Professional-patient Relationship Research Articles

Empiètement, rejet ou tempérance : l’adolescence en pédiatrie au risque de la surviolence

ContextThe work of the clinical psychologist in pediatric hospitals aims to promote the subjective appropriation of the experience by the child, by ensuring a feeling of continuity and security. It is particularly important to ensure the quality of the relation between subject, entourage, and caregivers. However, a certain amount of violence exists in the relation between caregiver and patient. We suggest that beyond the violence of caregiving itself, there is an “over-violence” (Tomkiewicz, 1991) which risks undermining the patient's feeling of security. ObjectivesWe believe that this over-violence arises when caregivers are confronted with intolerable experiences in the face of the vital risk incurred by the patient. This article aims to examine the emergence of this over-violence and its modes of expression. MethodThis work is based on several situations encountered in different pediatric wards, based on three cases of adolescent patients who put their caregivers in difficulty and required the intervention of hospital psychologists to understand the issues at hand. ResultsThrough these different clinical cases we identify two mechanisms of over-violence. First, encroachment, in the form of excessive control of patients’ behavior, which echoes the control that exists over the bodies of sick children. second, rejection, as an attempt to evacuate that which is violent, despite the needs of the patient, sometimes justified by the imperative of freeing hospital beds for other patients. We also identify the effects of a paradoxical over-violence in the oscillation between these two poles. DiscussionFaced with potential death and the anxiety it arouses, caregivers confronted with violent affects deploy unconscious defense mechanisms that can undermine the professional-patient relationship and can produce over-violence in care. Faced with this phenomenon, reflecting together as a team allows for the regulation of affects and promotes temperance in the professional-patient relationship. Psychologists practicing in somatic hospitals are instrumental in the setting up and maintaining of spaces for regulation or analysis of professional practice in services in which psychological care is not the primary task.

Assessment of Awareness, Perception, and Opinions Towards Artificial Intelligence among Health Care Professionals and Medical Students at Tertiary Care Teaching Hospital: A Cross-sectional Study

Background: Artificial intelligence (AI) in healthcare, including machine learning and deep learning, enhances diagnosis and treatment across specialties like cardiology, dermatology, and ophthalmology. Its applications extend to transcription, patient data organization, and remote healthcare, offering support to medical professionals and transforming medical education for students and trainees. Methods: A prospective cross-sectional study was conducted with consecutive sampling, and 90 medical students were included in the study. Data was collected using Questionnaire data forms and analysed. Results: The findings revealed that 73.9% of students were aware of AI, but a significant 80.0% reported a lack of formal education on the subject. Positive perceptions included the recognition of AI's efficacy in reducing errors (71.1%) and facilitating patient education (56.7%). However, concerns were raised regarding potential impacts on the healthcare professional-patient relationship. The majority (56.7%) advocated for the integration of AI knowledge and skills into the academic curriculum. The mean positive perception score of 29.8 showed associations with age, and year of study. Conclusion: This study underscores the need to address gaps in AI awareness and advocates for the integration of AI education into pharmacy curricula. The findings highlight nuanced perspectives among students and emphasize the potential benefits of tailored educational strategies to harness positive attitudes toward AI integration in healthcare.

Scoping literature review and focus groups with healthcare professionals on psychosocial and lifestyle assessments for childhood obesity care.

Background: Childhood obesity is a complex disease resulting from the interaction of multiple factors. The effective management of childhood obesity requires assessing the psychosocial and lifestyle factors that may play a role in the development and maintenance of obesity. This study centers on available scientific literature on psychosocial and lifestyle assessments for childhood obesity, and experiences and views of healthcare professionals with regard to assessing psychosocial and lifestyle factors within Dutch integrated care.
 Methods: Two methods were used. First, a scoping review (in PubMed, Embase, PsycInfo, IBSS, Scopus and Web of Science) was performed by systematically searching for scientific literature on psychosocial and lifestyle assessments for childhood obesity. Data were analysed by extracting data in Microsoft Excel. Second, focus group discussions were held with healthcare professionals from a variety of disciplines and domains to explore their experiences and views about assessing psychosocial and lifestyle factors within Dutch integrated care. Data were analysed using template analysis, complemented with open coding in MAXQDA.
 Results: The results provide an overview of relevant psychosocial and lifestyle factors that should be assessed and were classified as child, family, parental and lifestyle (e.g. nutrition, physical activity and sleep factors) and structured into psychological and social aspects.
 Insights into how to assess psychosocial and lifestyle factors were identified as well, including talking about psychosocial factors, lifestyle and weight; the professional-patient relationship; and attitudes of healthcare professionals.
 Conclusions: This study provides an overview of psychosocial and lifestyle factors that should be identified within the context of childhood obesity care, as they may contribute to the development and maintenance of obesity. The results highlight the importance of both what is assessed and how it is assessed. The results of this study can be used to develop practical tools for facilitating healthcare professionals in conducting a psychosocial and lifestyle assessment.

Pregnant women’s mental health during the COVID-19 pandemic according to the trimester of pregnancy

ABSTRACT Aim: This study aimed to analyse the psychological impact of the COVID-19 pandemic on pregnant women according to the pregnancy trimester, comparing their psychopathological symptomatology, pregnancy-specific stress, resilience and perceived stress to those of women pregnant before the pandemic. Methods: A total of 797 pregnant women participated in the study, one group of 393 women pregnant before the pandemic and the other of 404 women pregnant during the pandemic. Student-t test was used to analyse continuous data and the Chi-square test was used for categorical data. Results: Psychopathological symptomatology was significantly higher in six subscales of the SCL-90-R in pregnant women during COVID-19: somatisation, interpersonal sensitivity, depression, anxiety, phobic anxiety, obsessions-compulsions, mainly on the first two trimesters. There is also a higher level of pregnancy-specific stress in pregnant women during the pandemic on the first two trimesters, most likely due to the hypervigilance and fears related to the COVID-19 disease. Nevertheless, perceived stress, usually elevated during pregnancy, was lower in women pregnant during the pandemic in comparison to those pregnant before, as a positive consequence of being on lockdown and diminishing the exposure to daily stressful situations. Conclusions: Knowing the struggles these women go through during each trimester of pregnancy can be the key to a better health professional-patient relationship, consequently having a positive impact on their mental and physical health.

Black box problem and African views of trust

This article draws on the thinking about trust in African scholarship to describe the problems black box clinical artificial intelligence (AI) generates in health professional-patient relationships. Notably, under the assumption of a black box problem, the view of trust as inherently relational implies that health professionals cannot explain whether and how a clinical AI incorporates a patient’s values or leverages the same (in its outputs) to honour fiduciary relations. Additionally, the African view of trust as experience-based and accepting responsibility implies that health professionals can neither be held accountable for black box clinical AI outputs that they can hardly understand nor provide material information (concerning what the clinical AI does and why). Finally, given the understanding of trust as a normative concept, health professionals cannot accept patients’ vulnerabilities, and patients cannot give the same. Given that trust will play a vital role in the global acceptance of clinical AI, future studies should research—from other positionalities—how the black box problem will challenge the relationship of trust in the medical context.

Stroke Survivor's Satisfaction and Experience with Rehabilitation Services: A Qualitative Systematic Review.

Research in healthcare is increasingly focused on quality assurance and continuous quality improvement aiming to promote service quality. Satisfaction is a key endpoint in outcomes research and service benchmarking, along with "traditional" clinical outcomes. What controls stroke survivors' satisfaction differs among qualitative studies' conclusions, but there is general consensus on the importance of communication, improvement in activity, and engagement in goal setting. This review aims to collect and synthesise studies of the satisfaction of stroke survivors with rehabilitation services. A systematic search was conducted in seven electronic databases, including CINAHL, OVID, Pedro, Scopus Midline, Web of Science, and PubMed. The database search yielded 1339 studies, while one additional work was identified through hand searching. After removing duplicates, 74 studies were read in full, and after resultant exclusions, 12 qualitative studies were systematically reviewed, extracted, and appraised by two reviewers independently (HAS and RT) and the third reviewer (CS) was available for any disagreement. Five analytical themes were identified: Healthcare Professional-Patient Relationship (HCP), Delivery Service, Perceived Patient Autonomy (PPA), Expectations Shape Satisfaction, and Culture Influences Satisfaction. The studies of survivors' satisfaction, experiences, and their rehabilitative needs with the services they receive have provided different factors that influence their satisfaction during rehabilitation in different countries worldwide. However, the context in which the studies were conducted is quite limited, and more detailed studies are required for many underexplored contexts.

“It is difficult for us to treat their pain”. Health professionals’ perceptions of Somali pastoralists in the context of pain management: a conceptual model

Pain is one of the most neglected areas of care in sub-Saharan Africa. Access to adequate pain management is important, especially in marginalised populations, such as pastoralists. Little is known...

Trusting relationships between patients with non-curative cancer and healthcare professionals create ethical obstacles for informed consent in clinical trials: a grounded theory study

BackgroundClinical trial participation for patients with non-curative cancer is unlikely to present personal clinical benefit, which raises the bar for informed consent. Previous work demonstrates that decisions by patients in this setting are made within a ‘trusting relationship’ with healthcare professionals. The current study aimed to further illuminate the nuances of this relationship from both the patients’ and healthcare professionals’ perspectives.MethodsFace-to-face interviews using a grounded theory approach were conducted at a regional Cancer Centre in the United Kingdom. Interviews were performed with 34 participants (patients with non-curative cancer, number (n) = 16; healthcare professionals involved in the consent process, n = 18). Data analysis was performed after each interview using open, selective, and theoretical coding.ResultsThe ‘Trusting relationship’ with healthcare professionals underpinned patient motivation to participate, with many patients ‘feeling lucky’ and articulating an unrealistic hope that a clinical trial could provide a cure. Patients adopted the attitude of ‘What the doctor thinks is best’ and placed significant trust in healthcare professionals, focusing on mainly positive aspects of the information provided. Healthcare professionals recognised that trial information was not received neutrally by patients, with some expressing concerns that patients would consent to ‘please’ them. This raises the question: Within the trusting relationship between patients and healthcare professionals, ‘Is it possible to provide balanced information?’. The theoretical model identified in this study is central to understanding how the trusting professional-patient relationship influences the decision-making process.ConclusionThe significant trust placed on healthcare professionals by patients presented an obstacle to delivering balanced trial information, with patients sometimes participating to please the ‘experts’. In this high-stakes scenario, it may be pertinent to consider strategies, such as separation of the clinician-researcher roles and enabling patients to articulate their care priorities and preferences within the informed consent process. Further research is needed to expand on these ethical conundrums and ensure patient choice and autonomy in trial participation are prioritised, particularly when the patient’s life is limited.

Patients' experiences of patient-centred care in hospital setting: A systematic review of qualitative studies.

Patient-centred care (PCC) has been proposed as an appropriate approach for addressing current shifts in healthcare needs. Although the importance of PCC is generally recognised, PCC is poorly understood by patients in the hospital settings. To identify patients' experiences of PCC in hospital settings. This systematic review followed the Joanna Briggs Institute's (JBI) guidance for systematic reviews of qualitative evidence and the PRISMA checklist for reporting systematic reviews. The search strategy included peer-reviewed qualitative studies published after 2010 in English or Finnish. The databases searched were SCOPUS, MEDLINE, CINAHL and Medic. Unpublished studies and grey literature were searched in MedNar. Ten qualitative studies were included, and their quality was assessed by two independent reviewers using JBI quality assessment criteria. The data were analysed using thematic analysis. Studies were included if they had explored adult patient experiences of PCC in hospital settings. A thematic analysis produced 14 subthemes which were grouped into five analytical themes: the presence of the professional, patient involvement in care, receiving information, the patient-professional relationship and being seen as a person. This review suggests that the implementation and provision of PCC in hospitals is incomplete and patients' involvement in their own care should be in the focus of PCC. The majority of patients experienced receiving PCC, but others did not. The need for improvement of patient involvement was strongly emphasised. Patients highlighted the importance of professionals being present and spending time with patients. Patients felt well-informed about their care but expressed the need for better communication. Meaningful patient-professional relationships were brokered by professionals demonstrating genuine care and respecting the patient as an individual. To improve the implementation of PCC, patient experiences should be considered in the development of relevant hospital care strategies. In addition, more training in PCC and patient-professional communication should be provided to health care professionals.

Reflective based learning for nursing ethical competency during clinical practices.

A combination of theoretical and practical approaches is required to learn and acquire ethical competencies in caring. Occasionally, reflection on practical action differs from theoretical learning. In the context of reflective learning, issues such as ethical values can be discussed since they evoke conflict among nursing students. To identify ethical conflicts encountered by nursing students during clinical placements and to determine their cooperation strategies. Qualitative study with a content analysis according to Elo and Kinglas framework. Students enrolled in a nursing program at a Spanish university aged between 22 and 35, mainly women. The study includes 134 ethical reflections from nursing students in the last year of the nursing program, written during their clinical practices in a variety of learning environments. The research team analyzed the reflections using an inductive content analysis method. Ethical permission was obtained by the management center according to Law 3/2028, and all the participants accepted to participate through the informed consent form. Three main categories emerged from the analysis of the ethical reflections: (1) evaluation of professional performance and patient care; (2) the student as the protagonist of the dilemma; (3) student coping. Student dilemmas and concerns are related to ignorance, student-patient communication, mistakes made and self-confidence. Some situations conflict with the autonomy of patients and their rights, and can contribute to stressful situations for patients. Stress factors include hospital routines, which the patient cannot modify, and asymmetric relationships with staff, which encourage passivity. All ethical problems detected by the students begin with the professional-patient relationship, including issues related to bad news, errors or malpractice. Reflection on the ethical values of nursing, both in the classroom and in clinical practices, allows students to develop a greater ethical awareness of care, enhancing their decision-making skills in ethical dilemmas.

Computer-Supported Experiential Learning-Based Tool for Healthcare Skills.

Care experiences and health outcomes may suffer greatly because of healthcare professionals' deficient educational preparation and practices. The limited awareness about the impact of stereotypes, implicit/explicit biases, and Social Determinants of Health (SDH) may result in unpleasant care experiences and healthcare professional-patient relationships. Additionally, as healthcare professionals are no less prone to have biases than other people, it is essential to deliver the learning platform to enhance healthcare skills (e.g., awareness of the importance of cultural humility, inclusive communication proficiencies, awareness of the enduring impact of both SDH and implicit/explicit biases on health outcomes, and compassionate and empathetic attitude) of healthcare professionals which eventually help to raise health equity in society. Moreover, employing the "learning-by-doing" approach directly in real-life clinical practices is less preferable wherein high-risk care is essential. Thus, there is a huge scope to deliver virtual reality-based care practices by engaging the digital experiential learning and Human-Computer Interaction (HCI) approach to enhance patient care experiences, healthcare experiences, and healthcare skills. Thus, this research provides the Computer-Supported Experiential Learning (CSEL) approach-based tool or mobile application that facilitates virtual reality-based serious role-playing scenarios to enhance the healthcare skills of healthcare professionals and for public awareness.

Scoping literature review and focus groups with healthcare professionals on psychosocial and lifestyle assessments for childhood obesity care

BackgroundChildhood obesity is a complex disease resulting from the interaction of multiple factors. The effective management of childhood obesity requires assessing the psychosocial and lifestyle factors that may play a role in the development and maintenance of obesity. This study centers on available scientific literature on psychosocial and lifestyle assessments for childhood obesity, and experiences and views of healthcare professionals with regard to assessing psychosocial and lifestyle factors within Dutch integrated care.MethodsTwo methods were used. First, a scoping review (in PubMed, Embase, PsycInfo, IBSS, Scopus and Web of Science) was performed by systematically searching for scientific literature on psychosocial and lifestyle assessments for childhood obesity. Data were analysed by extracting data in Microsoft Excel. Second, focus group discussions were held with healthcare professionals from a variety of disciplines and domains to explore their experiences and views about assessing psychosocial and lifestyle factors within Dutch integrated care. Data were analysed using template analysis, complemented with open coding in MAXQDA.ResultsThe results provide an overview of relevant psychosocial and lifestyle factors that should be assessed and were classified as child, family, parental and lifestyle (e.g. nutrition, physical activity and sleep factors) and structured into psychological and social aspects. Insights into how to assess psychosocial and lifestyle factors were identified as well, including talking about psychosocial factors, lifestyle and weight; the professional-patient relationship; and attitudes of healthcare professionals.ConclusionsThis study provides an overview of psychosocial and lifestyle factors that should be identified within the context of childhood obesity care, as they may contribute to the development and maintenance of obesity. The results highlight the importance of both what is assessed and how it is assessed. The results of this study can be used to develop practical tools for facilitating healthcare professionals in conducting a psychosocial and lifestyle assessment.

"More Spiritual Health Professionals Provide Different Care": A Qualitative Study in the Field of Mental Health.

In recent years, there has been an exponential increase in studies demonstrating the positive effects of the religiosity/spirituality (R/S) approach on patients' physical and mental health. In mental health units, patients want professionals to be sensitive to their spiritual and/or religious needs, which is a fundamental aspect of a holistic approach to patients. Qualitative research with an exploratory and descriptive design with an ethnographic-phenomenological approach through in-depth interviews with sixteen professionals from Spanish mental health units. There is no consensus on the definition of spirituality; however, all of them believe that R/S has a positive influence on the health of patients in coping with illness. They believe that their own R/S may interfere with the professional-patient relationship and their attention to spiritual needs. Few professionals address these needs, citing limitations such as lack of time and lack of specific training in spiritual care. More research is needed on the spiritual care of mental health professionals to define the framework, professional training, and associated challenges in the spiritual care of patients.

Computer-supported expert-guided experiential learning-based tools for healthcare skills

Healthcare professionals, just like any other community, can exhibit implicit biases. These biases adversely impact patients’ health outcomes. Promoting awareness of both social determinants of health (SDH) and the impact of implicit/explicit biases assists healthcare professionals to understand their patients well and improve care experiences. In addition, it helps to augment the long-lasting empathy and compassion in healthcare professionals towards patients for care treatments while maintaining better healthcare professional-patient relationships. Thus, this research provides Computer-Supported Expert-Guided Experiential Learning (CSEGEL) tools or mobile applications that facilitate healthcare professionals with a first-person learning experience to augment advanced healthcare skills (e.g., professional communication, cultural humility, awareness of both SDH and impact of biases on health outcomes). The CSEGEL tools in the form of mobile applications incorporate virtual reality-based serious role-playing scenarios along with a novel Life Course module to deliver first-person experiential learning capability to augment the advanced healthcare skills of healthcare professionals and public awareness. Finally, a preliminary data analysis is provided to demonstrate the positive influence of CSEGEL tools and measure the required number of sample sizes for concrete evidence to show effective results.

Effectiveness of a brief motivational intervention in the management of risky alcohol use in primary care: ALCO-AP20 study protocol.

Motivational interviewing (MI) could be a method for minimizing alcohol-related harm. The study aims to assess the effectiveness of a brief intervention, based on a MI, in patients with risky alcohol use attended in Primary Care (PC). A cluster-randomized, two-arm parallel, multicenter, open-label, controlled clinical trial. Fifty PC healthcare professionals from the province of Córdoba (Spain) will be randomized to one of the two study groups: (1) Experimental Group (EG): MI-based approach; (2) Control Group (CG): Usual care based on health advice. EG intervention: Professionals will receive a training program focused on MI, consisting of a training workshop and the use of pre- and post-workshop questionnaires to measure knowledge and skills acquired, as well as the degree of empathy, with a videotape of the health professionals with standardized patients, before and after the workshop, and subsequent training feedback. CG intervention: Workshop on the management of risky alcohol use based on health advice; participants will also complete the pre-and post-workshop questionnaires and be videotaped. Study population: Patients ≥ 14 years old with risky alcohol consumption (28 Standard Drink Units-SDU-/week in men and 17 SDU/week in women) or excessive alcohol use (≥ 6 SDU in men or ≥ 4 SDU in women, in less than 2 h). It would be necessary to include 110 subjects/group to find a difference of 20% between the percentage of patients in abstinence between EG (37%) and CG (20%), alpha error of 5%, and statistical power of 80%. Assuming a loss rate of 5% and the cluster design effect, the number of subjects to be recruited is estimated at 197/group. The follow-up period will be 12 months. The primary outcome variables will be the self-reported alcohol use level and the Alcohol Use Disorders Identification Test (AUDIT) questionnaire score. The study aims to demonstrate the effectiveness of the motivational approach in the comprehensive treatment of the patient with risky alcohol use, improving the empathy of the healthcare professionals and strengthening the healthcare professional-patient relationship to achieve the behavioral change of the patients with this problem in primary care consultations. ClinicalTrials.gov.

Barriers and enablers to structured care delivery in Australian rural primary care.

The primary aim of this study was to explore the barriers and enablers to structured care delivery in rural primary care, reflecting on Australian research findings. CINAHL and Scopus databases were searched in August 2021. Inclusion criteria included English language, full-text studies, published since 2011, reporting on the barriers and enablers to the delivery of structured care within rural and remote primary care. Structured care was conceptualised as care that was organised, integrative and planned. A total of 435 studies were screened. Thirty-four met the inclusion criteria. Barriers to the provision of structured care related to workforce shortages, limited health care services and health care professional capacity, cultural safety and competency, limited resourcing, insufficient knowledge and education, geographical isolation, inadequate care coordination, unclear roles and responsibilities and poor health professional-patient relationships. Health care system and geographical barriers and enablers encountered in rural areas are complex and multidimensional. Identification of the specific challenges to structured care delivery highlights the need for a focussed review of workforce supply and distribution challenges as well as the investigation of system integration, leadership, governance and funding reform that would be required to support rural primary care.

Healing, Wholeness, and the Professional-Patient Relationship

The proposed revisions to Part Three of the Ethical and Religious Directives (ERDs)—on the professional-patient relationship—call attention to a number of timely, culturally relevant issues that require an understanding of the dignity of the human person and the true health of body, mind, and spirit. Several key issues newly discussed in these proposed revisions include transgender policies, the question of referrals for unethical clinical interventions, and triage and limited-resource allocation protocols for crisis situations. This paper draws on the theological and philosophical basis forunderstanding the professional-patient relationship, especially in light of the metaphor of Christ the physician, in order to consider how the ERDs effectively address these key issues and promote true healing in Catholic health care.

Explaining the negative effects of patient participation in patient safety: an exploratory qualitative study in an academic tertiary healthcare centre in the Netherlands

ObjectiveAlthough previous studies largely emphasize the positive effects of patient participation in patient safety, negative effects have also been observed. This study focuses on bringing together the separate negative effects...

Validação da versão brasileira do Questionário de Profissionalismo da Penn State College of Medicine

Abstract Introduction: Assessing professionalism represents a challenge for medical educators given the nature of its construct, which comprises diverse values, beliefs, and principles. Understanding this psychological phenomenon is fundamental for reaching the goals in medical education. Objective: This study aimed to translate into Brazilian Portuguese and to validate the Penn State College of Medicine Professionalism Questionnaire. Method: The questionnaire was translated, and cross-culturally adapted into Brazilian Portuguese using data from 249 medical students. An exploratory factor analysis was conducted, using a polychoric matrix and the Robust Diagonally Weighted Least Squares method of extraction. The following model adequacy indexes and criteria were used: Root Mean Square Error of Approximation (RMSEA) adjustment indexes <0.08, Comparative Fit Index (CFI) and Tucker-Lewis Index (TLI) >0.90. Result: The exploratory factor analysis obtained a KMO = 0.920, and a significant Bartlett’s test of sphericity (2719.0, gl = 630; P <0.001). The parallel analysis yielded a three-factor solution, which showed adequate levels of reliability: Professional-Patient Relationship, Professional Development and Ethical Commitment. The three-factor solution was the best one found to represent the data. Conclusion: The questionnaire evidenced good psychometric properties and appropriateness to evaluate medical students’ professionalism, contributing to reach more desirable ethical standards in medical education.

Social representations of nurses of the Emergency Care Unit towards people with mental disorder

Objective: To understand the Social Representations of nurses from an Emergency Care Unit about the care provided to people with mental disorders. Method: Qualitative exploratory study, supported by the theoretical and methodological framework of the Theory of Social Representations. Interviews were conducted from July to August 2021. The data were processed using the IRaMuTeQ software. Results: 22 nurses were interviewed. From the processed data, three discursive categories were constructed: the tortuousness of the Psycho-Social Care Network (RAPs): in search of a path; the abyss between the health professional and the person with mental disorder; and unveiling the care of nurses in the Mental Health Emergency Care Unit. Conclusion: We identified a lack of knowledge about the Psychosocial Care Network, anchoring elements associated with previous negative experiences that influence the professional-patient relationship, and nursing care permeated by cognitive barriers. Such findings are unprecedented in the locality studied and relevant to promote the qualification of the work of nurses in mental health in the Emergency Care Unit.