Medicine

<h3>Context:</h3> While health-care workers (HCW) spend their working hours caring for others, many are challenged to find the time and energy for self-care and suffer because of it. <h3>Objective:</h3> To examine facilitators and barriers facing organizations to a) support health-care workers psychological self-care and b) protect them from moral distress. <h3>Study Design and Analysis:</h3> Key informants were identified through scholarly and grey literature reviews and snowball recruitment. Potential informants were invited to participate in a one-hour, semi-structured interview. Interviews were audio recorded, transcribed verbatim and analyzed using a thematic approach in NVivo 12. <h3>Setting:</h3> Interviews were conducted between November 2021 and February 2022 with HCW from multiple disciplines and health-care sectors across Canada. <h3>Population Studied:</h3> Anyone who self-identified as working in the health-care field, including front line workers and administrators. <h3>Instrument:</h3> An interview guide was developed for this study informed by the literature review. <h3>Outcome Measures:</h3> Facilitators and barriers to a) supporting psychological self-care and, b) protection from moral distress at the individual, team, and organizational levels. <h3>Results:</h3> A total of 29 interviews were completed with 30 participants. Facilitators to supporting psychological self-care included prioritizing self-care and utilization of available resources, positive peer relationships, and supportive leadership, policies, and guidelines. Barriers included hesitancy among HCW to identify themselves as feeling burnt out, an existing unsupportive culture as well as management who were unable to relate to their workers. HCW identified several facilitators to protection from moral distress, including a feeling that their work was making a difference, open communication within teams, and supportive resources such as a wellness team. In contrast, some HCW felt that moral distress was not well understood, and that an unhealthy culture of overwork coupled with a lack of resources were key barriers to protection. <h3>Conclusions:</h3> In this exploration of psychological health and safety in health-care workplaces across Canada we uncovered a multitude of opportunities for improvement. Participants not only spoke of their challenges to supporting psychological self-care and being able to protect themselves from moral distress but offered many suggestions that organizational leaders can implement in the short-term and longer-term.

Este estudo tem por objetivo apresentar e discutir os achados de um mapeamento do campo de saber da Educação Ambiental. Para tanto, nos debruçamos sobre os seus aspectos filosóficos, epistemológicos, éticos e políticos a partir da identificação de produções científicas disponíveis em cinco portais de busca acadêmica. Realizamos a seguir uma análise documental, com o uso de duas ferramentas presentes nas obras de Michel Foucault: formações discursivas e verdade. A partir disto, percebemos a recorrência, em maior número, da teorização crítica. Dos 96 trabalhos encontrados, 70 anunciam a utilização do aporte teórico crítico. Portanto, entendemos que os jogos de diferença, entre as teorizações recorrentes no campo, produzem modos específicos de explicar, compreender e fabricar o saber da Educação Ambiental.

We conducted a prospective and contextual study to examine the effects of community social-economic-physical distress and subcultural orientation on mortality following onset of 13 life-threatening diseases in later life. We also examined the inter-relationship between the effects of community social, economic and physical distress (i.e. poverty, physical disorder and low collective efficacy) and subcultural orientation (i.e. anomie and tolerance of risk behaviour) on the survival chances of seriously ill older patients. Three data sources were combined to construct the working sample: 1990 Census data, the 1994-95 PHDCN-CS, and the COSI data. Fifty-one ZIP code areas in Chicago and 12,672 elderly patients were studied. Community distress (HR = 1.04; 95% CI = (1.01, 1.07)) and anomie (HR = 1.26; 95% CI = (1.02, 1.54)) are found to be significantly and positively associated with a higher hazard of death. Moreover, community anomie contributes to the effect of community distress on post-hospitalisation mortality. The social, economic, physical and cultural environment in which people live appears to exert a significant impact on whether older people facing life-threatening illness live or die.

Loneliness is more complex and multi-faceted than it may appear at first glance. Most of the characterizations that we have of loneliness in the extant literature tend to focus on the absence of other people and on the social, mental, and physical distress that can be caused by this type of absence. Although the experience of absence may be a fundamental and encompassing aspect of loneliness, loneliness may also reflect a deeper, more complex experience. This paper integrates data from a qualitative study on the phenomenology of loneliness with philosophical theories on the self. It argues that there is a connection between the experience of absence and the impossibility to appear in the world and that this may consequentially lead to the disruption of self-experience.

Discourse plays an important role in medicine, and medical discourse in the broadest sense (discourse in and about healing, curing, or therapy; expressions of suffering; and relevant language ideologies) has profound anthropological significance. As modes of social action, writing and speaking help constitute medical institutions, curative practices, and relations of authority in and beyond particular healing encounters. This review describes cultural variation in medical discourse and variation across genres and registers. It then surveys two approaches to analyzing medical discourse: conversation analysis (CA) and discourse studies echoing Foucault's work, attempting to spur dialogue between them. Such dialogue could be fruitful because, despite hesitancy to invoke macrosocial variables, conversation analysts as well as Foucaultian discourse analysts have reflected on medical authority. Finally, the article reviews recent attempts to contextualize closely analyzed interactions—written exchanges as well as face-to-face clinical encounters—vis-à-vis the global circulation of linguistic forms and ideologies.

Understanding the factors that precipitate caregiving crises that cannot be resolved at home is central to improving options for care at life's end. The purpose of this study was to explore caregivers' perceptions of the crises that preceded and were resolved by relocation during end-of-life care. In-depth interviews were conducted with 36 caregivers of people who died in a hospice house. The results illuminate a conceptual model of the caregiving crisis, which has three stages: (a) precipitating factors--the interrelationship between illness trajectory and reciprocal suffering (physical, psychological, emotional and social distress), (b) crisis, and (c) resolution (settled or unsettled). Relocation presents an opportunity for families to relinquish the burden of end-stage care so that they can resume and complete a lifelong relationship. Careful recognition of and attention to the intimate dynamics that accompany suffering and dying are essential elements of palliative care, which aims to uphold the dignity of the dying person and the integrity of the family in both caregiving and bereavement.

Over the last decade a consistent increase in stress-related psychological consequences at the workplace, usually called ‘mobbing’, has been seen. It claimed physical, psychical and social distress as its victims,...

How do patients with cancer experience living with malignant fungating wounds (MFWs)? Qualitative study using grounded theory. A medical centre in east Taiwan. 10 patients who were 42–72 years of...

The Aftermath of Suicide: A Qualitative Study With Guyanese Families

The literature discusses bullying in terms of the misuse of a power situation over another individual repeatedly. Single, isolated incidences do not qualify as an act of bullying. Rather, bullying is the repetition of these acts combined with the desire on the part of the individual with the greater power base to cause physical, emotional, or social distress in another individual.

Dismenorrhea is a medical condition characterized by severe uterine pain during menstruation that manifests as cyclical lower abdominal pain. Dismenorrhea is classified into primary dismenorrhea in the absence of pathology and secondary dismenorrhea in the event of an identifiable pathological condition. About 40-70% of women of childbearing age suffer from dismenorrhea accompanied by associated psychological, physical, behavioral, and social distress. This is the main cause of the decline in the quality of life of adolescents. The pathophysiological process due to increased myometrium activity caused by excessive production of prostaglandins that cause ischemia. Risk factors are very important in enforcing the diagnosis of dismenorrhea and also in distinguishing between primary and secondary dismenorrhea. Mainstay treatment is generally supportive by relieving symptoms in primary dismenorrhea and surgical treatment may be recommended for secondary dismenorrhea. Therefore, patients with primary dismenorrhea may only require simple non pharmacological and analgesic therapies, whereas patients with secondary menorrhea require treatment for major problems.

The objective of this article is to present the process of constructing new objects of medical intervention. Analysis of reconstructing the past as a medical object offers the possibility of a more complete comprehension of the expansive character of medical power, since this is extended beyond space (present) into time (past, future). The thematic of this article is placed in the context of social constructionist theory and is based on the reasoning of the work of M Foucault about appearance and the way scientific medical discourse functions as a technique of surveillance and exercise of power and control, both on the individual subject and on the whole of the population (bio-power). In the process of expansion of medical discourse, the notion of time plays an important role as it gives a dynamic dimension to social analysis. Defining past and future as medical fields, as medicalized objects, composes in a critical way Foucault's work and the wider questioning of social constructionist theory, while giving it a dynamic quality.

Beyond burnout: Moral suffering among healthcare workers in the first COVID-19 surge

<i>Varietals of Capitalism: A Political Economy of the Changing Wine Industry</i>. By Xabier Itçaina, Antoine Roger, and Andy Smith. Ithaca, N.Y.: Cornell University Press, 2016. Pp. v+266. $45.00.

This piece is my raw fragmented thoughts and memories of the COVID 19 pandemic as I continue to work in the ED. The challenges of physical, moral, and ethical distress of COVID 19 remain.