Online person-centered expressive arts for helping professionals during COVID-19: A mixed-methods case study exploring professional stress and resilience

This dissertation research applied the Person-Centered Expressive Arts (PCEA) process developed by Natalie Rogers, Ph.D. (N. Rogers, 1993, 2011) to an online therapeutic setting for helping professionals who self-reported an increase in professional stress during the COVID-19 pandemic. The research explored the mental health needs of helping professionals, their resilience, PCEA as a therapeutic modality, and the facilitation of PCEA in an online environment. There was one primary research question and three sub-questions. The primary research question was, "What are the lived experiences of helping professionals who have self-reported an increase in professional stress during the COVID-19 pandemic when engaged in the PCEA process?" Sub-questions related to perceptions of professional stress, any impacts of PCEA on resilience, and perceptions of the online therapeutic environment. This mixed-methods research used case study and quantitative pre- and post-study measures to explore participants' professional quality of life (Pool, Stamm, 2009) and resilience (5x5RS, DeSimone et al., 2017b). PCEA sessions included meditation, sounding, drawing, painting, clay, collage, movement, writing, and verbal processing. Six helping professionals were identified through an email networking recruitment strategy. Participation included two semi-structured interviews (pre- and post-study), three sessions of online PCEA processes, completion of the pre- and post-study measures, and an optional debriefing meeting for participants to confirm the interpretation of data. All interviews and PCEA sessions were held separately with each participant through Zoom videoconferencing. This research included no group meetings. Thematic analysis and cross-case synthesis were used to analyze the research data. Cross-case findings were that participants: (1) experienced personal growth and a deeper connection with the self, (2) felt more deeply connected with others, (3) found that the person-centered approach was beneficial and led to a sense of safety and relational creativity, (4) experienced a deeper connection with everyday creativity, and (5) experienced a connection with spirituality through engagement in the PCEA process (n = 4). This research explored professional stress, resilience, and everyday creativity among helping professionals during three sessions of online PCEA processes. It suggests that PCEA is a valuable therapeutic modality to address the stressors of the COVID-19 pandemic and serves as an uplifting, engaging, and empowering practice that can be used to benefit individuals, groups, and communities. Keywords: case study, COVID-19 pandemic, cross-case synthesis, everyday creativity, helping professionals, mixed-methods, online therapeutic services, Person-Centered Expressive Arts, resilience, spirituality, stress, thematic analysis. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Clients' experiences on North America's first take-home injectable opioid agonist treatment (iOAT) program: a qualitative study.

BACKGROUND: To support public health measures during the COVID-19 pandemic, oral opioid agonist treatment (OAT) take-home doses were expanded in Western countries with positive results. Injectable OAT (iOAT) take-home doses were previously not an eligible option, and were made available for the first time in several sites to align with public health measures. Building upon these temporary risk-mitigating guidelines, a clinic in Vancouver, BC continued to offer two of a possible three daily doses of take-home injectable medications to eligible clients. The present study explores the processes through which take-home iOAT doses impacted clients' quality of life and continuity of care in real-life settings. METHODS: Three rounds of semi-structured qualitative interviews were conducted over a period of seventeen months beginning in July 2021 with eleven participants receiving iOAT take-home doses at a community clinic in Vancouver, British Columbia. Interviews followed a topic guide that evolved iteratively in response to emerging lines of inquiry. Interviews were recorded, transcribed, and then coded using NVivo 1.6 using an interpretive description approach. RESULTS: Participants reported that take-home doses granted them the freedom away from the clinic to have daily routines, form plans, and enjoy unstructured time. Participants appreciated the greater privacy, accessibility, and ability to engage in paid work. Furthermore, participants enjoyed greater autonomy to manage their medication and level of engagement with the clinic. These factors contributed to greater quality of life and continuity of care. Participants shared that their dose was too essential to divert and that they felt safe transporting and administering their medication off-site. In the future, all participants would like more accessible treatment such as access longer take-home prescriptions (e.g., one week), the ability to pick-up at different and convenient locations (e.g., community pharmacies), and a medication delivery service. CONCLUSIONS: Reducing the number of daily onsite injections from two or three to only one revealed the diversity of rich and nuanced needs that added flexibility and accessibility in iOAT can meet. Actions such as licencing diverse opioid medications/formulations, medication pick-up at community pharmacies, and a community of practice that supports clinical decisions are necessary to increase take-home iOAT accessibility.

Exploring Clinical Decision-Making among the Uro-oncology Multidisciplinary Team: A Qualitative Study.

OBJECTIVE: The aim of this qualitative study was to understand the clinical decision-making process among the genitourinary oncology (GU) multidisciplinary team (MDT) and how patients are engaged in the process. DATA SOURCES: A qualitative descriptive study design was conducted and has been reported according to the Consolidated Criteria for Reporting Qualitative Studies (COREQ). Members of the GU MDT were recruited from a metropolitan tertiary hospital and cancer regional center in Australia serving a population of 550,000. Semistructured interviews were conducted, and the audiorecordings were transcribed; an inductive thematic analysis was used to provide insight from multiple perspectives. CONCLUSION: Three themes emerged: (1) the role and scope of the uro-oncology MDT, (2) lack of person-centered clinical decision-making, and (3) the barriers and facilitators. Amid the COVID-19 pandemic, the MDT discussions transitioned to virtual application, which was found to be convenient and efficient and improved attendance. The GU cancer MDT had a prominent biomedical focus that lacked person-centered considerations. Additional research is needed to explore how person-centered outcomes can be incorporated into the clinical decision-making process. IMPLICATION FOR NURSING PRACTICE: The GU MDT is increasingly important in the care of uro-oncology patients. There appears to be barriers to the implementation of person-centered discussions in the MDT. The effective delivery of multidisciplinary care is contingent on an appropriate mechanism for collaborative communication between all MDT members and patients given the limited involvement of the patient in the MDT itself.

Provider experiences with relaxing restrictions on take-home medications for opioid use disorder during the COVID-19 pandemic: A qualitative systematic review.

BACKGROUND: Historical restrictions on take-home medications for opioid use disorder have generated considerable debate. The COVID-19 pandemic shifted the perceived risks and benefits of daily clinic attendance and led to widespread policy reform, creating an unprecedented opportunity to explore the impact of more flexible prescribing. We conducted a qualitative systematic review to synthesize the evidence on providers' experiences with relaxing restrictions on take-home doses of medications prescribed for opioid use disorder during the COVID-19 pandemic. METHODS: The protocol for this systematic review was registered in PROSPERO (CRD42022360589; https://www.crd.york.ac.uk/prospero/). From Sept.-Nov. 2022, we searched Medline, Embase, CINAHL, PsycInfo, Web of Science, the Cochrane Register of Controlled Trials, and the grey literature from 2020 onward. Studies were eligible for inclusion if they used qualitative methods to investigate providers' experiences with relaxed restrictions on take-home medications for opioid use disorder during the COVID-19 pandemic. We appraised study quality using the CASP qualitative checklist and used thematic synthesis and GRADE-CERQual to synthesize the results. RESULTS: We retrieved 13 articles representing 11 studies. Six were conducted in the United States and most focused on changes to methadone treatment. Providers' experiences with increased flexibilities around take-homes were broadly positive, despite widespread initial concern over client safety and the potential for medication misuse. For a small number of providers, concerns about diversion were a specific manifestation of more general unease with loss of control over clients and the treatment process. Most providers appreciated increased flexibilities and described them as enabling more individualized, person-centered care. CONCLUSION: Our findings support the continuation of flexibilities around take-homes and demonstrate that regulations and policies that reduce flexibility around take-homes conflict with person-centered approaches to care. Stronger guidance and support from professional regulatory agencies may help increase uptake of flexibilities around take-homes.

Typical coping patterns: A person-centered approach to coping

Applying the person-oriented approach to coping can provide a unique perspective by revealing typical latent patterns. The study examined typical latent patterns shown by task-, emotion- and avoidance-oriented trait-based coping styles. We performed secondary analyses with Latent Profile Analysis on our former data and three independent datasets containing coping measures with the CISS-48 scale (Endler & Parker, 1994). Gender differences were also studied. Two basic profiles seem universal: the first is characterized by a high level of task-oriented coping, and the second profile is with moderately high scores on all three coping styles. The finding indicates that two fundamental latent coping profiles exist, which suggests a within-subject comparison in practice instead of investigating the absolute value of coping styles. Comparing data before and after 2020, COVID-19 does not seem to affect these profiles. The person-centered approach provides a possibility for the integration of coping-related findings. © 2023 The Authors

A qualitative study to explore the acceptability and feasibility of implementing person-focused evidence-based pain education concepts in pre-registration physiotherapy training.

Objectives: The purpose of this study was to engage with physiotherapy clinicians, academics, physiotherapy students and patients to explore the acceptability, feasibility, and practical considerations of implementing person-focused evidence-based pain education concepts, identified from our previous research, in pre-registration physiotherapy training. Design: This qualitative study took a person-focused approach to ground pain education in the perspectives and experiences of people who deliver and use it. Data was collected via focus groups and in-depth semi-structured interviews. Data was analysed using the seven stage Framework approach. Setting: Focus groups and interviews were conducted either face to face, via video conferencing or via telephone. This depended on geographical location, participant preference, and towards the end of data collection the limitations on in-person contact due to the Covid-19 pandemic. Participants: UK based physiotherapy clinicians, physiotherapy students, academics and patients living with pain were purposively sampled and invited to take part. Results: Five focus groups and six semi-structured interviews were conducted with twenty-nine participants. Four key dimensions evolved from the dataset that encapsulate concepts underpinning the acceptability and feasibility of implementing pain education in pre-registration physiotherapy training. These are (1) make pain education authentic to reflect diverse, real patient scenarios, (2) demonstrate the value that pain education adds, (3) be creative by engaging students with content that requires active participation, (4) openly discuss the challenges and embrace scope of practice. Conclusions: These key dimensions shift the focus of pain education towards practically engaging content that reflects people experiencing pain from diverse sociocultural backgrounds. This study highlights the need for creativity in curriculum design and the importance of preparing graduates for the challenges that they will face in clinical practice.

Investigating the Comparative Effectiveness of Place-Based and Scatter-Site Permanent Supportive Housing for People Experiencing Homelessness During the COVID-19 Pandemic: Protocols for a Mixed Methods, Prospective Longitudinal Study.

BACKGROUND: Permanent supportive housing (PSH) is an evidence-based practice to address homelessness that is implemented using 2 distinct approaches. The first approach is place-based PSH (PB-PSH), or single-site housing placement, in which an entire building with on-site services is designated for people experiencing homelessness. The second approach is scatter-site PSH (SS-PSH), which uses apartments rented from a private landlord while providing mobile case management services. OBJECTIVE: This paper describes the protocols for a mixed methods comparative effectiveness study of 2 distinct approaches to implementing PSH and the patient-centered quality of life, health care use, and health behaviors that reduce COVID-19 risk. METHODS: People experiencing homelessness who are placed in either PB-PSH or SS-PSH completed 6 monthly surveys after move-in using smartphones provided by the study team. A subsample of participants completed 3 qualitative interviews at baseline, 3 months, and 6 months that included photo elicitation interviewing. Two stakeholder advisory groups, including one featuring people with lived experience of homelessness, helped guide study decisions and interpretations of findings. RESULTS: Study recruitment was supposed to occur over 6 months starting in January 2021 but was extended due to delays in recruitment. These delays included COVID-19 delays (eg, recruitment sites shut down due to outbreaks and study team members testing positive) and delays that may have been indirectly related to the COVID-19 pandemic, including high staff turnover or recruitment sites having competing priorities. In end-July 2022, in total, 641 people experiencing homelessness had been referred from 26 partnering recruitment sites, and 563 people experiencing homelessness had enrolled in the study and completed a baseline demographic survey. Of the 563 participants in the study, 452 had recently moved into the housing when they enrolled, with 272 placed in PB-PSH and 180 placed in SS-PSH. Another 111 participants were approved but are still waiting for housing placement. To date, 49 participants have been lost to follow-up, and 12% of phones (70 of the initial 563 distributed) were reported lost by participants. CONCLUSIONS: Recruitment during the pandemic, while successful, was challenging given that in-person contact was not permitted at times either by program sites or the research institutions during COVID-19 surges and high community transmission, which particularly affected homelessness programs in Los Angeles County. To overcome recruitment challenges, flexible strategies were used, which included extending the recruitment period and the distribution of cell phones with paid data plans. Given current recruitment numbers and retention rates that are over 90%, the study will be able to address a gap in the literature by considering the comparative effectiveness of PB-PSH versus SS-PSH on patient-centered quality of life, health care use, and health behaviors that reduce COVID-19 risk, which can influence future public health approaches to homelessness and infectious diseases. TRIAL REGISTRATION: ClinicalTrials.gov NCT04769349; https://clinicaltrials.gov/ct2/show/NCT04769349. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/46782.

Together, at a distance: experiences with a novel technology for social contact among older people and their relatives in Norway during the COVID-19 pandemic.

BACKGROUND: The recognition that people are social beings is fundamental for person-centered care. During the COVID-19 pandemic, the lives of older people were restricted in ways that dramatically reduced their opportunities for face-to-face contact. Limited contact with family members due to social distancing raised concerns about the well-being of older people. In Norway, interactive technologies were therefore introduced to older people to help them maintain social contact while practicing physical distancing. OBJECTIVES: This study was designed to examine how older people and their relatives experienced the use of technology-mediated communication through KOMP, a tablet-like device for supporting social contact in care facilities and homes during the pandemic. METHODS: We adopted an open phenomenological approach inspired by Kvale and Brinkmann (2009) to explore how the use of KOMP became meaningful during the pandemic. The study was based on individual interviews with 4 residents in care facilities and 13 relatives. RESULTS: The lived experiences of using KOMP among older people and their relatives revealed that adopting digital communication helped older people, and their families mitigate social distancing and maintain relationships with each other, despite the restrictions imposed by the government. Virtual involvement through KOMP afforded meaningful interconnections in the social lives of the users and their distant family members, thereby supporting their roles as parents and grandparents despite the distance, and promoting cross-generational connections among family members. Digital meetings also provided opportunities for older people and their relatives to enjoy each other's presence in favored places, by conveying a homely atmosphere, for instance. These virtual encounters did not rely exclusively on talk as the only means of communication. CONCLUSION: This study suggests that communicating via KOMP was a meaningful activity for the participants. Technologies for social contact can, to some extent, facilitate person-centered care for older people in care facilities and their private homes, despite circumstances requiring social distancing.

Psychological Adjustment Profiles of LGBTQ+ Young Adults Residing with Their Parents during the COVID-19 Pandemic: An International Study.

The COVID-19 pandemic has been associated with poor mental health symptoms, particularly among vulnerable populations such as LGBTQ+ individuals. In the present study, we aimed to (i) identify different psychological adjustment profiles among LGBTQ+ young adults during the COVID-19 pandemic and compare LGBTQ+ young adults in relation to (ii) sociodemographic characteristics and COVID-19-related experiences and (iii) the internal and external protective resources associated with each adjustment profile. An online questionnaire was administered to 1699 LGBTQ+ young adults from six countries (Brazil, Chile, Italy, Portugal, Sweden, and the UK). A cluster analysis was conducted, and four profiles of psychological adjustment were identified: unchallenged, resilient, distressed, and at-risk. The at-risk cluster scored lowest in social support (particularly from family). The profiles of participants who experienced the highest levels of pandemic adversity (at-risk and resilient) comprised mostly South American participants, those under lockdown at the time of survey completion, those who self-identified as transgender and non-binary, and those with a plurisexual sexual orientation. Interventions should consider strategies to help young adults maintain support systems and reinforce the value of positive family relationships. Specific groups within the LGBTQ+ community that seem to be in a particularly vulnerable situation may need additional tailored support.

The Impact of COVID-19 on the Person-Centered Care Practices in Nursing Homes.

The COVID-19 pandemic has had a significant impact on long-term care residents, family, and staff. Nursing homes are facing persistent challenges such as staff shortage, lack of personal protective equipment (PPE), and staff experiencing mental health issues including burnout. COVID-19 precautions may have made implementing person-centered care (PCC) in nursing homes more difficult. This report provides a descriptive analysis of perceived COVID-19 impact on the PCC practice in nursing homes. Surveys (N = 379) were collected from 11 nursing homes across Georgia. PCC practice barriers include reduced choice for residents, staff anxiety related to COVID-19 precautions, increased prevalence of short-staffing, and expanded duties for direct care workers. Facilitators for PCC were also present and included staff engagement, the provision of mental health resources, supervisor support, and empowerment of staff. Applied practice and research to address these barriers and expand implementation of facilitators is needed.

Person-Centered Healthcare Practice in a Pandemic Context: An Exploration of People's Experience of Seeking Healthcare Support.

Background: The recent COVID-19 pandemic increased pressure upon healthcare resources resulting in compromised health services. Enforced national lockdown led to people being unable to access essential services in addition to limiting contact with social support networks. The novel coronavirus, and subsequent condition known as long covid were not well-understood and clinicians were not supported by existing guidelines or pathways. Our study explored people's experiences of healthcare during this period with a person-centered "lens." Methods: Ninety-seven people participated in our online survey about their experiences of the pandemic, particularly while socially isolated and their experiences of healthcare. Following completion of the survey, 11 of these participants agreed to further semi-structured interviews to explore this further in their own words. Interview conversations were transcribed, checked; together with the responses to open questions in the survey. The data were then analyzed thematically by members of the research team. We conducted framework analysis from a post-positivist perspective, using the Person-centered Practice Framework to explore participants' experiences. Results: There were few examples of people describing person-centered care. People experienced barriers to accessing support, and negative experiences of care that represented complexities enacting person-centered care at each level of the framework (processes, practice environment, prerequisites, and macro context). These barriers were influenced greatly by the pandemic, for example, with health professionals being harder to access. Some experiences related to the ways in which health professionals responded to the context, for example, positive examples included active listening, recognition of people's experiences, seeking to find out more, and engaging in collaborative problem-solving. Discussion: People want to feel heard, supported to navigate healthcare systems, source trustworthy information, find appropriate services, and collaborate in learning and problem-solving with healthcare professionals. There have been enormous challenges to the provision of healthcare throughout the pandemic. Moving forward is crucial with emphasis on overcoming barriers to person-centered healthcare. This should focus on steps now and also in planning for the possibility of further rapid changes in the demand for and provision of healthcare.

"I Can't Take Any Chances": A Mixed Methods Study of Frailty, Isolation, Worry, and Loneliness Among Aging Adults During the COVID-19 Pandemic.

Little is known about how frailty has shaped experiences of living through the COVID-19 pandemic. In this cross-sectional mixed methods study, we analyzed data from the nationwide COVID-19 Coping Study from December 2020 through January 2021 (N = 2094 US adults aged ≥55) to investigate quantitative associations between frailty and the prevalence of physical isolation, worry about COVID-19, and loneliness. Reflexive thematic analysis explored aging adults' lived experiences of frailty during the pandemic. In multivariable-adjusted population-weighted modified Poisson regression models, we found that frailty was associated with increased prevalence of physical isolation, worry about COVID-19, and loneliness. Qualitative experiences of aging with frailty during the pandemic were diverse, and encompassed isolation, worry, and loneliness, as well as coping strategies and resilience. The findings may inform individualized multi-factorial strategies (e.g., physical activity, nutrition, and social interaction) to support well-being among adults aging with frailty during the pandemic.

Community Initiated Care: A blue-print for the practical realization of contextual behavioral science

There is a vast unmet need for mental health care and support in the United States and globally. Although expanding specialty services is needed, this is neither sufficient nor necessary to comprehensively address the current and future demand. Traditional models of care which have focused on mental disorders, while useful for many, remain out of reach, unaffordable, and not timely for helping the vast majority of individuals in need of mental health support. There is a growing movement of community-based networks and organizations which aim to fill this need by harnessing existing community resources to promote mental health and prevent mental and substance use disorders. This paper describes our effort to derive a blue-print for an approach, which we call "Community Initiated Care (CIC)", building on these real-world experiences and the growing science on lay person delivered brief psychosocial interventions in community settings. CIC serves as a back-bone for training lay persons to support the mental health and well-being of others in their communities. CIC is envisioned as an equitable, efficient, safe, and timely form of contextualized support to promote mental health and prevent selfharm, mental health and substance use problems. CIC is not intended to replace clinical interventions;instead, we envisage the supportive encounter to use a person-centered approach to bolster existing positive coping skills, promote positive social engagement, reduce risk of future mental health problems, and encourage other forms of help seeking when appropriate. This article explores how our thinking is aligned with and responsive to the strategies and tactics of the Contextual Behavioral Science Task Force to promote programs that are multidimensional, process-based, prosocial, practical, and multi-level. Development, implementation, and evaluation of CIC will not only advance contextual behavioral science but also move society forward to more equitable mental health and well-being.

Cross-sectional Survey Examining Patient Attitudes and Preferences for Rescheduling Screening Colonoscopies Canceled due to the COVID-19 Pandemic.

Background. Early in the COVID-19 pandemic colonoscopies for colorectal cancer (CRC) screening were canceled. Patient perceptions of the benefits and risks of routine screening relative to health concerns associated with the COVID-19 pandemic were unknown. Purpose. Assess patient anxiety, worry, and interest in CRC screening during the COVID-19 pandemic. Methods. A random sample of 200 patients aged 45 to 75 y with colonoscopy cancellation due to COVID-19 in March to May 2020 were surveyed. Anxiety, COVID-19 and CRC risk perceptions, COVID-19 and CRC worry, likelihood of following through with colonoscopy in the next month, and interest in alternatives to colonoscopy were assessed. Subsequent screening was tracked for 12 mo. Results. Respondents (N = 127/200, 63.5%) were on average 60 y old, female (59%), college educated (62% college degree or more), and White (91%). A substantial portion of patients (46%) stated they may not follow through with a colonoscopy in the next month. There was greater interest in stool-based testing than in delaying screening (48% v. 26%). Women, older patients, and patients indicating tolerance of uncertainty due to complexity reported they were less likely to follow through with colonoscopy in the next month. Greater interest in stool-based testing was related to lower perceptions of CRC risk. Greater interest in delaying screening was related to less worry about CRC and less tolerance of risk. Over 12 mo, 60% of participants completed screening. Patients who stated they were more likely to screen in the next month were more likely to complete CRC screening (P = 0.01). Conclusions. Respondents who had a colonoscopy canceled during the COVID-19 pandemic varied in interest in rescheduling the procedure. A shared decision-making approach may help patients address varying concerns and select the best approach to screening for them. Highlights: In the wake of the first wave of the COVID-19 pandemic, almost half of patients stated they were not likely to follow through with a colonoscopy in the short term, about half were interested in screening with a stool-based test, and only one-quarter were interested in delaying screening until next year.Patients who perceived themselves at higher risk of colorectal cancer were less interested in stool-based testing, and patients who were more worried about colorectal cancer were less interested in delaying screening.A shared decision-making approach may be necessary to tailor screening discussions for patients during subsequent waves of the pandemic, other occasions where resources are limited and patient preferences vary, or where patients hold conflicting views of screening.

Integration of Mental Health Support Teams in COVID-19 Units within French General Hospitals: A Qualitative Study.

Introduction: This study aimed to explore the lived experience of mental health professionals (mhPs) who had been redeployed on support teams (MHSTs) implemented in general hospital for patients with coronavirus disease 2019 (COVID-19) and their families, in order to scale up mental and physical health care integration in times of epidemic crisis. Methods: This multicentered qualitative study followed an IPSE (Inductive Process to analyze the Structure of lived Experience) research design. MhPs' recruitment took place in three general hospitals of Seine-Seine-Denis department, in Paris suburbs (France). Results: Twenty-two participants were included. Data analysis produced three central axes: 1) the mhP in the epidemic crisis, underlying how participants confronted the unknown and adapted; 2) retrieving fundamentals of support therapy, that were: being present and listening, bonding with patients' families, and ensuring care continuity; and 3) moving forward with other health professionals, highlighting the collaborative work they developed and experienced. Discussion: The epidemic prompted mhPs to rethink the values likely to guide the integration of their intervention with other individual and organizational care stakeholders, at different levels of health system. Normative integration based on shared appraisal of patients' and families' needs is highly required to overcome the multiple and sometimes contradictory health issues inherent in the crisis. Conclusion: Person- and family-centered approach of integrated care (IC) is essential to address fragmentation between mental and physical health care in times of epidemic crisis. Hospital and political leaders should support and draw from bottom-up mental health IC initiatives such as MHSTs, that embody this vision, in order to improve health systems preparedness for future crises.

Introduction: Cette étude a visé à explorer l'expérience de professionnels de santé mentale (mhPs) redéployés sur des équipes de soutien (MHSTs) implantées à l'hôpital général pour les patients atteints par la maladie à coronavirus 2019 (COVID-19) et leurs familles, afin d'améliorer l'intégration des soins de santé mentale et physique en période de crise épidémique. Méthodes: Cette étude qualitative multicentrique a suivi le protocole de recherche IPSE (Inductive Process to analyze the Structure of lived Experience). Le recrutement des mhPs a eu lieu dans trois hôpitaux généraux du département de Seine-Saint-Denis, en banlieue de Paris (France). Résultats: Vingt-deux participants ont été inclus. L'analyse des données a fait émerger trois axes centraux : 1) le mhP dans la crise épidémique, soulignant comment les participants se sont confrontés à l'inconnu et se sont adaptés ; 2) retrouver les fondamentaux de la thérapie de soutien, qui étaient : être présent et écouter, faire du lien avec les familles des patients, et assurer la continuité des soins ; 3) avancer avec les autres professionnels de santé, sur la base du travail collaboratif que les participants ont développé et dont ils ont fait l'expérience. Discussion: L'épidémie a conduit les mhPs à repenser les valeurs susceptibles de guider l'intégration de leur intervention avec les autres acteurs du soin, individuels et organisationnels, à différents niveaux du système de santé. Une intégration normative basée sur une compréhension partagée des besoins des patients et de leurs familles apparaît primordiale pour répondre aux enjeux de santé multiples, et parfois contradictoires, inhérents à une telle crise. Conclusion: Une approche du soin intégré centrée à la fois sur le patient et la famille est essentielle pour palier la fragmentation des soins de santé mentale et physique en période de crise épidémique. Les décideurs hospitaliers et politiques devraient soutenir et s'appuyer sur des initiatives de soin intégré émanant du terrain telles que les MHSTs, qui incarnent cette vision, afin d'améliorer la préparation des systèmes de santé à de futures crises.

"Talking on the Phone Is Very Cold"-Primary Health Care Nurses' Approach to Enabling Patient Participation in the Context of Chronic Diseases during the COVID-19 Pandemic.

Strengthening patient participation is considered a crucial element of primary health care (PHC) nurses' practice when working with chronically ill patients. The COVID-19 pandemic had extraordinary effects on PHC nursing routines and how chronically ill patients' could be involved in their own care. This study investigates the adaptation of Spanish PHC nurses' approaches to supporting the participation of patients living with chronic illness during the COVID-19 pandemic. To reach this goal, we interviewed 13 PHC nurses who practiced in PHC centers in Spain. The interviews were analyzed using thematic coding. Three themes emerged from the descriptions of the nurses: (1) High COVID-19-related workload, decreasing health promotion, and chronic care, (2) Emphasis on patients' and families' self-responsibility, (3) Expanded digital and telephone communication with fewer in-person consultations. Nurses felt especially challenged to uphold the support for vulnerable groups, such as older people or patients without family support. Future research should focus on how the participation of the most vulnerable chronic patients can be supported in the context of the growing relevance of remote care.

Military Culture and Cultural Competence in Public Health: U.S. Veterans and SARS-CoV-2 Vaccine Uptake

As part of the U.S. effort to encourage vaccination for SARS-CoV-2, scholars have emphasized the importance of culture and identity in vaccine uptake decisions. The culture and identity of military service are poorly understood in the context of understanding Veterans' acceptance of COVID-19 vaccines. In analyzing data from semi-structured interviews with Veterans in homeless transitional housing, this article examines their willingness to get vaccinated for COVID-19. Themes invoking military culture included (a) mandatory vaccinations in the military;(b) cynicism and mistrust toward the government;and (c) trust of and reliance on Veteran peers with shared military culture in decision-making. To further understand how military culture influences vaccine uptake and explore avenues for building culturally competent, trust-based health care interventions with Veterans, a previously published case study of Veterans volunteering in Team Rubicon (TR) disaster relief is examined. Veteran participants in TR described the experience of being in a Veteran-centric organization as an empathetic context wherein they were able to: (a) address their reintegration struggles;(b) gain a new appreciation of their Veteran status;and (c) connect with trusted peers. Given TR's credibility, Veteran-serving health care organizations could collaborate with Veteran-led organizations to expand shared efforts to address Veterans' distrust of government-promoted vaccines.

Integrated Patterns of Subjective Job Insecurity: A Multigroup Person-Centered Study.

Past research attests to the pivotal role of subjective job insecurity (JI) as a major stressor within the workplace. However, most of this research has used a variable-centered approach to evaluate the relative importance of one (or more) JI facets in explaining employee physical and psychological well-being. Relatively few studies have adopted a person-centered approach to investigate how different appraisals of JI co-occur within employees and how these might lead to the emergence of distinct latent profiles of JI, and, moreover, how those profiles might covary with well-being, personal resources, and performance. Using conservation of resources (COR) theory as our overarching theoretical framework and latent profile analysis as our methodological approach, we sought to fill this gap. To evaluate the external validity of our study results, we used employee sample data from two different countries (Italy and the USA) with, respectively, n = 743 and n = 494 employees. Results suggested the emergence of three profiles (i.e., the "secure", the "average type", and the "insecure") in both country samples. The "secure" group systematically displayed a less vulnerable profile in terms of physical and psychological well-being, self-rated job performance, positive orientation, and self-efficacy beliefs than the "insecure" group, while the "average" type position on the outcomes' continua was narrower. Theoretically, this supports COR's notion of loss spirals by suggesting that differing forms of JI appraisals tend to covary within-person. Practical implications in light of labor market trends and the COVID-19 pandemic are discussed.

Making knowledge clips with patients: What learning mechanisms are triggered in medical students?

OBJECTIVE: To prepare medical students for a rapidly changing healthcare landscape, where new means of communication emerge, innovative teaching methods are needed. We developed a project-based learning course in which medical students design audiovisual patient information in collaboration with patients and with students in Communication and Information Sciences (CIS). We studied what learning mechanisms are triggered in medical students by elements of a project-based-learning course. METHODS: In this qualitative study, twelve sixth year medical students that participated in the course were individually interviewed. Data were analyzed according to the principles of qualitative template analysis. RESULTS: We identified four learning mechanisms: Challenging assumptions about patients' information needs; Becoming aware of the origin of patients' information needs; Taking a patient's perspective; Analyzing language to adapt to patients' needs. These learning mechanisms were activated by making a knowledge clip, collaborating with patients, and collaborating with CIS students. CONCLUSION: Collaborating with patients helped students to recognize and understand patients' perspectives. Working on a tangible product in partnership with patients and CIS students, triggered students to apply their understanding in conveying information back to patients. PRACTICE IMPLICATION: Based on our findings we encourage educators to involve patients as collaborators in authentic assignments for students so they can apply what they learned from taking patients' perspectives.

Variable-centered and person-centered approaches to understanding a satisfying single life: A focus on singles' social lives

Despite the worldwide increase in the unpartnered population, little research has examined what factors contribute to a satisfying single life. This is an important gap in the literature as the degree to which one is satisfied with one's relationship status has been shown to be a more important determinant of well-being than relationship status per se. In the present research, I examined situational (Studies 1-3) and individual factors (Studies 4-6B) related to a satisfying single life, with a focus on single individuals' social experiences. In the first three studies (N = 3,890), I examined if and how having satisfying relationships with family and friends or having a satisfying sexual life is associated with single individuals' satisfaction with singlehood. Results showed that having satisfying friendships and a sexually satisfying life were both associated with single individuals' feelings of satisfaction about being single. In the next four studies (N = 3,195), I drew on the Fundamental Social Motives Framework to examine single individuals' motivations to pursue different types of social experiences in relation to satisfaction with singlehood. Across two Western samples (primarily European and American) and one Korean sample (collected during the COVID-19 pandemic in 2020-2021), I identified three different configurations of motives that exist within the single population. Importantly, the profile characterized by high independence motives in combination with low affiliation and mating motives seemed to be associated with greater satisfaction with singlehood compared to the profile characterized by strong interest in self-protection and social connections as well as the profile characterized by little interest in self-protection but moderate interest in affiliation. Despite considerable consistency, these profile features did not perfectly replicate in a smaller sample collected before the pandemic, highlighting the need to interpret the data with the historical background in mind. Overall, the present research provides novel evidence that maintaining satisfying friendships and sexual lives may contribute to a satisfying single life;at the same time, individuals oriented towards independence in the absence of strong interest in affiliation or romantic partnership may be prone to experiencing singlehood as more satisfying. (PsycInfo Database Record (c) 2022 APA, all rights reserved)