Well-being in long-term care: an ode to vulnerability.

In health care, well-being is considered to be composed of multiple interacting dimensions and to regard the subjective (affective and cognitive) evaluation of these dimensions. These dimensions are often referred to as physical, psychological, and social domains of life. Although there are various disease-specific and group-specific conceptual approaches, starting from a universal perspective provides a more inclusive approach to well-being. Indeed, universal approaches to well-being have striking overlaps with dementia-specific approaches. Although many initiatives have been launched to promote person-centered care and attention for well-being in recent decades, the current COVID pandemic showed that the primary focus in (Dutch) long-term care was still on physical health. However, a well-being perspective can be a central base of care: it is a means to include positive aspects, and it can be applied when addressing problems such as challenging behavior in the sense that both are about needs. Furthermore, providing care from this perspective is not only about the well-being of frail people and their loved ones but also about the well-being and needs of the involved professionals. Increasingly, research shows the importance of the quality of the resident-carer relationship, the carer's behavior, and their well-being for improving the well-being of residents. Applying the care approaches 'attentiveness in care' and relationship-centered care can contribute to the well-being of all involved stakeholders as these uphold the reciprocity of care relationships and take the values and attitudes, but also the vulnerability of those involved, into account.

Advance care planning in dementia care: Wants, beliefs, and insight.

BACKGROUND: Advance care planning gives patients and their family members the possibility to consider and make decisions regarding future care and medical procedures. AIM: To explore the view of people in the early stage of dementia on planning for future care. RESEARCH DESIGN: The study is a qualitative interview study with a semistructured interview guide. The data were analyzed according to the Qualitative Analysis Guide of Leuven. PARTICIPANTS AND RESEARCH CONTEXT: Dementia nurses assisted in the recruiting of people with dementia for participation in the study. Study information was mailed to 95 people with early stage dementia. Ten people with dementia and eight caregiver spouses participated in the study. ETHICAL CONSIDERATIONS: People with dementia belong to a vulnerable patient group, and care was taken in the areas of informed consent and accessible information. FINDINGS: The views of people with dementia are characterized by a complex storyline involving tensions and movement within the themes of wants, beliefs, and levels of insight. Participants wanted to think about the future but also wanted to live in the here and now. DISCUSSION: High demands are placed on the advance care planning process for people with dementia and their family caregivers. A dignity-enhancing approach in dementia care emphasizes the dignity of and respect for this vulnerable and care-dependent patient group. CONCLUSION: The process of advance care planning in dementia care needs to go beyond person-centered care to a relationship-centered process. The illness trajectory and the impact on autonomy need to be taken into consideration.

Integrating Communication Skills, Awareness of Self and Others, and Reflective Feedback into One Inclusive Anatomical Representation of Relationship-Centered Health Care.

The American Veterinary Medical Association Council on Education mandates in standard 11 that all accredited colleges of veterinary medicine must develop and deliver formal processes by which students are observed and assessed in nine competencies. The eighth competency combines clinical communication and sensitivity toward soliciting and understanding individual narratives across a diverse clientele to facilitate health care delivery. Several frameworks have been designed to structure health care consultations for teaching and coaching purposes. The Calgary-Cambridge guide (CCG) provides an evidence-based approach to outlining the flow of consultations, incorporating foundational communication skills and elements of relationship-centered care into a series of sequential tasks. Although the CCG was intended for use as a flexible tool kit, it lacks visible connections between concrete experiences (e.g., the consultation) and reflective observation (e.g., the feedback). This teaching tip describes the development of a novel anatomical representation of the consultation that integrates process elements of the CCG with other core curricular concepts. By combining knowledge, technical skills, critical thinking, reflection, cultural humility, and self-awareness into a skeletal consultation model, linkages are established between communication and intergroup dialogue skills, diversity and inclusion (D&I). This model has been further adapted as feline, caprine, porcine, equine, avian, and reptilian versions for in-class use as strategic visual aids that highlight key areas of focus for Professional Skills class sessions. Future developments by the authors will explore how to link species-specific consultation models to assessment rubrics to reinforce the connection between content (what) and process (how).

In, But Out of Touch: Connecting With Patients During the Virtual Visit.

Covid-19 has rapidly changed physician-patient interaction, from hands-on to hands-off medicine. In this essay, 2 family physicians on different continents reflect on the meaning of touch in clinical practice and how virtual care is transforming this tacit aspect of patient care. Although technology enables physicians to stay in touch with patients verbally, we have lost the ability to physically touch. Traditionally, touch is central to medical practice, physical examination guides diagnosis and informs management. But the silent language of touch fulfills a deeper symbolic function, enabling physicians to acknowledge patient concerns in a tangible way. Touch expresses healing, extending beyond skin-to-skin contact to express humanity, caring, and connection. As we adapt to novel technologies, we wonder how, as family physicians, we will adapt our clinical acumen to extend our ability to connect with patients.

Physical Distancing With Social Connectedness.

In light of concerns over the potential detrimental effects of declining care continuity, and the need for connection between patients and health care providers, our multidisciplinary group considered the possible ways that relationships might be developed in different kinds of health care encounters.We were surprised to discover many avenues to invest in relationships, even in non-continuity consultations, and how meaningful human connections might be developed even in telehealth visits. Opportunities range from the quality of attention or the structure of the time during the visit, to supporting relationship development in how care is organized at the local or system level and in the use of digital encounters. These ways of investing in relationships can exhibit different manifestations and emphases during different kinds of visits, but most are available during all kinds of encounters.Recognizing and supporting the many ways of investing in relationships has great potential to create a positive sea change in a health care system that currently feels fragmented and depersonalized to both patients and health care clinicians.The current COVID-19 pandemic is full of opportunity to use remote communication to develop healing human relationships. What we need in a pandemic is not social distancing, but physical distancing with social connectedness.

How to assess experienced quality of care in nursing homes from the client's perspective: results of a qualitative study.

BACKGROUND: The culture shift in nursing homes from task-oriented to person-centered care has created a need to assess clients' experienced quality of care (QoC), as this corresponds best with what matters to them. This study aimed to gain insight into how to assess experienced QoC in nursing homes from the client's perspective. METHOD: A qualitative study was performed consisting of a focus group with client representatives (n = 10), a focus group with nursing home staff (n = 9) and a world café with client representatives and staff recruited from the Living Lab in Ageing & Long-Term Care (n = 24). Three questions about assessing experienced QoC from the client's perspective were addressed during data collection: 1) What content needs to be assessed? 2) What assessment procedures are needed? and, 3) Who needs to be involved in the assessment? Semi-structured questions, photo elicitation and creative writing were used to answer these questions. Conventional content analysis was used to analyze the data. RESULTS: Participants indicated that experienced QoC mostly occurs within the interactions between clients, family and staff, highlighting the impact of relationships. They suggested assessments should focus on three aspects: 1) knowledge about the client, 2) a responsive approach, and 3) a caring environment. These can be assessed by having conversations with clients, their families and staff, and additionally observing the clients in their living environments. Sufficient time and resources are prerequisites for this. Additionally, the person performing the quality assessments needs to possess certain communication and empathy skills. CONCLUSION: It is important to include the perspectives of the client, family and staff when assessing experienced QoC, in line with the principles underlying relationship-centered care. In order to be feasible, it is recommended to incorporate quality assessments into the nursing homes' daily routines. Further research with clients, family and staff in nursing homes is needed to develop a feasible, reliable and valid method that assesses experienced QoC from the client's perspective.

Patients' experiences of the caring encounter in health promotion practice: a qualitative study in Swedish primary health care.

BACKGROUND: Previous studies have reported that organizational structures and cultures in primary health care are obstacles to district nurses doing successful work in health promotion practice (HPP). Because organizational structures are not easily changed, Jean Watson's Attending Nurse Caring Model (ANCM) was introduced and piloted at a primary health care center in Sweden, aiming to transform HPP so as to empower district nurses and increase their work satisfaction. AIM: To investigate patients' experiences of the caring encounter in HPP after introduction of the ANCM in Swedish primary health care, the aim being to explore the essential components of the caring encounter between patients and district nurses. METHODS: A descriptive and qualitative research design was used. Data collection was performed using individual face-to-face interviews with twelve patients at risk for developing CVD. Data analysis consisted of both deductive content analysis, using a categorization matrix based on the ANCM and, subsequently, inductive latent content analysis. RESULTS: The findings were abstracted into three themes: 1.'Feeling the deepest essence of being cared for': to be respected and being put at the center of the encounter; 2. 'Feeling acceptance and worth': being treated with openness and permissive attitudes, 3. 'Being in a supportive atmosphere that promotes hope': to feel trust and being trusted in the encounter, and being empowered by hope. The unifying main theme of the caring encounter was abstracted as 'Experiencing human dignity'. CONCLUSION: The present study revealed that the essence of the caring encounter between patients and district nurses in HPP is to be unconditionally accepted in an environment that inspires hope and encouragement. The ANCM seems to be a promising model to use for strengthening the caring encounter and supporting CVD patients in making healthy lifestyle choices. However, further studies of qualitative and quantitative designs are needed to investigate what the ANCM can contribute to HPP in Swedish primary health care.

A Qualitative Study About How Nurses in Belgium Offer Relationship Support to Couples in Palliative Care.

Although palliative care nurses are identified as key players in supporting couples during advanced illness, there is a lack of evidence about their knowledge and experiences with this particular role. The aim of the study was to explore palliative care nurses' attitudes, roles, and experiences in addressing relationship functioning of couples in daily practice. A qualitative study was conducted using in-depth interviews, observational research, and peer debriefing groups with palliative care nurses in Flanders, Belgium. Nurses support relationship functioning by creating a couple-positive care environment, by being present/acknowledging feelings, and by rectifying imbalances between couples. They do so in a proactive way, backed up by team support. Nurses hesitate toward explicitly unraveling and intervening in relationship problems, in favor of providing comfort or offering a strengths-based approach. The findings offer an urgent call to enhance the educational programs for palliative care nurses by integrating the theories and practice frameworks that guide relational assessment and intervention, which are being used in family nursing.

Family Physicians' Experiences of Physical Examination.

PURPOSE: The increased availability of reliable diagnostic technologies has stimulated debate about the utility of physical examination in contemporary clinical practice. To reappraise its utility, we explored family physicians' experiences. METHODS: Guided by principles of phenomenology, we conducted in-depth qualitative interviews exploring 16 family physicians' experiences of conducting physical examination: 7 (44%) men and 9 women (56%) whose clinical experience varied widely, from 11 (69%) urban and 5 (31%) rural locations. We recorded the interviews, transcribed them verbatim, and identified initial themes using template analysis. We worked reflexively, critiquing our own and other team members' interpretations, in order to synthesize and write a final interpretation. RESULTS: Participants described 2 facets of physical examination: making diagnoses and estimating prognoses rationally and objectively; and responding subjectively and intuitively to patients' illnesses, which formed relationships between doctor and patient that enacted medical care in the moment. Physical examination allowed physicians to use their own bodies to experience patients' illnesses. Performing physical examination was integral to being a family doctor because it promoted rapport and developed trust. CONCLUSIONS: Physical examination is part of the identity of family physicians. It not only contributes diagnostic information but is a therapeutic intervention in and of itself. Physical examination contributes to relationship-centered care in family practice.

Transforming Preprofessional Health Education Through Relationship-Centered Care and Narrative Medicine.

ISSUE: The Institute of Medicine identified health care education reform as a key to improving the error prone, costly, and unsatisfying U.S. health care system. It called for health care education that no longer focuses exclusively on the mastery of technical skills but teaches students the human dimensions of care and develops their ability to collaborate with patients and colleagues to alleviate suffering and improve health. When should this educational reform begin, by what frameworks should it be guided, and which methods should it employ are important questions to explore. EVIDENCE: There is increasing evidence that practitioners' relational skills, such as empathy and reflection, improve patients' health outcomes. Efforts to shift education toward patient-centered care in interprofessional teams have been made at the professional level, most notably in medical schools. However, reform must begin at the preprofessional level, to start cultivation of the habits that support humane care as early as possible and protect against empathic decline and the development of counterproductive attitudes to collaboration. The conceptual basis for reform is offered by relationship-centered care (RCC), a framework that goes beyond patient-centered care and interprofessional teamwork to focus on the reciprocal human interactions at the micro, mezzo, and macro levels of care. RCC identifies practitioners' relationships with patients, colleagues, community, and self as the critical interpersonal dimensions of healthcare and describes a foundation of values, knowledge, and skills required for teaching each dimension. The teaching of these foundations can be facilitated with techniques from narrative medicine, a compatible care model that conceptualizes health care as a context in which humans exchange stories and thus require narrative competence. IMPLICATIONS: We suggest beginning the educational reform at the preprofessional level with the implementation of a formal curriculum based on the 4 RCC dimensions with students expected to gain beginner levels of competency on these dimensions in addition to evidence-based principles of health sciences. This requires interprofessional collaboration among health professions, social science, and liberal arts faculty and training of health professions faculty in narrative medicine. Next, we suggest engaging in incremental change in the organizational culture with professional development and team-building activities. Although we need systematic research on the efficacy of the components of the transformation, their impact on students' learning, and their costs, it is important to engage in efforts to prepare professionals who are able to respond to the complex health needs of individuals and society in the 21st century.

Project on the Good Physician: Further Evidence for the Validity of a Moral Intuitionist Model of Virtuous Caring.

THEORY: In the Project on the Good Physician, the authors propose a moral intuitionist model of virtuous caring that places the virtues of Mindfulness, Empathic Compassion, and Generosity at the heart of medical character education. HYPOTHESES: Hypothesis 1a: The virtues of Mindfulness, Empathic Compassion, and Generosity will be positively associated with one another (convergent validity). Hypothesis 1b: The virtues of Mindfulness and Empathic Compassion will explain variance in the action-related virtue of Generosity beyond that predicted by Big Five personality traits alone (discriminant validity). Hypothesis 1c: Virtuous students will experience greater well-being ("flourishing"), as measured by four indices of well-being: life meaning, life satisfaction, vocational identity, and vocational calling (predictive validity). Hypothesis 1d: Students who self-report higher levels of the virtues will be nominated by their peers for the Gold Humanism Award (predictive validity). Hypothesis 2a-2c: Neuroticism and Burnout will be positively associated with each other and inversely associated with measures of virtue and well-being. METHOD: The authors used data from a 2011 nationally representative sample of U.S. medical students (n = 499) in which medical virtues (Mindfulness, Empathic Compassion, and Generosity) were measured using scales adapted from existing instruments with validity evidence. RESULTS: Supporting the predictive validity of the model, virtuous students were recognized by their peers to be exemplary doctors, and they were more likely to have higher ratings on measures of student well-being. Supporting the discriminant validity of the model, virtues predicted prosocial behavior (Generosity) more than personality traits alone, and students higher in the virtue of Mindfulness were less likely to be high in Neuroticism and Burnout. CONCLUSIONS: Data from this descriptive-correlational study offered additional support for the validity of the moral intuitionist model of virtuous caring. Applied to medical character education, medical school programs should consider designing educational experiences that intentionally emphasize the cultivation of virtue.

Evaluation of Fourth-Year Veterinary Students' Client Communication Skills: Recommendations for Scaffolded Instruction and Practice.

Effective client communication is important for success in veterinary practice. The purpose of this project was to describe one approach to communication training and explore fourth-year veterinary students' communication skills through an evaluation of their interactions with clients during a general practice rotation. Two raters coded 20 random videotaped interactions simultaneously to assess students' communication, including their ability to initiate the session, incorporate open-ended questions, listen reflectively, express empathy, incorporate appropriate nonverbal communication, and attend to organization and sequencing. We provide baseline data that will guide future instruction in client communication. Results showed that students' communication skills require development. Half of the students sampled excelled at open-ended inquiry (n=10), and 40% (n=8) excelled at nonverbal communication. Students needed improvement on greeting clients by name and introducing themselves and their role (n=15), reflective listening (n=18), empathy (n=17), and organization and sequencing (n=18). These findings suggest that more focused instruction and practice is necessary in maintaining an organized structure, reflective listening, and empathy to create a relationship-centered approach to care.

Project on the Good Physician: A Proposal for a Moral Intuitionist Model of Virtuous Caring.

THEORY: In the Project on the Good Physician, the authors endeavor to advance medical character education by proposing and testing a moral intuitionist model of virtuous caring that may be applicable to physician training. This model proposes that the moral intuition to care/harm motivates students to extend care to those in need. HYPOTHESES: Hypothesis 1: Medical students will report stronger preferences for the intuition to Care/harm over other moral intuitions in clinical decision making. Hypothesis 2: Care/harm will have the strongest correlation with Generosity than the other moral intuitions. Hypothesis 3: There will be positive associations between Care/harm and the caring virtues (Mindfulness, Empathic Compassion, and Generosity). Hypotheses 4-5: The virtue of Empathic Compassion (or Mindfulness) will moderate the relationship between Care/harm and Generosity. Hypotheses 6-7: Neuroticism (or Burnout) will negatively moderate the association between Care/harm and Generosity (or between Empathic Compassion and Generosity). METHOD: The authors used data from a 2011 nationally representative sample of U.S. medical students (N = 500) to test the relationship between the moral intuition to Care/harm and physician caring virtues. Moral intuitions were assessed using the Moral Foundations Questionnaire, whereas physician virtues were measured using scales adapted from validated constructs. RESULTS: The authors found that students reported stronger preferences for the intuition to Care/harm over the four other moral intuitions. Each moral foundation was weakly but significantly correlated with Generosity, yet Care/harm had the strongest correlation among them. Neuroticism and Burnout did not weaken the link between Care/harm and the virtues. CONCLUSIONS: Data from the descriptive-correlational study reported here offer preliminary support for the construct validity of an educational model that targets the moral intuitions. The article concludes with a discussion of the implications of a moral intuitionist approach for medical character education and offers three hypotheses for future empirical research.

Being with a Person in Our Care: Person-Centered Social Work Practice that is Authentically Person-Centered.

Person-centered care (PCC) has emerged over the last several decades as the benchmark for providing quality care for diverse populations, including older adults with multiple chronic conditions that affect daily life. This article critiques current conceptualizations of PCC, including the social work competencies recently developed by the Council on Social Work Education, finding that they do not fully incorporate certain key elements that would make them authentically person-centered. In addition to integrating traditional social work values and practice, social work's PCC should be grounded in the principles of classical Rogerian person-centered counseling and an expanded conceptualization of personhood that incorporates Kitwood's concepts for working with persons with dementia. Critically important in such a model of care is the relationship between the caring professional and the care recipient. This article recommends new social work competencies that incorporate both the relationship-building attitudes and skills needed to provide PCC that is authentically person-centered.

Relevance of the rationalist-intuitionist debate for ethics and professionalism in medical education.

Despite widespread pedagogical efforts to modify discrete behaviors in developing physicians, the professionalism movement has generally shied away from essential questions such as what virtues characterize the good physician, and how are those virtues formed? Although there is widespread adoption of medical ethics curricula, there is still no consensus about the primary goals of ethics education. Two prevailing perspectives dominate the literature, constituting what is sometimes referred to as the "virtue/skill dichotomy". The first perspective argues that teaching ethics is a means of providing physicians with a skill set for analyzing and resolving ethical dilemmas. The second perspective suggests that teaching ethics is a means of creating virtuous physicians. The authors argue that this debate about medical ethics education mirrors the Rationalist-Intuitionist debate in contemporary moral psychology. In the following essay, the authors sketch the relevance of the Rationalist-Intuitionist debate to medical ethics and professionalism. They then outline a moral intuitionist model of virtuous caring that derives from but also extends the "social intuitionist model" of moral action and virtue. This moral intuitionist model suggests several practical implications specifically for medical character education but also for health science education in general. This approach proposes that character development is best accomplished by tuning-up (activating) moral intuitions, amplifying (intensifying) moral emotions related to intuitions, and strengthening (expanding) intuition-expressive, emotion-related moral virtues, more than by "learning" explicit ethical rules or principles.

What's going well: a qualitative analysis of positive patient and family feedback in the context of the diagnostic process.

OBJECTIVES: Accurate and timely diagnosis relies on close collaboration between patients/families and clinicians. Just as patients have unique insights into diagnostic breakdowns, positive patient feedback may also generate broader perspectives on what constitutes a "good" diagnostic process (DxP). METHODS: We evaluated patient/family feedback on "what's going well" as part of an online pre-visit survey designed to engage patients/families in the DxP. Patients/families living with chronic conditions with visits in three urban pediatric subspecialty clinics (site 1) and one rural adult primary care clinic (site 2) were invited to complete the survey between December 2020 and March 2022. We adapted the Healthcare Complaints Analysis Tool (HCAT) to conduct a qualitative analysis on a subset of patient/family responses with ≥20 words. RESULTS: In total, 7,075 surveys were completed before 18,129 visits (39 %) at site 1, and 460 surveys were completed prior to 706 (65 %) visits at site 2. Of all participants, 1,578 volunteered positive feedback, ranging from 1-79 words. Qualitative analysis of 272 comments with ≥20 words described: Relationships (60 %), Clinical Care (36 %), and Environment (4 %). Compared to primary care, subspecialty comments showed the same overall rankings. Within Relationships, patients/families most commonly noted: thorough and competent attention (46 %), clear communication and listening (41 %) and emotional support and human connection (39 %). Within Clinical Care, patients highlighted: timeliness (31 %), effective clinical management (30 %), and coordination of care (25 %). CONCLUSIONS: Patients/families valued relationships with clinicians above all else in the DxP, emphasizing the importance of supporting clinicians to nurture effective relationships and relationship-centered care in the DxP.

Mixed Method Evaluation of ACTS: Advancing Connection Through Storytelling-A Novel Approach to Improve Older Adult Engagement and Staff Interactions in Korean Nursing Homes.

BACKGROUND: A culture centered on relationships and communication is necessary to improve the quality of life of older adults living in nursing homes. OBJECTIVES: To examine the effects of a storytelling program by examining the cognitive, emotional, and psychosocial changes in older adults in facilities and explore staff experience of changes in care. METHODS: This mixed method study delivered a 6-week storytelling program based on relationship-centered care for residents of nursing homes (aged >65 years). Changes in emotional expression, depression, communication skills, social support, interpersonal relationships, nurse-patient interaction, and the person-centered environment as perceived by older adults were quantitatively analyzed using pre-intervention and post-intervention surveys. Qualitative data were collected through weekly stories created by residents, followed by focus group interviews with nursing home staff, analyzed using reflexive thematic analysis to enhance understanding of the program's outcomes. RESULTS: The 42 residents reported significant changes in their emotional expression, depression, communication skills, social support, interpersonal relationships, nurse-patient interaction, and person-centered environment scores after the 6-week intervention. Analysis of the residents' stories identified 5 themes. The staff focus group interviews identified 2 themes and 7 subthemes. Intervention group residents were more likely to initiate conversations, express themselves, carefully observe themselves and others, and actively participate in social activities. CONCLUSIONS: The storytelling program was useful in reducing older adults' negative emotions by allowing them to express their thoughts and feelings and improve their relationships, creating opportunities for social interaction. These effects could help foster relationship- and communication-centered facility cultures.

Building Authentic Connection in the Patient-Physician Relationship.

INTRODUCTION/OBJECTIVES: Delivering optimal patient care is impacted by a physician's ability to build trusting relationships with patients. Identifying techniques for rapport building is important for promoting patient-physician collaboration and improved patient outcomes. This study sought to characterize the approaches highly skilled primary care physicians (PCPs) use to effectively connect with diverse patients. METHODS: Using an inductive thematic analysis approach, we analyzed semi-structured interview transcripts with 10 PCPs identified by leadership and/or colleagues for having exceptional patient communication skills. PCPs practiced in 3 diverse clinic settings: (1) academic medical center, (2) Veterans Affairs clinic, and (3) safety-net community clinic. RESULTS AND CONCLUSIONS: The thematic analysis yielded 5 themes that enable physicians to establish connections with patients: Respect for the Patient, Engaged Curiosity, Focused Listening, Mutual Participation, and Self-Awareness. Underlying all of these themes was a quality of authenticity, or a state of symmetry between one's internal experience and external words and actions. Adopting these communication techniques while allowing for adaptability in order to remain authentic in one's interactions with patients may facilitate improved connection and trust with patients. Encouraging physician authenticity in the patient-physician relationship supports a shift toward relationship-centered care. Additional medical education training is needed to facilitate authentic connection between physicians and patients.

Unpacking patient perspectives on social needs screening: A mixed methods study in western Colorado primary care practices.

OBJECTIVE: Explore factors influencing patient comfort with and perceived helpfulness of screening for health-related social needs. METHODS: In a parallel secondary mixed-methods analysis of data from three primary care clinics, we used logistic regression to examine effects of practice- and patient-level factors on comfort with and perceived helpfulness of social needs screening. We applied narrative analysis to 20 patient interviews to further understand how patients' lived experiences influenced their perceptions of screening. RESULTS: Among 511 patients, receiving an explanation about screening was associated with increased odds of comfort (OR 2.1, 95% CI [1.1-4.30]) and perceived helpfulness (OR 4.7 [2.8-7.8]). Those experiencing more needs were less likely to report comfort (3 + needs vs. 0: OR 0.2 [0.1-0.5]). Narratives elucidated how a history of stigmatizing experiences increased discomfort disclosing needs and captured how relationship quality with healthcare teams influenced perceptions of screening for patients with extensive needs. CONCLUSION: Practice-level (screening explanation and therapeutic rapport) and patient-level factors (history and extent of needs) are key influences on comfort with and perceived helpfulness of screening. PRACTICE IMPLICATIONS: Good communication about screening benefits all patients. Patients with extensive social needs may require additional sensitivity to their past experiences.

A narrative medicine intervention in pediatric residents led to sustained improvements in resident well-being.

BACKGROUND: Burnout in pediatric residents is widespread. Certain factors are associated with decreased burnout, such as empathy, self-compassion, mindfulness, and resilience, while perceived stress is associated with increased burnout. Narrative medicine may reduce burnout by its impact on protective and exacerbating factors and can be an active tool to promote wellness. The objective of this pilot study was to evaluate immediate and delayed benefits of a longitudinal narrative medicine intervention for pediatric residents using qualitative and quantitative measures. MATERIALS AND METHODS: We designed a voluntary longitudinal narrative medicine intervention implemented via Zoom teleconferencing software over five months for pediatric residents at Nationwide Children's Hospital. It consisted of six one-hour long sessions where residents engaged with literature, responded to a writing prompt, and shared their reflections. It was evaluated using open-ended survey questions and established quantitative assessment tools of well-being with validity evidence. Results were compared before the intervention, immediately after, and six months later using one-way ANOVA and multiple linear regression. Qualitative data was analyzed using thematic analysis. RESULTS: Twenty-two (14% of eligible) residents participated in at least one session. After the intervention, the following themes emerged for benefits to resident well-being: the ability to Build Community, have an Outlet for Self-Expression, reap Emotional and Mental Health Benefits, and work on Personal Growth. Benefits were sustained even six months later, which has not been shown previously. While there were significant qualitative findings, between all three time points, there was no change in any quantitative well-being measures. CONCLUSION: Our longitudinal narrative medicine pilot study showed meaningful sustained qualitative benefits, though no quantitative changes, in measured well-being outcomes that have been previously associated with lower resident burnout. While not a panacea, narrative medicine can be a useful strategy for residency programs to improve pediatric resident well-being even after completion of planned interventions.Key MessageWe used a mixed-methods approach to assess the effects of a longitudinal narrative medicine intervention on well-being in pediatric residents.Open-ended responses indicated that residents found utility in and appreciated the intervention and experienced sustained improvements in their mental and emotional health, though the sample size was likely too small to show quantitative changes in well-being measures.Narrative medicine is not a panacea, but it can be a useful tool to provide to pediatric residents to promote sustained improvements in their well-being through the framework of relationship-centered care.