"This Is What You Get When You Lead with the Arts": Making the Case for Social Wellness.

Like other key terms in the medical and health humanities-empathy, creativity, and reflection, to name just a few-wellness has become a weasel word, rife the language of optimization, duty, and self-perception. While alternative vocabularies exist-well-being and quality of life among them-these options usually privilege the objectives of academic (often psychological) research, health institutions, and the economic state apparatus, rather than people themselves. In mind of these concerns, why attempt to make a case for wellness at all? We present a historically informed, theoretically driven, praxis-guided framework for a renewed vision of social wellness (a concept first defined in the late 1950s). While definitions since Bill Hettler's "hexagonal" model (1980) have included mutual respect for others and the assumption of cooperative behaviors, conspicuously absent from contemporary definitions and usage is any mention of the aesthetic realm, which we-alongside philosophers like Amartya Sen and Martha Nussbaum-take as a central human capability. How can the relational possibilities of arts engagement be understood as not just a means of promoting individual wellness, but also as a method and outcome of social wellness? We propose that social wellness is ultimately premised on the interplay between wellness of the collective and the strength of the relational encounters it engenders. We turn to a key practice paradigm-community arts engagement-as both a vehicle for and site of social wellness. With brief reference to a Canadian exemplar, we conclude with concrete recommendations for addressing critical opportunities for advancing arts-led social wellness initiatives involving academic and community partners.

What is Intergenerational Storytelling? Defining the Critical Issues for Aging Research in the Humanities.

Intergenerational storytelling (IGS) has recently emerged as an arts- and humanities-focused approach to aging research. Despite growing appeal and applications, however, IGS methods, practices, and foundational concepts remain indistinct. In response to such heterogeneity, our objective was to comprehensively describe the state of IGS in aging research and assess the critical (e.g., conceptual, ethical, and social justice) issues raised by its current practice. Six databases (PsycINFO, MEDLINE, PubMed, Scopus, AgeLine, and Sociological Abstracts) were searched using search terms relating to age, intergenerational, story, and storytelling. Peer-reviewed, English-language studies conducted with participants residing in non-clinical settings were included. One thousand one hundred six (1106) studies were initially retrieved; 70 underwent full review, and 26 fulfilled all inclusion criteria. Most studies characterized IGS as a practice involving older adults (> 50 years old) and conventionally-aged postsecondary/college students (17-19 years old). Typical methodologies included oral and, in more recent literature, digital storytelling. Critical issues included inconsistently reported participant data, vast variations in study design and methods, undefined key concepts, including younger vs. older cohorts, generation, storytelling, and whether IGS comprised an intentional research method or a retrospective outcome. While IGS holds promise as an emerging field of arts- and humanities-based aging research, current limitations include a lack of shared data profiles and comparable study designs, limited cross-cultural representation, and insufficiently intersectional analysis of widespread IGS practices. To encourage more robust standards for future study design, data collection, and researcher reflexivity, we propose seven evidence-based recommendations for evolving IGS as a humanities-based approach to research in aging and intergenerational relations.

The Aftermath and the Aftermyth: Learning From Memoirists Who Experienced Sexual Assault While at University.

There is an abundance of research on the health consequences of sexual assault during university, but less attention has been paid to how sexual assault also shapes women's everyday lives. To develop an understanding of the everyday aftermath of sexual assault, we used narrative inquiry to analyze how women textually represent everyday living after sexual assault during university within four memoirs. Memoirists discussed their lives as significantly changed and worked to repair their lives after sexual assault by engaging in a range of everyday activities. Although no single behavioral response was described, some memoirists were perceived as deviant if they engaged in behaviors that contradicted prevailing cultural myths and expectations about how one should behave after sexual assault. We need to create room for women to engage in personal, idiosyncratic responses if we are to challenge restrictive standards for doing in the aftermath of sexual assault during university.

Beyond empathy: a qualitative exploration of arts and humanities in pre-professional (baccalaureate) health education.

For nearly four decades, researchers have explored the integration of arts and humanities content into health professions education (HPE). However, enduring controversies regarding the purpose, efficacy, and implementation of humanities initiatives suggest that the timing and context of trainees' exposure to such content is a key, but seldom considered, factor. To better understand the affordances of introducing humanities-based health curriculum prior to the HPE admissions gateway, we conducted a qualitative instrumental case study with participants from Canada's first Health Humanities baccalaureate program. Fully anonymized transcripts from semi-structured interviews (n = 11) and focus groups (n = 14) underwent an open-coding procedure for thematic narrative analysis to reveal three major temporal domains of described experience (i.e., prior to, during, and following their participation in a 12-week semester-long "Introduction to Health Humanities" course). Our findings demonstrate that perceptions of arts- and humanities content in health education are generated well in advance of HPE admission. Among other findings, we define a new concept-epistemological multicompetence-to describe participants' emergent capability to toggle between (and advocate for the role of) multiple disciplines, arts and humanities particularly, in health-related teaching and learning at the pre-professional level. Improved coordination of baccalaureate and HPE curricula may therefore enhance the development of capabilities associated with arts and humanities, including: epistemological multicompetence, aesthetic sensibility, and other sought-after qualities in HPE candidates. In conclusion, attending to the pre-professional admissions gateway presents a new, capabilities-driven approach to enhancing both the implementation and critical understanding of arts and humanities' purpose, role, and effects across the "life course" of health professions education.

Narrative Training as a Method to Promote Nursing Empathy Within a Pediatric Rehabilitation Setting.

PURPOSE: Empathy is deemed essential to nursing, yet interventions that promote and sustain empathy in practicing nurses within healthcare organizations are limited. We tested the feasibility and perceived impact of an arts-based narrative training intervention involving pediatric rehabilitation nurses for the purpose of promoting nursing empathy. DESIGN AND METHODS: One-group qualitative repeated-measures design at an urban Canadian pediatric rehabilitation hospital. Eight nurse participants attended six 90-minute weekly group narrative training sessions and two in-depth interviews pre- and post-intervention. RESULTS: The intervention positively impacted participants in three primary domains: Empathy for Patients and Families, Empathy Within Nursing Team, and Empathy for the Self. Major findings included: increased value placed on patients' and families' backstory, identification of "moral empathic distress" (MED), enhanced sense of collaborative nursing community, and renewal of professional purpose. CONCLUSIONS: This study is the first of its kind conducted in the pediatric rehabilitation nursing context. Results indicate that arts-based narrative training enhances nursing empathy and contributes to a supportive nursing culture. PRACTICE IMPLICATIONS: In addition to enhancing empathy in clinical domains, nurses who participated in narrative training reported improved team collaboration, self-care practices, and renewed professional purpose. The results from the intervention are encouraging and future research needs to explore its utility in other settings with larger and more diverse sample.

Site, Sector, Scope: Mapping the Epistemological Landscape of Health Humanities.

This essay presents a critical appraisal of the current state of baccalaureate Health Humanities, with a special focus on the contextual differences currently influencing the implementation of this field in Canada and, to a lesser extent, the United States and United Kingdom. I argue that the epistemological bedrock of Health Humanities goes beyond that generated by its written texts to include three external factors that are especially pertinent to undergraduate education: site (the setting of Health Humanities education), sector (the disciplinary eligibility for funding) and scope (the critical engagement with a program's local context alongside an emergent "core" of Health Humanities knowledge, learning, and practice). Drawing largely from the Canadian context, I discuss how these differences can inform or obstruct this field's development, and offer preliminary recommendations for encouraging the growth of baccalaureate Health Humanities-in Canada and elsewhere-in light of these factors.

Exploring the Realities of Curriculum-by-Random-Opportunity: The Case of Geriatrics on the Internal Medicine Clerkship Rotation.

BACKGROUND: While major clerkship blocks may have objectives related to specialized areas such as geriatrics, gay and lesbian bisexual transgender health, and palliative care, there is concern that teaching activities may not attend sufficiently to these objectives. Rather, these objectives are assumed to be met "by random opportunity".((1)) This study explored the case of geriatric learning opportunities on internal medicine clinical teaching units, to better understand the affordances and limitations of curriculum by random opportunity. METHODS: Using audio-recordings of morning case review discussions of 13 patients > 65 years old and the Canadian geriatric core competencies for medical students, we conducted a content analysis of each case for potential geriatric and non-geriatric learning opportunities. These learning opportunities were compared with attendings' case review teaching discussions. The 13 cases contained 40 geriatric-related and 110 non-geriatric-related issues. While many of the geriatric issues (e.g., delirium, falls) were directly relevant to the presenting illness, attendings' teaching discussions focused almost exclusively on non-geriatric medical issues, such as management of diabetes and anemia, many of which were less directly relevant to the reason for presenting to hospital. RESULTS: The authors found that the general medicine rotation provides opportunities to acquire geriatric competencies. However, the rare uptake of opportunities in this study suggests that, in curriculum-by-random-opportunity, presence of an opportunity does not justify the assumption that learning objectives will be met. CONCLUSIONS: More studies are required to investigate whether these findings are transferrable to other vulnerable populations about which undergraduate students are expected to learn through curriculum by random opportunity.

Old news: why the 90-year crisis in medical elder care?

North American and European demographic projections indicate that by 2030, persons aged 65 and older will outnumber those younger than 15 by a ratio of 2:1. Curiously, principles of geriatric care have not taken strong hold among nongeriatric specialties, even as we approach the time of greatest need. To explore historical precedents for the current crisis in elder care, this article revisits the prescriptions of G. Stanley Hall's Senescence: The Last Half of Life (1922), a text widely recognized as one of the founding texts in the medicalized study of aging. It presents in brief three of Hall's major concerns-paucity of knowledge of nongeriatric specialists, the need for individualized care of elderly adults, and the prevalence of attitudinal obstacles in medical professionals caring for older persons-to demonstrate how little the language and content of modern appraisals have evolved since 1922. This disconcerting sense of paralysis is presented as an opportunity to advance important questions aimed at stimulating a more-comprehensive research agenda for addressing the future of medical elder care.

Questioning context: a set of interdisciplinary questions for investigating contextual factors affecting health decision making.

OBJECTIVE: To combine insights from multiple disciplines into a set of questions that can be used to investigate contextual factors affecting health decision making. BACKGROUND: Decision-making processes and outcomes may be shaped by a range of non-medical or 'contextual' factors particular to an individual including social, economic, political, geographical and institutional conditions. Research concerning contextual factors occurs across many disciplines and theoretical domains, but few conceptual tools have attempted to integrate and translate this wide-ranging research for health decision-making purposes. METHODS: To formulate this tool we employed an iterative, collaborative process of scenario development and question generation. Five hypothetical health decision-making scenarios (preventative, screening, curative, supportive and palliative) were developed and used to generate a set of exploratory questions that aim to highlight potential contextual factors across a range of health decisions. FINDINGS: We present an exploratory tool consisting of questions organized into four thematic domains - Bodies, Technologies, Place and Work (BTPW) - articulating wide-ranging contextual factors relevant to health decision making. The BTPW tool encompasses health-related scholarship and research from a range of disciplines pertinent to health decision making, and identifies concrete points of intersection between its four thematic domains. Examples of the practical application of the questions are also provided. CONCLUSIONS: These exploratory questions provide an interdisciplinary toolkit for identifying the complex contextual factors affecting decision making. The set of questions comprised by the BTPW tool may be applied wholly or partially in the context of clinical practice, policy development and health-related research.

"But I see old people everywhere": dispelling the myth that eldercare is learned in nongeriatric clerkships.

PURPOSE: To test the assumption that knowledge, attitudes, and skills (KAS) in geriatrics are learned via exposure to elderly patients in nongeriatric clerkships. In the developed world, the proportion of adults > or = 65 years old will soon surpass the proportion of children <14. However, clinical clerkships containing geriatric rotations are not mandated by the Liaison Committee for Medical Education. METHOD: The authors assessed differences in geriatrics-focused KAS between medical students who completed a rotation in eldercare and those who completed a traditional nongeriatric clerkship. Over two academic years, the authors randomly assigned 263 clinical clerks to a clerkship year that did (eldercare group) or did not contain a two-week rotation focused on geriatrics. All students completed questionnaires that assessed their knowledge of and attitudes toward geriatric patients before and after their clerkships. Before graduation, all students completed an objective structured clinical examination (OSCE) including a clinical station focused on geriatrics. RESULTS: Questionnaire and OSCE station response rates were 74.8% and 100%, respectively. The eldercare group had significantly higher knowledge scores (P = .004). Students' attitudes toward older adults worsened over the clerkship year in both groups, but slightly less in the eldercare group; that group had significantly higher OSCE geriatric station scores and overall pass rates (both: P < .001). CONCLUSIONS: Geriatrics is often regarded as a nonessential discipline. This study showed, however, that a clerkship year containing a specialized geriatric rotation is significantly more effective than a traditional clerkship year in preparing students to care for an aging population.