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Compassion in the Clinical Context: Constrained, Distributed, and Adaptive.

ABSTRACT: BACKGROUND:Compassion is intrinsically situated within particular contexts and how these contexts can shape compassion has not been well-described. OBJECTIVE:The purpose of the study was to describe how individual and contextual challenges can impact compassion within critical care and palliative care settings. DESIGN:This qualitative study adopted phenomenology and autoethnography to inform data collection, and principles of activity theory and realist inquiry for data interpretation. PARTICIPANTS:Five clinicians who work in critical care (n = 3) and palliative care (n = 3) participated in the study. APPROACH:Qualitative data were obtained from ethnographic observations, interviews, and focus groups. Participants observed and recorded field notes (n = 53) on instances of suffering and compassion in their workplace settings. At the end of the study period, they participated in a focus group or individual interview to reflect on their experiences. Data was analyzed using constructivist grounded theory techniques and iteratively synthesized through group discussion and model building. KEY RESULTS:The findings reflected four phenomena associated with compassion in context: individual gaps and lapses in compassion, relational challenges, contextual constraints on compassion, and distributed compassion. Individual gaps and lapses in compassion involved inattention, intention vs. perception, personal capacity, and personal toll. Relational challenges included receptivity, fragmentation, and lack of shared understanding. Contextual constraints consisted of situational pressures, the clinical environment, gaps in education, and organizational culture. The distribution of compassion within teams and how teams adapt their behaviors in response to perceived needs for greater compassion modulated these challenges. CONCLUSIONS:The study illustrates the many ways in which compassion can be shaped by context and highlights the role of teamwork in identifying gaps and lapses in compassion and responding in a way that supports patients, families, and colleagues.

SUBMITTER: Roze des Ordons AL

PROVIDER: S-EPMC6957623 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Compassion in the Clinical Context: Constrained, Distributed, and Adaptive.

Roze des Ordons Amanda L AL MacIsaac Lori L Hui Jacqueline J Everson Joanna J Ellaway Rachel H RH

Journal of general internal medicine 20191021 1

<h4>Background</h4>Compassion is intrinsically situated within particular contexts and how these contexts can shape compassion has not been well-described.<h4>Objective</h4>The purpose of the study was to describe how individual and contextual challenges can impact compassion within critical care and palliative care settings.<h4>Design</h4>This qualitative study adopted phenomenology and autoethnography to inform data collection, and principles of activity theory and realist inquiry for data int ...[more]

PMID: 31637638

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Project description:Understanding the nature of consciousness is one of the grand outstanding scientific challenges. The fundamental methodological problem is how phenomenal first person experience can be accounted for in a third person verifiable form, while the conceptual challenge is to both define its function and physical realization. The distributed adaptive control theory of consciousness (DACtoc) proposes answers to these three challenges. The methodological challenge is answered relative to the hard problem and DACtoc proposes that it can be addressed using a convergent synthetic methodology using the analysis of synthetic biologically grounded agents, or quale parsing. DACtoc hypothesizes that consciousness in both its primary and secondary forms serves the ability to deal with the hidden states of the world and emerged during the Cambrian period, affording stable multi-agent environments to emerge. The process of consciousness is an autonomous virtualization memory, which serializes and unifies the parallel and subconscious simulations of the hidden states of the world that are largely due to other agents and the self with the objective to extract norms. These norms are in turn projected as value onto the parallel simulation and control systems that are driving action. This functional hypothesis is mapped onto the brainstem, midbrain and the thalamo-cortical and cortico-cortical systems and analysed with respect to our understanding of deficits of consciousness. Subsequently, some of the implications and predictions of DACtoc are outlined, in particular, the prediction that normative bootstrapping of conscious agents is predicated on an intentionality prior. In the view advanced here, human consciousness constitutes the ultimate evolutionary transition by allowing agents to become autonomous with respect to their evolutionary priors leading to a post-biological Anthropocene.This article is part of the themed issue 'The major synthetic evolutionary transitions'.

Project description:Background:Previous health literacy research has often focused on individual functional health literacy, ignoring the cultural contexts through which many people experience health care. Objective:We aimed to explore the nature of maternal health literacy among ethnic minority women in a low-resource setting in Vietnam. Methods:Using a qualitative approach, we conducted focus groups with 42 pregnant women, mothers, and grandmothers of children younger than age 5 years from the Thai and Hmong ethnic groups. Semi-structured interviews were conducted with key informants and thematic analysis was performed. Key Results:The findings of our thematic analysis aligned well with the concept of distributed health literacy. We found that ethnic minority women drew upon family and social networks of health literacy mediators to share knowledge and understanding, assess and evaluate information, communicate with health professionals, and support decision-making. Family members were also involved in making health decisions that had the potential to negatively affect women and children's health. Conclusions:Family members are an important source of information for ethnic minority women, and they influence decision-making. Relatives and husbands of pregnant women could be included in maternal health education programs to potentially strengthen the health literacy of the whole community. The distributed health literacy concept can be used to strengthen health promotion messages and to reduce the risk of negative health outcomes. [HLRP: Health Literacy Research and Practice. 2019;3(1):e31-e42.]. Plain Language Summary:Distributed health literacy refers to how health literacy skills and practices are distributed through social networks. This concept applies well to the maternal health context in Vietnam. Older women are trusted sources of information, and family influences decision-making during pregnancy. Women's limited autonomy increases the importance of family involvement. Distributed health literacy could be used to strengthen health promotion messages.

Dataset Information

Compassion in the Clinical Context: Constrained, Distributed, and Adaptive.

Publications

Compassion in the Clinical Context: Constrained, Distributed, and Adaptive.

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