ABSTRACT
@#The COVID-19 outbreak touches the vulnerabilities of frontline doctors. The scope of their inner experiences includes fear/anxiety, uncertainty, isolation, fatigue, moral distress or outrage. Learning how to manage the inner subjective experiences can improve the doctors’ capacity to serve at the frontline. Fear, though common and multi-layered, may be masked by storylines that externalises our difficulties. A method to contain and process fear and other unsettling emotional states is RAIN: Recognise, Allow, Investigate and Nurture. To cope with uncertainty, one needs to stay open to tolerate various outcomes and remainder issues. A framework that provides a narrative for groundedness is described, which comprises the elements of faith in the medical science and our practice, due diligence that supports the faith, acting with courage and compassion, and the focus of another- or community-directed service.
ABSTRACT
Purpose: There are relatively few student-led medical conferences worldwide. A group of medical and nursing students from Yong Loo Lin School of Medicine, National University of Singapore, organized an annual student-led faculty-supported inter-professional Student Medical-Nursing Education Conference (SMEC), which consisted of plenary talks, lectures and workshops, and a scientific competition. This research focused on the evaluation of workshops conducted during the 8th SMEC 2012. Method: The authors used various process variables to survey the conference participants on the educational value of the 4 plenary lectures and 20 workshops, half of which were run by experienced healthcare professionals and the other half by current seniors or recent graduates. Results: A total of 270 medical and nursing students completed the survey. Good to excellent educational value was reported for most of the workshops. Higher educational value was associated with use of props (correlation coefficient, r=0.733 and 0.568), adherence to workshop topic/focus (r=0.608 and 0.815) and openness of presenter to questions (r=0.555 and 0.453). Conclusion: A student-led, faculty-supported interprofessional conference organized by medical and nursing students had good to excellent self-reported education value in helping their fellow medical and nursing students learn about various healthcare disciplines and prepare for medical and nursing school.
ABSTRACT
Agitation and delirium are commonly encountered symptoms in palliative care. Based on the clinical features, delirium may present in the hypoactive, hyperactive and mixed forms. By reason of the prevalence, the significant distress and symptom burden, as well as the possibility of reversibility, it is vital that the clinician be vigilant in identifying and treating delirium and its symptoms. This article describes how delirium may present, the clinical features, aetiologies and the methods to screen and diagnose delirium. When managing a delirious patient in the palliative care setting, it is necessary to contextualise any investigation and intervention in terms of the disease condition and trajectory, the level of distress and the care preferences and goals of the patient and family. Non-pharmacological management should always be in place though pharmacological treatments also have a definite role in the relief of distressing symptoms of agitation and delirium. Support and education for the patient, family and care providers are integral and continuous aspects of care for the agitated or delirious terminally ill patient.
ABSTRACT
Patients are often advised to adopt healthier behaviours or change unhealthy ones on the basis that what they are doing or not doing is detrimental to their health. Some of these changes may include going on a diet, exercising, stopping cigarette smoking and even relaxing and sleeping more. MI was initially developed by Rollnick and Miller as a strategy for addictive behaviour change, but it has found many applications in helping patients change other health related behaviours. MI was initially defined as a client-oriented, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence. The guiding stance, whilst respecting the patient's autonomy and the patient as the agency of change, maintain controls of the direction and structure of the consultation to evoke the patient's own arguments and strategies for change. The guiding process thus avoids the struggle or "fights" with the patient over changing behaviour and has been likened more to "dancing" with the patient. The four counselling principles in MI are: Develop discrepancy; Express empathy; Roll with resistance; and Support self-efficacy. Facilitating the patient to process and speak more about why and how to change then becomes one of the strategies to motivate change. In MI, this is known as change talk. Once change talk is elicited, the ways the practitioner can respond are: Elicit more (with open questions); Affirm; Reflect; and Summarise. Once the patient decides to change, goal setting becomes the next important process. Needless to say, the goal setting process must be done in collaboration with the patient, with the patient having the final say.