. With increasing audit and protocol driven practise it seems that often humanity gets sidelined. HbA1c's become more important than the relationship the patient has with their disease. 

Conclusion: The reintegration of humanity into the practise of medicine  will help empower patients with insight that will not only enhance their quality of life but will also help save millions of  dollars that currently is wasted within the victim / fix it model of medicine. I see the tide turning and this conference is evidence of a resurgence in a broader understanding of medicine through personhood.

 

 

B04-A

Creative Team Building with Staff Through Mandala Making

Sondra Goldman, Donald Berman Maimonides Geriatric Centre, Cote St-Luc, Quebec, Canada

Objectives: Participants will learn how art therapists can achieve individual or group goals through the use of art materials and processes.  They will also learn how organizational goals can be incorporated into relevant art making experiences.  The presentation begins with a brief overview of art therapy and the history of mandala making in community building.  We will then review the mandala-making staff workshops. The discussion will close with an exploration of how this process may be applied to other work environments. 

Methods: These workshops were originally offered to our long-term care staff on eight different occasions during, "Planetree Month" in May of 2011, a month dedicated to staff self-care. The “Planetree Month” planning committee asked the art therapist to develop a team-building exercise that would be fun, creative and completed within 45 minutes.  The committee also hoped that the workshop participants, who had little or no artistic experience or skill,  would make a collective art work (within the time constraints,) that would be a source of pride for the participants and be good enough to be installed on the walls of the centre as a testament to the teamwork achieved.

Results: The goals of the workshop were accomplished through the careful design of this workshop.  More than 200 staff members participated, embraced the process and completed eight mandalas which are now permanently displayed on the walls of Donald Berman Maimonides Geriatric Centre. Creativity can bring out the best in people, creating synergy and positive community growth.

 

B04-B

Whole Person Team Care

Glen Komatsu1,2, Denise Hess3

1. Providence TrinityCare Hospice, Torrance, California, USA 

2. Providence TrinityKids Care Hospice, Torrance, California, USA 

3. Providence Little Company of Mary Medical Center, Torrance, California, USA

In the rapidly changing environment of 21st century healthcare, effective interdisciplinary team-based care is a key ingredient in providing whole person care across the continuum. Interdisciplinary teams face significant issues and challenges in providing whole person care given the boundaries that exist between various healthcare disciplines. Systemic institutional barriers and hierarchies commonly work against team communication, cooperation, and collaboration. These work environments contribute to work-related stress, staff turnover, inefficient, lower quality care, burnout, and compassion fatigue. Ultimately team environments that do not foster team member well-being are unlikely to find success in creating environments that foster whole person care. Given these realities, teams who hope to provide whole-person care need strategies for creating and sustaining a team environment of self-awareness, self-compassion, mindfulness and non-judgmental presence.

This session will present the outcomes of three innovative approaches to interdisciplinary care team flourishing through case study analysis of hospital-based palliative care teams, and adult/pediatric hospice teams. The first intervention illustrates a process for developing and implementing a team retreat experience. Combining elements of team building, experiential learning and discussion of assigned readings, palliative care and hospice teams exhibit increased team trust, respect and communication across discipline boundaries. The second intervention demonstrates positive meaning-making through the use of a “spiritual narrative.” Through sustained reflection on a guiding metaphor, “spiritual narratives” enhance team identity formation, function, and sustainability. The third intervention outlines a model for group mindfulness meditation. Through regular practice of mindfulness meditation as an integrated component of the work day, team members sought to increase their self-awareness, presence, attunement and compassion in clinical interactions. Attendees of this workshop will be inspired and equipped to with new ways to enrich interdisciplinary team flourishing while providing excellent whole person care.

 

B04-C

Patients’ Stories of Interprofessional Whole-Person Care

Kateryna Aksenchuk1,2, Jasna K. Schwind1, Sherry Espin1, Beth McCay1, Jacqui Gingras1

1. Ryerson University, Toronto, Ontario, Canada 

2. University Health Network, Toronto, Ontario, Canada

Objectives: Interprofessional whole-person care has been depicted as being able to enhance patient health outcomes, increase healthcare provider satisfaction with care delivery, lower healthcare spending and decrease wait times for receiving care. Limited research has been conducted into exploring patients’ experiences of being recipients of this type of care. The objective of this oral presentation is to disseminate findings of a Master of Nursing study through patients’ stories of experience receiving care on a unit where interprofessional care is practiced. 

Methods: Three participants underwent a two step data collection process: a one hour semi-structured interview and a 30 minute symbolic image artistic exercise, as adapted from Schwind’s Narrative Reflective Process. Participants were invited to describe how they experienced receiving care from an interprofessional team and whether or not they believed whole-person care was delivered to them. Collected data are being analyzed using Clandinin and Connelly’s Narrative Inquiry approach of three dimensional space, temporality, sociality and place.

Results: The emerging results suggest that participants express satisfaction with the care they received from the interprofessional team on their unit. Their stories indicate that strong interprofessional team-work can contribute to patient satisfaction in care received. For these teams to be successful, from the patients’ point of view, there needs to be: better communication between care providers, greater involvement of the patient in decision making, proper identification of who comprises the teams, and consistency in team composition.

Conclusion: By acknowledging experiences and feelings of patients who have received care from an interprofessional team, there is potential to increase sustainability of these teams. The data generated through this study can potentially help healthcare providers, who are members of interprofessional teams, to deliver more effective, comprehensive whole-person care within healthcare institutions.

 

B04-D

Restoring Core Values: An International Charter for Human Values in Healthcare

Elizabeth Rider1, Ming-Jung Ho2, William T. Branch, Jr.3, Diana Slade4,5, Suzanne Kurtz6,7, Jack Pun Kwok Hung5

1. Harvard Medical School, Boston, MA, USA 

2. National Taiwan University, Taipei, Taiwan 

3. Emory University School of Medicine, Atlanta, GA, USA 

4. University of Technology Sydney, Sydney, New South Wales, Australia 

5. Hong Kong Polytechnic University, Kowloon, Hong Kong 

6. University of Calgary, Calgary, Alberta, Canada 

7. Washington State University, Pullman, WA, USA

Background:  The human dimensions of healthcare are fundamental to the practice of compassionate, safe, and ethical relationship-centered care. Attending to the human dimensions improves patient and clinician satisfaction, outcomes and quality of care; however, these dimensions have not received the emphasis necessary to make them central to every healthcare encounter.  We established an international collaborative effort to identify and promote the human dimensions of care. 

Objectives:  a) To describe work to date on the International Charter for Human Values in Healthcare; b) To discuss translation of the Charter’s universal values into education, research, and practice. 

Methods:  An international working group of expert educators, clinicians, linguists, and researchers identified initial values that should be present in every healthcare interaction. The working group and four additional groups -- National Academies of Practice (NAP) USA, International Conference on Communication in Healthcare, Interprofessional Patient-Centered Care Conference, American Academy on Communication in Healthcare Forum -- identified values for all healthcare interactions and prioritized top values. The NAP group also prioritized top values for interprofessional interactions. Additional data was gathered via a Delphi process and 2 focus groups of Harvard Macy Institute scholars and faculty. 

Results: Through iterative content analyses and consensus, we identified 5 categories of core human values that should be present in every healthcare interaction: Capacity for Compassion, Respect for Persons, Commitment to Integrity and Ethical Practice, Commitment to Excellence, and Justice in Healthcare. Through further consensus and Delphi methodology, we identified values within each category. 

Conclusions: The International Charter for Human Values in Healthcare [1] is a cooperative effort to restore core human values to healthcare around the world. Major healthcare and education partners have joined this international effort. We are working to develop methods to translate the Charter’s universal values into education (teaching, assessment, curricula), research and practice. 

Reference:
1. The International Charter for Human Values in Healthcare. http://charterforhealthcarevalues.org

 

C01-A

Enduring Witness - The Inner Journey of a Compassionate Doctor

Hilton Koppe, North Coast GP Training, Lennox Head, New South Wales, Australia

“Enduring witness” is a 30 minute DVD produced in Australia.  It traces the fictional relationship between a family practitioner (Geoff) and one of his female patients (Lisa) as she make the transition from adolescence to adulthood, through snippets from consultations about contraception, marriage, pregnancy and caring for her young children.  Lisa then develops breast cancer, and we watch how Geoff manages breaking the news, assisting her with treatment, remission, relapse and palliative care.  Issues relating to after care for Lisa’s family are covered at the end.

Some of Geoff’s “qualities” as a doctor (empathy, openness, patient-centredness) are the very same factors which put him at risk of burn out and compassion fatigue. The story is told primarily through the eyes of the doctor, and we gain access to some of his “hidden thoughts”.

The primary goal of the DVD is to promote discussion about preventing burnout and compassion fatigue which can occur from managing emotionally draining situations in clinical practice.  There is further opportunity to explore issues such as breaking bad new, support for colleagues, boundary issues and surviving the ups and downs of working with people at the end of their lives.

The DVD will be shown at the start of the workshop.  This will then be followed by a facilitated discussion between participants.  Discussion will focus on both personal responses of participants to the DVD, and also on how as practitioners we can best deal with the emotional challenges that arise in clinical practice.

 

C01-B

Therapeutic Conversations with Seriously Ill People and Their Families

Cory Ingram1,2, Ellen Wild2

1. Mayo Clinic, College of Medicine, Mankato, Minnesota, USA 

2. Mayo Clinic Health System, Mankato, Minnesota, USA

Seriously ill people and those they love encounter health care professionals regularly.  Published studies, representing how seriously ill people prefer to be communicated with suggest they would like open, honest and thoughtful communication.  Additionally, these studies emphasize that seriously ill people prefer to talk about their illness when they are ready.  Medical professionals are often on the frontline of communication with these people.  There is a paucity of education on communicating with seriously ill people in professional education spanning many health care professions.

Our workshop will empower participants in all capacities to better communicate with seriously ill people.  We will teach not how to communicate information but rather how to have a therapeutic interaction that is consistent with what we know to be true about what seriously ill people value in their communication with their health care team.

We will use patient narratives both oral and video, role play and reflection to convey an easy to implement framework to therapeutic communication.

Session attendees will be able to
1.  Understand foundational communication desires of seriously ill people and their families.
2.  Describe a framework to approach difficult conversations with a therapeutic intention.
3.  Implement practical approaches to enhance their communication with seriously ill patients and families they encounter daily.

 

C02-B

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

Marion Briggs , Northern Ontario Medical School, Sudbury, Ontario, Canada

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 practice
2.  Elaborate and understand their own experience of collaborative practice
3.  Differentiate between social and scientific paradigms and explain the differences and implications
4.  Explain the concept and implications of the practices of particular communities and of first- and second-order breakdowns
5.  Understand the nature of collaboration and distinguish it from included and related concepts of communication, coordination, cooperation, and co-location
6.  Articulate personal definitions of and strategies for and identify personal commitments to collaborative practice related to whole person care

 

C03

Who Am I?  Exploring Our Professional Identities: A Workshop for Health Care Professionals

Christine Sanderson1, Lisa Marr2

1. Calvary Health Care Syndey, Beverly Park, Sydney, New South Wales, Australia 

2. University of New Mexico Hospital, Albuquerque, New Mexico, USA

Objectives:
1.  Explore the history and meaning of each participant’s own professional identity
2.  Reflect on how professional identity affects the ability to be present with the patient
3.  Create a space to playfully explore benefits and burdens of the professional persona for caregivers and patients
4.  Consider possible new ways of being present as professional caregivers which may be safe, authentic, and often joyful 

Background: Health care is highly professionalised. Health professionals are perceived as powerful and prestigious, with great responsibility for patients’ well-being. Social expectations of health professionals are extremely pervasive. Professionalisation involves learning and negotiating one’s role, and becoming comfortable in the professional persona. To offer whole person care requires the professional caregiver to be simply and authentically present with the patient. Yet the professional persona can be a barrier to presence, often using behaviours that are distancing, disease-focused, and impersonal. Over time, working as a professional can deeply affect our experience of ourselves. 

Workshop process: This workshop offers an opportunity to explore the effects of professional identities on
us as caregivers and as persons.

Some topics that will be considered: How do we experience our professional identities?  Benefits and burdens of the roles we have adopted? Do they sustain us or not?  How do they help, and hinder, our ability to be present for patients?  How do we want to proceed in future? Through interactive, creative exercises in a supportive environment, participants will investigate the professional identities they have crafted over time.  Using meditation and writing exercises, participants will reflect on the self that offers whole person care to patients, and what is needed for this self to flourish.  Participants will share insights and challenges to being present, as a professional, with patients.

 

C04-A

The Health and Wellness of Future Physicians: Barriers to Change and Innovations in Undergraduate Medical Curricula

Hamish Wilson, University of Otago, Dunedin, Otago, New Zealand

Objectives: 1) To build on existing theory about the health and wellbeing of medical students and physicians; 2) To explore barriers to educational and institutional change; 3) To identify current educational innovations that improve the resilience of students and future doctors.  

Methods: Current explanatory models and research findings have been augmented through interviews with key academics and educators in North America, Australia and UK, as well as through reviewing innovative curricular interventions related to health and wellness of students and physicians.    

Results: Medical students are at risk of anxiety, depression and burnout,(1) while doctors suffer a range of occupational health hazards that illustrate psychological vulnerability.(2) Many commentators have called for changes to undergraduate education to improve the general resilience of doctors.(3, 4) The long delay in addressing physician stress may relate to the tacit assumptions of biomedicine that act as guiding principles in clinical practice.(5) While helpful in increasing the efficacy of modern medicine, these assumptions act as barriers to more progressive curricula. A ‘whole person care’ paradigm of patients is becoming well theorised, but acknowledging the ‘whole person’ of the student and physician is still work-in-progress. Fortunately, recent initiatives in many countries illustrate substantial progress. Undergraduate programs now focus on self-awareness, interpersonal skills, work-life balance, whole person care, and career choice. Methods vary widely and include coaching on physical, mental, and emotional health. Mindfulness, mentoring and Balint groups are increasing. Reflective practice is a prominent feature in a revised approach to professionalism. 

Conclusions: There is increasing evidence that the self-care of physicians will impact on patient outcomes. (6, 7) We also have a moral responsibility as educators, faculty and senior clinicians to provide more humane learning and working environments for students and doctors. Innovative educational initiatives are finding ways to overcome significant historical and institutional barriers.  

References
1. Jennings M. Medical student burnout: interdisciplinary exploration and analysis. J Med Humanities. 2009;30(4):253-69.
2. Linzer M, Gerrity M, Douglas JA, McMurray JE, Williams ES, Konrad TR. Physician stress: results from the physician worklife study. Stress Health. 2002;18(1):37-42.
3. Dunn L, Iglewicz A, Moutier C. A conceptual model of medical student well-being: promoting resilience and preventing burnout. Acad Psychiatry. 2008;32(1):44-53.
4. Seritan A, Hunt J, Shy A, Rea M, Worley L. The state of medical student wellness: A call for culture change. Acad Psychiatry. 2012;36(1):7-10.
5. McWhinney I. Changing models: The impact of Kuhn's theory on medicine. Fam Pract. 1984;1(1):3 -9.
6. West CP, Tan AD, Habermann TM, Sloan JA, Shanafelt TD. Association of resident fatigue and distress with perceived medical errors. JAMA. 2009;302(12):1294-300.
7. Wallace JE, Lemaire JB, Ghali WA. Physician wellness: a missing quality indicator. The Lancet. 2009;374(9702):1714-21.

 

C04-B

Compassion Training:  The Missing Link in Healthcare Education?

Kirsten Deleo1,2,3, Angela Anderson4,5, Crystal Cullerton-Sen1

1. Spiritual Care Program, Berne, New York, United States 

2. Sukhavati, Baad Sarrow, Berlin, Germany 

3. Dechen Shying, Garranes, Allihies, West Cork, Ireland 

4. Hasbro Children's Hospital, Providence, Rhode Island, United States 

5. Brown University, Providence, Rhode Island, United States

Compassion is an essential skill in whole person care. But, can it be cultivated through training?

Current research in neuroscience elucidates the mechanisms of empathy and compassion and provides a new framework for professional education. It suggests that clinical detachment is neither effective for ensuring good care, nor a realistic strategy to prevent burnout. Cultivating compassion on the other hand, increases non-judgmental awareness, builds resilience, and enables us to respond more effectively to others’ needs with greater empathy (Frickson, 2008, Klimecki, 2102, Lutz, 2004). Moreover, it is a skill we can learn (Wasner et al, 2005, Lutz 2009). Despite these findings, however, training in compassion is largely absent in current professional curricula.

Presenters will review current findings on compassion and its benefits, and demonstrate how we can train in it using examples from two unique compassion skills-training curricula: (1) a training for pediatric residents working in an inner-city hospital and (2) a certificate program in contemplative end-of-life care for hospice/palliative care workers. 

These models are inspired by the contemplative tradition of Tibetan Buddhism, with its long-standing and effective methodologies for deepening the human capacity for compassion. This approach has formed the basis of many scientific studies on compassion and the emerging field of contemplative-based, secular training models (Lutz, 2009). Participants engage in contemplations on compassion as well as mindfulness and meditation. The aim is to support clinicians to generate self-compassion - the foundation for building resilience and extending compassionate care – thereby improving communication and the overall quality of care.

The workshop will introduce key principles, feature hands-on experience of selected methods, and include a discussion of the potential impact on the greater healthcare system.

A wider implementation of compassion training promises to be the missing link for building a fulfilling clinical practice and strengthening our capacity to provide effective whole-person care.

 

C04-C

Sharing and Supporting the Hopes and Dreams of Students and Faculty in a Canadian BScN Program

Sue Coffey1, Hilde Zitzelsberger1, Marianne Cochrane2, Katherine Cummings2

1. University of Ontario Institute of Technology, Oshawa, Ontario, Canada 

2. Durham College, Oshawa, Ontario, Canada

Healthcare educators are in a unique position to support students’ personal and professional development. The UOIT-DC Nursing Program curriculum is founded on caring values that assert a commitment to the primacy of relationships. According to humanistic nursing, caring involves the interrelated concepts of ‘being’ and ‘doing’ in which both require an active presence and willingness to come to know another person (Paterson  and  Zderad, 1976). A deeply held tenet of nursing practice is the notion that when a nurse knows or understands a person, he or she will be better able to care for that person.  We believe that this notion also pertains to student and faculty relationships in nursing education, ultimately leading to more effective and meaningful learning opportunities and experiences.

This poster will report on a qualitative study exploring undergraduate nursing students’ hopes and dreams when they begin their education and the ways these hopes and dreams may shift and evolve as they progress through the program. The intersections of students’ hopes and dreams for their education and faculty members’ hopes and dreams in teaching students will be presented.  The impetus for the project arose from conversations among faculty members about the complex relational nature of nursing education and our hope to enhance relational awareness and practices through a deeper understanding of the aspirations and goals that students hold. Exploration of how the findings may contribute to deeper understandings of and responsiveness to students and the significance of nursing practice and education to them will be presented.

REFERENCES
Paterson, J. G.,  and  Zderad, L. T. (1976). Humanistic nursing. New York: John Wiley  and  Sons.

 

C04-D

Electronic Health Record (EHR) Training in Undergraduate Medical Education: Theory-Informed Development of a Longitudinal Curriculum for Empowering Patient- and Relationship-Centered Care in the Computerized Setting

Joanna J. Sharpless1, Paul George1, Shmuel P. Reis2,1, Julie Scott Taylor1, Hedy S. Wald1

1. Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA 

2. Bar-Ilan University Faculty of Medicine in the Galilee, Safed, Israel 

Objectives: While electronic health record (EHR) use is becoming state-of-the-art, formal teaching of Health Care Information Technology (HCIT) competencies is not keeping pace with burgeoning use. Medical students require training to become skilled users of HCIT but formal pedagogy is sparse. Fundamental challenges include preserving and fostering effective health care provider-patient communication skills in the computerized setting to preserve patient and relationship-centered care and facilitate reciprocity within whole person care. Thus, curriculum innovation with overarching goal of empowering undergraduate medical students’ patient- and relationship-centered interviewing skills, information mastery, electronic documentation skills, and HCIT-supported patient education is needed.  

Methods: The authors describe innovative, systematic curriculum development for EHR training within a series of clinical skills courses at their institution, informed by Kern et al.’s framework, narrative medicine, and reflective practice. Initially, a didactic and an observed standardized patient encounter were piloted in Year 3. Subsequent surveys of participating faculty both validated the session’s educational value and identified the need for additional practice opportunities.   

Results: In addition to the existing presentation and individualized practice, second iteration revisions include reflective readings and exercises, relevant “introductory” skills presented in grid format, and opportunities for direct observation of and by mentor physicians in clinical settings.  The behavior grid was then expanded to include “advanced” Year 4 skills, i.e. patient participation for chart building, patient education/information sharing, shared decision-making, and sending information to the interprofessional health care team.   

Conclusions:  Effective triangulation of physician-patient-computer may be optimized with medical education curriculum developing competencies of effective EHR use preserving patient-and relationship-centered care, reflection, and narrative medicine. Systematic, longitudinal monitoring of learners' skill development by faculty, standardized patient, self-assessment, and reflective writing will inform our innovative multi-faceted, longitudinal, transferable curriculum presented herein. Further research is needed on formal pedagogy for EHR use by learners.

 

D02-A

Music Therapy in Whole Person Care at the End of Life

Deborah Salmon, McGill University Health Centre, Montreal, Quebec, Canada

Whole Person Care aims to be deeply present to the person in the patient; acknowledging the integration of physical, psychosocial and spiritual facets of human experience, and creating a space in which healing, or a greater sense of wholeness, may occur. Music offers a potent tool in this endeavor. With its inherent capacity to engage body, mind and spirit, music can stimulate or calm, transport us to other times and places, reach our innermost emotions, and connect us to ourselves, our loved ones and our spirituality. In palliative care, music therapy joins with whole person care to meet patients and their loved ones as fully as possible.

Concepts central to whole person care will be presented and illustrated through the lens of clinical music therapy. For example, exploring how the skilful use of music addresses many dimensions of personhood will highlight Cassell’s concept of personhood. Demonstrating the ability of a significant melody to access and externalize personal meaning will integrate ideas from Frankl on meaning.  Observing how relationship and creativity function as healing connections will draw from Mount, as will the idea of helping one move on a continuum from suffering to healing (Mount, Hutchinson, Kearney). The role of the health care professional as a ‘vulnerable-enough’ caregiver (Papadatou) or ‘wounded healer’ (Kearney) will also be touched upon. Throughout the presentation, poignant images, stories and video clips of patients engaging in music therapy at the end of life will serve to both enliven the didactic material and demonstrate how music therapy can create a space in which experiences of greater integrity may occur.

 

D02-B

Using the Arts to Explore Whole Person Care

Peter Silberberg, Hilton Koppe, North Coast General Practice Training, Ballina, New South Wales, Australia

There has been an increase in the use of arts in Australian General Practice medical education in recent years.  This workshop will aim to continue the Australian journey by exploring how the arts can teach about the whole person care.  It will be facilitated by two medical educators experienced in these teaching techniques.  Participants will be asked to contribute an example from the arts (film, writing, image, music etc) and be guided via skilled facilitation in how this could be used to explore whole person care.  There will be discussion of how these pieces could be used in teaching and clinical practice.  Potential benefits and pitfalls will be highlighted.  At the conclusion, these resources will be collated for distribution and made freely available.

Learning objectives include: (i) how to use the arts in teaching whole person care, (ii) to discuss different methodologies and the pros and cons of each one (iii) to allow participants an opportunity to experiment and participate with different mediums (iv) to collate a list of different examples used from the workshop to distribute to the group.

Please note, if you attend this workshop you will need to bring a small contribution of art (film, writing, image, music etc) to share with the group. Electronic versions are welcome. It does not need to be original.

 

D03

Facilitating Whole Person Care Using Video Reflexive Ethnography

Aileen Collier1,2, Mary Wyer2, Katherine Carroll2, Suyin Hor2, Brydan Lenne2,3, Rick Iedema2

1. Flinders University, Adelaide, South Australia, Australia 

2. University Technology Sydney, Sydney, New South Wales, Australia 

3. Sydney University, Sydney, Australia

Aim: Explore the application and potential of video reflexive ethnography (VRE) to facilitate whole person care (WPC).  

Objectives: Discuss the ethical issues associated with VRE; explore the foundations of the methodology; and discuss its potential to facilitate WPC.

Description: WPC requires a paradigm shift in how we see those we care for, how we see our co-workers and how we see ourselves. VRE involves videoing real-time everyday clinical practice and or patient and family accounts of care, and then involving participants to analyse the visual data that they feature in or have gathered themselves. Uniquely, video footage can challenge the taken for granted and attune people to dimensions of themselves and others that they might not otherwise have considered. This has the potential to open people up to alternative ways of thinking and perceiving, being and acting. It offers “transformative potential” towards WPC. 1 2 3 4 5

We draw from our diverse disciplinary perspectives to explore the potential of VRE as a tool to facilitate WPC. Using specific examples from five research studies, this workshop will demonstrate the use of VRE in a variety of health care contexts. The contexts of the studies we draw from include: end of life care; autism diagnostics; infection control, and intensive care.

The workshop proceeds in four parts. We first invite you, the participant, to engage in a video reflexive event, where you are expected to reflect on the socio-interactive conduct that you produce as a group in response to a specific task.  We then describe the process of VRE, outline its pedagogic and theoretical foundations, and present some examples from our research. We then invite questions about the theoretical basis and practical approach of VRE. Finally, participants will be asked to project a version of reflexive video onto their 'home' area of research, and reason about potential outcomes.

1 Carroll, K., Iedema, R.  and  Kerridge, I. 2008, 'Reshaping ICU Ward Round Practices Using Video Reflexive Ethnography', Qualitative Health Research, vol. 18, no. 3, pp. 380-390.
2 Collier, A. 2012, 'Safe Healing Environments', in N. Godbold  and  M. Vaccarella (eds), Autonomous Responsible Alone: The Complexities of Patient Empowerment, Interdisciplinary Press, London, pp. 155-170.
3 Iedema, R. 2011, 'Creating Safety by Strengthening Clinicians' Capacity for Reflexivity ', British Medical Journal, vol. 20, pp. S83-S86.
4 Iedema, R.  and  Carroll, K. 2011, 'The 'clinalyst': Institutionalising reflexive space to realise safety and flexible systematisation in health care', Journal of Organisational Change Management vol. 4, no. 1, pp. 65-86.
5 Iedema, R., Long, D., Forsyth, D.  and  Lee, B.B. 2006, 'Visibilising Clinical Work: Video ethnography in the contemporary hospital', Health Sociology Review, vol. 15, pp. 156-168.

 

D04-A

Exercise-Never Too Late: The Meaning of Exercise for Advanced Palliative Care Patients

Roslyn Savage , Jill Gibbons, Kathy Potter, Calvary Health Care Sydney, Glebe, New South Wales, Australia

Objective:  Increasing evidence supports the role of exercise for palliative care patients through maximizing physical function, improving fatigue and overall quality of life in the face of advancing disease. The objective of this study was to explore the meaning of exercise for these patients and their carers and to increase the understanding and value of exercise for this population. 

Methods:  An emergent qualitative study design was employed using semi structured interviews with patients attending a palliative care gym program and their carers.  Thirteen patients and seven carers participated.Interviews were taped and transcribed verbatim and analyzed to identify common themes. 

Results:  Patients and carers identified improvement in strength, confidence and mood that enabled greater participation in life.  Access to an open flexible program that allowed patients control of their exercise was important.  Exercise contributed to promoting self identity and as a consequence provided a source of inner strength.  Benefit was also felt from the shared positive experience in a safe environment.  Carers used the session as a form of respite or opportunity for  interaction. 

Conclusions:  Patients perceive exercise as important as it enables independence but it also provides significant psychosocial and spiritual support.  Carers similarly identify the benefits beyond improved physical function.  Exercise is a positive treatment regime that contributes to wholistic care.

 

D04-B

Exploring the Relational Aspects of Patient and Doctor Communication

Richard Hovey1,2, Helen Massfeller2

1. McGill University, Montréal, Québec, Canada 

2. University of Calgary, Calgary, Alberta, Canada

The alliance concept is an essential component of therapeutic relationships. Contrary to empirical evidence, its relevance is often not acknowledged in medical encounters. This circumstance invites the question, ‘‘How can the doctor and patient connect relationally with each other to improve the communication process and promote healing?’’ We propose that healing can be accomplished through dialog that emphasizes the collaborative nature of the partnership between the doctor and patient. The typical conversation in a medical encounter may be reduced to an information exchange and a medium for prescribing directives. This being-with approach can override patients’ involvement in the process. A positive doctor–patient relationship may be one of the most important, and most frequently overlooked, factors for predicting patient response to negative medical information. Receiving such news is potentially upsetting for the patient and may require the doctor to let go of the conversational medical agenda and adopt a being-for mode of relationship. We propose that this approach invites the doctor and patient to work together and negotiate how to manage the chronic illness eliciting patient-preferred treatment options. The authors propose the adoption of the being-for relationship as a way of enhancing the therapeutic potential of the doctor–patient relationship.

 

D04-C

Creating Significant Life Rituals in Neuro-Palliative Care

Lana Kim McGeary1,2

1. McGill University Health Center, Montreal, Quebec, Canada 

2. Montreal Neurological Hospital, Montreal, Quebec, Canada

Ritual can be described as an act which helps make sense of life, “there is what many people recognize as a spiritual quality to life, which in suffering, confronts people with questions and possibilities that reach beyond the immediate dilemmas of physical insult.” (Cobb and Robshaw, 1998); in this vein, ritual serves as a vehicle to navigate the inherent moments of sorrow and suffering in our lives. Fred Bird describes ritual as something which allows for communication, representation, meaning making, validation and relationing. (Bird, 1995) This presentation explores the ways in which creating accessible and significant contemporary rituals, within a hospital setting, may serve as a means to crystallize our deepest sensitivities for life, and living. It looks at some of the ways rituals can serve as a bridge to wholing and healing, within the patient, with family members and with health care professionals interacting with patient.  Through examples from spiritual care counseling, within a multidisciplinary team setting, in neuro-palliative care, a path is set for some simple ways to ritually nurture quality of life issues, as part of a whole person care health protocol.

 

D04-D

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

Qinyi Zhao1, Nicolò Bernardi2, Patricia Dobkin1

1. McGill Programs in Whole Person Care, McGill University, Montréal, Québec, Canada 

2. Department of Psychology, McGill University, Montréal, Québec, Canada

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.

 

E04-A

Healing the Feelings and Feeling the Healing: Hypnotic Approaches in Cancer and Palliative Care

Sylvain Néron1,2,3, Daniel Handel4

1. McGill University, Montréal, Québec, Canada 

2. Segal Cancer Center - Jewish General Hospital, Montréal, Québec, Canada 

3. Jewish General Hospital, Lady Davis Institute for Medical Research, Montréal, Q 

4. National Institutes of Health (NIH), Bethesda, Maryland, USA

This workshop will focus on clinical demonstrations of hypnotic suggestion through metaphors for self-regulation improvements, pain relief, palliation of symptoms, and amelioration of hope in the face of advanced or progressive illness. These materials were designed (Néron and Handel, In Press)  for health care professionals who use – or may decide to use – clinical hypnosis in their professional work with patients.
The role of adjunctive hypnotic therapy in cancer care is to help manage distressing symptoms and to give the sufferer a sense of control via mind-body regulation. Physicians and health care professionals can integrate personalized hypnotic approaches in order to help patients regulate physiological functions, alleviate pain, enhance the release of tension, reframe hope, facilitate new levels of personal adjustments, and promote or restore healing spiritual experiences.

The workshop will include case-based, video clip demonstrations to cover the following topic areas: a) addressing patients’ misconceptions about hypnosis, b) establishing appropriate clinical goals, c) using hypnotic techniques in different medical settings, d) developing quick ways of reaching a hypnotic state, e) teaching self-hypnosis, f) preparing for medical procedures, g) reframing hope, and h) promoting healing spiritual experiences. 

Objectives: Participants will be introduced to ways of:
a) Integrating guided clinical hypnosis procedures at bedside and in several medical contexts.
b) Empowering the sufferer by teaching him or her how to use self-hypnosis for symptom relief and for addressing their existential issues.

Néron, S., and Handel, D. Hypnotic Approaches in Cancer and Palliative Care. Quebec: Presses de l’Université du Québec, In Press.

 

E04-B

Self-Care and Self-Discipline through Qi Gong

Steven Aung, University of Alberta, Edmonton, Alberta, Canada

Objectives: One of the most important aspects of Qi Gong practice is to understand self-care and self-discipline as a practitioner’s service both to themself and to others. Self-care and self-discipline is physical, mental, and spiritual. By understanding one’s responsibility in this way, practitioners are free to practice medicine as a relationship between themselves and patients, helping them to become a healer. 

Methods: Traditional Chinese Medicine as a philosophy and practice will be introduced in the context of developing a successful Qi Gong practice. Basic Qi Gong techniques in posture, movement, breathing, phonation, and visualization will be demonstrated interactively.  Increasing self-awareness will be emphasized, so that practitioners can use Qi Gong techniques to develop healing skills in their medical practice.  

Results: Although it requires long-term commitment to receive many of the deeper rewards of a dedicated Qi Gong practice, many of the early benefits are possible with only a modest investment in performing proper Qi Gong techniques. Practitioners will learn to increase their mindfulness and concentration, and understand the value of self-care and self-discipline. Through short practice sessions, the utility of Qi Gong in improving healing will become evident to the novice and initiated alike.  

Conclusions: Qi Gong is a series of ancient techniques from Traditional Chinese Medicine that promote self-care and self-discipline as a service to oneself and others. Qi Gong is a valuable method for taking care of oneself, and also allows practitioners to transfer its benefits to patients during the compassionate practice of medicine. It forms a foundation for whole person care by strengthening practitioners to provide healing to patients on the physical, mental, and spiritual levels.

 

 

Posters

Complementary Therapies

 

P01

Reiki for Whole Person Care: Case Studies in Oncology Patients, a Preliminary Report 

Martha Gomez, Maddalena Gonzo, Cedars CanSupport, Montréal, Québec, Canada

Objective: Reiki has been introduced as part of the complementary therapy program for oncology patients in two major university hospitals to which our institution is affiliated, with the objective to provide whole person care. Reiki is a deep relaxation technique that promotes balance, healing and harmony in all aspects of the person – body, mind, emotions and spirit. A Reiki session is given using very light or no touch on a fully clothed individual, sitting or lying down. Reiki is best understood by actually experiencing a session.  The objective of this preliminary study is to document how Reiki can support and benefit oncology patients in facing the day-to-day challenges related to their illness.

Methodology: Weekly Reiki sessions lasting from 20 to 60 minutes have been conducted with adult patients. Inclusion criteria: any patient living with cancer: all stages, from pre-diagnosis to diagnosis, ongoing treatment (in and out-patients), post-treatment and palliative care. Data has been collected using a questionnaire and a symptom scale, before and after sessions, as applicable. Qualitative experiences from palliative care patients will also be obtained from staff and family caregivers.

Results: Preliminary results after each session indicate a significant reduction of anxiety and stress, in addition to improving regulation of pain, fatigue, emotional state, and digestive issues. Patients commonly express a feeling of serenity, calmness, and peace. Qualitative results will be presented.

Conclusion: Data collected so far suggests that Reiki as a complementary therapy, improves overall quality of life for patients. A more relaxed and less anxious patient facilitates the intervention of medical staff and lightens the efforts of caregivers and family. Closer communication between the medical and complementary therapies staff can manifestly enrich the whole person care.


P02

Whole Person Care at the Ottawa Integrative Cancer Centre

Dugald Seely1, 2, 3, Laura Weeks1, Gillian Flower1, Sarah Young1, Anne Pitman1, Raina Cordell1

1. Ottawa Integrative Cancer Centre, Ottawa, Ontario, Canada 

2. Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada 

3. Ottawa Hospital Research Institute, Ottawa, Ontario, Canada 

Objectives: An interprofessional team of healthcare practitioners at the Ottawa Integrative Cancer Centre (OICC) provides individualized and whole person care in an effort to bridge the gap between conventional and complementary cancer care. The objective of this presentation is to describe the population receiving care at the OICC in terms of demographic and disease-related characteristics, in addition to their experience receiving care in terms of therapies received and preliminary outcomes.

Methods: All people receiving care at the OICC are invited to complete a registration package that documents demographic and disease-related characteristics in addition to baseline quality of life (EORTC-QLQ C30), cancer-related symptom (ESAS) and patient-identified concerns or problems (MYCaW). Every 3 months, a follow up assessment is completed for continuing patients.

Results: In the 18 months since opening, more than 600 unique people have received care at the OICC. Most commonly people consult a naturopathic doctor, often in combination with a general practitioner, nutritionist, acupuncturist, physiotherapist, or counselor. The majority of people seek care to manage cancer and treatment-related side effects, including pain, neuropathy, energy, and digestive concerns. Other people are seeking supportive interventions to their prescribed standard care, to control or cure their cancer, or to prevent a recurrence. Approximately one half of people self-identify as under distress for at least one common cancer-related symptom. Preliminary results will be presented regarding quality of life, cancer related symptoms and patient-identified concerns, stratified as possible by age, sex, cancer type, stage and types of treatment received.

Conclusions: The results presented here contribute to an understanding of who seeks integrative and whole person care as well as the growing body of literature regarding potential benefits. Results will be used to guide development of a clinical trial designed to assess the feasibility, safety, effectiveness, and cost-effectiveness of integrative, whole person cancer care.

 

Creative Arts

 

P03

No Talent Required: Using Drama Therapy in Support Groups for Cancer Patients

Jennifer Finestone, Cedars CanSupport, MUHC, Montréal, Québec, Canada

Objectives:  It is well known that a cancer diagnosis impacts a person’s mental, emotional and spiritual well-being as well as their body.  Many patients and caregivers seek out support groups to bolster themselves in this challenging time.  While talk and peer-based groups can provide validation and understanding, drama therapy can provide a beneficial approach for support groups.   

Methods: Drama therapy is a gentle form of creative therapy between a trained therapist and one or more clients with a specific therapeutic intention.  It uses action methods (such as role play, storytelling, improvisation, writing, and projective tools) to facilitate creativity, imagination, learning, insight and growth.  Drama therapy provides a creative-expressive basis for support groups within a humanistic framework.  

Results: Drama therapy-based support groups encompass the patient’s holistic experience and address all aspects of their cancer experience in order to provide meaning.  In addition to validating participants’ perspectives, they help participants to come to terms with their experiences and emotions, to gain insight into their responses and to learn new ways of dealing with them.  Drama therapy utilizes the concepts of distance, projection and witnessing to allow clients to explore challenging issues in a safe – and potentially playful – way.  It is a flexible approach that can be adapted to the specific needs of participants and therefore is well equipped to serve a broad spectrum of issues and concerns in varying and supportive ways.

Conclusions: This poster will highlight some of the theory behind drama therapy-based support groups to show the advantages these groups entail.  It will also showcase various creative interventions that have been used with cancer patients.

 

P04

Narrative Reflective Process: A Means to Whole Person Research Cluster Formation

Jasna Schwind, Elizabeth McCay, Jennifer Lapum, Suzanne Fredericks, Heather Beanlands, Daria Romaniuk, Susanna Edwards, Karen LeGrow, Ryerson University, Toronto, Ontario, Canada

Objectives:  As nursing faculty members of Health and Illness research cluster our focus is on promoting humanistic practices, such as person-centered care, for individuals and their families living with illness and its consequences. In keeping with this holistic focus we wanted to explore a non-traditional approach to building a productive professional collaboration.

Methods:  In the early stages of our research cluster formation, we chose to engage in Schwind’s Narrative Reflective Process (NRP), a creative self-expression activity that is informed by the Connelly and Clandinin’s Narrative Inquiry research approach. Creative activities included storytelling, metaphors and drawing. We began the process by working in pairs, telling stories of our research experiences, both positive and negative. We then drew images that metaphorically represented each of these. Following, we described our images to the cluster group, while considering common narrative threads. The process ended by the group envisioning our interpretation of our collaborative cluster work. Throughout the year, our cluster met on a regular basis working on our common interest of person-centred care. One year later, we recreated our images to see how the view of our collaborative cluster work had evolved. This time we chose to create one large image together.

Results:  We found that our creative experiential activities opened possibilities for trust and created a safe space for research cluster members to share their developing ideas. We felt that by sharing our personal experiences through drawings and metaphors allowed us to connect with one another as whole persons. It allowed us to recognize that we are more than just our professional roles.

Conclusions:  Through the creative self-expression of NRP we engaged the research cluster members as whole persons. As a result, the cohesion, trust and collaboration resulted in increased research creativity and productivity, which would not have been possible to create alone. 


Education

 

P05

Whole Person Teaching Makes an Effective Baccalaureate Nursing Teacher: Student Voices Enlighten Us

Nancy Matthew-Maich1, Lynn Martin2, Carrie Mines1, Rosemary Ackerman-Rainville1, Cynthia Hammond1, Amy Palma2, Carmen Roche1, Darlene Sheremet1, Rose Stone1 

1. Mohawk College, Hamilton, Ontario, Canada 

2. McMaster University, Hamilton, Ontario, Canada

Objectives: The goals of this study were to understand: 1) what makes an effective teacher in each level of the baccalaureate nursing program, 2) what are the skills, attributes and strategies of an effective teacher in both theory and clinical courses, and 3) how does this impact student learning and the student experience in each level of the curriculum?

Methods: A qualitative description approach was used. All BScN students at two sites (1000 students) were emailed an invitation to participate in an online survey to identify what makes an effective teacher in the baccalaureate nursing program. Students were also invited to participate in focus groups to discuss what makes an effective teacher and the impact on their learning. It is anticipated that six focus groups of 10 to 12 students will be conducted. Survey and focus group data are analyzed using qualitative content analysis.
 
Findings: A preliminary finding emergent from the data is that students perceive whole person teaching, that is understanding the learner as a whole person, makes an effective teacher. This study has the potential for important impact on students and faculty in baccalaureate nursing programs. The results will be used to plan faculty development initiatives throughout all levels within relevant programs. Findings, conclusions and recommendations will be shared at the conference.

Conclusions: Will be available at the time of the conference. Faculty members are learning how to optimally facilitate learning in a new context that embraces a person-centered, problem based, self-directed and small group learning approach. Students are in the best position to articulate what makes an effective teacher in each year of the four year program. Students were eager and empowered to share their perceptions and faculty eager to learn from student voices to optimize student experiences and learning.

 

P06

Attitudinal Changes of Health Sciences Students Participating in an Interprofessional Education (IPE) Course Enriched with Complementary and Alternative Medicine (CAM) Education and CAM Fair – A Two Year Study 

Anastasia Kutt, Sunita Vohra, University of Alberta, Edmonton, Alberta, Canada

Objectives: Whole person care is ideally provided by a high functioning team, knowledgeable about all the therapies a patient has available to them (conventional or complementary), who coordinates efforts to efficiently meet all of a patient’s health care needs.  Therefore, health sciences students at Canadian universities require team skills, and basic knowledge about complementary and alternative medicine (CAM).  This project evaluates the attitudinal changes of health sciences students participating in a teaching intervention combining interprofessional education (IPE) and complementary and alternative medicine (CAM) education.

Methods: At our university, “IntD410 Interprofessional Health Team Development” is a mandatory 10-week, 30-hour IPE course for all undergraduate health sciences students including medicine, nursing, pharmacy, physical therapy, and occupational therapy.  The CAM-stream was developed by adding: (i) several didactic lectures; (ii) large group learning provided by CAM providers (i.e. Qi Gong, Mindfulness Meditation); (iii) small group work solving discovery-style cases; and (iv) the CAM Fair, providing one-on-one interactions with CAM providers. The CAM-stream was offered in 2012 (N=71) and 2013(N=120). Quantitative data was collected via pre/post validated questionnaires testing student attitudes towards CAM, interprofessional learning, and collaboration. Qualitative feedback was collected via reflective assignments and course evaluations.

Results: Quantitative assessment revealed that the CAM-stream’s CAM beliefs increased, as did their recognition of the need for interprofessional learning. Qualitatively, initial reflections revealed that many students did not know what each other’s professions entailed, and they had misconceptions about CAM.  Final reflections revealed the students felt more comfortable evaluating CAM practices, and recognized the value in collaboration. The CAM Fair was cited as the most impactful part of the curriculum.

Conclusions: IPE and CAM education are urgently needed in Canadian universities to overcome biases and misconceptions, to develop team skills, and to provide coordinated whole person care.  They are effectively taught concurrently.

 

P07

Fostering Resilience over Multiple-losses for Nursing Staff in the Palliative Care Unit: Whole Person Approach – Part 1

Minako Munesada, Yukie Kurihara, Satoe Takahashi, Keiko Tanaka, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan

Objectives: “Bereavement overload” due to multiple losses is one of the stressors for the nursing staff working at Palliative Care Unit (PCU), which may be especially tough to those with less exposure to such situation.  A support program was developed for the nursing staff of newly-opened PCU (April 2011) in order to foster resilience and wellness despite multiple losses.  We conducted a study to evaluate the effectiveness of the support program with “whole person approach” – consisting of 3 modules; 1) lecture on grief and bereavement (mind), 2) experiential workshop on body awareness and relaxation (body/spirit), and 3) group discussion (mind/spirit), for the increased sense of self-efficacy, awareness of their inner healing power, and fostering mutual understanding and support.

Methods: 20 nurses were randomly assigned to two groups for the action research project.  Data included participant observation, individual and focus group interviews with one of the investigators.  The support program package was offered from October to December 2012 (A) and from January to March 2013 (B) respectively, using wait-list control method.  Self-efficacy scale was used at the base line, at the completion of package A, and at the completion of package B.  Participants also answered brief survey after each module, followed by semi-structured interview.

Results: The self-efficacy score initially showed decline of both groups (intervention/control) , reflecting the “tough two months” with the highest number of the total deaths as well as deaths within 5 days post admission.  However, intervention group showed more gradual decline comparing to the control group, plus higher elevation 3 months later, which may indicate some effect of the program.

Conclusions: The support program was positively received and contributed to the nursing staff’s increased sense of self-efficacy and resilience over “bereavement overload.”  Continued program development is in progress based on the feedback.

 

P08

Fostering Resilience over Multiple Losses for Nursing Staff in the Palliative Care Unit: Whole Person Approach – Part 2

Yukie Kurihara, Minako Munesada, Satoe Takahashi, Keiko Tanaka, Tokyo Metroplitan Komagome Hospital, Tokyo, Japan

Objectives: “Bereavement overload” due to multiple losses is one of the stressors for the nursing staff working at Palliative Care Unit (PCU), which may be especially tough to those with less exposure to it.  A support program was developed for the nursing staff of newly-opened PCU (April 2011) in order to foster resilience and wellness despite multiple losses.  We conducted a study to evaluate the effectiveness of the support program with “whole person approach” – consisting of 3 modules: 1) lecture on grief and bereavement (mind), 2) experiential workshop on body awareness and relaxation (body/spirit), and 3) group discussion (mind/spirit), for the increased sense of self-efficacy, awareness of their inner healing power, and fostering mutual understanding and support.

Methods: 20 nurses were randomly assigned to two groups for the action research project.  Data included participant observation, individual and focus group interviews with one of the investigators.  The support program package was offered from October to December 2012 (A) and from January to March 2013 (B) respectively, using wait-list control method.  Self-efficacy scale was used at the base line, at the completion of package A, and at the completion of package B.  Participants also answered brief survey after each module, followed by semi-structured interview.

Results: The participants’ overall responses were positive, with comments like “becoming more aware of my own grief process” (module 1), “was amazed by the power of awareness and simple touch” (module 2), “inspired by learning others’ perspectives on death and dying” (module 3).  Shared learning and reflection as well as “learning something tangible” seem to be important components of the program.

Conclusions: The support program was positively received and contributed to the nursing staff’s increased sense of self-efficacy and resilience over “bereavement overload.”  Continued program development is in progress based on the feedback.


P09

Using Popular Nursing Literature Critique to Help Nursing Students Explore Their Perceptions of Disability 

Charles Anyinam2, Sue Coffey1

1. University of Ontario Institute of Technology, Oshawa, Ontario, Canada 

2. George Brown College, Toronto, Ontario, Canada

Objectives: Disabled people have a history of disadvantage, discrimination, and disempowerment that continues to present day. Despite strong critique and activism by disabled people, popular understandings of disability as necessarily tragic, medically based, and individualistic requiring ‘fixing’ persist among health professionals.  Recent research demonstrates that health professional students often harbour negative attitudes that may directly affect their relationships with and care provided to disabled clients (Sabin & Akyol, 2010; Scullion, 1999).  Further, personal accounts and research evidence suggests that the relationship between healthcare providers and disabled people is often unsatisfactory (Sabin & Akyol, 2010; Seccombe, 2007; Scullion, 1999).

Methods: Nursing education has a responsibility to ensure that nursing practice with disabled people is enabling rather than disabling (Scullion, 1999a, 1999b, 2000; Sabin & Akyol, 2010). A key strategy is to imbed within curricula opportunities for students to engage in the processes of critical thinking towards and analysis of disability and the experiences of disabled people. This poster describes an approach to teaching-learning in which critique of ‘popular culture’ nursing literature is used to support student exploration of messaging about disability.

Results and Conclusions: The purpose and description of the assignment, authors’ experiences, and outcomes for both teachers and learners will be presented. Application beyond nursing to other health professions will be described.

References:

Sabin, H. & Akyol, A. D. (2010). Evaluation of nursing and medical students\' attitudes towards people with disabilities. Journal of Clinical Nursing, 19, 2271­2279.

Scullion, P. A. (1999). Conceptualizing disability in nursing: Some evidence from students and their teachers. Journal of Advanced Nursing, 29, 648­657.

Scullion, P. A. (2000). Enabling disabled people: Responsibilities of nursing education.  British Journal of Nursing, 9(15), 1010-1015.

Seccombe, J. A. (2007). Attitudes towards disability in an undergraduate nursing curriculum: A literature review. Nurse Education Today, 27, 459­465.

 

Healing

 

P10

Healing as Recycling Energy from Negative to Positive

Steven Aung, University of Alberta, Edmonton, Alberta, Canada

Objectives: For many practitioners and patients, the most critical aspect of medical practice is healing. Healing requires compassion in order to elevate clinical practices above the skills of a medical technician. At the same time, the act of healing is deeply involved. When practitioners heal, they must take care not to experience physical, mental, or spiritual fatigue or injury to themselves. By practicing healing as recycling energy from negative to positive, practitioners develop contemplative compassion. The more practitioners treat patients, the more they understand how to recycle and heal, and the better the practitioner they become.

Methods: Healing recycling involves practitioners engaging their own chakra system on the physical, mental, and spiritual levels. Negative energy is drawn from the patient and flows through the practitioner to their solar plexus, where it is converted to positive energy. The practitioner then returns the positive energy to the patient as a vital healing force. In order to avoid injury through this process, practitioners must purify and harmonize themselves through practice and discipline in body, mind, and spirit exercises. 

Results: Traditional Chinese Medical philosophy will be introduced and used to examine the concepts of energy, healing, discipline, and holistic medicine. The various modalities of healing recycling will be demonstrated, including through the hand, the eye, the nose, and the third eye. By practicing healing recycling, practitioners will avoid becoming “wounded healers”, and improve their overall ability to heal.

Conclusions: Practitioners who can contemplate compassion in their medical practice become healers. Without compassion, there is no healing. Without healing, there is no medicine.  Therefore, the practice of medicine needs a better understanding of how to recycle energy. At the same time, greater healing will translate into improved quality of life for patients.

 

P11

Healing at the End of Life: The Voice of the Patient 

Cory Ingram, Mayo Clinic College of Medicine and Mayo Clinic Health System, Mankato, Minnesota, United States

In palliative care we have the privilege to care for seriously ill people and their families.  Some people value capturing their life story or illness journey on film.  I have been fortunate to have been invited into the lives of many people close the end of life for a heartfelt conversation.

On an interactive iPad incorporated in the poster, the recorded narrative of patients and one bereft spouse the poster audience will experience the lived experience of people close to the end of life as they reflect on their lives.  The narratives will demonstrate how each lived with a new found improved quality of life in the face of increasing symptoms, declining functioning and the approaching end of life; otherwise known as healing.  Topics of healing and quality of life, patient-centered care, dignity, human development, spirituality and love will be the focus of their stories.  The stories lay bare the very practical, emotional, existential, and personal experience central to our provision of whole person care through palliative care.  The poster audience will experience a renewed sense of the impact of a dedicated approach to whole person care as experienced through those on the receiving end.

 

P12

'Flowers Will Bloom': Assessing Support for Survivors of Japan's 3/11 Disaster through the Charity Song

Ikuko Ota, Hiroshima City University, Hiroshima, Japan 

Objective: NHK, Japan’s public broadcast network, produced a theme song in March 2012 to promote public support for survivors of the 3/11 disaster of 2011. The objective of this study is to evaluate how and to what extent this charity song Hana wa Saku (“Flowers Will Bloom”) has contributed to assisting survivors of the disaster.

Methods: First, the song’s characteristics are considered in two categories, (1) the way the original Japanese recording was conducted, and (2) the song itself. Then, the effects on the survivors are assessed through analyzing the actual ways the song was performed and their repercussions covered by the media.

Results: (1) Along with the composer and the lyricist, all singers (thirty-six celebrities) of the original Japanese recording had strong personal links to the region affected by the disaster. In the video-clip performance, each singer relays a phrase of the song, holding a gerbera daisy instead of a baton. This performance has left a lasting impression of connectedness specifically between the survivors and the victims. (2) According to lyricist IWAI Shunji, the song’s words represent “a message from those who lost their lives to the people they left behind.” Repeatedly listening to the fictional messages of their loved ones in heaven, through the voices of the living people trying to provide comfort, have particularly helped young survivors bounce back from their sufferings.

Conclusion: Responding to NHK’s call, more than 10,000 people have posted their amateur performances of the song on the official website by May 2013. All royalties and other proceeds of the song are being donated for recovery efforts for the affected region (28,907,109 yen as of March 2013). Findings demonstrate that, despite differences in its impact among survivors, this charity song can be an effective and accessible means to foster public support for the survivors.

Mind-Body Medicine

 

P13

Impact d'une formation à la gestion du stress sur le vécu de la maladie dans l'insuffisance rénale chronique dans un hôpital universitaire français

Corinne Isnard Bagnis1, Celine Khaldi2

1. Pitié Salpetrière Hospital, Paris, France 

2. Chaire de Recherche en Education Thérapeutique, Fondation UPMC, Paris, France

Introduction : Les patients vivant avec une maladie rénale chronique expriment une franche altération de leur qualité de vie. Parmi les éléments impactant ces résultats, le stress chronique lié à la maladie et ses traitements et la douleur sont des plaintes très prévalentes et insuffisamment prises en charge. Cette étude évalue l'impact de la participation de patients insuffisants rénaux chroniques à un programme de gestion du stress par la méditation de pleine conscience (développé aux USA il y a plus de 25 ans par J. Kabat Zinn).

Patients et Méthodes : L’enquête s’est concrétisée par la réalisation d’un dispositif « d’observation participante » par une sociologue au sein d’un programme MBSR (meditation-based-stress-reduction program) mis en place dans un service de néphrologie et la réalisation d’une enquête longitudinale : suivi des patients après la formation réalisés dans le cadre de « récits de vie ». Les résultats sont qualitatifs et portent sur la gestion du stress, la capacité à prendre soin de soi et à se mettre en posture de résilience.

Résultats : Les premiers résultats permettent de rendre compte d’une amélioration des compétences des patients dans la gestion du stress, dans leur capacité à prendre soin d’eux, à anticiper les difficultés liées à leurs pathologies et à développer des mécanismes de compensation.  L’enquête permet aussi de rendre compte d’une amélioration dans le vécu des malades du système de soin et une vision plus positive de l’hôpital et du rapport avec les soignants.

Discussion et Conclusion : Les programmes d'education thérapeutique peuvent s'enrichir d'interventions pédagogiques orientées vers l'acquisition de compétences necessaires au maintien de soi en vie avec la maladie. L'amélioration de la gestion du stress par la méditation de pleine conscience pourrait être un moyen d'améliorer la qualité de vie des patients et en tous cas de diminuer le stress perçu.

 

P14

Exploring the Relationship Between Subjective Ratings of Mindfulness Practices and Outcomes in Patients Participating in an MBSR Program

Nicolò F. Bernardi, Qinyi Zhao, Patricia L. Dobkin, McGill University, Montréal, Québec, Canada

Objectives: The present study explored relationships between outcomes of the Mindfulness-Based Stress Reduction (MBSR) program and the importance attributed by patients to the mindfulness practices taught.

Methods: Patients with chronic illnesses (46.8% breast cancer; N=126) completed questionnaires pertaining to medical symptoms, stress, and mindfulness, pre- and post-MBSR.  At program completion, each patient rated the importance of the mindfulness practices employed.  Stepwise linear regression analyses were run to investigate associations between changes in outcome variables and subjective ratings of practice importance.

Results: Increases in mindfulness were associated with high ratings of importance for sitting meditation (p LT 0.02) and homework manual (p LT 0.02; Adjusted R2 = 0.10). Decreases in medical symptoms were associated with high ratings for the body scan (p LT 0.01) and small group exercises (p LT 0.01; Adjusted R2 = 0.13). High ratings for the body scan were moderately, albeit significantly, correlated with decreases in perceived stress (p LT 0.01, Adjusted R2 = 0.05). A cluster analysis performed on all 10 of the ratings of practice importance showed that greater importance was associated with better outcomes for all three dependent variables (p LT 0.01).  A qualitative examination of patients’ answers to open-ended questions revealed that incorporating mindfulness practices in daily life was a central component of the lifestyle changes experienced during the course of the program.

Conclusions: Understanding the mechanisms underlying MBSR’s effectiveness is important as this program becomes recognized as an empirically-supported intervention. These results suggest that specific types of practice (concentration vs. the body scan) are related to distinct outcomes (dispositional mindfulness vs. medical symptoms, respectively). Overall, awareness of the importance of practicing is connected to actual program outcomes.

 

P15

Perceived Effects of a Somatic Psychopedagogy (SPP) Program in Nurse Training: An Exploratory Study

Josée Lachance, Pierre Paillé, Jean-François Desbiens, Marianne Xhignesse, Université de Sherbrooke, Sherbrooke, Québec, Canada 

Background: Developed in Europe in the 1980’s, somatic psychopedagogy (SPP) is a formative practice geared toward care giving and support. Characterized as a type of mind-body medicine, it examines how the use of the body and its movement allows for the development of one’s conscience, one’s sense of self and of others, which are all desirable qualities for professionals within the health care sector.

Purpose: To explore if and how SPP training followed by nurses modifies their perception of the quality of their self awareness, their presence in regard to others, as well as their relationship with respect to health and their professional practice.

Methods: Qualitative research based on two types of semi-structured interviews: comprehensive and elicitation. Exploratory interviews with three nurses trained (or in training) in SPP. The content of the interviews was first analyzed thematically then grouped by categories. 

Findings: The three participants perceived a change in the quality of their presence with respect to themselves and to others as well as changes within the nature of their relationships with their patients, colleagues and healthcare team members. Content analysis of the interviews has allowed us to conclude that relationships with the health care team evolved into a better ability to give recognition and a better quality of interaction between members. Participants also reported an increased ability to express their opinions in both their personal and professional lives. A second level of analysis has allowed for the identification of differences between nurses just finishing their first year of training and those having completed the full four-year course. 

Conclusion: Interesting transformations are reported at different levels confirming the relevance of a second phase of the project. The latter will permit to identify whether physicians trained in SPP experience changes similar to those of the nurses, and if so, whether they perceive these as having an impact on their practice.

Mindful Clinical Practice

 

P16

Primary Care and the Ethics of Integrating Genomic Medicine

Vasiliki Rahimzadeh, McGill University, Montréal, Québec, Canada

Objectives: To explore the practical barriers to, and implications of, incorporating genomic technologies in the primary care setting. In evaluating the primary care mission and anticipated role of genomic medicine in conversation with one another, I discuss the ways in which the primary care philosophy problematizes innovations afforded to clinical medicine through whole genome sequencing. I discuss these themes in relation to the evaluation frameworks that must precede full integration, specifically the Analytic validity, Clinical validity, Clinical Utility and Ethical, legal social considerations (ACCE) model. Finally, my analysis will consider the added ethical nuances for integrating genomic medicine in the wake of new standards for healthcare delivery in the U.S.

Methods: I review the literature concerning 1) models for evaluating the applicability of emerging genomic technologies in the primary care setting, namely the ACCE model proposed by the Center for Disease Control, and 2) anticipated changes to primary care delivery through proposed healthcare legislation.
 
Results: Three main facets of primary care delivery problematize full integration of genomic medicine in clinical practice. They include: primary care providers' propensity to maintain therapeutic relationships with patients over the lifecourse, acuity to community health patterns, and gaps in genetic/genomic-specific knowledge among practicing clinicians. Implementation of genomic medicine requires that technologies be adaptable to the heterogeneity of the primary care clinic, in both the diverse populations it serves and broad spectrum of resource availability.

Conclusions: The rapid pace at which genomic technology has fundamentally altered the direction of medical research scene is extraordinary to say the least. The potential benefits for incorporating these innovations depict a clinical landscape that predicts and prevents disease before it manifests, and cares for patients using treatments that are tailored to their own genetic person. The primary care arena presents unique challenges to the evaluation, diffusion and translation of genomic technologies. Yet the same aspects that present limitations also reinforce the reasons why the primary care setting is a critical forum in which to operationalize genomic medicine in practice. With so much dialogue generated around ushering in a new era of medicine, it is unclear whether this is celebrating the novelty of the genomic revolution, or the reinvigoration of a longstanding clinical tradition in patient-centered primary care.

 

P17

Doctor, You Can Be Less Error Prone Right Now 

John Meagher, Dalhousie University, Halifax, Nova Scotia, Canada

The Problem:
From moment to moment, while tending their patients, physicians can slip from:
patience to impatience;
genuine enquiry to assumptions;
attention to the task-at-hand to inattention;
certain doubt to doubtful certainty;
  and from doing what is inconvenient to doing what is convenient.
In summary, one can slip from neo-cortex  to archi-cortex (reptilian brain) emphasis. (The hazardous attitudes associated with aviation and medical mishaps are reptilian in character).  This is expressed: to err is human, the reptilian part.

Objectives: Therefore, to improve decisions, one needs to reclaim the new-brain emphasis, the advocate for the patient’s interests.

Method: To be aware which emphasis one commands, ask oneself a few reptilian-revealing questions. Then counter the reptilian attitude by specific and or generic antidotes to be less error prone.

Conclusion: Doctors should realize that there is also another patient one is tending: the patient called oneself, whose symptoms are haste, egoism and apathy and whose diagnosis is the reptilian brain. While this lesion is inoperable and the prognosis is guarded, yet amid the uncertainty and demands of our medical tending, one can toggle back to patience and doing the inconvenient to reach after fact and reason.

 

P18

Mindfulness-Based Medical Practice: Exploring the Link between Self-Compassion and Wellness

Julie Anne Irving1, Patricia L. Dobkin2, Jeeseon Park-Saltzman2, Marilyn R. Fitzpatrick2, Tom A. Hutchinson2

1. Centre for Addiction and Mental Health, Toronto, Ontario, Canada 

2. McGill University, Montréal, Québec, Canada

Objectives: In light of the detrimental impact of burnout upon clinicians and their patients, the identification of means through which the well-being of health care professionals can be fostered and protected is timely and important.  The present study explored outcomes associated with participation in Mindfulness-Based Medical Practice (MBMP), a program modeled after Mindfulness-Based Stress Reduction which included additional mindful communication exercises to foster the integration of mindfulness in various clinical settings. 

Methods: Physicians, nurses, psychologists, occupational therapists, and social workers enrolled in the 8-week MBMP program.  Participants (N = 110) between the age of 24 and 82 years (M = 46.5, SD = 11.4: 73% women) completed self-report measures prior to and following the program; the Maslach Burnout Inventory, Perceived Stress Scale-10 and the Ryff Scales of Psychological Well-Being. Two process measures designed to capture mechanisms of change were administered: the Mindful Attention Awareness Scale, and the Neff Self-Compassion Scale.

Results: Results from paired-sample t-tests indicated that health care professionals enrolled in MBMP can benefit from the program. Analyses demonstrated significant decreases upon measures of perceived stress [p= .000], emotional exhaustion [p= .000], depersonalization [p= .000], and an increase in personal accomplishment [p= .000] as well as mindfulness [p=.000], self-compassion [p= .000], and well-being [p= .000].  Hierarchical regression analyses indicated that change scores on perceived stress (Beta = -1.46, p LT 0.000) and self-compassion (Beta = 9.02, p LT 0.006) predicted changes in well-being in this sample. Additionally, participants rate perceived importance of having taken part in the course using a Likert-scale from 1-10 (M=8.5, SD = 1.51).

Conclusions: This study suggests that for health care professionals enrolled in MBMP may experience a variety of benefits associated with participation in the program. Further, increases in self-compassion may hold particular implications for well-being in this population.

Narrative Medicine

 

P19

Clinical and Personal Value of Narrative Medicine Writing Workshops for Physicians and Practitioners

Tom Janisse, The Permanente Medical Groups, Kaiser Permanente, Oakland, California, USA

Objectives: We write to tell our stories of patient encounters and come to understand them. A story discovers meaning in medicine. The objective is to write and tell stories of clinical encounters to develop self-awareness, patient perspectives and to demonstrate caring behaviors.

Methods: One session takes 60 minutes (full exercise in poster). Longer sessions have multiple writing opportunities, longer small-table conversations, and a primer on developing character and setting in writing.

Results: Over 8 years, in two conferences and 24 workshops (in 13 cities), 951 participants rated the sessions overall as 4.75 of 5, and 75% would use narrative in their practice. Also, 144 participants attended 20 writing groups.

Selected Participant Comments:

“Reminds me why we became doctors.”

“Taking time to remember that each patient has an unfolding story is life affirming, however I found it startling to consider the doctor as part of the story.”

“The training/sharing I had today will change how I view each patient interaction.”

“Opened my eyes to how important my stories can be, and a new creative outlet.”

“I know the people around my table better in two hours than I know the colleagues I work with everyday.”

“I see this as a wellness mechanism! I am unlikely to meditate or go out for lunch during my busy day, but see myself able to close my office door and take 10 minutes to reflect upon a patient interaction in an attempt to find comfort or meaning there.”

Conclusions: Offering a forum for physicians and practitioners to recall, write and share meaningful clinical moments has professional and personal value, as evidenced by the ratings and comments. Publishing the copyedited writings (with permission) in a medical journal, booklets, or a medical lit-art e-journal heightens the value, and allows others to share the experiences.

 

Nursing

 

P20

A Role for Cancer Nurses: Responding to Distress in Cancer Patients

Margaret Fitch1, Deborah McLeod2, Doris Howell3, Esther Green4

1. Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada 

2. QEII Health Sciences Centre, Halifax, Nova Scotia, Canada 

3. University Health Network, Toronto, Ontario, Canada 

4. Cancer Care Ontario, Toronto, Ontario, Canada

Background: Although all patients experience distress, between 35-45% experience clinically significant levels of distress such as anxiety, depression and adjustment difficulties. Early identification of distress and the provision of relevant interventions is a standard of quality cancer care. Nurses have a critically important role in identifying individuals with distress and providing interventions to manage distress.

Objectives: Our objectives are to define the role of cancer nurses in responding to emotional distress experienced by cancer patients and to document the best practices for implementing a program of screening for distress in ambulatory settings.

Methods: A programmatic approach to screening for distress (6th vital sign) has been implemented in several cancer facilities across Canada. The program includes protocols for screening, algorithms for assessment, and guidelines for evidenced based interventions. Introduction of the programs have included relevant education of nurses and close attention to uptake and utilization of practice guidelines.  Implementation has been mounted within the context of continuous quality improvement and the use of rapid cycle evaluation.

Results: Evaluation of successful program implementation has shown increased patient satisfaction with care. Patient concerns provide the focus for opening conversations with individuals and the basis for planning person-centered approaches to care. Patient concerns are identified through the screening maneuver beyond those related to tumor and side effect management. Nurses are in an excellent position to respond to scores on a standardized distress screening tool as part of their patient assessments. The assessments provide a foundation for individualized or tailored interventions.

Conclusions: Using a concrete programmatic approach, including screening, focused evidence-based assessment and interventions, offers benefits in achieving person-centered care for cancer patients. In busy clinical settings, an intentional effort is needed to implement a programmatic approach to screening followed by appropriate assessment and intervention.

 

P21

Reasons for Returning to the Emergency Department:  Perspectives of Patients and the Liaison Nurse Clinician 

 

Molywan Vat1, Coralie Borduas1, Carol Common2, Andrea Laizner1, 2, Christine Maheu1

1. McGill University Ingram School of Nursing, Montréal, Québec, Canada 

2. McGill University Health Center, Montréal, Québec, Canada

Objectives: The authors wanted to understand the reasons why patients discharged from internal medicine units return to the emergency department within a short term period. The purpose of the study was to explore patients’ perspective of their reasons for returning to the emergency department within fourteen days post-discharge from an internal medicine unit, and to examine how these reasons relate to those determined by the liaison nurse clinician prior to discharge.

Methods: A qualitative descriptive design was selected to develop the study and individual face-to-face semi-structured interviews were conducted with participants. A convenience sample of eight participants was recruited from a major teaching hospital in Montreal, Canada. The study triangulated three different data sources, which were the patient’s perspective through the interview and the liaison nurse clinician’s perspective through the use of two evaluation tools, which were the Bounceback Probability Legend and the LACE Index Scoring Tool.

Results: The participants attributed their return to the emergency department due to 1) being discharged too soon, 2) feeling weak at discharge, 3) having limited discharge instructions prior to discharge, and 4) having limited resources available to rely on for help once home. It was also noticed that participants went through a decision-making process for choosing to return to the emergency department. Additionally, the liaison nurse clinician’s evaluation tools identified different reasons from those the participants had attributed to their return to the emergency department.

Conclusions: The findings suggest that health care professionals must evaluate and assess patients on several components upon their discharge, such as the understanding of their illness, primary concerns, and readiness prior to discharge. The study provides further data in supporting the need of patient’s involvement in the process of discharge planning.

 

Organizational Structure

 

P22

The Role of a Physiatrist (Rehabilitation Physician) in the Palliative Care Team

Chieko Miyata, Tsuji Tetsuya, Saori Hashiguchi, Meigen Liu, Keio University School of Medicine, Tokyo, Japan

Objective: Although palliative care consultation teams (PCTs) have become an integral part of all regional cancer care hospitals, cancer rehabilitation is still in the developing stage in Japan. At our hospital, a physiatrist, or a rehabilitation physician, joined the PCT as a member, and we have been achieving good results. The purpose of this study is to clarify the role of a physiatrist as a member of the PCT by investigating the current status of the PCT at our hospital.

Method: We retrospectively analyzed the records of 144 patients receiving rehabilitation out of 345 patients who had started receiving PCT services from April 2012 to March 2013 at Keio University Hospital.

Results: Among the 144 patients, 67 patients (46.5%) had already received rehabilitation before starting PCT services, and the remaining 77 patients (53.5%) started receiving rehabilitation based on the recommendation by the physiatrist. In the later group, Dietz Cancer Stage Classifications were: preventative, 6.5%; restorative, 40.0%; supportive, 45.5%; and palliative, 9.1%. ECOG-PS were: PS0, 0.0%; PS1, 23.4%; PS2, 29.9%; PS3, 28.6%; and PS4, 18.2%. The main purposes of rehabilitation were: 1) fracture prevention and pain relief of limbs with bone lesions, 2) social support (e.g. measures for the reduction of nursing requirement, assistance in finding social aids, counseling for family members), 3) psychological support, 4) treatment of lymphedema, 5) management of breathlessness, 6) and approaches to swallowing deficits.

Conclusions: Half of the cancer patients started rehabilitation after the intervention by the PCT. Many patients receiving PCT services also needed rehabilitation services and the physiatrist had an important role of evaluating the rehabilitation needs. Physiatrists can act as important members of PCTs to maximize QOL while addressing the physical, psychological, social and spiritual needs of both patients and their families.

 

Other

 

P23

CLEAR: Whole Person Care Model for the Health Sciences Professions

Carla Gober, Kathy McMillan, Loma Linda University Health, Loma Linda, California, United States

Whole-person care has been important throughout the 150-year history of Loma Linda University and Hospital system (now Loma Linda University Health - LLUH). Since the 1950s, the motto is, “To make man whole.” However, up to 2011 there was no corporate-wide understanding of whole-person care, or a model to guide teaching and practice. Connected to this has been the question of whether spiritual care and whole person care were similar categories of understanding.

Objective / Methods: In 2011 a group of nine researchers and clinicians designed a research/development project for the purpose of developing a whole-person care model to guide all teaching and practice at LLUH. A consultation group of approximately 300 researchers, clinicians, students and staff of LLUH were invited to give feedback during the course of the project through online avenues and group forums. This larger group was open to all interested people throughout LLUH. The research/development group considered all comments, critiques and suggestions made by the larger consultation group, with all work public to both groups.

Results / Conclusions: From the process emerged the first draft of a whole-person care model in March of 2012, with the following qualities: measureable, memorable, practical, flexible, and teachable. After several pilot tests, the model was adopted by LLUH as the model to guide all teaching and practice at LLUH. Since that time, the model has been integrated into the orientation of new employees (clinical and university), the teaching practices of three schools (medicine, nursing, and religion) and is being integrated into the remaining four schools by 2014. It is also guiding the development of the online wellness website for the corporation. Finally, it is used to guide two new developments for the School of Medicine:  1) a Narrative Project designed for the first year School of Medicine students, and 2) the Integrative Whole-Person Care Simulation Labs developed for second year School of Medicine students.

The poster presentation will describe the whole-person care model itself, the research/development process behind it, and give examples of how it has transformed teaching and practice in the university and clinical/hospital arenas.

 

Palliative and Hospice Care

 

P24

Watch Over Me©: Therapeutic Conversations in Advanced Dementia 

Cory Ingram, Mayo Clinic College of Medicine, Mayo Clinic Health System, Mankato, Minnesota, United States 

“Watch over me” is a framework and strategies that clinicians can use in providing practical support and counseling to patients with dementia and their families. This framework is intended to address the needs and experiences of simultaneous trajectories of illness experienced by people with dementia and their family caregivers. These experiences can be described through the stages of dementia for the person with the disease and corresponding stages in the family’s journey. Each individual’s and family’s experiences are unique, yet these intentionally simplified schemas provide a context through which to address predictable problems and decisions regarding matters of physical health, living situation and caregiver needs and well being.

Watch Over Me builds on trust between each patient and his or her caregivers, including the person’s chosen proxy decision-makers. It also builds on and fosters trust between a patient and family and the patient’s doctor. Watch Over Me brings the trusting, covenantal values within loving relationships into the processes of planning and caring. This approach complements and balances the contractual values that are protective or defensive and are embedded in medical ethics and advance directives.

Communication with patients and families living with dementia is sometimes difficult and may be uncomfortable for physicians and other professional health care providers, yet it is always valued by patients and families and very often helpful in clarifying people’s perspective and priorities, thereby informing current plans of care.  This presentation will offer practical therapeutic communication strategies to facilitate advance care planning conversations with patients and families as a person with dementia progresses to advanced stages.

Program Management

 

P25

Achieving Person-centered Care: The Need for Multiple Strategies

Margaret Fitch1, 2, Irene Nicoll2, Fay Bennie2

1. Sunnybrook Health Sciences Centre, Toronto, Ontario,  Canada 

2. Canadian Partnership Against Cancer, Toronto, Ontario Canada

Background: Evidence from patient satisfaction surveys, needs assessments, and stakeholder forums provide a clear picture that cancer patients are not receiving the full range of supportive care services that could be of benefit to them. The cancer system needs to undergo a shift toward person-centered care. Such a cultural shift requires concerted effort and multiple strategies to be successful.
 
Objective: The purpose of the Cancer Journey Action Group of the Canadian Partnership Against Cancer is to provide leadership to achieve person-centered care in the Canadian cancer care system.

Methods: The Cancer Journey Action Group has developed and implemented several initiatives to demonstrate how person-centered care can be achieved. The initiatives include programs in screening for distress (6th vital sign), patient navigation, on-line support groups, survivorship care plans projects, cancer transition education, and palliative care/end-of-life education. Tools to support this work have been designed including evidence-based practice guidelines, algorithms, and on-line education modules. Evaluation has focused on program uptake, educational effectiveness, inter-professional teamwork and patient satisfaction. 

Results: All initiatives have been evaluated by patients/survivors as helpful. Issues of importance to patients/survivors are the focus of conversations with, and assessments by, health care professionals. Critical success factors across the respective programs for achieving person-centered care include clarity of a shared vision, leadership, persistent and concerted effort, and consistent messaging in communications. 

Conclusions: Demonstration projects undertaken for each topic area have provided an excellent opportunity to learn about best practices to implement the respective approaches. Guiding principles for implementation and relevant tools/resources have been developed as a result. Although progress toward person-centered care is evident, intentional and concerted efforts are necessary to sustain momentum of these efforts in routine clinical practice.

 

Research

 

P26

Persons with Early-stage Dementia Reflect on Being Outdoors: A Repeated Interview Study

Annakarin Olsson1,2, Claudia Lampic3, Kirsti Skovdahl2, Maria Engström1,4

1. University of Gävle, Gävle, Sweden 

2. Örebro University, Örebro, Sweden 

3. Karolinska Institute, Stockholm, Sweden 

4. Uppsala University, Uppsala, Sweden 

Objectives: The aim was to describe how persons with early-stage dementia reflect on being outdoors.
 
Methods: A purposive sample of 11 persons with early-stage dementia, living in Sweden, was repeatedly interviewed. Data were analysed using qualitative content analysis.

Results: The persons with dementia described being outdoors as a confirmation of the self. The confirmation of their ability to maintain desired activities, despite the dementia disease, was important to them. However, some confirmations were not positive; the realization that one could no longer perform certain activities could be devastating. Two sub-themes emerged: Shifting between “still being part of it all” and a sense of grief and loss and striving to keep on despite perceived barriers. Past but no longer possible outdoor activities were greatly missed, and the informants longed to be able to perform these activities once again. First sub-theme was based on the categories sensory experiences, social interaction, freedom and independence and self-confidence. “Being part of it all” was related to external input (sensory stimulation), internal feelings (a sense of freedom and independence) and relations to others (social interactions). When reflecting on being outdoors, the informants described different kinds of barriers and how they dealt with them. Barriers were mentioned in relation to their own abilities (now and in the future), but also in relation to the environment. To resolve possible difficulties associated with being outdoors, they used various adaptation strategies. Despite the described barriers, being outdoors was of great value to them.

Conclusion: Being independently outdoors seems to contribute to well-being and feelings of self-worth among persons with early-stage dementia. If a person with dementia, despite cognitive limitations, wants and is able to be independently outdoors, it is important for relatives and healthcare staff to encourage and facilitate this, e.g., by discussing adaptation strategies to deal with orientation problems.

 

P27

The International Centre for Communication in Healthcare: Creating Safer and More Compassionate Healthcare Systems around the World

Diana Slade1,2, Christian M.I.M. Matthiessen1, Elizabeth A. Rider3, Jack Pun Kwok Hung1

1. Hong Kong Polytechnic University, Kowloon, Hong Kong 

2. University of Technology Sydney, Sydney, New South Wales, Australia 

3. Harvard Medical School, Boston, Massachusets, United States

Background:  The role of communication in healthcare receives increasing attention, yet little research exists that brings together perspectives from interprofessional healthcare researchers and practitioners with linguists and communication specialists. The International Centre for Communication in Healthcare[1] is a response to increasing recognition of the central role of communication and relationships in the delivery of safe, effective and compassionate healthcare.

Objective: To develop a worldwide, multidisciplinary collaborative of internationally recognized healthcare professionals and communication experts working together to translate research into education and practice to improve patient safety, communication and relationships in healthcare.

Methods: The International Collaborative for Communication in Healthcare (a precursor to the Centre) began in 2010, and was founded at Hong Kong Polytechnic University (PolyU) in March 2011. We initiated research collaborations and presented colloquia, workshops and papers at international conferences.

Results: The Centre, co-convened by PolyU and University of Technology, Sydney, was formally launched at PolyU in June 2013 with over 50 members from over 10 countries. The Centre is developing a strategic research agenda for communication in healthcare to improve the quality and safety of patient care, and to mobilize knowledge and expertise gained from research to guide teaching and implementation of communication skills and compassionate care in healthcare education and practice.  In an early initiative in 2011, we created the International Charter for Human Values in Healthcare[2], a collaborative effort involving people, organizations and institutions around the world working together to restore core human values to healthcare. The values of the International Charter inform the Centre’s research, education and practice initiatives. 

Conclusions: Effective communication is increasingly recognized as integral to safe, effective, and compassionate healthcare. The International Centre for Communication in Healthcare brings together interdisciplinary researchers, educators and practitioners from diverse disciplines to explore and improve communication and relationships in healthcare settings around the world.

References:
1. The International Centre for Communication in Healthcare.  Hong Kong Polytechnic University and University of Technology, Sydney. http://icchweb.org 

2. The International Charter for Human Values in Healthcare. December 2, 2012. http://charterforhealthcarevalues.org

 

P28

Proposed Consensus-Based Canadian Integrative Oncology Research Priorities

Laura Weeks1, Dugald Seely1, 2, 3, Lynda Balneaves4, Heather Boon5, Anne Leis6, Doreen Oneschuk7, Stephen Sagar8, Marja Verhoef9

1. Ottawa Integrative Cancer Centre, Ottawa, Ontario, Canada 

2. Canadian College of Naturopathic Medicine, Toronto, Ontario, Canada 

3. Ottawa Hospital Research Institute, Ottawa, Ontario, Canada 

4. University of British Columbia, Vancouver, British Columbia, Canada 

5. University of Toronto, Toronto, Ontario, Canada 

6. University of Saskatchewan, Saskatoon, Saskatchewan, Canada 

7. University of Alberta, Edmonton, Alberta, Canada 

8. McMaster University, Hamilton, Ontario, Canada 

9. University of Calgary, Calgary, Alberta, Canada

Objectives: An increasing number of integrative oncology programs are being established across Canada that offer a combination of complementary and conventional medical treatments in a shift towards whole-person cancer care. It was our objective to identify consensus-based research priorities within a coherent research agenda to guide Canadian integrative oncology practice and policy moving forward.

Methods: Members of the Integrative Canadian Oncology Research Initiative and the Ottawa Integrative Cancer Centre organized a 2-day consensus workshop, which was preceded by a Delphi survey and stakeholder interviews.

Results: Eighty-one participants took part in Round 1 of the Delphi survey, 52 in Round 2 (66.2%) and 45 (86.5%) in Round 3. Nineteen invited stakeholders participated in the 2-day workshop held in Ottawa, Canada. Five inter-related priority research areas emerged as a foundation for a Canadian research agenda: Effectiveness; Safety; Resource and Health Services Utilization; Knowledge Translation; and Developing Integrative Oncology Models. Research is needed within each priority area from a range of different perspectives (e.g., patient, practitioner, health system) and that reflects a continuum of integration from the addition of a single complementary intervention within conventional cancer care to systemic change. Participants brainstormed strategic directions to implement the developing research agenda and identified related opportunities within Canada. A voting process helped to identify working groups to pursue strategic directions within the interest and expertise of meeting participants.

Conclusion: The identified research priorities reflect the needs and perspectives of a spectrum of integrative oncology stakeholders. Ongoing stakeholder consultation, including engagement from new stakeholders, is needed to ensure appropriate uptake and implementation of the Canadian research agenda.

 

P29

Person-Centred Dentistry: When Do We Start?

Nareg Apelian1, Jean-Noel Vergnes1,3,4, Christophe Bedos1,2

1. McGill University, Montréal, Québec, Canada 

2. Université de Montréal, Montréal, Québec, Canada 

3. Centre Hospitalier Universitaire de Toulouse, Toulouse, France 

4. Université Paul Sabatier, Toulouse, France

Objectives: Although most health professions have adopted person-centred approaches in the last decades, dental professionals still rely on traditional paternalistic models. The objective of this research was to develop a model of person-centred care in dental practice.

Methods: Adopting an action-research approach, we started our process by adapting Stewart and colleagues' model of person-centred care to the field of dentistry. We then implemented and tested the new clinical approach in a private dental office of Montreal, Canada. During several months, an academic researcher observed the clinical activities of a dental practitioner, who was also the first researcher.  At the end of each appointment, the observer and the practitioner shared their observations about the encounter and evaluated the clinical approach. Both suggested improvements to the model and implemented solutions to the next patients. After 39 rounds of observation-evaluation-improvement, a form of saturation was reached in the development of the clinical approach.

Results: The clinical encounter goes through four different stages. The first stage is how the relationship is built through an open dialogue on illness, fears and expectations. The second stage consists in gathering clinical information through examination, tests and questioning. The third stage is a disease-centered presentation of the results of the examination. The final stage is the development of a treatment plan after establishing a common ground through frank discussions and shared decision making.  From this approach, a model emerged consisting in a stage of understanding, followed by planning, intervention, then back to understanding. This cycle takes place within the context of a patient-dentist relationship with mutual trust. This relationship, central to the encounter, acknowledges the whole-person dimension and psychosocial context of each party.

Conclusions:  We hope this model will inspire other professionals and teaching institutions to develop their own approaches by using it as a theoretical framework.

 

Self-Care

 

P30

The Caregiver’s Wandering: The Quest for Identity Integration in the Workplace Using Reflection, Talking Circles, and Creative Expression 

Pascale Annoual, Arts, Racines and Therapies, St-Laurent, Québec, Canada

These workshops are inspired by the observations of the author in the field of mental health services delivery.  The way the caregiver’s role is interpreted is different between the caregiver and the management team - the clinician cannot imagine her professional commitment without considering personal values and motivations, whereas the employer considers personal motivations an impairment to professional effectiveness.  This may explain the high rate of burnout for the practitioners working in already stressful conditions in healthcare.  Could the reconciliation of personal and professional dimensions prevent this disavowal of human capital?  Holistic art therapy proposes to integrate the divide, to repair the rupture often experienced by the caregiver in clinical practice.  Furthermore the ethnopsychiatry approach helps to reintegrate bio-psychosocial and spiritual narratives to rebalance the power struggles of workplace which may undermine the professional’s performance and fundamental raison d’être. The caregiver can become whole, balancing interpersonal, interdisciplinary and intercultural dimensions in healthcare practices.

 

Social Media

 

P31

The Information Senses of Whole Person Care: A PatientsLikeMe.com Case Study

Robert Douglas Ferguson, McGill University, Montréal, Québec, Canada

Objectives: Whole Person Care (WPC) situates the act of curing within a larger framework of healing, in which meeting psychological and social needs of patients during times of illness are also considered integral to patient outcomes and wellbeing. That is, WPC entails greater attention to how information behaviors can balance competing biological, psychological, and social dimensions of patient care within the therapeutic relationship (Hutchinson, 2011; Kaslow et al., 2007; Donadio, 2005, Mount, 2003).  But what role does documentation play in patient-provider communication and meeting the biopsychosocial needs of patients via WPC? This poster visually represents a content analysis of data collected from PatientsLikeMe.com using Marchionini’s (2010) Information Sense Framework to reflect upon the role of personal health information management in WPC.

Methods: Over an 8-month period starting in September 2010, the researcher engaged in participant-observation within PLM’s Mood Disorder Community, a social networking site and research platform for patients. Grounded Theory (Charmez, 2006; Strauss and Corbin, 1987) was used to analyze site members’ virtual interactions and evaluate the subjective impact of maintaining and sharing a public personal health record (PHR) with off-website care providers.

Results: Observations confirm Information Senses is viable for interpreting the WPC functions of PHR. Site members described online PHR as effective self-management tools, by helping patients visualize, track, and understand changes in their health between visits; and enhancing the subjective quality of provider-patient relationships and communication during visits.

Conclusions: Maximizing potential benefits entails reconceptualization of medical documentation beyond diagnostic, care-coordination, and audit functions for care providers exclusively. PHR also serve communicative and reminding functions that are underexploited. Leveraging documentation to enhance the quality of communication and trust between patients and care providers, through patient-accessibility health records for example, offers a viable route towards the realization of WPC and meeting biopsychosocial needs efficiently.

 

Social Movement

 

P32

Dying with Dignity in Québec: Palliative Care, Moral Expertise, and the Debate on Euthanasia

Nora Hutchinson, Cambridge University, Cambridge; Wellcome Trust, London, United Kingdom

On March 22, 2012, the Select Committee on Dying with Dignity of the National Assembly of Québec released its final report recommending the adoption of “medical aid in dying” in the province of Québec, Canada.  The majority of palliative care physicians, professed experts in end of life care, rejected the committee’s conclusion.  And yet, the recommendation of the committee, in framing euthanasia as “medical aid in dying,” placed the practice squarely within the realm of their putative expertise. 

The objective of this project is to examine the role of palliative care physicians in the Dying with Dignity debate in Québec and to answer the following question: why were palliative care practitioners unable to influence the outcome of the debate?  My methods include a detailed analysis of the committee proceedings of the Select Committee on Dying with Dignity and a review of the sociological literature on committees and on expertise, the philosophical literature on euthanasia, and the historical literature on palliative care.

I draw broad conclusion about: (i) committees, and the way in which committee formation and format prioritize certain societal values; (ii) medical expertise, and the devaluation of certain forms of knowledge in the evidence-based medicine framework; (iii) moral expertise, and its presumed absence in Western democratic society.

 

Spirituality

 

P33

Spirituality in Medicine

Steven Aung, University of Alberta, Edmonton, Alberta, Canada

Objectives: Spirituality is a vital component of whole person care; healing always involves body, mind, and spirit. We can anticipate the resolution of health problems holistically by providing correct physical, mental, and spiritual alignment to our dear patients. Alignment is accomplished both through the patients’ awareness of relaxation and self-care, and the harmonization and purification of the healing energy of the practitioner.  Therefore, the patient and practitioner engage upon a healing journey through spiritual connection that vitalizes the process of medicine.

Methods: Traditional Chinese Medicine has employed a physical, mental, and spiritual approach for thousands of years. Enhancing spirituality in medicine involved strengthening exercises of the body, mind, and spirit. Patients are encouraged to increase their awareness of themselves on each level. Practitioners should learn to cultivate positive healing energy that will enhance their medical practice. Qi Gong posture, breathing, phonation, and visualization exercises will be demonstrated to introduce Traditional Chinese Medical philosophy and practice.

Results: Session participants will receive a general orientation to Traditional Chinese Medicine and learn specific skills in Qi Gong. Patients will learn greater attention to physical, mental, and spiritual alignment. Practitioners will learn to engage themselves for whole person healing, by understanding the relationship between patient and the practitioner. 

Conclusions: Spirituality is vitally important in medicine to enhance the quality of both its preventive and healing aspects. Treatment is a two way relationship. Practitioners must treat patients with good intentions. Patients must prepare for a healing process that engages them on the physical, mental, and spiritual levels. Practitioners and patients, therefore, must work hand in hand, heart to heart, towards the goal of health and well-being.

 

P34

Faut-il parler de l'âme? Réflexions à propos de 2 patients.

M-Christine Kopferschmitt-Kubler 1,2, Philippe Fraisse 1, Annick Kocher3, Alexa Muller1, Jonathan Graffi1, Denis Ledogar 3, Elisabeth Quoix 1

1 Service de Pneumologie HUS, Strasbourg, France 

2 Service de soins palliatifs HUS, Strasbourg, France 

3 Aumônerie HUS, Strasbourg, France

Deux patients souffrant d’un cancer broncho-pulmonaire métastatique ont évoqué l’âme.
Patient 1 : il ne signale aucune inquiétude face à la mort « je suis au clair avec ma spiritualité ». Il croit en une vie après la mort, avec lumière et amour, dans la paix de Dieu. De retour à domicile, il écrit par mail avant son décès : « je crois avoir trouvé une approche pour parler de la spiritualité. Référez-vous aux temps anciens et aux médecines orientales ou africaines, quand les médecins étaient aussi des médecins de l’âme »
Patient 2 : une forte angoisse a cessé brutalement «  Docteur, j’ai découvert que j’avais une âme et qu’elle est belle ». Cette découverte est liée à la discussion avec un chaman, accompagnant sa famille. Ce patient a évoqué un grandissement de son âme, et son immortalité.
Des étudiants hospitaliers (EH, 26/31) ont participé à une étude par questionnaire sur la perception face à la fin de vie. Pour 21 EH (81%) l’âme existe. Leurs définitions parlent de souffle, présence, croyance, entité abstraite, invisible, ce qui donne la vie, ce qui reste après la mort, Divine ou moléculaire. Parmi eux, 10 pensent que l’âme est immortelle, 2 non, 7 doutent et 2 ne savent pas. La croyance la plus fréquente est l’existence de l’âme (81%), suivie de l’existence de Dieu/Puissance supérieure (62%), puis d’une forme de vie après la mort (54%).

Conclusion : Un patient évoque l’âme et son immortalité. L’autre souhaite un médecin de l’âme. Même si notre civilisation ne parle plus de l’âme, l’existence de l’âme est une croyance forte chez les étudiants hospitaliers. Face à une souffrance spirituelle, faut-il aborder la question de l’âme et en parler? En médecine globale, faut-il redonner, à côté du corps, une place à l’âme ?

 

Theory and Philosophy

 

P35

Integral Medicine: Treating the Whole—Patient, Provider, Healthcare System

David Petrie1, Joel Kreisberg2, Gary Huffaker3, E. Baron Short4, Olga Jarrín5

1. Dalhouse University, Halifax, Nova Scotia, Canada 

2. Integral Health and Medicine Center, Berkeley, California, United States 

3. Kaiser Permanente, Riverside, California, United States  

4. Medical University of South Carolina, Charleston, South Carolina, United States 

5. University of Pennsylvania, Philadelphia, Pennsylvania, United States

Purpose: Integral Medicine is an approach to health, disease and healing that invites multiple perspectives and modes of inquiry to synergistically support healing for patients, providers and health care systems.

Approach: Integral Theory is a framework for organizing information that considers four perspectives essential to view the whole patient simultaneously – any or all of which may illuminate health or illness in a patient, population or system: “Interior-Individual” (mind, psycho-spiritual development, etc.), “Exterior-Individual” (molecules, cells, organs, bodies, etc.), “Interior-Collective” (cultural, ethical practices or norms, etc.), and “Exterior-Collective” (socioeconomic, environmental system, etc.).

Major Points: In practice, the application of Integral Theory to patient care can lead to four quadrant diagnosis and therapy for everything from status asthmaticus to chronic fatigue syndrome. When applied to the personal and professional development of providers an Integral Theory framework may improve critical thinking, ethical reasoning, mindfulness and empathy. At the healthcare system design level, patients have better outcomes when cared for by organizations ranked as having better work environments (where nurses report low rates of burnout, adequate time with patients, good relationships with colleagues, and opportunities for advanced training and continuing education).

Conclusions: Treating the whole person becomes more than simply including body, mind and spirit.  The whole person includes multiple epistemological ways of knowing.  Building on Integrative, Alternative, Complementary, Evidence-based Medicine, and Values-based care, Integral Medicine offers a methodology for integrating the “best” of each of these medical methodologies. Integral Theory, in this respect, can act as a meta-theory weaving together many of the converging concepts emerging in the service of whole patient care. Integral methodology also provides a common map/language for knowledge integration/translation and a shared inter-professional approach to whole patient care at the patient, population and health system levels.

 

Wellness

 

P36

Imagine the poss-ABILITIES!

Therapeutic  Recreation: An Integral Aspect of Whole-Person Health Care 

Erica Botner, Concordia University; Recreotherapy Montréal, Montréal, Québec, Canada

The word recreation is really a very beautiful word. It is defined in the dictionary as “the process of giving new life to something, of refreshing something, of restoring something.” This something, of course, is the whole person.

Bruno Hans Geba

Background: The purpose of Therapeutic Recreation is to enable all individuals to improve quality of life, and achieve optimal health through meaningful experiences in recreation and leisure. We believe in the inherent capacities of individuals for wellness, personal growth, happiness and freedom, with or without absence of disease.  Therapeutic Recreation is a profession which provides service to, and advocates for individuals with disabilities, illnesses, and other conditions in clinical, community and educational settings. We recognize that everyone has the right to have access to and experience the healing benefits from recreation and leisure opportunities. Therapeutic Recreation follows a systematic process of developing a therapeutic relationship, assessment, goal setting, program development, implementation through individual and group facilitation, documentation and evaluation. Programs are designed based on the strengths, interests and needs of the participants and promote improving wellness within the physical, emotional, spiritual, behavioural and social domains (according to the participant and their context) and to educate individuals about the skills and resources required to participate in recreation and leisure. We use evidence-based practice to create outcome-based interventions suitable to the participant’s abilities.

Content: Presentation will be descriptive, drawing attention to the profession of Therapeutic Recreation and how it fits well with the whole person approach. Topics include 

Evidence: Current research indicates a significant number of positive health outcomes resulting from participation in Therapeutic Recreation programs such as:

  • Improved physical, cognitive, social and emotional functioning
  • Leisure and life skill development to enhance functional independence, self worth, and quality of life of individuals and their families
  • Adjustment to disability and/or illness and post-traumatic growth
  • Reduced boredom, stress, anxiety, and agitation
  • Reduced decline in physical, cognitive, and psychosocial functioning and as a result reduce the need for health care services
  • Reduced secondary disability and associated higher health care costs

Conclusion: There is strong evidence that Therapeutic Recreation interventions are healing, support wholeness, and can have a major positive impact in the outcomes of people served. Thus, Therapeutic Recreation should be an integral part of any multi-disciplinary health care team that uses a whole-person care approach.

 

 

For more information, please visit the Congress' website: http://www.wpc2013.ca/