Mourning and restoration

During the endless days of March and April 2020, New York City experienced more than 20,000 COVID-19 deaths and was considered the "epicenter" of a new global pandemic. Nursing homes witnessed the virus's contagion at staggering rates, with elderly and debilitated patients coming in by the dozens, gasping for breath, scared they would die and never see their loved ones again. Our hospital and our lives were quickly transformed. The author spent most of his clinical effort during those months running a new eight-bed hospice unit in our hospital. The author then presents the story of a hospice patient, a fifty-nine-year-old Black male-to-female transgender homeless woman. She had been diagnosed with an aggressive squamous cell carcinoma. She underwent chemotherapy, radiation therapy, and surgery, including a diverting colectomy, leaving her with a permanent ostomy. She had several other medical problems-chronic kidney disease, heart disease, diabetes, major depression, and chronic lymphedema. Taking care in her last days of life was agonizing. The possibility to have spent more time getting to know her. To explore her world and navigate the challenges of her health and condition together. This is the privilege of the doctor-patient relationship. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Enhancing Therapeutic Processes in Videoconferencing Psychotherapy: Interview Study of Psychologists' Technological Perspective.

BACKGROUND: The COVID-19 pandemic caused a surge in the use of telehealth platforms. Psychologists have shifted from face-to-face sessions to videoconference sessions. Therefore, essential information that is easily obtainable via in-person sessions may be missing. Consequently, therapeutic work could be compromised. OBJECTIVE: This study aimed to explore the videoconference psychotherapy (VCP) experiences of psychologists around the world. Furthermore, we aimed to identify technological features that may enhance psychologists' therapeutic work through augmented VCP. METHODS: In total, 17 psychologists across the world (n=7, 41% from Australia; n=1, 6% from England; n=5, 29% from Italy; n=1, 6% from Mexico; n=1, 6% from Spain; and n=2, 12% from the United States) were interviewed. We used thematic analysis to examine the data collected from a sample of 17 psychologists. We applied the Chaos Theory to interpret the system dynamics and collected details about the challenges posed by VCP. For collecting further information about the technology and processes involved, we relied on the Input-Process-Output (IPO) model. RESULTS: The analysis resulted in the generation of 9 themes (input themes: psychologists' attitude, trust-reinforcing features, reducing cognitive load, enhancing emotional communication, and engaging features between psychologists and patients; process themes: building and reinforcing trust, decreasing cognitive load, enhancing emotional communication, and increasing psychologist-patient engagement) and 19 subthemes. Psychologists found new strategies to deal with VCP limitations but also reported the need for more technical control to facilitate therapeutic processes. The suggested technologies (eye contact functionality, emergency call functionality, screen control functionality, interactive interface with other apps and software, and zooming in and out functionality) could enhance the presence and dynamic nature of the therapeutic relationship. CONCLUSIONS: Psychologists expressed a desire for enhanced control of VCP sessions. Psychologists reported a decreased sense of control within the therapeutic relationship owing to the influence of the VCP system. Great control of the VCP system could better approximate the critical elements of in-person psychotherapy (eg, observation of body language). To facilitate improved control, psychologists would like technology to implement features such as improved eye contact, better screen control, emergency call functionality, ability to zoom in and out, and an interactive interface to communicate with other apps. These results contribute to the general perception of the computer as an actual part of the VCP process. Thus, the computer plays a key role in the communication, rather than remaining as a technical medium. By adopting the IPO model in the VCP environment (VCP-IPO model), the relationship experience may help psychologists have more control in their VCP sessions.

The psychiatrist in scrubs

Comments on the article, It is time for a dress code in psychiatry by R. Balon and M. K. Morreale (2020). I read with great interest the editorial by Balon and Morreale, in which a cogent case is put forth regarding the ramifications of a psychiatrist's attire on the psychiatrist-patient relationship and perceptions of psychiatric treatment. As a child and adolescent psychiatrist who provides consultation to a pediatric emergency department, the topic of appropriate attire for psychiatrists has been especially salient at a time when I, and my colleagues working in the emergency department, have been required to wear scrubs, a face mask, and eye protection when assessing and treating patients as part of hospital practices intended to mitigate the spread of COVID-19. Recent scholarly literature has highlighted potential challenges in the formation of a therapeutic alliance stemming from the use of face masks in psychiatric practice. Our choice of attire is among the manifold factors that influence our interactions with patients, and even when this choice is removed, it is essential that we remain attuned to the potential impacts of our appearances. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

How women are asked about domestic violence: An exploratory case study of medical practitioners in Ghana

This is a qualitative exploratory case design to understand how medical practitioners inquire about domestic violence among women who present for medical care in hospitals in Ghana. This case study was guided by three conceptual frameworks namely social constructionism (participants' reality), ecological framework (institutional and cultural factors), and public health framework (preventive). Six (3 females and 3 males) medical practitioners who provide direct medical care in urban regional hospitals of Ghana were purposively selected to participate in virtual interviews due to COVID-19 travel restrictions. Participants were asked a total of thirty-two questions to identify domestic violence inquiry practices with women, attitudes, and perceptions towards DV inquiry, barriers of DV inquiry, and provider level of knowledge of DV Act 732 Ghana and DV training. Interview transcripts were organized using NVivo to create initial codes and themes respectively. Emergent findings indicated that medical practitioners do not routinely ask women for domestic violence experiences when they do not present with an initial diagnosis of some injury related to DV although they believe DV inquiry is necessary to provide holistic and trauma-informed care to women. DV inquiry is related to factors such as non-existing protocols in hospitals, cultural and logistical challenges that impede inquiry efforts, and victim self-disclosure. Based on the findings of this study, some implications for the health care sector in Ghana such as the Ministry of Health and service were outlined. The study addressed the gap in the literature by focusing on response to DV in Ghanaian government health care settings. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Exploring the association among provider-patient relationship, communication, accessibility and convenience, and perceived quality of care from the perspective of patients living with HIV before and during SARS-CoV-2 pandemic

Globally, 37.8 million people were living with human immunodeficiency virus and acquire immunodeficiency syndrome (HIV/AIDS) in 2018, with 1.7 million new cases reported and 57% receiving antiretroviral therapies. Nearly 76,000,000 people have been diagnosed with HIV and an estimated 33,000,000 people have died of HIV/AIDS since the beginning of the epidemic. The focus of this research was to investigate the perspective of persons living with HIV in respect to their relationship with their provider, provider communication, accessibility, and their perceived quality of care before and during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic using a cross-sectional quantitative analysis. This cross-sectional quantitative study was conducted to ascertain whether a relationship exists between provider patient relationship, communication, accessibility and convenience, and perceived quality of care from the perspective of patients living with HIV before and during the SARS-CoV-2 pandemic using a regression analysis. Fifty-eight individuals participated in the study and their responses were anonymous. The study was guided by a patient-centered care model as an approach to inform health care providers who are providing services in HIV care. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Rapport building: An authenticity training model for in-hospital treatment teams

The Researcher in an Applied Clinical Psychology program interacted with a panel of physicians that considered the importance of building a rapport in a workshop designed to understand and develop skills in a diverse field. It includes feedback from physicians as a way to refine the final product;feedback that was instrumental in making it possible to ask and receive additional information in which improved the effectiveness of the final product. Scientific evidence of the importance of rapport-building specifically relating to effective patient care was shown. The methodology and the design of the model formulated and developed to show how effective patient care skills can be learned and used by all clinicians relating different cultures by understanding diversity and the necessity thereof. The theoretical aspects of the clinical field relating to rapport building was discussed and researched with the panel members. This topic was followed by a discussion regarding research results. Lastly, the training model was presented. Theories related to rapport building and information from the panel members received contributed to information all clinicians can use for future skill development. Hence, further showing how vital rapport building is a necessity to relating to patients during and after the COVID-19 pandemic. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Containment and therapeutic relationships in acute psychiatric care spaces: The symbolic dimensions of doors

Background: There is an increasing trend of door locking practices in acute psychiatric care. The aim of the present study was to illuminate the symbolic dimensions of doors in Greek mental health nurses' experiences of open and locked working spaces. Results: A sequential mixed-method designexplored the experiences of nurses working in both open and locked psychiatric acute care units. Participants experiences revealed four types of doors related to the quality of recovery-oriented care: (a) the open door, (b) the invisible door, (c) the restraining door, and (d) the revolving door. Open doors and permeable spacesgenerated trust and facilitated the diffusion of tension and the necessary perception of feeling safe in order to be involved in therapeutic engagement. When the locked unit was experienced as a caring environment, the locked doors appeared to be "invisible". The restraining doors symbolized loss of control, social distance and stigma echoing the consequences of restrictingpeople's crucial control over spaceduring the COVID-19 pandemicin relation toviolence within families, groups and communities. The revolving door (service users' abscondence/re-admission) symbolised the rejection of the offered therapeutic environment and was a source of indignation and compassion fatigue in both open and locked spaces attributed to internal structural acute care characteristics (limited staffing levels, support, resources and activities for service users) as well as 'locked doors' in the community (limited or no care continuity and stigma). Conclusions: The impact of COVID-19 restrictions on people's crucial control of space provides an impetus for erecting barriers masked by the veil of habit and reconsidering the impact of the simple act of leaving the door open/locked to allow both psychiatric acute care unit staff and service users to reach their potential. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Mitfuhlen: A feeling space to think in

In the article, author shares her experience of working as a student counselor at a university during pandemic. Author wishes to explore a particular approach to the therapeutic endeavor which author will call 'Mitfuhlen'. It is a German word whose most literal translation means 'feeling with'. Author will describe how Mitfuhlen enables the therapeutic couple to share feelings together in order that they can be thought about together. Author will propose that the practice of Mitfuhlen creates a venue that is co-created by the therapist and patient, and facilitated by the frame and setting. Author will describe this venue as a 'feeling space to think in'. Author will explore this approach using a particular example from clinical work with a university student. Author is doing so because it was with this student that author used the term 'feeling space to think in' for the first time. The adaptation of the seemingly straightforward word, Mitfuhlen, 'feeling with', to the therapeutic setting offers an additional tool to the therapist's repertoire. Certainly it is closely allied to other techniques, yet it makes a valuable contribution towards models of working with transference. Perhaps most significantly, Mitfuhlen enables the therapist to approach the analytic situation as one in which experience is mutually shared in order that change may occur. Although my work with Cathy was curtailed by time constraints and carried out digitally from a great distance, author is certain that a creative dynamic was at work between us which enabled me to recognize therapy as a 'feeling space to think in'. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Relationship-centered consultation skills for audiologists: Remote and in-person care

To compound the problem of low uptake of hearing aids, recent data suggest untreated hearing loss is linked to several other conditions that erode a person's overall quality of life, especially as they age. One popular approach geared to better meet the needs of persons with hearing loss is to practice patient-centered care. Something that is easy to talk about (ask any audiologist and they say that they do it) but challenging to implement. Patient-centered care might seem like a recent advance, but the term has been around for more than 30 years. Relationship-centered communication acknowledges the clinician's expertise and judgment, while respecting the person's preferences, perspectives, and ultimately his or her ability to decide what intervention is best. Recently, Wallhagen, Strawbridge, and Tremblay (2021) proposed that audiologists should work within the 4M's framework. The 4M's framework suggests that what Matters is relationship-centered communication, and it needs to be combined with being mindful of Medication that might impact the individual's overall wellbeing and communication ability, along with Mobility (maintaining overall daily physical functioning) and Mentation (sustaining good cognitive and emotional health). The 4M's framework reminds us that hearing loss is not independent of other health conditions and the ability to capture the full totality of the individual's situation is built on a foundation of holistic, empathic communication. This book intends to provide some practical guidance, based on scientific principles, around this foundation of holistic communication. Furthermore, it shows that relationship-centered communication is not confined to in-person visits;that strong professional relationships can be forged in the virtual world-something that should interest all stakeholders as we move into the post-COVID era of tele-audiology and remote care. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

The medical treatment relationship and corona

What does the current COVID-19 pandemic teach us about the doctor-patient relationship? What terms and concepts are significant? Why is Balint work an ideal technique for exploring these multi-layered relationships in depth? The author explores these questions in her opening lecture of last year's 59th Sils Balint Study Week. (PsycInfo Database Record (c) 2022 APA, all rights reserved) (German) Was lehrt uns die aktuelle Covid-19-Pandemie uber die Arzt- Patientenbeziehung? Welche Begriffe und Konzepte haben dabei eine Bedeutung? Warum ist Balintarbeit eine ideale Technik, diese vielschichtigen Verhaltnisse vertieft zu erforschen? Diesen Fragen geht die Autorin in ihrem Eroffnungsreferat der letztjahrigen 59. Silser Balint-Studienwoche nach. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

The empowering role of hospitable telemedicine experience in reducing isolation and anxiety: Evidence from the COVID-19 pandemic

Purpose: This paper aims to explore how hospitable telemedicine services empowered patients during the COVID-19. Expanding from the technology aspect, this research integrated the philosophy of hospitality organizational culture by including factors related to human-human interaction as significant predictors for patients' sense of empowerment (perceived competence and control) in coping with their emotional stress (anxiety and isolation). Design/methodology/approach: Survey data were obtained from 409 general consumers who have used video-based virtual consultation since February 2020. Stepwise multiple regression and simple linear regression analyses were used for hypotheses testing. Findings: The results reveal that the doctors' reliability, responsiveness and empathy significantly predict patients' perceived competence and control. Perceived usefulness and convenience of telemedicine technology enhance patients' perceived competence and control. Patients' sense of empowerment significantly reduces their anxiety and sense of isolation. Research limitations/implications: To fully understand the role of hospitality in people's telemedicine experiences, future studies are encouraged to not only examine the patients-clinicians interactions but also explore the patients-support staff interactions. Practical implications: Health care providers' "bed-side" manners empower patients in managing their emotional stress. Health care providers should be trained for their empathetic ability and communication skills. Strategies such as collaborating with hospitality schools and business schools can be implemented to help build medical student's patient-centric attitudes and skills. Originality/value: This paper provided empirical evidence for the value of hospitality in health care and offered useful suggestions for health care providers, especially by empowering vulnerable people during catastrophic events such as COVID-19. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

BPM Support for Patient-Centred Clinical Pathways in Chronic Diseases.

Epidemiological trends over the past decade show a significant worldwide increase in the burden of chronic diseases. At the same time, the human resources of health care are becoming increasingly scarce and expensive. One of the management concepts that can help in solving this problem is business process management (BPM). The results of research conducted in the healthcare sector thus far prove that BPM is an effective tool for optimizing clinical processes, as it allows for the ongoing automatic tracking of key health parameters of an individual patient without the need to involve medical personnel. The aim of this article is to present and evaluate the redesign of diagnostic and therapeutic processes enabling the patient-centric organization of therapy thanks to the use of new telemedicine techniques and elements of hyperautomation. By using an illustrative case study of one of the most common chronic diseases, Chronic Obstructive Pulmonary Disease (COPD), we discuss the use of clinical pathways (CPs) prepared on the basis of the current version of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) as a communication tool between healthcare professionals, the patient and his or her caregivers, as well as the method of identifying and verifying new knowledge generated on an ongoing basis in diagnostic and therapeutic processes. We also show how conducting comprehensive, patient-focused primary health care relieves the health care system, and at the same time, thanks to the use of patient engagement and elements of artificial intelligence (predictive analyses), reduces the significant clinical risk of therapy.