Intimate Care Research Articles

A Multisite Quality Improvement Initiative to Enhance the Adoption of Screening Practices for Intimate Partner Violence Into Routine Primary Care for Women Veterans.

The Veterans Health Administration established comprehensive women's health clinics (CWHCs) to provide coordinated, high-quality primary care to women veterans. Intimate partner violence (IPV) is prevalent among women using these clinics. The Veterans Health Administration recommends screening women for IPV, yet screening uptake is low in CWHCs nationwide. We describe a multisite quality improvement initiative to enhance the adoption of IPV screening practices in the Veterans Health Administration's CWHCs. This quality improvement initiative, implemented in 2017-2018, included 4 steps in which we (1) conducted a baseline survey of screening practices at CWHCs throughout the United States; (2) selected and tailored evidence-based implementation strategies based on identified barriers and facilitators; (3) deployed multicomponent implementation support, targeting low-adopting facilities; and (4) conducted a follow-up survey to evaluate changes in IPV screening practices from baseline (winter 2017) to 1-year follow-up (winter 2018) using quantitative and qualitative analyses. Responders from 62 CWHC sites provided information on IPV screening practices and barriers; 42 low-adopting sites were targeted for implementation support. At follow-up, responders provided information on IPV screening practices, perceived usefulness of implementation support strategies, and continued barriers. Among sites that responded to both surveys (n = 47), the number of sites that implemented recommended screening practices increased by 66.7%, from 15 at baseline to 25 at follow-up (P = .02). Emergent themes reflected barriers and facilitators for IPV screening implementation. Improvement in IPV screening practices in CWHCs is a pivotal step toward enhancing care for women. Yet, even with numerous implementation supports, barriers to adoption persist at many sites. Findings on modifiable barriers and unique facilitators can inform next steps for increasing screening uptake.

Everyone needs to breathe

This article is written with an eye towards the future and a foot in the past. It is partly autobiographical, and in each of four parts offers reflective somatic practices. The author is sheltering at home, so her thoughts centre on the meaning of home, family and pets. At the same time, she articulates somatic skills to cultivate embodied presence, insightful verbal interactions and healing touch. Her writing invites readers into somatic movement explorations and somatic communication practices through poetry. Life and death, love and war, ground her article. The section on Simbi involves global shadow work through butoh and the healing essence of water. Golden shadows appear as elemental and ecosomatic in Morphic Curiosity, a butoh invitation to site-specific dance. Video links and photographs further embody the work. The final section, Dance back the world, presents somatic witnessing as an extraordinary process of intimate notice and care. Becoming friends with the whole world is an exhortation of Mahatma Gandhi, and the life work of this author. Her article was written before the brutal murder of George Floyd and the international protests that began in America as cries for social and racial justice. Now we have a new imperative for Gandhi’s call, because everyone has a right to breathe.

Consent in Pelvic Care.

Consent is a clear dialogue between individuals to engage in a specific activity. Expectations for consent to intimate examinations in health care should be equal to, if not exceed, expectations for intimate interactions in society. In reality, current definitions of consent in health care vary. These blurry definitions lead to individualized interpretation, incomplete fulfillment, and opportunities for misunderstanding by both patient and health care provider. If a patient does not believe they have consented to an examination or procedure, they are likely to rightfully identify with one of consent's antonyms, assault. Within the field of gynecology, a history of misogyny, racism, and classism illuminates abhorrent contexts of assault disguised as care. Similar practices persist in the modern application of pelvic care, ranging from overt sexual assault to coercion disguised as guidance. Health care providers and students who seek to improve consent practices can look to evidence-based frameworks such as trauma-informed care and shared decision making, both of which are embraced widely by professional organizations. These approaches often take precedence during the first pelvic examination; care for people who are lesbian, bisexual, queer, transgender, or nonbinary; and care for anyone with a known history of sexual assault; they can be easily extrapolated to all intimate examinations. Beyond obtaining consent for the examination itself, health care providers must also intentionally obtain consent to include students in care and openly discuss new universal recommendations for chaperone presence. Scripting for common procedures, such as bimanual examinations for pelvic care or cervical examinations in labor, allows health care providers to practice trauma-informed language, include evidence-based guidance, and avoid unintentional bias. Contemporary providers of intimate pelvic care must work to understand and strengthen the definition of consent and ensure its realization in practice.

Demystifying sexual connotations: A model for facilitating the teaching of intimate care to nursing students in South Africa

Background. The concept of intimate care is not freely used in nursing education and practice. Nursing students provide basic nursing care that requires physical and psychological closeness to diverse patients. During the execution of some basic nursing care, patients’ body parts that are considered intimate, private and sexual, are exposed and touched. This encounter with a patient’s naked body may bring about feelings of anxiety, embarrassment and discomfort for nursing students and patients. Objective. To develop and describe a model for facilitating the teaching of intimate care to nursing students in South Africa. Methods. The study was conducted at two nursing education institutions (NEIs) in Gauteng Province. A qualitative, theory-generating, research design that is explorative, descriptive and contextual in nature was used to develop a model for facilitating the teaching of intimate care to nursing students. A combination of stages of theory-generating approaches was used to identify and define the main concept. The structure and process of the model were visually portrayed and described. Results. The findings of this study demonstrate that intimate care is not facilitated in NEIs and nursing students are not well prepared and supported to provide intimate care to diverse patients competently, confidently and comfortably. Facilitating the teaching of intimate care to nursing students was identified as the main concept. Based on this, a model to facilitate the teaching of intimate care to nursing students was therefore proposed, described and visually illustrated. Conclusion. The developed model will assist nurse educators in facilitating the teaching of intimate care in NEIs and in providing continuous support to nursing students. It will empower students to implement intimate care competently, comfortably and confidently, enabling them to establish nurse-patient intimate care relationships based on trust, respect and dignity.

Beyond Loving Nature: Affective Conservation and Human-pig Violence in the Philippines

ABSTRACT Contemporary social theory has forcefully argued for a ‘loving’ postenvironmentalism based on intimate care and making kin with the non-human world. These arguments are a central part of an influential and cross-disciplinary scholarly discourse, increasingly adopted by environmental anthropologists, that envisions a universal moral ecology of ‘care, love and kinship’ as the solution to the near-apocalyptic social and environmental conditions of the Anthropocene. Drawing on ethnographic work in the Philippines, I explore how this narrowed affective repertoire maps awkwardly onto indigenous Pala’wan explanations of their relationship with the non-human world where reciprocity and respect are held in tension with fear, violence and death. I focus, in particular, on the Palawan bearded pig (Sus ahoenobarbus), an endemic species that has become an emblematic conservation species while also being extensively hunted by indigenous peoples across the Island.

Negotiating the practical ethics of 'self-tracking' in intimate relationships: Looking for care in healthy living.

In this paper, we offer insights into practices of tracking as part of healthy living through talk about home blood pressure and weight from adults living in the UK. Drawing on theoretical resources from feminist ethics of care and Science and Technology Studies on care as socio-material practice, we build on interest in the relational dimensions of tracking and the potential for intimate surveillance and care using monitoring technologies. Our cases offer not only new perspectives in a field that has often focused on fitness tracking but also help go beyond a narrow focus on surveillance, showing how surveillance and care may be intertwined in the everyday negotiation of health-related tracking and other 'health practices' in family life. Using the diversity in our relatively large sample, and reflecting on the different types of interview completed, we highlight the varied ways in which adults engage with tracking blood pressure and weight (or body mass index) in the context of established relationships. The combination of attentiveness and appeals to responsibility for maintaining health as something owed to a partner can make tracking a very ethically sensitive area. In this paper we emphasise that reciprocity is one important way in which couples make tracking feel more like care. Tracking together or discussing it can take couples in this direction even if the actual practice remains somewhat difficult. On the other hand, responsiveness to someone else's feelings, including a desire to avoid the topic altogether, or avoid weight as a specific parameter, might all help move towards more caring tracking. We therefore develop a more sustained account of care in relation to tracking than in previous work, and a novel account of tracking as a (potential) care practice between adult partners.

Mask-Ed (KRS Simulation) an approach to deliver intimate care for neophyte nursing students: the creator's experience.

Nurses deliver intimate care to patients in a variety of ways, especially when attending to showering, bathing, toileting and managing chronic or surgical wounds located in body regions such as the genitalia or breasts. Neophyte undergraduate nursing students can experience fear and anxiety at the thought of carrying out this level of care; hence, there is a need for preparation prior to undertaking clinical placements when students encounter real patients. The preparation should begin in the laboratory context of their tertiary educational settings. Traditionally, task trainers and manikins have been used to demonstrate and practise this care in such environments. However, the realism of experiencing true human responses, by both the patient and student, can be lost through these modalities. In recent years, a simulation approach, Mask-Ed, has enabled intimate care to be taught to students in a university setting in Australia where the laboratory context provides a safety net. Mask-Ed involves the informed educator wearing highly realistic silicone props that include torsos, faces and hands. Having donned the props, the educator then transforms into another person. The newly created person has a backstory designed to enable the educator to become a platform for teaching and to coach students through the clinical experience. The following discussion explains the background to Mask-Ed and the underlying framework that is used to implement the technique to teach intimate care. Mask-Ed is considered one of the most realistic approaches to simulation and is used in healthcare facilities and tertiary educational institutions globally.

Associations Between Gender, Resiliency Factors, and Anxiety in Neuro-ICU Caregivers: a Prospective Study.

Informal caregivers of patients admitted to the neuroscience intensive care unit (Neuro-ICU) are at risk for developing chronic anxiety. Resiliency factors may reduce risk, yet their differential effects for female and male caregivers have not been studied in this population. We aim to examine interactions between gender and baseline resiliency factors and anxiety at baseline, 3months, and 6months. Prospectively studied caregivers (N = 96) of patients admitted to the Neuro-ICU completed baseline sociodemographics and resiliency measures (coping, mindfulness, self-efficacy, intimate care, and caregiver preparedness), and anxiety severity at baseline (hospitalization), 3months, and 6months. Baseline anxiety predicted future anxiety (3 and 6months). Caregivers who reported high (versus low) baseline coping, mindfulness, self-efficacy, and preparedness for caregiving reported lower baseline anxiety (ps ≤ 0.012). An interaction between caregiver gender and baseline mindfulness was seen at 3months (p = 0.021), with high mindfulness males reporting lower anxiety than high mindfulness females, and low mindfulness males reporting higher anxiety than low mindfulness females. Results emphasize the protective role of resilience in the trajectory of anxiety among informal caregivers. Findings emphasize the need to rapidly deploy skills-based treatment to Neuro-ICU caregivers to prevent future development and maintenance of anxiety, specifically emphasizing mindfulness in male caregivers.

Plastic pigs and public secrets in translational neonatology in Denmark

This paper explores how a translational research platform in Denmark uses piglets as infant models. Drawing on meanings of “public” as “open” and “visible,” we track how researchers and clinicians together and separately turn research piglets and premature infants into both public and un-public beings in laboratory and clinical settings. In these complex multispecies relationships, researchers and clinicians alike create and retain certain “zones of unknowing” in which intimate cross-species care relations are fostered. While critical social scientists call for greater public recognition of animals in accounts of human health, our study demonstrates that “zones of unknowing” enable the involved professionals to care simultaneously for neonatal beings and the greater public good. To account for the efforts involved in contributing to the greater public good, we introduce the term “publication work.” We argue that publication work relies as much on porosity between species and spaces as on actively drawing boundaries between species and between public and private spaces. Plastic pigs and public secrets are crucial to realise the ambition of more-than-human public health.

Characterization of female intimate hygiene practices and vulvar health: A randomized double-blind controlled trial.

Inappropriate feminine hygiene practices are related to vulvar unpleasant symptoms (such as skin changes, lesions, burning, pruritus, fissures, and dyspareunia). We assessed the daily use effects of intimate cleansers on vulvar skin by comparing two specific products for intimate care: Saugella Hydraserum (SIS), based on natural extracts, and a standard product based on lactic acid, such as Lactacyd Feminine Hygiene (LTC). Forty healthy women were enrolled in this double-blind controlled study. After randomization, the cleansers were used twice daily for 30days. The hydration level was determined using the Corneometer® CM 825, the pH using the Skin-pH-Meter PH 905® and the sebum level using the Sebumeter SM815® . Measurements were performed at baseline and on day 30 on the labia majora and labia minora. Both cleansers showed a reduction in the hydration level, but this was much less evident in the SIS group (-6.3% SIS vs -23,7% LTC). The pH values of the SIS group were lower than those of the LTC group, especially on the labia minora (5.27±0.08 and 5.6±0.1, respectively, P=.025). The sebum increased in both groups, but in the LTC group, it was higher on the labia majora (+96.2% vs +46.8%, respectively, P=.003), while on the labia minora, it was higher in the SIS group (+24.7% vs +17.1%, respectively P=NS). Both cleansers tested showed high performance for safety and tolerability on vulvar skin, but SIS showed better efficacy than LTC on some parameters.

Compassion fatigue in critical care nurses and its impact on nurse-sensitive indicators in Saudi Arabian hospitals

AimTo examine the previously untested relationship between the level of compassion fatigue (CF) in critical care nurses and the rates of three nurse-sensitive indicators in four critical care units in hospitals in Saudi Arabia. BackgroundCF can manifest in nurses who provide direct, intimate care to patients with different levels of illness including nurses working in specialty areas such as critical care where they care for patients experiencing challenging illnesses. Pressure injuries, patient falls, and medication errors are key nurse-sensitive indicators that identify critical care nurses as the primary causal agent. These indicators also correlate with burnout and poor multidisciplinary team communication, both factors that govern CF. MethodsA multisite survey was conducted to collate and examine the number of reported pressure injuries, falls, and medication errors over 3 months at four hospitals in two Saudi Arabian cities during 2018 to determine the relationship between the occurrence of these nurse-sensitive indicators and the level of CF in critical care (intensive care unit [ICU]) nurses. A survey of 516 critical care nurses was undertaken; analysis was performed using the Professional Quality of Life Scale, version 5 (ProQol-5), and results were further analysed using Pearson's correlations and three-way analysis of variance. ResultsThe results of the regression analysis indicated resilience as a predictor explained 66% of the compassion satisfaction (CS) variance (B = 0.318, R2 = 0.436, F(2, 12.495) = 123.013, p < 0.001) and 26% of the burnout (BO) variance (B = 0.152, R2 = 0.067, F(2, 11.500) = 3.279, p < 0.001). In addition, the level of resilience as a predictor explained 15.4% of the secondary traumatic stress (STS) variance (B = 0.063, R2 = 0.024, F(2, 7.758) = 2.785, p = 0.006). Conversely, coping strategies did not predict CS, BO, or STS (p > 0.05) at a statistically significant level. The concurrent measure of CF, BO, and STS found that almost 20% of the critical care nurse participants reported having very low CS, indicating increased potential for the development of CF. In addition, male nurses reported experiencing higher levels of stress and BO than female nurses. This study also found that neither the number of patients being treated nor the number of beds in the care setting affected the rate of the nominated nurse-sensitive indicators. The results for rates of pressure injuries did vary among the hospitals, with the worst performing hospital reporting pressure injury rates of one in every 40 patients and the better performing hospital reporting no cases of pressure injuries after treating more than 100 patients. Patient falls and medication errors were rare occurrences and did not vary between hospitals. SignificanceThis study indicates that there is a possible issue contributing to the differential level of care between hospitals. The mode and length of time nurses spend on handover may also reflect communication issues that increase both the rate of nurse-sensitive indicators and the level of CF reported by nurses. Therefore, the implications of this study, in terms of improving nursing practice, occurs in handover to ensure that information on aspects of nonpatient critical care are fully covered, such as time of patient turning to avoid pressure injuries.

Elderly and care personnel’s user experiences of a robotic shower

PurposeThe purpose of this study is to explore the expectations and experiences regarding a robotic shower, from a dual user perspective.Design/methodology/approachThis was an explorative qualitative study in which elderly and personnel were interviewed before the robotic shower was installed and again after four or five months of usage.FindingsThe elderly participants found the robotic shower empowering. The personnel’s experiences encompassed their own work conditions, as well as the user value for the elderly. A shared experience for both user groups was a more independent shower situation for the elderly.Research limitations/implicationsLow user frequency among the elderly may have affected the results; more frequent use may lead to different user experiences. Understanding whether and to what extent long-term use affects user experience is important for future adoption and implementation.Practical implicationsImplementation of digital assistive technology (DAT) should focus on the user value of the DAT for all possible user groups, as the different users may experience different values over time. In addition, approaching adoption and acceptance issues of DAT from a learned helplessness perspective may help users find value in the DAT and the independence these aim to provide, helping users maintain or increase quality of life.Originality/valueThis study presents a dual user experience of a DAT in an intimate care situation and shows the importance of including both elderly and personnel to fully understand the value of DATs.

A mixed-methods evaluation of college student and provider perspectives on a smartphone application for help-seeking after violence

Objective To elicit feedback on the acceptability, usability, and dissemination options for the bMOREsafe smartphone application (app). Participants: Forty-nine students and six service-providers provided feedback on the bMOREsafe app between April 2015 and March 2016. Methods: Students responded to an anonymous online survey and providers participated in semi-structured interviews. Descriptive and thematic analyses were completed. Results: Students rated the app as useful, however less applicable to themselves and their peers. Students stated they would be most receptive to recommendations about the app from peers and social media. Qualitative data from service providers fell into three main categories: trauma-informed aspects; inclusivity vs. specificity; and within an app, language matters. Conclusions: Smartphone technology can provide confidential information and resources to help students make decisions related to sexual assault or intimate partner violence care. While students and providers identified apps as a useful strategy for sharing this information, dissemination challenges remain.

Promoting intimate care facilitation in Nursing Education Institutions in South Africa

BackgroundBasic nursing care includes intimate care that requires a nurse and a patient to be in close physical and psychological proximity. The patient's body parts are exposed, and his/her fragile body is seen and touched by a nurse, who is a stranger. The nurse and patient need to establish a relationship based on respect and trust. In South Africa, nursing education institutions use simulation to teach intimate clinical procedures. However, intimate care is not effectively facilitated, and nursing students are not supported when providing such care to diverse patients. PurposeExplore nurse educators’ understanding and experiences of the teaching of intimate care to undergraduate nursing students. MethodA qualitative phenomenology research approach and a social interactionism theory were merged to explore nurse educators' understanding and experiences of teaching intimate care to undergraduate nursing students. Eleven nurse educators working in the selected Nursing Education Institutions in Gauteng Province were purposively sampled. Data were collected using individual in-depth interviews and a focus group. Data were analysed using Moustakas' (1994) phenomenological data analysis method. ResultsFour major themes emerged: the care provided by nurses, facilitation of intimate care, intimate care guidance and support, and intimate care challenges. ConclusionIntimate care should be promoted in NEIs and should form part of the curriculum that promotes caring. It must be facilitated using reality simulation to allow nursing students to experience intimate care realities in a safe environment. This will empower them to be competent, comfortable and confident in providing intimate care to diverse patients.

The nature and extent of prisoners’ social care needs: Do older prisoners require a different service response?

Summary In light of longstanding concern about the lack of social care in prisons, the 2014 Care Act made local authorities in England responsible for identifying, assessing and meeting prisoners’ social care needs. However, service planning is difficult, for little is known about the level of demand or the extent to which the needs of older and younger prisoners differ. Against this background, face-to-face interviews (including screens for social care needs, substance misuse and mental health problems) were undertaken with a sample of male prisoners in North-West England. Findings Three hundred and ninety-nine participants were aged 18–49 and 80 aged 50 plus. Overall, more than a 10th of participants had problems maintaining personal hygiene, dressing and/or getting around the prison safely; a significant minority lacked meaningful occupation; and approaching a sixth acknowledged problems forming/maintaining relationships. Older prisoners were significantly more likely than younger prisoners to need help with personal hygiene, dressing and moving around safely and to identify problems with their physical health and memory. Applications The findings highlight the substantial number of older prisoners who could potentially benefit from some form of social care and support if they are to maintain their safety and dignity and make best use of their time in prison. They also underline the need to develop suitable screening and assessment tools for older prisoners, and for further research on the best service models for prisoners requiring intimate personal care.

The prevalence of young carers - a standardised survey amongst school students (KiFam-study).

Children and adolescents who provide care, assistance or support for a chronically ill family member are called young carers. While there is a growing body of research about their specific situation, needs and impact of caring, only very few studies provide information on prevalence rates. The aim was to provide prevalence data for young carers in Germany, and to describe and quantify the nature and extent of their help. A cross-sectional study. Data collection took place between 2016 and 2017 in 44 secondary schools (fifth to 13th grade) in North Rhine-Westphalia, Germany. A total of 6313 students aged from 10 to 22years participated in this study. They represent 0.5% of the basic population. Based on the results of a preliminary qualitative study, a standardised electronic questionnaire was developed, which comprised four subject areas: socio-demographic information, general daily aids, health-related quality of life and chronic illness within the family. Statistical analyses included chi-square tests for nominal data and univariate analyses of variance for metrical data together with 95% confidence intervals. 19.6% (n=1238) of all respondents state that someone in their family needs help due to a chronic illness. Nevertheless, not all of them are involved in caring activities. The prevalence of those defined as young carers in this study is 6.1% (n=383), 64% are girls. They take on a wide range of activities. In addition to domestic work, they help their ill relatives with mobility, dressing and undressing, medication, feeding, personal hygiene and with intimate care. The data provide a good insight into the situation of young carers. The prevalence rate is higher than expected. It refers to the social relevance of this topic and the need for further investigations.

An exploration of the influences on under-representation of male pre-registration nursing students

BackgroundWorldwide, men are under-represented in the nursing profession. In Scotland less than 10% of pre-registration nursing students are male. Reasons for this imbalance need to be understood. ObjectivesTo explore the views of male pre-registration nursing students, nursing lecturers and school teachers about this imbalance. DesignMixed methods study using focus groups and online survey. SettingsFocus groups in four locations across Scotland. Online survey sent to teachers across Scotland. Participants and methodsEight focus groups with 33 male nursing students; four focus groups with 21 university and college nursing lecturers; 46 school teachers returned the online survey. ResultsAlthough nursing was considered a worthwhile career with job stability and many opportunities, it was also viewed as not being a career for men. Assumptions about the profession and femininity were challenging for men and use of the term ‘male nurse’ was felt to be anomalous. In some circumstances the provision of intimate care to particular patient groups caused difficulty. Positive encouragement from others, a positive role model or knowledge of nursing from significant others could be helpful. However concerns about low earning potential and negative media publicity about the NHS could be a disincentive. Being mature and having resilience were important to cope with being a male nursing student in a mainly female workplace. Some more ‘technical’ specialties were felt to be more attractive to men. ConclusionsNursing is viewed as a worthwhile career choice for men, but the gendered assumptions about the feminine nature of nursing can be a deterrent.

\u201cI prefer a male nurse to a female nurse\u201d: patients\u2019 preference for, and satisfaction with nursing care provided by male nurses at the Komfo Anokye teaching hospital

BackgroundAlthough most male nurses join the profession for self-actualisation, the cultural and societal stereotyping of male nurses as “He-Man”, “gay” and “troublemakers”, and their marginalisation at the hospital during certain personal and intimate care procedures, tend to deepen the existing gender discrimination prevalent within the nursing profession. This study therefore assessed patients’ preference for, and satisfaction with nursing care provided by male nurses at the medical and surgical wards of Komfo Anokye Teaching Hospital [KATH].MethodsAn inferential cross-sectional study design, in which the prevalence of a condition among an identified population is determined, was used. Using convenience sampling, 150 respondents who meet certain practical criteria and are available and willing to participate were sampled. Data from a context-based research instrument on the opinion, preference and satisfaction of patients with male nursing were analysed using χ2 test, Mann Whitney U test, ordinal logistic regression and logistic regression.ResultsThe study indicates that more females than males had ever been attended to by a male nurse for the period considered by the study, and females described male nurses as polite and courteous and were comfortable with their treatment. Being single [OR = 0.111, 95% CI (0.013–0.928)] and professing Islamic faiths [OR = 36.533, 95% CI (2.116–630.597)] were functions of respondents’ preference for a male nurse. Significantly too, affiliating to a religious sect (OR = 2.347, 95% CI [0.076–1.630]) and being educated (OR = 1.387, 95% CI [0.040–0.615]), were associated with higher odds of falling in one of the higher categories of satisfaction with nursing care provided by male nurses as against the lower categories.ConclusionAlthough marital status, religious affiliation and educational level were the significant predictors of patients’ preference for, and satisfaction with care provided by male nurses, the effect of the other variables should not be overlooked. The finding disproves assertions on the negative effect of religion on male nurses. It is recommended that public awareness be created on the role of male nurses in the healthcare delivery system to promote acceptance of gender diversity in the nursing profession.

Gender Differences in Longitudinal Associations Between Intimate Care, Resiliency, and Depression Among Informal Caregivers of Patients Surviving the Neuroscience Intensive Care Unit.

Informal caregivers (e.g., family and friends) are at risk for developing depression, which can be detrimental to both caregiver and patient functioning. Initial evidence suggests that resiliency may reduce the risk of depression. However, gender differences in associations between multiple psychosocial resiliency factors and depression have not been examined among neuroscience intensive care unit (neuro-ICU) caregivers. We explored interactions between caregiver gender and baseline resiliency factors on depression symptom severity at baseline through 3 and 6months post-discharge. Caregivers (N = 96) of neuro-ICU patients able to provide informed consent to participate in research were enrolled as part of a prospective, longitudinal study in the neuro-ICU of a major academic medical center. Caregiver sociodemographics and resiliency factors (coping, mindfulness, self-efficacy, intimate care, and preparedness for caregiving) were assessed during the patient's hospitalization (i.e., baseline). Levels of depressive symptoms were measured using the Hospital Anxiety and Depression Scale at baseline, 3months, and 6months post-discharge. Baseline depressive symptoms predicted depressive symptoms at both 3- and 6-month follow-ups, with no difference at any time point in rates of depression by gender. At baseline, greater levels of coping, mindfulness, and preparedness for caregiving were individually associated with lower levels of concurrent depression regardless of gender (ps < 0.006). The main effect of baseline coping remained significant at 3-month follow-up (p = 0.045). We observed a trend-level interaction between gender and baseline intimate care, such that among male caregivers only, high baseline intimate care was associated with lower depression at 3-month follow-up (p = 0.055). At 6-month follow-up, we observed a significant interaction between caregiver gender and baseline intimate care, such that male caregivers reporting high intimate care reported lower symptoms of depression than females reporting high intimate care (p = 0.037). Results support implementation of psychosocial resiliencyinterventions for caregivers of patients admitted to the neuro-ICU early in the recovery process. Male caregivers may particularly benefit from strategies focused on increasing intimate care (e.g., physical and emotional affection with their loved one)and quality of the patient-caregiver dyadic relationship.

Meaning and relationship-centered care: Recommendations for clinicians attending to the spiritual distress of patients at the end of life

Summary The end of life is an inherently spiritual experience. In this setting, clinicians have an opportunity to invite patient spirituality into the room, to respond as a person, and even to prescribe spiritual interventions, while remembering to handle such spiritual clinical work with care. Bearing witness to suffering and loss, clinicians are at risk for burnout. But burnout may come more from the avoidance of grief than from its presence. To work with patients at the end of life in a sustainable way, clinicians can practice self-care, seek meaning in their work, and develop relationship and emotional intimacy with their patients. The promise of such care is a model of practice called relationship-centered care, where the relationship between the patient and the clinician as a human is central. Such work allows for the possibility of “bi-directionality” and “exquisite empathy” but requires a careful awareness of the patient, the environment, and deep self-awareness . Such intimate spiritual care offers both paradox and promise. Responding to patient spirituality, clinicians may be moved to pay deeper attention to our own spiritual life—our humanity, our relationships, and the ultimate meaning in our own lives.