A discourse analysis of health provider interactions with parents who are reluctant to vaccinate

ObjectiveVaccine hesitancy is a persistent barrier to vaccination uptake, and health professionals report interactions with such parents to be difficult. Using discourse analytic techniques, we examine the foundation of a therapeutic relationship: the display of empathy and attempts to build rapport, in consultations between immunisation specialists and vaccine reluctant parents.MethodsConsultations between consenting clinicians and parents in two Specialist Immunisation Clinics in Australia were recorded. Twelve conversations between the clinicians and parents were analysed using interactional sociolinguistic (IS) discourse analytic methods.ResultsThis paper takes a case study approach by citing two interactions that exemplify the interactional work of the consultants as they strive to engender mutual understanding and goodwill, noting examples of discursive choices that demonstrate empathy and the building of rapport.ConclusionAwareness of discourse strategies that interweave relational and clinical goals enable a more nuanced understanding of communication skills that support a guiding partnership in vaccine related decisions with parents.Practical implicationsThrough highlighting the strategic interactional work that displays empathy and builds rapport, we can inform educational approaches and build a repertoire of communication choices that strengthen the communication skills of health professionals.     

共情护理对女性抑郁症脑电生物反馈治疗患者治疗依从性及生活功能的影响

目的探讨共情护理对女性抑郁症脑电生物反馈治疗患者治疗依从性及生活功能的影响。方法选择2018年1月至2019年6月于我院行脑电生物反馈治疗的女性抑郁症患者98例,根据护理方法不同分为对照组(49例,常规护理)与观察组(49例,共情护理)。比较两组的治疗依从性和生活功能。结果干预后,观察组用药、自我观察、临床护理依从性均高于对照组(P <0.05)。干预后,观察组的躯体功能、心理功能、社会功能、物质生活评分高于对照组(P <0.05)。结论共情护理可提高女性抑郁症脑电生物反馈治疗患者的治疗依从性和生活功能,促进患者恢复。     

Autonomic arousal explains social cognitive abilities in high-functioning adults with autism spectrum disorder

Empirical research into behavioural profiles and autonomic responsivity in individuals with autism spectrum disorders (ASDs) is highly variable and inconsistent. Two preliminary studies of children with ASDs suggest that there may be subgroups of ASDs depending on their resting arousal levels, and that these subgroups show different profiles of autonomic responsivity. The aim of the present study was to determine whether (i) adults with high-functioning ASDs may be separated into subgroups according to variation in resting arousal; and (ii) these ASD arousal subgroups differ in their behavioural profiles for basic emotion recognition, judgements of trustworthiness, and cognitive and affective empathy. Thirty high-functioning adults with ASDs and 34 non-clinical controls participated. Resting arousal was determined as the average skin conductance (SCL) across a 2 min resting period. There was a subgroup of ASD adults with significantly lower resting SCL. These individuals demonstrated poorer emotion recognition, tended to judge faces more negatively, and had atypical relationships between SCL and affective empathy. In contrast, low cognitive empathy was a feature of all ASD adults. These findings have important implications for clinical interventions and future studies investigating autonomic functioning in ASDs.     

Neural responses to perceiving suffering in humans and animals

The human ability to perceive and understand others' suffering is critical to reinforcing and maintaining our social bonds. What is not clear, however, is the extent to which this generalizes to nonhuman entities. Anecdotal evidence indicates that people may engage in empathy-like processes when observing suffering nonhuman entities, but psychological research suggests that we more readily empathize with those to whom we are closer and more similar. In this research, we examined neural responses in participants while they were presented with pictures of human versus dog suffering. We found that viewing human and animal suffering led to large overlapping regions of activation previously implicated in empathic responding to suffering, including the anterior cingulate gyrus and anterior insula. Direct comparisons of viewing human and animal suffering also revealed differences such that human suffering yielded significantly greater medial prefrontal activation, consistent with high-level theory of mind, whereas animal suffering yielded significantly greater parietal and inferior frontal activation, consistent with more semantic evaluation and perceptual simulation.     

Empathy in medical education: A case for social construction

In this brief review, we build upon suggestions in Pedersen’s [1] excellent critical review of empathy research in medical education and make the case for an increase in social constructivist scholarship related to emotions and empathy within medical education contexts. In the process, we define social construction, as well as provide several key opportunities in which these types of theories could provide insights for medical educators.     

共情护理改善老年脑梗死患者负性情绪的作用

目的探讨共情护理改善老年脑梗死患者负性情绪的作用。方法选取我院自2013年2月~2014年7月收治的153例老年脑梗死患者,随机分为观察组和对照组,观察组77例,对照组76例,对照组给予常规护理,观察组在常规护理的基础给予共情护理,分析各自护理方式对两组病例负性情绪的影响。结果护理前,两组病例抑郁自评量表(SDS)评分和焦虑自评量表(SAS)评分比较,P0.05,差异不具有统计学意义;护理后,两组病例SDS评分和SAS评分均有所下降,而对照组下降的程度小于观察组,观察组改善程度优于对照组,P0.05,差异具有统计学意义。结论共情护理能够有效改善老年脑梗死患者负性情绪的作用,患者依从性好,有利于病情的恢复。     

La passion du soin et du travail psychiques,un paradoxe ?

Is passion, a concept difficult to define, disturbing affect by its double emotional and representative dimension, “a normal pathological state”? It concerns any relation to an “object” that wants to occupy a considerable place in existence. Can a therapist be passionate or be crossed by passion? Whether it is cultural, artistic, sporting, passion can provoke, we know it well, a passionate outburst. How can one accept its necessity while being wary of its destructive side (mystical passion, delusional passion) where the subject ends up getting lost? Etymology may provide a partial response to the polysemy of the word that has created confusion. Passion comes from the Latin “passio” which refers to the fact of suffering, experiencing. The Greek root “pathos” gave pathology whose original meaning is the study of passions and then that of diseases, and also non-medical terms (pathetic…). The semantic confusion has been based on this for centuries. Passion remains difficult to pin down. What maintains my desire, my passion in this solitary work? I need to remain in the unceasing research, in the questioning. Here are the basics inscribed in me: reading, working meetings that bring pleasure to think while maintaining openness to the unconscious by better grasping the counter-transference, belonging to a society to share the same passion of human knowledge and the same desire to heal. Passions remain pervasive and some take up more space than the object of passion. This is one of the many paradoxes. An other: the passion, this “dark complacency to vertigo” (Paul Ricoeur), allows to alienate oneself in the bond to better find oneself, to recreate oneself. We cannot, escape knowledge about ourselves. Beyond its excess, constitutes a real psychic work of elaboration and symbolization. Let us keep alive this passion for psychic care and work. To do this, let us remain confident in our theoretic-clinical commitments as well as in the changes we deem necessary to help those who come to tell us about their suffering. Who are they? Interest in their own mental health is initially acquired for neurotic patients; it is legitimate and useful. With patients working on a psychotic register, this is not the case and we are faced with an obstacle cited by Marcel Sassolas, which is “the distrust developed by these people towards their own psychic activity”. The only real objective of psychiatric care remains the safeguarding and restoration of their psychic activity, knowing full well that being present is a source of danger. What maintains our desire for care and psychic work with the attention we pay to it? The way we work with the richness of the commitments it unders understands – psychoanalysis for me – allows us to understand the human in an exceptional and exciting way. Here are two of my tools. First empathy. It is a dialectic between understanding and feeling that manifests, occurs, in an unseeded manner at the level of the preconscious of one (therapist) or the other (patient). My other tool is this therapeutic device that is co-work (shared associative movement). Daniel Widlöcher's co-thought… The latter has taken up the Freudian concept of “induction of thought”. This allows him to link empathy, through “the transfer of thought”, to the associative and representational co-thinking of the therapist and the patient. What is this co-work? In psychoanalytic relaxation, for example, we know that a particular word, a phrase, a phoneme can have, for the relaxer, an emotional impact that is inscribed in his thought (reverie) and in his body (sensation). Passion allows creative psychic care by producing from living. It strengthens our need for new projects that boost our motivation and confidence. It maintains our desire to be at the heart of psychic work and that of transmitting that strength. Creativity is not the ability to create a work, it is the ability to creatively live a meaningful life (Winnicott). It is vitality in the service of self-building. Stay alive and passionate, even late in practice, not because of knowledge, experience, but because of the uninterrupted work in self-discovery. To conclude? I consider that a living therapeutic process, that is, subjective appropriation, implies a passionate character in the therapist who offers a place for what is to be deposited there. We are often in paradoxical situations. To better understand its scope, I rely on the Oxford Dictionary's definition: a paradox is an assertion that seems absurd, though maybe truly well-founded. It's all in the maybe. Isn’t the psyche that heals the psyche the passion of dialogue with our unconscious?     

Adaptation of the Youth Connectedness to Provider scale to assess the relationship between health professionals and adolescent and young adult patients

ObjectiveThe aim was to adapt an instrument that evaluates the relationship between young individuals and health professionals to the Brazilian population, which will be called the Escala de Avaliação de Vínculo entre Jovens e Profissionais de Saúde (Youth Connectedness to Provider scale).MethodThe questionnaire known as the Youth Connectedness to Provider scale consists of seven Likert-like questions. The translation, back-translation, evaluation by ten specialists, and pre-test with 43 adolescents and young adults aged between 10 and 24 years were performed to assess the clarity and reliability of meanings. The content validity index was calculated for each question. Subsequently, the clinical validation was performed with 83 patients aged 10–24 years old and Cronbach's alpha coefficient was calculated.ResultsA content validity index >0.8 (considered satisfactory) was obtained for all items analyzed by experts and adolescents. At the clinical validation, it showed a high internal consistency (Cronbach’s alpha = 0.76). The questions showed a good correlation, except for the question about judgment (Spearman’s rho = 0.03–0.19).ConclusionsThe scale adaptation showed an adequate agreement rate at the translation evaluation and a good reliability index in the questions. This instrument provides information on strengths and topics that require more attention from professionals to improve the relationship with their patients; it can be a valuable parameter in assessing the medical consultation quality.