The unspoken work of general practitioner receptionists: a re-examination of emotion management in primary care

Dealing with illness, recovery and death require health care workers to manage not only their own emotions, but also the emotions of those around them. While there is evidence to suggest that core occupations such as nursing are well versed in the nature of and need for such work, little is known about the requirements for emotion management on the part of front-line administrative staff. In response, findings from a three-year ethnographic study of UK general practice, suggest that as a first-point-of-contact in the English health care system GP receptionists are called upon to perform complex forms of emotion management pursuant to facilitating efficacious care. Two new emotion management techniques are identified: (1) emotional neutrality, and (2) emotion switching, indicating a need to extend emotion management research beyond core health occupations, while at the same time reconsidering the variety and complexity of the techniques used by ancillary workers.     

医护人员突发公共卫生事件知识调查分析

目的：考察突发公共卫生事件下,医护人员对事件相关知识和信息的了解状况,及其对情绪的影响。方法：采用自编调查问卷,调查一所综合性医院中各类医护人员。结果：突发公共卫生事件下,各类医护人员对与突发事件相关的知识和信息的了解以及信息来源,均无显著差异。较之本院工作人员,外院进修人员对信息透明和知情的要求最低。在知情的情况下治疗和护理SARS病人,医护人员更多体验正性情绪;而不知情的情况下的情绪反应更多是负性的。结论：在突发公共卫生事件下,应让医护人员及时充分地享有和运用各类信启、资源,增强心理储备和情绪调节,避免因信息缺失带来过多负性情绪反应。     

妇幼保健机构医护人员心理健康状况分析及对策

目的：调查分析妇幼保健机构医护人员的心理健康状况、探究缓解医护工作人员心理压力及负面情绪的对策方法。方法采用症状自评量表(SCL-90),对某妇幼机构的167名医护人员进行问卷调查。结果本组医护人员SCL-90分量表测量结果在躯体化、强迫、人际敏感、抑郁、焦虑、敌对6项因子平均值都显著高于全国常模,该群体不同性别在SCL-90上人际敏感、抑郁、焦虑因子有非常显著差异,此外医生组躯体化的得分低于护士组,敌对的得分高于护士组。结论被调查医护人员总体心理健康状况低于普通人群,妇幼保健机构应着力营造良好的工作环境和积极的医院文化氛围,提高医护人员自我情绪管理能力,从而让他们更好地面对工作与生活。     

Concern about AIDS among hospital physicians, nurses and social workers

In this study, the authors examine the worry and discomfort experienced by direct care health professionals in treating AIDS patients and how their profession, attitudes, knowledge, experience and demographic characteristics influence their emotional reaction to those patients. The research focuses on experienced emotion as distinct from expressed emotion, as an important factor in explaining health behaviors among professionals. To address these issues 536 health care professionals comprising 132 physicians, 378 nurses and 26 social workers employed at a University teaching hospital in Chicago were surveyed. The findings suggest that health care workers' emotional reactions to HIV depend on the type of patient interaction. We found for all three professions, as the invasiveness of contact increased, the level of worry and amount of discomfort also increased. Nurses however, on the whole were the most adversely affected by their patient contacts. We conclude that emotional reactions in the workplace cannot be explained by cognitions, beliefs and attitudes alone. This study suggests that work roles, work assignments, and professional authority contribute to emotional reactions to patients with AIDS.     

Weighing the cons and pros: women's reasons for discontinuing hormone replacement therapy

As a greater proportion of U.S. women move into midlife, there has been increased interest in meeting their preventive health needs. Although hormone replacement therapy (HRT) may not be an option for all postmenopausal women, it has been documented as prolonging life expectancy and protecting against osteoporosis. Despite its advantages for many women, often those who initiate HRT discontinue its use within a short time. The purpose of this qualitative study is to gain insights into women's reasons for discontinuing HRT. We collected data by semistructured interview from three diverse samples: 10 women who had been on HRT for two years or less, 11 health care providers of women, and 34 women who had gone off HRT. Reasons for discontinuing fell into seven broad categories: general Gestalt, somatic complaints, mind (knowledge, emotion), not being heard, hassles, indecisive medical community, and cons outweighed pros. Results indicate that women who discontinue HRT do so for a variety of reasons, many of which are connected to the health care system and its providers. Outcomes also suggest that sharing in decision making along with increased education, support, and individualized care are necessary to better address the preventive health care needs of postmenopausal women.     

WEIGHING THE CONS AND PROS: WOMEN'S REASONS FOR DISCONTINUING HORMONE REPLACEMENT THERAPY

As a greater proportion of U.S. women move into midlife, there has been increased interest in meeting their preventive health needs. Although hormone replacement therapy (HRT) may not be an option for all postmenopausal women, it has been documented as prolonging life expectancy and protecting against osteoporosis. Despite its advantages for many women, often those who initiate HRT discontinue its use within a short time. The purpose of this qualitative study is to gain insights into women's reasons for discontinuing HRT. We collected data by semistructured interview from three diverse samples: 10 women who had been on HRT for two years or less, 11 health care providers of women, and 34 women who had gone off HRT. Reasons for discontinuing fell into seven broad categories: general Gestalt, somatic complaints, mind (knowledge, emotion), not being heard, hassles, indecisive medical community, and cons outweighed pros. Results indicate that women who discontinue HRT do so for a variety of reasons, many of which are connected to the health care system and its providers. Outcomes also suggest that sharing in decision making along with increased education, support, and individualized care are necessary to better address the preventive health care needs of postmenopausal women.     

Experiencing the postpartum period: a comprehensive approach of social phenomenology

The aim of this study was to achieve an understanding of what new mothers served by private health care realize about the postpartum period, as well as identifying what their help and care needs are, during this life cycle. The research development proposition has been grounded on a qualitative research model with the phenomenological approach. Some categories came out from the statements: Taking charge of her child; feeling overloaded, overwhelmed and insecure; sensing herself vulnerable; experiencing a magic and unique emotion; reporting postpartum care satisfaction. After reviewing the categorical analysis, the postpartum living experiences as described by the subjects have been found quite similar to that of women without private health care. Nevertheless, the access to good quality in private health services became an important aspect because it enabled a close subjective relationship of mother and health care professional, allowing a safe postpartum experience.     

Health care social work treatment of patient and family emotion: a synthesis and comparison across patient populations and practice settings

Health care practitioners and researchers alike are beginning to acknowledge the importance of emotion in health. Nevertheless, health care social workers continue to assume most of the responsibility for actually dealing with the emotions of patients and families. Literature exploring social work interventions with emotion are restricted to a single patient population and practice setting. This study conducted a content analysis of pertinent literature, systematically codifying strategies across patient populations and practice settings according to a pragmatic conceptual foundation of the professional emotion treatment process. Analysis yielded a comprehensive conceptually clustered matrix of 45 strategies, establishing an objective and systematic basis for identifying and understanding this professional emotion treatment process for social work educators, practitioners, and researchers alike.     

Health Care Social Work Treatment of Patient and Family Emotion

ABSTRACT

Health care practitioners and researchers alike are beginning to acknowledge the importance of emotion in health. Nevertheless, health care social workers continue to assume most of the responsibility for actually dealing with the emotions of patients and families. Literature exploring social work interventions with emotion are restricted to a single patient population and practice setting. This study conducted a content analysis of pertinent literature, systematically codifying strategies across patient populations and practice settings according to a pragmatic conceptual foundation of the professional emotion treatment process. Analysis yielded a comprehensive conceptually clustered matrix of 45 strategies, establishing an objective and systematic basis for identifying and understanding this professional emotion treatment process for social work educators, practitioners, and researchers alike.     

Emotional congruence in learning and health encounters in medicine: addressing an aspect of the hidden curriculum

This paper aims to draw attention to and provide insights into an area that is of educational significance for clinical teachers, namely the need to acknowledge and respond appropriately to the emotional context of both learning and health encounters in order to improve the outcomes of both. This need has been highlighted by recent calls for more attention to be paid to the role of emotion within medical education and within health care provision. What is already known about the role of emotion in learner-teacher encounters and in patient-doctor encounters will be used to develop the concept of emotional congruence within these two types of encounter as a challenge to clinical teachers to examine their own practice. The reasons why emotional congruence is not always apparent in the learning environment of the teaching hospital will be discussed using the model of the ‘hidden curriculum’. It will be suggested that explicit strategies to counteract the hidden curriculum in relation to emotion can bring about transformative change in individual practice and the health care environment that has the potential to improve both learning and health outcomes.     

The comparative performance of for-profit and nonprofit home health care services in the US

OBJECTIVE: To determine, by way of an exhaustive, systematic, and comprehensive review and summary of all scientific published studies, whether or not there are any performance differences between private for-profit and private nonprofit home health care providers. The second objective is to discover the proportion of all research on this topic that is devoted to home health care services compared to all other health services providers. DATA SOURCES: Computerized bibliographic searches of relevant databases and published indexes and abstracts were undertaken. They included Medline (Ovid and Pubmed versions), Web of Science (Social Sciences Citation Index and Science Citation Index), ABI/Inform, and Sociological Abstracts. Follow-up searches of reference lists in each article obtained from the computerized search were then completed. STUDY DESIGN: This systematic review retained for analysis all published studies that compared the performance of for-profit and nonprofit health care providers on access, quality, cost/efficiency, and/or amount of charity care, based on data collected after 1980. As a quality control measure only studies published in peer reviewed journals were included. Studies were coded according to the article's stated conclusions: for-profit superiority, nonprofit superiority, or no difference/mixed results. PRINCIPAL FINDINGS: The comparative performance of for-profit and nonprofit home health service organizations is one of the most understudied areas of health care provider services in the US today. Only 6 of the over 1030 comparisons of the two concerned home health care. No data on this topic have been collected since 1991, and no articles about it have been published in a peer-reviewed journal since 1995. CONCLUSION: Research on the relative performance of for-profit and nonprofit home health care services is a research priority urgently in need of attention.     

Three doors to spiritual reflection: ethnographic research on the role of emotion, images, and sacred texts in spiritual reflection done by non-chaplaincy health care professionals

This is an ethnographic study exploring the role of emotion, images, and sacred texts in the spiritual reflection of non-chaplaincy health care professionals who offer spiritual care to their patients. Purposeful sampling of 20 health care professionals was employed. These non-chaplaincy professionals were interviewed and the researchers also kept field notes on the cultures in which they worked. Both interviews and field notes were transcribed and analyzed using the constant comparative method of data analysis. Findings indicate that emotion and images are the main doors that these professionals use to reflect spiritually on their practice of spiritual care. Sacred texts are the third door. Outcomes of the use of feelings and emotions in spiritual reflection are a deeper sense of peace, grounding and letting go, that is, transformation. Recommendations for collaboration with chaplains and further research are offered.     

Three Doors to Spiritual Reflection: Ethnographic Research on the Role of Emotion,Images, and Sacred Texts in Spiritual Reflection Done by Non-Chaplaincy Health Care Professionals

This is an ethnographic study exploring the role of emotion, images, and sacred texts in the spiritual reflection of non-chaplaincy health care professionals who offer spiritual care to their patients. Purposeful sampling of 20 health care professionals was employed. These non-chaplaincy professionals were interviewed and the researchers also kept field notes on the cultures in which they worked. Both interviews and field notes were transcribed and analyzed using the constant comparative method of data analysis. Findings indicate that emotion and images are the main doors that these professionals use to reflect spiritually on their practice of spiritual care. Sacred texts are the third door. Outcomes of the use of feelings and emotions in spiritual reflection are a deeper sense of peace, grounding and letting go, that is, transformation. Recommendations for collaboration with chaplains and further research are offered.     

A retrospective on access to health care

PURPOSE: The purpose of this paper is to provide a general review about the major programs and factors characteristic of major changes in the health care access, from both consumer and provider perspectives. Customers' perspective emphasizes the fiscal control, with particular focus on the agencies that function as fiscal intermediaries and enablers, such as insurance companies. Providers' perspective concentrates on providers of health care services, such as physicians, nurses, technicians as well as various types of medical care facilities. DESIGN/METHODOLOGY/APPROACH: Historical approach was adopted to address the health care access issue, a general concept that summarizes the specific dimensions describing the fit between the patient and the health care system. FINDINGS: It is self-evident that reform is needed and that major efforts should be made to remedy shortcomings in order to safeguard the health and welfare of the nation. ORIGINALITY/VALUE: To achieve the goal of a truly caring commonwealth, we must improve quality and safety in health care, increase access and utilization of technology, promote greater consumer involvement at all stages, restructure the medical malpractice system to reach all who may be injured by systemic errors, and develop sustainable financing less subject to the vagaries of state revenues. However, the access issue still remains a basic and important problem we have to confront.     

男兵非特殊军事训练伤后EQ问卷测查

目的：探讨非特殊军事训练伤男兵ＥＱ的影响,为心理卫生保健提供依据。方法：采用ＥＱ相关因子中的５项自测表对１４７例男兵因非特殊训练伤住院伤员进行测查。随机选择无本类伤男兵１０３例作为对照组。结果：研究组ＥＱ相关因子平均得分均与对照组不同,其中冒险性得分相差显著（Ｐ〈０．０５）,情绪调节力、情绪稳定度、愤怒驾奴度及度变能力得分相关非常显著（Ｐ〈０．０１）。结论：非特殊军事训练伤显著影响男兵ＥＱ;ＥＱ也     

Defining cultural competence: a practical framework for addressing racial/ethnic disparities in health and health care

OBJECTIVES: Racial/ethnic disparities in health in the U.S. have been well described. The field of "cultural competence" has emerged as one strategy to address these disparities. Based on a review of the relevant literature, the authors develop a definition of cultural competence, identify key components for intervention, and describe a practical framework for implementation of measures to address racial/ethnic disparities in health and health care. METHODS: The authors conducted a literature review of academic, foundation, and government publications focusing on sociocultural barriers to care, the level of the health care system at which a given barrier occurs, and cultural competence efforts that address these barriers. RESULTS: Sociocultural barriers to care were identified at the organizational (leadership/workforce), structural (processes of care), and clinical (provider-patient encounter) levels. A framework of cultural competence interventions--including minority recruitment into the health professions, development of interpreter services and language-appropriate health educational materials, and provider education on cross-cultural issues--emerged to categorize strategies to address racial/ethnic disparities in health and health care. CONCLUSIONS: Demographic changes anticipated over the next decade magnify the importance of addressing racial/ethnic disparities in health and health care. A framework of organizational, structural, and clinical cultural competence interventions can facilitate the elimination of these disparities and improve care for all Americans.     

The role of emotion in patient safety: Are we brave enough to scratch beneath the surface?

Healthcare professionals work in emotionally charged settings; yet, little is known about the role of emotion in ensuring safe patient care. This article presents current knowledge in this field, drawing upon psychological approaches and evidence from clinical settings. We explore the emotions that health professionals experience in relation to making a medical error and describe the impact on healthcare professionals and on their professional and patient relationships. We also explore how positive and negative emotions can contribute to clinical decision making and affect responses to clinical situations. Evidence to date suggests that emotion plays an integral role in patient safety. Implications for training, practice and research are discussed in addition to strategies to facilitate health services to understand and respond to the influence of emotion in clinical practice.     

围生儿生长发育的影响因素与保健

围生期是围生儿生长发育较快的时期,母亲的营养、疾病、情绪、环境暴露均会影响围生儿的生长发育,造成较高的死亡率和致残率。了解围生儿发育的影响因素对做好围生期保健,减少不良妊娠结局和实现优生优育具有重要意义。     

Nursing Schadenfreude: The culpability of emotional construction

The purpose of this paper is to examine the concept of Schadenfreude – the pleasure felt at another’s misfortune – and to argue that feeling it in the course of health care work, as elsewhere, is evidence of a deficient character. In order to show that Schadenfreude is an objectionable emotion in health care work, I first offer some conceptual remarks about emotions generally and their differential treatment in Kantian and Aristotelian thought. Second, I argue that an appreciation of the rationality of the emotions is crucial to our self-understanding as persons in general and nurses in particular. Third, I present a critique of Portmann’s (2000, When Bad Things Happen to Other People. London: Routledge) defence of Schadenfreude with examples from both nursing and medical scenarios. Specifically, I show how his exculpation of the emotion in terms of low self-esteem and a commitment to justice are not compelling. I argue that we are active in the construction of our emotional experiences of Schadenfreude, how we may indeed ‚nurse’ the emotion, and thus become culpable for them in ethical terms.     

Gender differences in emotion regulation and relationships with perceived health in patients with rheumatoid arthritis

Emotion regulation has been associated with perceived health in rheumatoid arthritis, which is diagnosed three times more often in women than men. Our aim was to examine gender differences in styles of emotion regulation (ambiguity, control, orientation, and expression) and gender-specificity of the associations between emotion regulation and perceived health (psychological well-being, social functioning, physical functioning, and disease activity) in 244 female and 91 male patients with rheumatoid arthritis. Women reported more emotional orientation than men, but did not differ from men with regard to ambiguity, control, and expression. Structural equation modelling showed that relationships between emotion regulation and perceived health were more frequent and stronger for women than men. This held especially for the affective dimension of health, while associations were similar for both women and men with regard to social and physical functioning. Only for women, the association between ambiguity and disease activity was significant, which appeared to be mediated by affective functioning. The observations that women are more emotionally oriented than men and that emotion regulation is more interwoven with psychological health in women than men, support the usefulness of a gender-sensitive approach in research and health care of patients with rheumatoid arthritis.