Fear Of Embarrassment Research Articles

Psychological safety, the hidden curriculum, and ambiguity in medicine

Psychological safety is a feeling that individuals are comfortable expressing and being themselves, as well as comfortable sharing concerns and mistakes without fear of embarrassment, shame, ridicule, or retribution. It has long been recognized as part of successful patient safety and quality improvement processes. However, in the realm of medical education, psychological safety is a relatively unknown concept to many educators and learners alike. Learners, whether students or postgraduate trainees, are in a phase of cognitive apprenticeship whereby they learn not only skills and knowledge from teachers as part of an explicit and formal curriculum. At the same time, a hidden curriculum is also part of the learning environment in the form of norms, values, and behaviors exhibited by teachers. These norms, values, and behaviors become part of the culture of the clinical learning environment. The vulnerability of learners in this environment is magnified by the hierarchal nature of medicine, and the complexity, uncertainty, and the ambiguity inherent to medical conditions. This is especially true of cognitive specialties such as rheumatology. Educators who engage in unprofessional behaviors that result in learner humiliation and shame may serve to dampen productive discourse and scientific dialog. Therefore, educators must embrace psychological safety to foster learning and facilitate high-performing teams in the clinical learning environment.Key Points• Psychological safety improves communication and teamwork by allowing individuals to be comfortable expressing and being themselves, as well as comfortable sharing concerns and mistakes without fear of embarrassment, shame, ridicule, or retribution.• Commonly studied in the context of patient safety and quality improvement, psychological safety should extend towards medical education particularly in the context of allowing medical students and postgraduate trainees to be able to voice clinical reasoning in the face of ambiguity.• Educators take on a leadership role when having learners under their supervision; as leaders, educators are the prime movers of psychological safety• Learners in the process of developing their self-identity in the context of their chosen profession adopt not only knowledge and skills within the framework of an explicit and formal curriculum but also norms and values from daily behavior and language educators present in the clinical learning environment of learners; these norms and values are collectively part of the hidden curriculum.

Childhood constipation

Constipation is a common problem in childhood. It is often under-reported and families may delay seeking help due to fear of embarrassment and a negative response from healthcare professionals. Healthcare professionals may also underestimate the impact of constipation on the child and their family and this may subsequently contribute to poor clinical outcomes. Although it is rarely life-threatening, many children and young people experience psychological, social and educational consequences that require prolonged support. Signs and symptoms of childhood constipation are often poorly recognised. Delayed diagnosis, suboptimal therapy and lack of understanding of the condition often contribute to the ongoing symptoms and multiple medical consultations.

From Fear of Loss to Shalom : Theological Reflection on Dementia

Modern society values competence, intelligence and autonomy, it devalues those who are unable to demonstrate their ability to communicate and experience problems with cognition. Beyond the question of why dementia occurs, what this means for those living with dementia gives families and friends a significant challenge. The challenge which dementia brings raises questions regarding not only what it means to remember, but also what it means to be human. As a theological discussion, this paper considers the stories of people living with dementia and how the scientific discovery of dementia brings fear of loss of self and relationships around us, where assumptions are made about people with dementia accompanied with the fear of embarrassment by stigma. After a few theological considerations, I recount the stories of people living with dementia and reflect on them, particularly regarding the issue around the meaning of loss. This paper also suggests ways in which the church community may respond to the need to care for people with dementia and their families; by holding the person’s identity rather than being threatened by them after the diagnosis; and by being attentive to the need for moral solidarity and care for people with dementia. As implicated, the radical gesture of Christian hospitality in communion is proposed for the Church to demonstrate the imminent presence of God’s shalom to hold people with dementia and their identity together in the body of Christ. This paper is also a small tribute for my dear friend, Ruth, who had lived her life in honoring Jesus regardless of Alzheimer’s related dementia.

Health Sciences Lecturers and Students’ Perspectives on the Ethical Aspects of Peer Physical Examination (PPE)

Globally, universities make use of peer physical examination (PPE) in health professions students’ teaching of physical examination skills. PPE has many educational benefits, such as teaching normal anatomy and function, development of compassion and empathy, to feel what it is like to be examined from a patient’s perspective, improvement of communication skills, correcting errors in technique and improve confidence. The benefits for patients include protection from repeated examinations by unskilled students. The aim of the study was to investigate health sciences students’ perceptions of the ethical aspects of PPE. A qualitative investigation, which included two focus group interviews with students and one with lecturers, was used for data collection. Most students and lecturers regarded PPE as beneficial, as it provides a safe environment for students in the health sciences to improve their clinical competence and confidence, without fear of embarrassment or failure. Students stated that PPE promoted the development of empathy with and respect for their patients. It was suggested that in a culturally diverse society, guidelines specifically related to religious customs and convictions should be provided to give students an indication of appropriate and acceptable behaviour towards fellow students when practising PPE. The use of PPE in the training of students in the health professions should support the ethical principles of Beauchamp and Childress, namely beneficence, non-maleficence, autonomy and justice/fairness.

Hiring Agents’ Beliefs: A Barrier to Employment of Autistics

Capable, qualified, and working-age (18-65) autistic adults experienced an 83% unemployment rate in the United States in 2017 resulting in extreme poverty and severely decreased quality of life. Research dating from 1957 to 2016 inferred hiring agents’ beliefs were the cause. In this multiple regression study, the nature of the relationship between hiring agents’ beliefs and their selection of qualified autistic candidates was explored through Ajzen’s theory of planned behavior to determine what hiring agent’s beliefs, if any, influence the selection of qualified autistic candidates to fill open positions. I used the Hiring Agent Survey Regarding Selection of Qualified Autistic Candidates to anonymously gather data from hiring agents throughout the contiguous United States. Known values of the independent variable, the beliefs influencing hiring agents, were summed and clustered against the TPB-predicted, percentage-based, continuous-level dependent variable, which was hiring agents’ selection of qualified autistic candidates. This statistically significant regression analysis, F(45, 73) = 36.067, p < .001, adj. R2 = .930, predicted the degree to which each control, normative, and behavioral belief influenced hiring agents’ selection. Hiring agents’ desire for mandated comprehensive organizational diversity, along with their negative stereotypical associations and fear of embarrassment, signify a need for substantive policy and strategic interventions. Results of such aggressive diversity initiatives could considerably improve the nation’s socioeconomic health and substantively increase autistics’ quality of life.

Let's talk about sex: A feminist poststructural approach to addressing sexual health in the healthcare setting.

To explore the use of feminist poststructuralism (FPS) as a way to critique, understand and improve sexual health care and policy in healthcare settings. Sexual health is an important aspect of health; however, in healthcare settings, it often goes unaddressed by both healthcare providers and patients due to stigma, taboo, fear of embarrassment or uncertainty. Lack of attention to sexual health has been stated as a legitimate concern for patients across the lifespan; there remain gaps in implementing sexual health care discussions into practice in healthcare settings. A critical analysis will be presented to explore sexual health care and attitudes in the healthcare setting from patient and nursing perspectives using FPS. Feminist poststructuralism is used to examine the meaning of experience that is personally, socially and institutionally constructed through relations of power. FPS will also be applied to understand how sexual health discourses are negotiated in healthcare settings. SQUIRE guidelines were used in the preparation of this paper (See Appendix S1). The application of a feminist poststructural lens to sexual health care in healthcare settings may be used by healthcare professionals to understand, question and challenge how social and institutional beliefs, values and practices surrounding sexual health, inclusive of a patient's sexual pleasure or sexual activity, are experienced by healthcare professionals and patients. This theoretical and methodological approach could lead to identifying possibilities for change in healthcare settings that are inclusive and supportive of sexual health care.

Botswana men's perspective on partner communication about sexual and reproductive health issues

ABSTRACTBackground: Partner communication is key to decision making about sexual and reproductive health issues. It enables men to share responsibility with their partners and promotes their involvement in sexual and reproductive health (SRH) services. The study investigated men's communication patterns about reproductive health issues.Method: A cross-sectional design using mixed methods was used. Criterion purposive sampling was employed to obtain 390 males who reported to have participated with their partners in any SRH service. Data were collected using a questionnaire complemented with 10 in-depth interviews. Analysis of variance was performed to examine differences in men's communication patterns by their demographic profiles.Results: Older, married men with children communicated more about SRH issues than their younger unmarried counterparts. Pearson moment correlation coefficient revealed a positive significant correlation between perceived importance of and frequency of communication. Men reported more comfort in communicating about child-care, family planning, pregnancy and prevention of mother-to-child transmission services but, felt uncomfortable talking about sex, child-birth and infertility. Communication was enhanced by affiliation to male clubs, media, partner support and personal loss. However, discussions were restricted by limited knowledge, cultural factors, fear of embarrassment and being judged as unfaithful.Conclusions: Men valued the importance of communicating about SRH issues though putting it into practice was a challenge. Interventions for enhancing communication should focus on younger couples. Specific issues such as infertility and child-birth need to be integrated into public education strategy to strengthen men's SRH knowledge.

Foreign bodies in the nasal cavity: incidental findings during routine orthodontic radiographs

Abstract: Foreign bodies in the nasal cavity are common amongst young children as they begin to explore their senses. The occurrence in teenagers often goes unreported from a fear of embarrassment therefore resulting in a delay in presentation or until they become symptomatic. The sequelae of foreign bodies in the nasal cavity include prudent discharge, epistaxis, sinusitis and respiratory symptoms. If left untreated this can lead to mucosal necrosis, cutaneous fistula, rhinolith formation and chronic pain. Here, two patients who had foreign bodies in their nasal cavity, which were only discovered as an incidental finding as part of their orthodontic assessment, are reported. CPD/Clinical Relevance: Clinicians should be mindful of the sequelae of foreign bodies in the nasal cavity and the need for thorough assessment of radiographic investigations, particularly in children.

Countering embarrassment-avoidance by taking an observer's perspective

The fear of embarrassment can have harmful effects in many important consumer domains (e.g. health and financial), especially for high public self-consciousness (PUBSC) consumers. This research examines how adopting the perspective of an observer interacts with trait PUBSC to influence embarrassment-avoidance. Study 1 demonstrates that individuals high in PUBSC (vs. not) are more likely to take an actor’s perspective and to feel personal distress when viewing an ad with an embarrassment appeal. Studies 2–3 show that seeing oneself as an observer is a helpful strategy for combatting embarrassment-avoidance for high PUBSC individuals. This process is effortful and requires cognitive resources. Together, Studies 1–3 demonstrate the power of our theory to explain, predict, and modify embarrassment-avoidance among individuals most likely to anticipate and avoid embarrassment.

Operating Theatre Mannerisms & Etiquette: Revisited!

Operating Theatre Mannerisms & Etiquette: Revisited!

Breast Cancer Screening Among Korean Americans: A Systematic Review.

Cancer is the leading cause of death for Korean Americans (KAs). Breast cancer (BC) is the most commonly occurring cancer among KA women, and its rate has been rapidly increasing. Low BC screening rates for KAs puts them at greater risk for late-stage breast cancer. We conducted a systematic review of the published literature on cancer screening among KAs, and identified 38 eligible studies. Despite significant increases in mammogram utilization over the past two decades, KAs have consistently lower rates of mammogram screening than other American populations. KA women also report lower rates of clinical breast examination and breast self-examination. Screening rates are higher among adults with higher socioeconomic status, greater acculturation to the United States, more cancer knowledge, higher perceived susceptibility to BC, more social support, and better access to health services. However, fear of finding something wrong, fear of embarrassment or lack of modesty, not knowing where to go for screening, believing that mammography is only necessary when symptoms are present, and perceived time and cost difficulties in accessing mammography were reported as barriers to mammogram screening. Coordinated efforts from clinicians, public health workers, KA cultural and religious organizations, and the broader breast cancer advocacy and awareness community are necessary for improving BC screening among KAs.

Awareness and sources of contraception information among female university students in Nigeria

Female university students are at the age of active sexual life, but desire to delay becoming mothers, thus making the provision to them of correct and timely information on contraception crucial. This study aims to investigate the level of awareness and information behaviour on contraception among Nigerian female university students. Using simple random sampling to select participants from the university’s nine colleges at the Federal University of Agriculture, Abeokuta, Nigeria, a total of 800 questionnaires were administered, of which 91.6% were duly completed. The findings showed that awareness of contraception among respondents was 95.2%; the most known contraceptive methods were the male condom, oral pills and injectables; most respondents (80.7%) first learnt of contraception at secondary school. Respondents’ most frequent sources of contraception information were friends, television and magazines/newspapers, but their most preferred sources were physicians/health workers, parents and university lectures/lecturers. The major barriers faced in seeking information on contraception were inability to get reliable and accurate information, lack of time and fear of embarrassment. Measures to increase the adoption of contraception among female students must take cognizance of their preferred sources of information to deliver correct and adequate information about contraceptive methods.

Sharps and Needlestick Injuries Among Medical Students, Surgical Residents, Faculty, and Operating Room Staff at a Single Academic Institution

The hospital is a place of high risk for sharps and needlestick injuries (SNI) and such injuries are historically underreported. This institutional review board approved study compares the incidence of SNI among all surgical personnel at a single academic institution via an anonymous electronic survey distributed to medical students, surgical residents, general surgery attendings, surgical technicians, and operating room nurses. The overall survey response rate was 37% (195/528). Among all respondents, 55% (107/195) had a history of a SNI in the workplace. The overall report rate following an initial SNI was 64%. Surgical staff reported SNIs more frequently, with an incidence rate ratio (IRR) of 1.33 (p = 0.085) when compared with attendings. When compared with surgical attendings, medical students (IRR of 2.86, p = 0.008) and residents (IRR of 2.21, p = 0.04) were more likely to cite fear as a reason for not reporting SNIs. Approximately 65% of respondents did not report their exposure either because of the time consuming process or the patient involved was perceived to be low-risk or both. The 2 most common reasons for not reporting SNIs at our institution are because of the inability to complete the time consuming reporting process and fear of embarrassment or punitive response because of admitting an injury. Further research is necessary to mitigate these factors.

Connect the Dots—March 2016

Connect the Dots—March 2016

It’s a Rap

It’s a Rap

They are laughing at me: cerebral mediation of cognitive biases in social anxiety.

The fear of embarrassment and humiliation is the central element of social anxiety. This frequent condition is associated with cognitive biases indicating increased sensitivity to signals of social threat, which are assumed to play a causal role in the maintenance of social anxiety. Here, we employed laughter, a potent medium for the expression of acceptance and rejection, as an experimental stimulus in participants selected for varying degrees of social anxiety to identify cerebral mediators of cognitive biases in social anxiety using functional magnetic resonance imaging in combination with mediation analysis. We directly demonstrated that cerebral activation patterns within the dorsal attention network including the left dorsolateral and dorsomedial prefrontal cortex mediate the influence of social anxiety on laughter perception. This mediation proved to be specific for social anxiety after correction for measures of general state and trait anxiety and occurred most prominently under bimodal audiovisual laughter presentation when compared with monomodal auditory or visual laughter cues. Considering the possibility to modulate cognitive biases and cerebral activity by neuropsychological trainings, non-invasive electrophysiological stimulation and psychotherapy, this study represents a starting point for a whole line of translational research projects and identifies promising targets for electrophysiological interventions aiming to alleviate cognitive biases and symptom severity in social anxiety.

Face values: the use of sensitive error correction to address adolescents' ‘face’ issues in the modern languages classroom

Anxiety about ‘performing’ in a foreign language in front of classmates may inhibit learners' contributions in the modern languages class through fear of embarrassment over possible error production. The issue of ‘face’, perceived social standing in the eyes of others, presents a sensitive matter for young adolescents developing their identity. Adolescents' self-esteem may depend, in large part, on peers' positive opinions. This article describes three of the strategies employed by three modern languages teachers when correcting errors committed in spoken interaction which appeared to address potential face issues for adolescent learners. Their approach may be helpful to modern languages teachers wishing to develop and extend sensitive correction strategies.

EPA-0914 – Social anxiety disorder and psycosis: A relation not always met

Objective When social anxiety and psychotic disorders occur in the same patient, they have mutual implications in both disease courses. Social anxiety disorder is mainly characterized by the fear of embarrassment in social or performance situations, accompanied by the intense concern about other people's opinion. Psychotic disorders are traditionally seen as being accompanied by affective blunting and deterioration of social skills. The authors pretend to review different interactions between these disorders, by exploring several clinical scenarios where both disorders influence themselves in different ways. Methods The authors review reports and literature in the files of Pumed, Medline and others. They also consult psychiatry textbooks. Results Many psychotic patients have other affective disturbances than that of affective blunting. Social anxiety is one of them; some studies point a prevalence of 25% in these patients. But if in some patients social anxiety seems to act as a trigger of psychotic symptoms, acting as a persistent stressor, other patients have anxiety in interacting with others as a consequence of having a psychotic disorder and the fear of being noted as having a serious mental disorder affecting ones behaviour. In a third scenario, social anxiety occurs as a product of a primary thought disorder (psychotic self-reference). It is possible to identify therapeutic implications of these comorbidity, namely by the use of cognitive behaviour therapy. Conclusion Comorbidity between psychosis and social anxiety can occur in different ways, influencing the prognosis of both disorders. It also can challenge the knowledge about these disorders.

Clinicians’ and Relatives’ Attitudes towards Informing Senile Patients about their Diagnosis in China

To evaluate the attitudes towards informing senile patients about the diagnosis among Chinese clinicians, patients and their relatives, and explore the factors restricting senior citizens from implementing their right of informed consent independently, a cross-sectional study was conducted in Beijing in June 2013. 100 clinicians, 250 competent inpatients and their closest relatives chosen by stratified random sampling method were measured by a questionnaire anonymously. There were 78 doctors, 203 patients and 218 relatives who responded, and 60.6% of the patients were over 65 years old. As with the young and middle-aged, almost all senile patients desired to learn about their condition. However, to avoid dispute or other troubles, 52.9% of medical staff tended to inform the family members first, and 9.5% of relatives were reluctant to disclose all the information to senile patients for fear of embarrassment or other undesirable negative effects. So increasing the communication skills training for clinicians, abandoning the rule of family members’ consent for competent patients and publicising the positive effects of informed consent are the key measures to safeguard senile patients’ rights in China.

Unwillingness to Participate in Colorectal Cancer Screening: Examining Fears, Attitudes, and Medical Mistrust in an Ethnically Diverse Sample of Adults 50 Years and Older

Identify the influence of medical mistrust, fears, attitudes, and sociodemographic characteristics on unwillingness to participate in colorectal cancer (CRC) screening. Cross-sectional, disproportionally allocated, stratified, random-digit-dial telephone questionnaire of noninstitutionalized households. New York City, New York; Baltimore, Maryland; San Juan, Puerto Rico. Ethnically diverse sample of 454 adults ≥50 years of age. Health status, cancer screening effectiveness, psychosocial factors (e.g., perceptions of pain, fear, trust), and CRC screening intentions using the Cancer Screening Questionnaire, which addresses a range of issues related to willingness of minorities to participate in cancer screening. Multivariate logistic regression was used to model the probability of reporting unwillingness to participate in CRC screening. Fear of embarrassment during screening (odds ratio [OR] = 10.72; 95% confidence interval [CI], 2.15-53.39), fear of getting AIDS (OR = 8.75; 95% CI, 2.48-30.86), fear that exam might be painful (OR = 3.43; 95% CI, 1.03-11.35), and older age (OR = 1.10; 95% CI, 1.04-1.17) were positively associated with unwillingness to participate in CRC screening. Fear of developing cancer (OR = .12; 95% CI, .03-.57) and medical mistrust (OR = .19; 95% CI, .06-.60) were negatively associated with unwillingness to screen. Findings suggest that CRC health initiatives should focus on increasing knowledge, addressing fears and mistrust, and normalizing CRC screening as a beneficial preventive practice, and should increase focus on older adults.