use of portraiture to foster humanistic care

It has been said that a picture says a thousand words, that art should speak for itself. Within the social sciences, there is recognition that images are not merely illustrations, but “texts” that can be read, studied and interpreted in different ways: they are visual narratives. When we look at a work of art, we respond with our own thoughts, feelings and ideas about what it communicates. When we look at a portrait specifically, we are not just looking at a picture of an individual, we are looking at a picture of someone being looked at. It is a visual record of an interaction, as much as a likeness of the person. The artist-sitter relationship has much in common with the doctor patient relationship involving trust, attention, and an openness to ambiguity and creativity. As clinicians that are tired and feeling overwhelmed, we may objectify patients. Engaging with art can help hone our skills to consistently see the whole person. It provides freedom to sit with ambiguity and maintain curiosity and can help us become more flexible in our thinking, to hold multiple possibilities in mind at the same time. Viewing art in a group provides opportunities to understand and appreciate others’ perspectives. Drawing on multiple portraiture projects related to pediatric epilepsy, youth mental health and dementia, this presentation will provide constructive ways in which portraiture can be used to foster humanistic, patient centred care, and to understand the power of distributed cognition.

impact of virtual care on relationship centered care: Observations of a family physician

The COVID-19 pandemic propelled many physicians and their patients into an unfamiliar world of virtual care. This presentation is based on the perceptions of a family physician/ teacher/ researcher with 43 years of interest in, and promotion of, a strong doctor-patient relationship. It will describe a protocol that governed how tele-medicine and video-conferencing took place over nearly 18 months in his practice. It will then describe observed positive and negative impacts for the patients, their family members, the physician, and members of the family medicine health care team. Interpretation will be made about what such observations mean for the doctor-patient relationship.

Satisfaction with Telepsychiatry during the COVID-19 pandemic: Patients’ and psychiatrists’ report from a University Hospital

Background: The COVID-19 pandemic has led to important changes in the approach to patients worldwide. Different agencies have proposed and implemented telemedicine-based care services in order to ensure access to health care for all people. Aim: The aim of this study was to determine the satisfaction of patients using the Telepsychiatry service offered by the Department of Psychiatry of the Hospital de Clínicas (National University of Asunción, Paraguay). Methods: A cross sectional and descriptive study has been conducted. Participants were recruited through a phone-based survey. Satisfaction with Telepsychiatry has been measured with an adapted version of a satisfaction survey in Teleneurology. As a complement, psychiatrists from the Hospital de Clínicas were also interviewed about their rate of satisfaction with Telepsychiatry. Results: A total of 530 patients were included, 51.3% of whom were women. The consultation satisfaction scale ranged between 2.15 and 4.30 with a mean score of 3.02 ± 0.32. Cronbach’s alpha for the scale was .897, indicating a good internal consistency. Patients’ satisfaction was higher for the perception of Telepsychiatry and lower for the doctor-patient relationship. Of the physicians, 87.5% were satisfied with the Telepsychiatry service. Conclusion: The satisfaction overall score indicates patients’ general satisfaction with the quality of care in Telepsychiatry, mainly regarding the perception of health care. and lower satisfaction with the doctor-patient relationship. Nine out of 10 psychiatrists felt satisfied with the Telepsychiatry service and considered that the degree of patient’s satisfaction was acceptable during the Telepsychiatry consultation.

Bioethics and Nutrition in the Older Adult

At the professional practice of nutrition, as in the rest of the health disciplines, it is necessary to follow high standards in order to establish the best doctor-patient relationship and the greatest benefit in the user's health. In a special way, the factors that are indexed in the nutrition of the elderly must be specified; since, during the stage of old age, individuals present physiological and psychosocial changes that affect their nutritional status, which lead to both overweight and malnutrition, implying malnutrition problems. Thus, recommendations are established for both the ethical aspects and the components that must be considered for the adequate feeding of the elderly, including the ethical considerations involved in the interventions.

Collaborative domestication

This article proposes an extension to domestication theory by introducing the concept of collaborative domestication, which we define as the ongoing mutual influence and interdependence of technology users in specific interactional contexts. This concept arose from our investigation of how patients integrate healthcare-related video consultations into their daily lives. In Denmark, the Covid-19 pandemic has expedited the implementation of video consultations in general practice, yet little is known about their use in this context. To address this, we conducted 13 interviews with patients and analysed the interviews from the perspective of domestication theory. We find that the general practitioner plays a central role throughout patients’ domestication processes, and the doctor–patient relationship significantly influences how patients experience video consultations. We argue that there is a collaborative aspect to domesticating video consultations that needs to be considered in both future studies and the ongoing implementation of video consultations

Surgeons’ non-transparent facemasks challenge the physician–patient relationship in the orthopedic outpatient clinic of a tertiary university hospital during the COVID-19 pandemic: a prospective cohort study of 285 patients

Background and purpose — Facemasks play a role in preventing the respiratory spread of SARS-CoV-2, but their impact on the physician–patient relationship in the orthopedic outpatient clinic is unclear. We investigated whether the type of surgeons’ facemask impacts patients’ perception of the physician–patient relationship, influences their understanding of what the surgeon said, or affects their perceived empathy. Patients and methods — All patients with an appointment in the orthopedic outpatient clinic of a tertiary university hospital during the 2-week study period were included. During consultations, all surgeons wore a non-transparent (first study week) or transparent facemask (second study week). Results of 285 of 407 eligible patients were available for analysis. The doctor–patient relationship was evaluated using the standardized Patient Reactions Assessment (PRA) and a 10-point Likert-scale questionnaire ranging from 0 (strongly disagree) to 10 (strongly agree). Results — A non-transparent facemask led to more restrictions in the physician–patient communication and a worse understanding of what the surgeon said. Patients’ understanding improved with a transparent facemask with greatest improvements reported by patients aged 65 years and older (non-transparent: 6 [IQR 5–10] vs. transparent: 10 [IQR 9–10], p < 0.001) and by patients with a self-reported hearing impairment (non-transparent: 7 [IQR 3–7] vs. transparent: 9 [IQR 9–10], p < 0.001). The median PRA score was higher when surgeons wore a transparent facemask (p= 0.003). Interpretation — Surgeons’ non-transparent facemasks pose a new communication barrier that can negatively affect the physician–patient relationship. While emotional factors like affectivity and empathy seem to be less affected overall, the physician–patient communication and patients’ understanding of what the surgeon said seem to be negatively affected.

The Effects of a Participatory Intervention in Mental Health Units on Nurses’ Perceptions of the Practice Environment: A Mixed Methods Study

BACKGROUND: The practice environment influences the quality of care and the nursing outcomes achieved in their workplaces. OBJECTIVE: To examine the perception of the clinical practice environment among nurses working in mental health units in the context of their participation in an action research study aimed at improving the nurse–patient relationship. METHOD: An explanatory sequential mixed methods study was designed. The data were collected in three phases in 18 mental health units ( n = 95 nurses). Quantitative data were collected through the Practice Environment Scale of the Nursing Work Index, and qualitative data were collected through reflective diaries and focus groups in the context of participatory action research. RESULTS: The nurses’ assessment of their practice environment shifted from positive to negative. Nurse manager leadership was the aspect that worsened the most. In addition, the perception of their participation in the affairs of the center and nursing foundations for quality of care decreased. The nurses considered it essential to be able to influence decision-making bodies and that the institution should promote a model of care that upholds the therapeutic relationship in actual clinical practice. CONCLUSIONS: Nurses perceived that they should be involved in organizational decisions and required more presence and understanding from managers. Furthermore, nurses stated that institutions should promote nursing foundations for quality of care. This study contributes to understanding how nurses in mental health units perceive their work environment and how it affects the improvement of the nurse–patient relationship in clinical practice.

Evaluation of Patient Satisfaction and Patient-physician Relationship in an Out- Patient Department Re-engineered through a Health Information Management System: A Descriptive Study Done at a Major Women’s Hospital in Sri Lanka

Introduction: Health information management is one of the major pillars in a health system that improves the effectiveness and efficiency of health services. It is essential to assess the patient perception towards re-engineered services provide through Hospital Information Management Systems (HIMSs) and how this implementation affects the doctor-patient relationship. The objective of the study was to describe the extent of patient satisfaction towards Out-Patient Department (OPD) services, pharmacy service and patient physician relationship in the OPD, re-engineered through a HIMS, at the Castle Street Hospital for Women (CSHW), Sri Lanka. Methods: A descriptive cross-sectional study was carried out among 362 out-patients aged over 18 years attending the OPD of the CSHW during 2018-2019. Consecutive sampling method, and an interviewer-administrated questionnaire were used to collect data. The quantitative analysis was done using the SPSS software version 23. The sentiment analysis was performed to analyze comments given by patients using the Rapid Miner software. Results: All participants were females with a mean age of 41years (±13.58). Almost all participants were satisfied with overall services provided by the OPD (99.7%) and the pharmacy (98.4%). The majority (65.3%) agreed that implementation of the HIMS had improved the doctor-patient relationship. All reported comments regarding the re-engineered services of the OPD were ‘positive’. The study also suggests considering providing information in all common languages while announcing the patient’s OPD number at the waiting area in future implementations. Conclusions: The majority of patients were satisfied with the overall OPD services provided through implementation of the HIMS at the CSHW, Sri Lanka. Keywords: Health information systems, Hospital information management system, Outpatientdepartment, Patient-physician relationship.