RESUMEN
BACKGROUND: Ten years of clinical and teaching experience has shown us that when teams or groups come together, it is often for a commonly understood and agreed upon purpose, but often without an agreed upon process of how to work together. Explicit guidelines in this regard promote psychological safety. CONTEXT: This article presents a method of developing agreements that can be used in a variety of settings to create psychological safety and cohesion. In our experience, agreements about how people join together seem to be developed implicitly. Assumption-based and implicit agreements can engender friction because unspoken or unclear agreements are not easily addressed because they are not universally understood. INNOVATION: A literature review helped to identify key factors contributing to psychological safety and led to creating 'CENTRE' to help clinical teams apply these factors. We are now starting to evaluate its impact. We believe a tool such as CENTRE facilitates the development of explicitly articulated group formation and maintenance guidelines, thus reducing the risk of interpersonal discord. IMPLICATIONS: We propose that a tool such as CENTRE be considered for a range of group situations, including clinical family meetings, teaching, professional teams and Balint-type groups. We are currently using this approach in clinical, academic and other professional environments. Findings from a survey of groups where CENTRE was used suggested that participants find the process useful. We believe a tool such as CENTRE can be used to help address relational issues, promote psychological safety, inclusion and trust among members, and reduce the risk of undeclared expectations and assumptions from dictating how groups function. Assumption-based and implicit agreements can engender friction because unspoken or unclear agreements are not easily addressed.
Asunto(s)
Educación Médica/métodos , Procesos de Grupo , Enseñanza/psicología , Humanos , Seguridad , Estudiantes de Medicina/psicologíaRESUMEN
While complementary and alternative medicine (CAM) can improve quality of life at end of life, little research exists on hospice residents' interest in using and sharing CAM experiences with a partner/friend/other family member. A pilot study conducted in British Columbia, Canada explored the extent of hospice residents' interest and openness to CAM use. A convenience sample of 48 hospice residents from 9 hospice sites completed questionnaire-based interviews. The majority of participants were Caucasian women over 60 years old. 81 percent expressed interest in receiving CAM; 79 percent used CAM prior to entering the hospice setting. 50 percent of those interested in using CAM felt their partner/friend/other family member would also be interested in receiving CAM, and half of that 50 percent reported personal interest in sharing the experience. Reasons reported for CAM interest were to enhance well-being, relaxation, and for pain relief. Further research could explore how resident-caregiver dyads may benefit from shared CAM experiences over the illness trajectory.
Asunto(s)
Terapias Complementarias , Hospitales para Enfermos Terminales , Evaluación de Necesidades , Prioridad del Paciente , Anciano , Colombia Británica , Terapias Complementarias/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Proyectos PilotoRESUMEN
OBJECTIVE: To develop a national role description for medical directors in long-term care (LTC) based on role functions drawn from the literature and the LTC industry. DESIGN: A questionnaire about the role functions identified from the literature was mailed or e-mailed to randomly selected medical directors, directors of care or nursing (DOCs), and administrators in LTC facilities. SETTING: Long-term care facilities in Canada randomly selected from regional clusters. PARTICIPANTS: Medical directors, DOCs, and administrators in LTC facilities; a national advisory group of medical directors from the Long Term Care Medical Directors Association of Canada; and a volunteer group of medical directors. MAIN OUTCOME MEASURES: Respondents were asked to indicate, from the list of identified functions, 1) whether medical directors spent any time on each activity; 2) whether medical directors should spend time on each activity; and 3) if medical directors should spend time on an activity, whether the activity was "essential" or "desirable." RESULTS: An overall response rate of 37% was obtained. At least 80% of the respondents from all 3 groups (medical directors, DOCs, and administrators) highlighted 24 functions they deemed to be "essential" or "desirable," which were then included in the role description. In addition, the advisory group expanded the role description to include 5 additional responsibilities from the remaining 18 functions originally identified. A volunteer group of medical directors confirmed the resulting role description. CONCLUSION: The role description developed as a result of this study brings clarity to the medical director's role in Canadian LTC facilities; the functions outlined are considered important for medical directors to undertake. The role description could be a useful tool in negotiations pertaining to time commitment and expectations of a medical director and fair compensation for services rendered.