Shame in patient-health professional encounters: A scoping review.

Shame can arise during patient-health professional encounters when discussing traumatising and stigmatising topics and can contribute to negative patient outcomes. This review aims to summarise what is known regarding shame in patient-health professional encounters. We conducted a scoping review using Levac and colleagues' approach and reported the findings using the PRISMA Extension for Scoping Reviews. We searched four databases (CINAHL, PsychINFO, PubMed and SocINDEX) for empirical studies that involved shame in patient-health professional encounters contextualised by trauma or stigma and were published in English. We categorised what is known regarding shame in empirical studies using inductive content analysis. We also collected stakeholders' perspectives on the review findings through an online survey. Our initial search yielded 3658 articles, of which 37 were included. We summarised the literature into four categories: (1) What health professionals say they do in patient-health professional encounters, (2) What health professionals think patients feel in patient-health professional encounters, (3) Patients' descriptions of their own shame during patient-health professional encounters and (4) Health professionals' descriptions of their own shame during patient-health professional encounters. Shame can arise in a variety of circumstances during patient-health professional encounters. More research is needed to identify what specific communication strategies used by health professionals during patient-health professional encounters contribute to or avoid patient shame.

Concept analysis of shame in nursing.

Nurses can facilitate opportunities for patients who feel shame to experience healing in their mental health. Disciplines such as psychology have extensive shame research, yet nursing may provide a unique perspective to bolster research on shame. The objective of this analysis is to examine the use of shame as a concept in nursing literature. This review was guided by Beth Rodgers' Evolutionary approach to concept analysis. Rodgers' approach entails investigating attributes, related terms, surrogate terms, antecedents, and consequences of shame; and examining the use of the concept shame over time to determine if its use changed. Sampled literature came from Cumulative Index to Nursing and Allied Health Literature Plus with Full Text, PubMed, Web of Science, and Health Source: Nursing/Academic Edition. The final sample used for analysis included 334 sources published between 1993 and 2020. The use of shame did not change during these years. Attributes were negative sense of self, feeling worthless, and feeling vulnerable. There were no surrogate terms and three related terms: guilt, humiliation, and embarrassment. Antecedents were trauma, stigma, and perception of moral wrongdoing. Consequences included healthcare avoidance, social withdrawal or isolation, negative coping mechanisms, resilience, lifestyle changes, and healthy coping. There is a discrepancy between the conceptualization and use of shame in nursing and other disciplines. Other disciplines, such as psychology, provide more direction about how interpersonal interactions can elicit or alleviate feelings of shame. Nurses can apply this conceptualization in their clinical practice to support patients experiencing shame.