Whole-person Health Care Research Articles

Whole person healthcare as social and environmental justice: new research directions toward a paradigmatic integration of an ecological whole system medicine framework

With increasing recognition of the interdependencies of human and planetary health, calls for a socially and environmentally just framework of health have centered on whole person healthcare (WPHC) approaches. This perspective piece proposes an argument for broadening the definition of human health from WPHC to one that is guided by the philosophical orientation of traditional whole system medicine (WSM) approaches, undergirded by the values of social and environmental justice, and supported by the practices of an allopathic-integrative medicine-based WPHC framework. This piece presents opportunities for praxis offered by a WSM–WPHC framework to address global inequity, environmental disparities, and sustainability challenges. An ecological WSM–WPHC framework envisages social and environmental justice in material and discursive ways by foregrounding environmental planetary ecological consciousness as constitutive of human consciousness and biopsychosocial composition. It argues for structural support through formalized programmatic pathways targeting funding opportunities and mechanisms that invite investigations addressing epistemic challenges of expanding definitions of evidence constituting basic science knowledge domains beyond mechanistic, causal, and formative paradigms. Furthermore, it calls for innovative research directions examining the integration and validation of evidence-based approaches incorporating the ontologically diverse and epistemically distinct ontological orientation of WSM and clinical approaches. A WSM–WPHC framework that positions human health within the parameters of social and environmental justice principles envisions the material enactment of the practice of health and medicine as a universal planetary value.

The Integration of Patient-Centered Care and the Biopsychosocial Model by Athletic Trainers in the Secondary School Setting.

Our purpose was to explore the degree to which secondary school athletic trainers (SSATs) perceive they are integrating the principles of patient-centered care (PCC) and the biopsychosocial (BPS) model in their practice. We used a cross-sectional design to explore the primary research question. We used the Global Perceptions of Athletic Trainer Patient-Centered Care (GPATPCC) tool and the Biopsychosocial Model of Health (BPSMH) tool, both measured on a 4-point Likert scale (1 = strongly disagree, 2 = disagree, 3 = agree, 4 = strongly agree, with an unscored "unsure" option). We sent the survey to 5665 SSATs through the National Athletic Trainers' Association. Results indicate participants expressed strong agreement (mode = 4) with 7 of the 14 statements and agreement (mode = 3) with the remaining 7 statements of the GPATPCC tool (grand mean = 3.4 ± 0.8). Overall, participants rated their level of agreement on the BPSMH as agreeing (mode = 3) for each item (grand mean = 3.0 ± 1.0). SSATs perceive they are integrating the principles of PCC and the BPS model in clinical practice. These findings align with two previous studies concluding that patients, parents, and providers believe athletic trainers provide care that is focused on whole-person healthcare.

577: ADDRESSING PATIENT AND FAMILY SPIRITUAL NEEDS: A NATIONAL NEEDS ASSESSMENT OF PEDIATRIC FELLOWS

Introduction: Spiritual care is an essential component of whole-person healthcare and becomes increasingly important in critical situations. Despite practice guidelines from the American College of Critical Care Medicine, studies have shown that adult critical care physicians rarely initiate conversations about patients’ and families’ spiritual needs and cite lack of training as a significant barrier. Little is known about the perspectives of pediatric physicians working in critical care settings as they relate to spiritual care. Methods: An IRB-approved survey was sent to 720 pediatric fellows training in critical care settings (165 Cardiology, 259 Critical Care, 296 Neonatology). Categorical data was compared using chi-squared test or Fisher’s exact tests. The Wilcoxon rank sum test was used to compare the percentage correct on ten multiple-choice questions about world religions. Written free text responses were independently reviewed and coded using inductive analysis by two research investigators. Results: 245 surveys were completed yielding a 34% response rate. 83% of fellows had never received prior spiritual care training and 72% of fellows indicated that they would be somewhat or very likely to incorporate spiritual care into their practice if they received training. Prior training was significantly associated with increased knowledge of a framework for taking a spiritual history (p < 0.001), the spiritual care resources at the fellow’s institution (p < 0.004), and spiritual practices that could influence medical care (p < 0.029). Prior training was significantly associated with frequency of taking a spiritual history (p < 0.0001), comfort taking a spiritual history (p < 0.0001), and referring patients/families to spiritual care resources (p < 0.016). Lack of time and training were the most commonly reported barriers to providing spiritual care in qualitative responses. Conclusions: Providing spiritual care for families is important in critical care. Pediatric fellows are open to incorporating spiritual care into their practice but lack the training to do so. Prior training is significantly associated with improved knowledge and skills in providing spiritual care. An opportunity exists to implement spiritual care training into pediatric training programs.

Continuing Professional Development Using Infographics Improves the Familiarity of the Social Determinants of Health

Context Secondary school athletic trainers (ATs) may not be aware of health care delivery strategies for the social determinants of health (SDOH). Specifically, secondary school ATs have demonstrated the lowest knowledge and practice of the SDOH. Objective The purpose of this study was to determine whether infographics as a continuing professional development method changed patient-centered–care screening considerations and familiarities with the SDOH. Design Randomized controlled trial. Setting Online survey with infographic intervention. Patient or Other Participants In total, 34 participants in the intervention group and 46 participants in the control group were included for the analysis. Intervention(s) The intervention group received a different SDOH infographic weekly for 12 weeks. The control group did not receive any infographics. Main Outcome Measure(s) The survey asked participants to rate their patient-centered–care tasks, screening consideration, and familiarity with the SDOH. Results A significant change-score improvement was identified for the intervention group relative to providing whole-person health care (P = .024) and recognizing the SDOH (P ≤ .001). No statistical differences were noted for screening and practices between the groups. However, familiarity with screening for 4 SDOH areas improved for the intervention group, including access to primary care (P = .007), poverty (P = .048), environmental conditions (P = .036), and social cohesion (P = .025). Conclusion The ATs improved their familiarity with screening for some SDOH after engaging in professional development using infographics, but screening practices and considerations did not change over the course of the study.

Patient-centered addiction medicine: What patients say helps them the most in their recovery - the role of whole-person Healthcare and prayer in opioid addiction recovery

Patient-centered addiction medicine: What patients say helps them the most in their recovery - the role of whole-person Healthcare and prayer in opioid addiction recovery

Personality Traits and Subjective Well-being of Fathers of Preterm and Full-term Infants: A Case Study of A Medical Center in Taiwan

Background: This study aimed to elucidate whether the demographics and personality traits of fathers, who are considered to be responsible for their families’ well-being, influence the fathers’ subjective well-being. Purpose: To investigate the relationship between the personality traits and well-being of fathers of preterm and term infants; and related factors. Design: Descriptive sampling was used in a cross-sectional study. Methods: The “Personality Inventory Scale” and “Subjective Well-Being Scale” were administered, which had respective internal consistencies of 0.83 and 0.95. Results: (1) The two groups reported moderate subjective well-being; (2) there was no significant difference in the overall personality traits between the two groups; (3) In both groups, the fathers’ subjective well-being increased with age; (4) In both groups, the core subjective well-being of fathers was higher than that of the noncore family, and their subjective well-being was not significantly affected by the number of children or by family socioeconomic status. In short, in both groups, the fathers’ subjective well-being was influenced by their personality, age, and family structure. Practice implications: Examining issues related to the personality traits of fathers of preterm infants is useful not only in the formulation of care and medical systems, solutions, and strategies for preterm infants but also in understanding family relationships to enhance subjective well-being. The present findings serve as a reference for the development of family-centered, whole-person health care.

Biotensegrity Is Needed in Athletic Training Professional Education

Context Tensegrity is a structural-organization model initially described in the architecture and design fields. By applying tensegrity design principles to biological structures, scientists have developed biotensegrity to explain a complex systems-on-systems structural-organization philosophy for integrated human movements. Objective To provide a brief historical overview of tensegrity and biotensegrity principles, including recommendations and benefits for integrating these structural models into athletic training education. Background Tensegrity and biotensegrity structures require constant interaction between continuous tension and discontinuous compression elements that connect through focal adhesion points. During the 1970s and 1980s, scientists applied tensegrity concepts to biological organisms to create an integrated model of human structure and interaction. Since then, biotensegrity has grown as an accepted biological structural model capable of explaining complex and integrated human movements. Synthesis By teaching tensegrity and biotensegrity principles, athletic training educators can provide athletic training students with a basic and consistent human body structural model. With this knowledge, students can better comprehend the integrated kinetic chain, including current and future prevention, examination, and rehabilitation paradigms. Results Although absent from the Practice Analysis, seventh edition, and the 2020 Commission on Accreditation of Athletic Training Education curricular content standards, tensegrity and biotensegrity relate to many injury prevention, examination, treatment, and rehabilitation concepts regularly taught in professional athletic training programs. Recommendation(s) Athletic training educators should consider ways to incorporate biotensegrity models into professional athletic training programs to improve critical thinking and whole-person health care principles of athletic training students. Conclusion(s) Integrating tensegrity and biotensegrity principles into professional athletic training programs provides a structural hierarchy of human body organization that athletic training students can apply to a multitude of current and future methodical approaches.

Educational Technique: Incorporating Social Determinants of Health Into Athletic Training Education

Context Social determinants of health (SDH) are reportedly more important in determining a patient's health status than the actual health care services provided. Given their role and unique clinical practice environment, athletic trainers will encounter patients who are influenced by SDH. It is important to educate future generations of athletic trainers on the importance of SDH to promote positive patient outcomes. Objective To detail a strategy for implementing concepts of SDH into athletic training education programs. Background A purposeful educational strategy that incorporates didactic concepts and clinical practice application of SDH for athletic training students is important to produce a deeper understanding of the role these factors play in populational health. Description Delivery methods such as presentation modules and learning activities are presented. Clinical Advantage(s) Integrating SDH through a tailored activity exposes students to the concepts of SDH and promotes observation and use in clinical practice. Awareness and recognition of how SDH support delivery of patient-centered care may promote patient and population health outcomes. Conclusion(s) The inclusion of SDH into athletic training education using lecture, observational learning, and reflective techniques can expose students to SDH in clinical practice and promote whole-person health care.

From Our Practices to Yours: Key Messages for the Journey to Integrated Behavioral Health

The historic, cultural separation of primary care and behavioral health has caused the spread of integrated care to lag behind other practice transformation efforts. The Advancing Care Together study was a 3-year evaluation of how practices implemented integrated care in their local contexts; at its culmination, practice leaders ("innovators") identified lessons learned to pass on to others. Individual feedback from innovators, key messages created by workgroups of innovators and the study team, and a synthesis of key messages from a facilitated discussion were analyzed for themes via immersion/crystallization. Five key themes were captured: (1) frame integrated care as a necessary paradigm shift to patient-centered, whole-person health care; (2) initialize: define relationships and protocols up-front, understanding they will evolve; (3) build inclusive, empowered teams to provide the foundation for integration; (4) develop a change management strategy of continuous evaluation and course-correction; and (5) use targeted data collection pertinent to integrated care to drive improvement and impart accountability. Innovators integrating primary care and behavioral health discerned key messages from their practical experience that they felt were worth sharing with others. Their messages present insight into the challenges unique to integrating care beyond other practice transformation efforts.

School nurses' familiarity and perceptions of academic accommodations for student-athletes following sport-related concussion.

The purpose of this study was to evaluate school nurses' familiarity and perceptions regarding academic accommodations for student-athletes following sport-related concussion. School nurses (N = 1,246) accessed the survey School Nurses' Beliefs, Attitudes and Knowledge of Pediatric Athletes with Concussions (BAKPAC-SN). The BAKPAC-SN contained several questions pertaining to concussion management and academic accommodations. There were significant differences regarding personal experience as well as familiarity of academic accommodations (p < .001) between school nurses who work at a school that employs an athletic trainer and school nurses who work at a school that does not employ an athletic trainer. There were significant weak positive relationships between years of experience and familiarity with academic accommodations (r = .210, p < .001), 504 plans (r = .243, p < .001), and individualized education plans (r = .205, p < .001). School nurses employed at a single school were significantly more familiar with academic accommodations (p = .027) and 504 plans (p = .001) than school nurses employed at multiple schools. Health care professionals should collaborate to effectively manage a concussed patient and should consider academic accommodations to ensure whole-person health care.

Imagine the poss-ABILITIES! Therapeutic Recreation: An Integral Aspect of Whole-Person Health Care

The word recreation is really a very beautiful word. It is defined in the dictionary as “the process of giving new life to something, of refreshing something, of restoring something.” This something, of course, is the whole person. (Bruno Hans Geba)Background: The purpose of Therapeutic Recreation is to enable all individuals to improve quality of life, and achieve optimal health through meaningful experiences in recreation and leisure. We believe in the inherent capacities of individuals for wellness, personal growth, happiness and freedom, with or without absence of disease. Therapeutic Recreation is a profession which provides service to, and advocates for individuals with disabilities, illnesses, and other conditions in clinical, community and educational settings. We recognize that everyone has the right to have access to and experience the healing benefits from recreation and leisure opportunities. Therapeutic Recreation follows a systematic process of developing a therapeutic relationship, assessment, goal setting, program development, implementation through individual and group facilitation, documentation and evaluation. Programs are designed based on the strengths, interests and needs of the participants and promote improving wellness within the physical, emotional, spiritual, behavioural and social domains (according to the participant and their context) and to educate individuals about the skills and resources required to participate in recreation and leisure. We use evidence-based practice to create outcome-based interventions suitable to the participant’s abilities.Content: Presentation will be descriptive, drawing attention to the profession of Therapeutic Recreation and how it fits well with the whole person approach.Evidence: Current research indicates a significant number of positive health outcomes resulting from participation in Therapeutic Recreation programs such as: improved physical, cognitive, social and emotional functioning; leisure and life skill development to enhance functional independence; self worth, and quality of life of individuals and their families; adjustment to disability and/or illness and post-traumatic growth; reduced boredom, stress, anxiety, and agitation; reduced decline in physical, cognitive, and psychosocial functioning and as a result reduce the need for health care services; reduced secondary disability and associated higher health care costs.Conclusion: There is strong evidence that Therapeutic Recreation interventions are healing, support wholeness, and can have a major positive impact in the outcomes of people served. Thus, Therapeutic Recreation should be an integral part of any multi-disciplinary health care team that uses a whole-person care approach.

Patient-Centered Medical Home: How It Affects Psychosocial Outcomes for Diabetes

Fragmentation of the current U.S. health care system and the increased prevalence of chronic diseases in the U.S. have led to the recognition that new models of care are needed. Chronic disease management, including diabetes, is often accompanied by a myriad of associated psychosocial issues that need to be addressed as part of a comprehensive treatment plan. Diabetes care should be aligned with comprehensive whole-person health care. The patient-centered medical home (PCMH) has emerged as a model for enhanced primary care that focuses on comprehensive integrated care. PCMH demonstration projects have shown improvements in quality of care, patient experience, care coordination, access to care, and quality measures for diabetes. Key PCMH transformative features associated with psychosocial issues related to diabetes reviewed in this article include integration of mental and behavioral health, care management/coordination, payment reform, advanced access, and putting the patient at the center of health care. This article also reviews the evidence supporting comprehensive and integrated care for addressing psychosocial issues associated with diabetes in the medical home.

C. Lillas and J. Turnbull: Infant/Child Mental Health, Early Intervention, and Relationship-Based Therapies: A Neurorelational Framework for Interdisciplinary Practice

This well-written, excellent book involves a neurorelational framework, complexity, reciprocity, dynamics, integration, and interdisciplinarity. However, just as Lillas and Turnbull argue that child development cannot be seen as the sum of its parts because that does not do justice to the whole, these few words also do no justice to the whole of this book. The authors succeed beautifully in intertwining neuroscience with interpersonal theories, grounded both in evidence-based findings and their clinical work. Starting from the simple question ‘‘What is the meaning of the behavior(s) we see?’’, the authors take the reader on a fascinating journey through the world of infant/child mental health, by which they gradually unravel the complexities of infant/child behavior. I think this book will strike experienced practitioners working in the field of infant/child mental health as a worthy contribution to the literature regarding infant/child development and early intervention. The book outlines important theories and empirical findings and is at the same time very practical, making use of diagrams, step-by-step interventions and worksheets (with a supplementary CD that provides summaries and background information as well as blank ready-to-print worksheets). By applying theoretical frameworks to case material, the authors succeed in offering a very comprehensible and useful book to the practitioner. In my opinion, this volume can also be used as a handbook for graduate students, which I hope will contribute to a more dynamic, integrative thinking in the training of social workers, psychologists, psychiatrists, pediatricians, occupational therapists, and medical practitioners. The American Psychological Association’s definition of ‘‘psychology’’ (American Psychological Association 2010) states, ‘‘[T]oday, as the link between mind and body is well-recognized, more and more psychologists are teaming with other healthcare providers to provide whole-person healthcare for patients.’’ However, daily practice sometimes proves otherwise. The authors, writing from their own experiences, address this lacuna and formulate possible answers to this problem in their book. In the first chapter, they define the problems that many parents and professionals experience in the current era of mental health practice, namely the lack of interdisciplinary collaboration. By describing themes of fragmentation, isolation, hierarchy and specialization, the authors pinpoint some of the most important gaps in contemporary clinical practice. A brief history of assessment and intervention approaches in this chapter, also provides insight in the development of the field. The authors argue that the trend in public policy and academic research toward interdisciplinarity (collaboration between disciplines)—which is not the same as multidisciplinarity (each discipline has its specificity but there is no interaction between them)—is a good thing. However, a clinical case transcript presented in the book, interpreted from different viewpoints, underscores that more implementation of interdisciplinary ideas in clinical practice should be realized. The neurorelational framework presented in the second chapter aims to provide a solution by bridging the gap between different disciplines focused on child development. In fact, what the authors accomplish in their book is a good example of what perhaps should be called ‘‘transdisciplinarity’’ (Choi and Pak 2006), namely the integration of the natural, social and health sciences in a humanities context. In their neurorelational framework, the authors integrate insights from neuroscience, relational, and S. Casalin (&) K. U. Leuven (University of Leuven), Leuven, Belgium e-mail: sara.casalin@psy.kuleuven.be

Review of Whole person healthcare: Humanizing healthcare (vol. 1); Whole person healthcare: Psychology, spirituality, &amp; health (vol. 2) and Whole person healthcare: The arts &amp; health (vol. 3).

This book review critically evaluates the Whole Person Healthcare (WPH) series. These 3 volumes advance a biopsychosocialspiritual model of the person and a holistic, integrative, multidisciplinary, multicultural, evidence-based approach to healthcare that addresses the complex interaction of these dimensions of health and illness. What is the place of WPH in the new medical continuum? Moving us away from the Cartesian dualism of scientific materialism towards a more humanistic paradigm, WPH focuses on issues of existential meaning in illness, as well as the psychological, emotional, imaginal, metaphorical, and symbolic element of being human through the expressive and creative arts. The constructs horizontal integration and practice as taught are introduced as an answer to our current crisis in clinical practice and public policy towards humanizing healthcare in the emerging model of collaborative care.

Using Disablement Models and Clinical Outcomes Assessment to Enable Evidence-Based Athletic Training Practice, Part I: Disablement Models

To present and discuss disablement models and the benefits of using these models as a framework to assess clinical outcomes in athletic training. Conceptual schemes that form the basic architecture for clinical practice, scholarly activities, and health care policy, disablement models have been in use by health care professions since the 1960s. Disablement models are also the foundation for clinical outcomes assessment. Clinical outcomes assessment serves as the measurement tool for patient-oriented evidence and is a necessary component for evidence-based practice. Disablement models provide benefits to health professions through organization of clinical practice and research activities; creation of a common language among health care professionals; facilitation of the delivery of patient-centered, whole-person health care; and justification of interventions based on a comprehensive assessment of the effect of illness or injury on a person's overall health-related quality of life. Currently, the predominant conceptual frameworks of disability in health care are those of the National Center for Medical Rehabilitation Research and the World Health Organization. Disablement models need to be understood, used, and studied by certified athletic trainers to promote patient-centered care and clinical outcomes assessment for the development of evidence-based practice in athletic training. CLINICAL AND RESEARCH ADVANTAGES: For clinicians and researchers to determine effective athletic training treatments, prevention programs, and practices, they must understand what is important to patients by collecting patient-oriented evidence. Patient-oriented evidence is the most essential form of outcomes evidence and necessitates an appreciation of all dimensions of health, as outlined by disablement models. The use of disablement models will allow the athletic training profession to communicate, measure, and prioritize the health care needs of patients, which will facilitate organized efforts aimed at assessing the quality of athletic training services and practices and ultimately promote successful evidence-based athletic training practice.

The Wholistic Health Center Project: an action-research model for providing preventive, whole-person health care at the primary level.

The Wholistic Health Center action-research project is designed to stimulate new approaches for rectifying a variety of maladies present in the nation's primary health care delivery system. In response to the call for an increase in health education programs, for availability of care in early stages of illness, for care focused on life stress factors, and for better coordination of care-the church-based Wholistic Health Centers utilize a unique multidisciplinary teamwork approach for diagnosis and treatment planning. The patient is involved as an active participant in this process. In conjunction with the University of Illinois, Department of Preventive Medicine and Community Health, the project has developed from its inception as a free clinic in Springfield, Ohio, to the establishment of two potentially self-supporting centers in middle and upper-income suburbs west of Chicago, Illinois.