2021 Capstone Projects

Andrew Alexander - The Widespread, Multilevel Impact of Compassionate Care on Healthcare Organization Success 

Andrew Alexander

In the first decade of the 2000s, the number of elderly men and women in American prisons increased by over 80%. Moreover, as the result of three-strike laws, life sentencing, and mandatory minimum sentences, spending the remainder of one's life in the confines of a correctional facility has become commonplace for incarcerated individuals. When combined with the poor health outcomes and the high prevalence of physical and mental disabilities among prisoners, these determinate sentencing practices result in an elevated risk for dying in captivity and in such a way that violates what is both professionally and morally acceptable. Fortunately, over the past few decades, many prisons and correctional facilities have adopted in-facility hospice programs in an attempt to restore compassion to the dying process. For individuals serving time in facilities that have yet to adopt such programs, however, early release programs, commonly referred to as compassionate release, offer a preferable alternative to dying in prison for many patients. Nonetheless, numerous obstacles ranging from the attitudes of correctional healthcare providers to inefficient and underdeveloped protocols oftentimes render these paths to ‘dying well’ ineffective at accomplishing their aim. Thus, this study seeks to summarize both what it means to ‘die well’ as well as the major approaches and barriers to providing compassionate and high-quality end-of-life care to the American prison population. Additionally, this study will examine existing end-of-life care programs and practices with the hopes of informing the future of a more compassionate model of end-of-life care for the incarcerated.


Hope Baldwin - Applying the Science of Compassion to the Future of Artificial Intelligence in the Medical Field 

Hope Baldwin

Recent advances in artificial intelligence with clinical applications has led many to consider how the implementation of such technologies into medicine will affect the healthcare system. And, extensive research has demonstrated the scientific basis of compassion and its positive impacts on patient, provider, and system outcomes. Although many think these ideas of technology and compassionate or humanistic healthcare are competing, the integration of AI into medical practice can ultimately serve to make healthcare more compassionate. Deep learning algorithms offer the potential to increase accuracy and efficiency in diagnosis and treatment strategies, while natural language processing can limit clerical duties of physicians to improve patient-physician encounters and decrease clinician burnout. Additionally, a shift from information overload towards increased integration of important skills like communication and emotional regulation in medical school curriculums, as well as the use of new learning technologies, can help to create more competent and compassionate physicians. If physicians truly desire to provide the best possible care for their patients, they will learn how to properly integrate AI into their practice as this shift in the medical field occurs, as such technology can enable increased physician competency and better patient-physician relationships by serving a model of healthcare that places compassion at the center.  


Mary Benz - Poverty in Medicine: Pathways Forward - examining the factors that lead to physician fatigue, burnout, and shortages in poor and underserved communities: the role of the compassion mindset in restoring and sustaining physicians in their practice with the underserved

Mary Benz

There are more than 640 counties in the United States that are considered “healthcare deserts” due to their limited access to healthcare resources, especially primary care physicians. Despite the great need for physicians and other healthcare professionals in these regions, many clinicians face significant challenges when practicing medicine in underserved communities, such as financial burden, lack of proper training, emotional distress, and role strain. These obstacles can make it exceedingly difficult for doctors to sustain careers for an extended period of time in these underserved communities, which is why there continues to be such an extreme shortage of healthcare workers in poor communities throughout the country. Although this is a complex, multifaceted problem, this analysis addresses the factors which can motivate or dissuade physicians from practicing in underserved communities, and promising strategies to sustain them in such work. Such strategies for improving a physician’s ability to thrive while caring for those of lower socioeconomic status include: incorporating proper training and exposure early on in medical training, improving federal loan repayment programs, building networks of support in local communities, teaching the compassion mindset, and encouraging physicians to engage with their spirituality. While these efforts are complex and require a great number of resources and engagement, they, nevertheless, provide realistic pathways forward in the effort to empower physicians and other healthcare workers to not only survive in their medical practice with the underserved but to thrive and find deep fulfillment as they care for the most vulnerable populations.


Kate Bockholt - Coping with Cancer: The Necessity of Prioritizing Compassion in Oncology  

Kate Bockholt

The burden of cancer on patients, caregivers and health care teams, and oncologists is extensive, and mental illness is identified as a comorbidity for many. Depression, anxiety, and post-traumatic stress disorder are especially common for cancer patients and survivors, leading to worsened cancer outcomes and continued psychological distress even after the completion of cancer treatment. These psychological disorders are also frequently observed in oncologists, who experience heightened risk of mental illness and burnout relative to many medical specialties. Through an extensive review of the available data and literature on the topic of cancer and mental illness, this paper discusses the burden of cancer, the association of mental illness with cancer and its continued impact through the lifetime of the patient, and the factors that contribute to the magnitude of this occurrence. Given the pervasiveness of mental illness in cancer patients and survivors, the need for compassionate care in medicine – specifically oncology – is established with evidence from the new science of compassion. The obligation to prioritize compassion in oncology is explained through a patient lens as well as a clinician lens, both of which exhibit an empirically grounded need for compassionate caring and evidenced benefits of this practice. The foundation for these practices is defined through an analysis of the mechanism by which compassionate caring (termed C2) is established, with a particular focus on the importance of emotional intelligence in clinicians. The feasibility of implementing compassionate caring practices in cancer care is analyzed with consideration of potential challenges and common hesitations, namely time and cost associated with training health care staff and administering these changes to current medical practices. Despite uncertainty and hesitancy from many, financial- and time-related costs of compassionate caring practices have not been found to be significant. The necessity of compassion in oncology is thus inarguable. Its immediate and longitudinal benefits and the marked improvement of mental and physical health outcomes provide hope for the future of cancer care – for patients and clinicians alike.


Leah Bode - The Neuroscientific Benefits of Hobbies and Leisure Activities for Healthcare Providers: How Self-care Improves Patient Care

Leah Bode

The job of caring for others in their most critical and vulnerable states takes a toll on healthcare providers. One study found that 60.7% of doctors experience exhaustion or stress three or more days of the week and that ‘having no coping mechanisms’ was a predictive factor for mental health problems in physicians (Chambers & Belcher, 1994). Periods of rest and recovery from the hard work of healthcare are vital to ensuring that providers remain both effective and compassionate caregivers. The brain undergoes important changes during periods of awake leisure, including processing the events of the day, building resiliency, improving mood, and boosting creativity. Hobbies have the ability to help providers recover from compassion fatigue and take proactive measures towards self-care. The chemical effect of neurotransmitters, the broaden and build theory of positive emotions, acts of self-compassion, and changes in creativity and memory all provide supportive evidence for how self-care is hugely beneficial to clinicians and their patients. Physical exercise, creating music, art/handcrafts, cooking/baking, and yoga/physical meditation are discussed in this paper as hobbies with particularly compelling evidence for healthcare providers. The culture of medical training is changing to embrace the emotional needs of trainees along with their educational responsibilities. The compelling evidence for hobbies’ neuroscientific benefits is presented as a way for clinicians to protect themselves against stress and burnout while sustaining skillful, compassionate care towards patients.

 


Aidan Crowley -  Mental Performance of Physicians in High-Stress Clinical Specialties During COVID-19: A Qualitative Interview Study

Aidan Crowley

The science of compassion is a novel field of inquiry within the study of psychological and behavioral aspects of the patient-physician encounter. More than simply being “kind” or having “bedside manners,” compassion is a four-step biological and psychological process that activates neurological pathways distinct from empathy (Vachon, 2020). Operating in a zone of balanced compassionate caring can mitigate physician burnout as well as improve accuracy of diagnosis, appropriateness of treatment, and patient health outcomes (Trzeciak & Mazzarelli, 2019). However, little is known about mental and emotional strategies and techniques physicians use to actively foster a compassion mindset in their daily work. This is especially true in high-stress clinical specialties such as surgery, emergency medicine, and critical care, and this stress is compounded in the context of a global pandemic. This qualitative interview study seeks to identify the practices and techniques by which physicians in high-stress clinical specialties remain mentally and emotionally present with their patients during the novel coronavirus pandemic. Semi-structured interviews were conducted using an appreciative inquiry approach with twelve physicians from specialties including surgery, emergency medicine, and critical care. Interview transcripts were independently analyzed using the qualitative methodology of grounded theory in NVivo software and discussed to majority consensus by a five-member research team. Results uncovered a broad range of techniques for actively maintaining mental performance before, during, and after work, as well as clear dichotomies between emotional processing and emotional “detachment.” Participants primarily acquired these techniques through trial-and-error over years of gradual professional development. These findings are relevant for physicians to share, disseminate, and train best practices for mitigating burnout and bolstering fulfillment in the emotionally demanding profession of medicine. They also suggest a need to promote increased discussion around such techniques longitudinally throughout physician formation, and they highlight a largely untapped resource in the psychology of the clinician mind.


Vanessa Davis - Compassionate Trauma-Informed Treatment of Patients in the Clinical Setting

Vanessa Davis

Adverse childhood experiences (ACEs) and trauma have significant detrimental impacts on patient emotional, physical, and cognitive health. Early traumatic experiences negatively affect neurological and physiological development, often resulting in a hindered or altered trajectory of development for brain regions involved in emotional regulation, such as the amygdala, prefrontal cortex, and hippocampus, as well as the hypothalamic-pituitary-adrenal (HPA) axis, contributing to decreased regulation of the cortisol stress-response and overall emotional regulation (Anda et al., 2006). These maladaptive alterations in development, combined with socio-economic factors, contribute to the increased health risk seen in victims. An ACE score of four or greater is correlated with increased risk for alcoholism, drug abuse, depression, suicide attempt, smoking, and obesity, among many others (Felitti et al., 1998). Trauma also affects the way victims interact with society, especially within the healthcare system. Victims often struggle forming healthy, positive interpersonal relationships and exhibiting a secure attachment style (Poole et al., 2018). This affects the way physicians must interact with them in the clinical setting to optimize the effects of treatment and increase positive outcomes. Despite high demand, few physicians are adequately trained to provide trauma-sensitive treatment, limiting the efficiency and consistency needed to provide optimal care (Kappel et al., 2020). Standardizing trauma-informed training within the medical curriculum and treatment in the clinical setting could help reduce some of the barriers that patients with trauma histories face within the healthcare system.


Irving Delgado-Arellanes - Compassionate Insights on the Treatment of Addiction  

Irving Delgado Arrellanes

Addiction is not a new problem that the United States and the world has faced, yet the attention and treatment of addiction has lagged behind the rest of modern medicine. Addiction is a complex problem that has been obscured by its reputation and the perspectives from the public and the clinical world continue to differ. Historically, patients recovering from addiction have been dehumanized and disregarded because of the nature of the condition. Here, I present a perspective that recovering addict patients are indeed deserving of standard quality of care, and that their condition should be viewed as a disease since there are profound physiological changes to the brain and other systems when a person has developed an addiction. Addiction has been studied in detail in the neurosciences, and its investigations reflect these profound changes in brain circuitry. Along with this perspective, I provide several dimensions of the problem of addiction including its differential development, perspective from society and perspective from clinicians. Addiction itself holds various implications beyond the health of the addict, such as aversive experiences in their social and emotional lives. It is important to consider these facets of patients since their condition is not only physiological in nature. The current state of treatment of addiction does not reflect the standard levels of other conditions despite there being several avenues of remedy. Rehabilitation centers struggle with funding and access to them is not consistent across communities. Novel treatments of addiction are currently being investigated and show great promise, such as psychedelic-assisted treatments. These treatments have had more success than their conventional alternatives because of their brain-restructuring mechanisms. Along psychedelic-assisted treatment are Mindfulness-Based-Interventions (MIBs) which employ a non-invasive and introspective approach to addiction treatment. They too have shown great promise without the risks and side effects of purely pharmacological interventions. Integrating these views, the way forward with the treatment of addiction lies in the effort to maintain a compassionate mindset with these patients and acknowledging the road to recovery is strenuous. In the end, addicts are humans too, and they deserve the same care and concern that any other condition calls for – hopefully medicine will reflect this in the future.       


Giuliana Di Bono - Causes, Consequences and Coping Methods for Burnout in Clinicians that Serve in Underserved Hospitals in Honduras

Giuliana Di Bono

In 2018 more than 78% of physicians reported they had burnout, 54.3% reported fatigue and 6.5% reported recent suicidal ideation.  Physician burnout is a global crisis that has been faced by all in the field and keeps increasing. Physician burnout keeps increasing due to a sense of powerlessness, lack of autonomy, asymmetric rewards and personal characteristics. Personal characteristics that negatively affect clinicians are perfectionism, self-criticism, sleep deprivation, over commitment, work life imbalances and a lack of social support. Physician burnout leads to negative consequences for themselves, the organization they work in and the patients they treat. Moreover, when clinicians serve in underserved hospitals and treat low income patients the burn out can be even more common. Due to the highly negative consequences of burnout there needs to be individual and systematic changes that aid in protecting/buffering physicians from burnout. This study focuses on an in depth of analysis of burn out factors and consequences and the accelerating factors for clinicians that serve in under serve hospitals. Additionally, this study will explore individual coping methods for clinicians that serve in under serve populations and propose ways that these health care organizations can protect their clinicians from burnout even with limited financial resources.  


Mariana Ferre - Applying the Science of Compassion to Improve the Caregiving Relationships of Dementia Patients and their Loved Ones

Mariana Ferre

Dementia is a progressive disease characterized by an observable decline in cognitive abilities such as memory, thinking, behavior, and the performance of daily activities. This disease poses one of the greatest global challenges for health and social care in the 21st century with approximately 50 million people currently affected and nearly 10 million new cases every year. In addition to debilitating the cognitive and psychological health of diagnosed individuals, the disability and dependency characteristics of dementia have been shown to negatively impact the health of patients’ loved ones, especially if they play a role of caregiver. The purpose of this paper is to help familial caregivers learn about the challenges both patients and caregivers will face in light of this diagnosis and provide resources to help them navigate the difficulties of caring for a loved one with dementia. More specifically, I will be discussing how compassionate skills, such as communication skills and emotion-based coping mechanisms, can be used to improve the livelihood and overall health of patients with dementia and their family members respectively. While there is still no cure for dementia, learning about the science of compassion and how it can be employed in the treatment of this disease can help improve the lives of both those who suffer from this disease and their loved one.


Mary Freedlund - Addressing Barriers to Healthcare: Applying the Science of Compassion at Free Clinics for Uninsured and Low-Income Patients  

Mary Freedlund

Approaching the healthcare system can be an especially complicated process for uninsured and low-income patient populations in the United States. High costs of care, a lack of sufficient healthcare coverage, and limited available resources at medical facilities essentially exclude the underserved from receiving medical care. Thus, free charitable clinics as well as residency-run free clinics function to make health resources more accessible to patients. While the mission of free clinics embodies the core attributes of compassionate caring in medicine, the act of providing compassionate care effectively to patients at free clinics requires further attention. Although physicians have no control over systemic practices that bar the underserved from medical care, they play an integral role in the health outcomes of uninsured and low-income patients at free clinics. How they choose to approach systemic challenges and utilize compassionate caring techniques affects their patient outcomes. This paper analyzes the perspectives and experiences of both patients receiving care and physicians providing care at free clinics. Utilizing the clinician compassion mindset and self-reflection techniques in free clinics has the potential to improve the experiences and health outcomes of physicians and their patients.


Michelle Grady - Compassionate Solutions to Conserve Dignity During End-of-Life Care

Michelle Grady

End-of-life care includes a variety of patient aspects such as physical needs, emotional support, spiritual support, and practical comforts. Far too often, the emotional needs of the patient and their family are unknowingly neglected by the healthcare provider in favor of attending to the physical suffering of the patient. Several barriers have been identified by patients, providers, and their families that block access to adequate end-of-life care. These barriers are namely fear and uncertainty revolving around prognosis and treatment options on behalf of both the patient and provider, which result in inadequate communication. These barriers then lead to a significant delay in conversations surround end-of-life care, contributing to a loss of dignity and quality of life for the patient. Compassion offers a way to overcome such barriers by using a holistic approach to care, one that incorporates the continuous interaction of psychological and physiological influences on patient well-being. Compassion centered communication enables providers to communicate with patients and families both in a timely and effective manner while addressing needs beyond physiological symptoms. Additionally, compassion acts as a safeguard for providers, offering protection from emotional exhaustion and depersonalization through the practice of self-compassion and mindfulness. End-of-life care can be better achieved through a compassionate approach to communication that promotes early and thorough discussion of possible paths, leading to the best possible outcome for all involved.


Meghan Greene - Pervasive Discrepancy in Quality Healthcare for Individuals with Intellectual Disabilities

Meghan Greene

A significant disparity exists in quality healthcare for individuals with intellectual disabilities, particularly in current mainstream healthcare services. Equal access to and quality of these services are lacking. Numerous explicit objectives exist to promote equal rights to high quality healthcare for individuals with intellectual disabilities, including from the United Nation’s Convention on the Rights of Persons with Disabilities. However, despite these professed efforts to increase inclusion of individuals with intellectual disabilities in mainstream healthcare services, this pervasive discrepancy persists due to systemic negative attitudes and perceptions towards the entire population of these individuals. In the current western world, stigma surrounds individuals with intellectual disabilities which creates implicit biases in physicians towards the entire population. In my opinion, this stigma is rooted in the uncertainty of treating those different from us, often due to lack of experience with doing so. Additional variability elicits negative attitudes of healthcare professionals that often detrimentally impact their medical decisions for individuals with intellectual disabilities. Furthermore, perceived lack of self-reliance of individuals with intellectual disabilities significantly contributes to the discrepancy in mainstream healthcare services. Preventing these individuals from contributing to their own medical decisions forcefully removes their autonomy, depriving them of basic human rights and further contributing to inconsistencies in healthcare for this population. Unfortunately, dehumanization of patients, particularly those with intellectual disabilities, is very prevalent in physicians and other healthcare staff. Because compassion prioritizes seeing each patient as a person, compassionate care in medicine is especially important for remediating the disparity. All healthcare professionals have an obligation to provide unbiased treatment, and this is especially true for those that treat individuals with disabilities. Compassionate care is characterized by a genuine desire for what is best for the patient regardless of preexisting attitudes or perceptions that often exist for patients with disabilities. Further research and efforts to combat this discrepancy should primarily focus on education. Educational efforts should aim to increase confidence in healthcare professionals to treat patients with intellectual disabilities, implement anti-stigma interventions and promote positive attitudes towards these individuals in future healthcare professionals.


Rebecca Hammond - Moral Injury: The Roots, Causes, and Manifestations in Physicians

Rebecca Hammond

Physicians commit suicide at rates higher than the general population and report increasingly worse mental health and well-being. Previously, poor physician mental health has been attributed to burnout. However, researchers and physicians alike are beginning to suggest that what was previously thought of as burnout is actually moral injury. Moral injury was first characterized in combat veterans and was suggested as an alternative diagnosis to PTSD. While practicing medicine is not synonymous to going to war, physicians on the front lines of healthcare face human suffering every day and may feel they are fighting a battle of allegiances between patients, hospital systems, insurance companies, and their own personal values. The COVID-19 pandemic has further highlighted this struggle. Moral injury is the psychological suffering that results from engaging in, failing to prevent, or witnessing an act or situation that violates one’s beliefs and values. It is related to concepts such as moral distress and disorders like PTSD and depression; however, it is unique. Moral injury is even identified by the US Department of Veterans Affairs as a distinct phenomenon that occurs in both military populations and healthcare professionals. There are a multitude of risk factors including younger age, shorter time spent practicing, low religiosity as well as a changing healthcare system that prioritizes the business side of healthcare. Scales are now being developed, such as the Moral Injury Symptom Scale-HP, to identify moral injury in healthcare professionals specifically. Further, studies are currently investigating its neural correlates via brain imaging. This paper reviews the roots, causes, and manifestations of moral injury in healthcare professionals, specifically physicians, and applies the research on moral injury in military populations to physicians. Included in this discussion is a review of possible therapeutic interventions to relieve symptoms of moral injury and long-term institutional changes to reduce the occurrence of potentially morally injurious events.


Sarah Hatfield - Additions to Standard Patient-Centered Care for Individuals with Severe or Profound Intellectual and Developmental Disabilities

Sarah Hatfield

The cultivation of a patient-centered care approach to medicine has become increasingly prevalent in recent years. Patient-centered care recognizes the role of patients in their own healthcare decisions and focuses on collaboration between the physician, with their vast medical knowledge, and the patient’s autonomy. People with intellectual and developmental disabilities make up a large portion of our population and are deserving of the same high-quality care that is emerging. Despite this fact, many physicians do not receive adequate training to feel comfortable and confident in providing high-quality care to the specific needs of these patients. People with serve or profound intellectual and developmental disabilities add a unique component to the patient-physician relationship with the addition of a caregiver, forming a non-conventional, triadic relationship. Navigating this triadic relationship and building it in trust may look different for people with severe or profound IDD. Additions to standard patient-centered care can be made to ensure people in this population are receiving the same high-quality care as others. Particular factors to focus on are figuring out effective modes of communication with the patient, having a recognition of common humanity towards the patient, and acceptance of physician’s role to enter into the patient-caregiver relationship forming a triad. These additions to standard patient-centered care, as well as others, will provide physicians with the proper knowledge and training to maintain a high standard of care for patients with severe or profound intellectual and developmental disabilities.


Nick Iovino - End-of-Life Care Behind Bars: Compassion for the Incarcerated and Dying

Nicholas Iovino

In the first decade of the 2000s, the number of elderly men and women in American prisons increased by over 80%. Moreover, as the result of three-strike laws, life sentencing, and mandatory minimum sentences, spending the remainder of one's life in the confines of a correctional facility has become commonplace for incarcerated individuals. When combined with the poor health outcomes and the high prevalence of physical and mental disabilities among prisoners, these determinate sentencing practices result in an elevated risk for dying in captivity and in such a way that violates what is both professionally and morally acceptable. Fortunately, over the past few decades, many prisons and correctional facilities have adopted in-facility hospice programs in an attempt to restore compassion to the dying process. For individuals serving time in facilities that have yet to adopt such programs, however, early release programs, commonly referred to as compassionate release, offer a preferable alternative to dying in prison for many patients. Nonetheless, numerous obstacles ranging from the attitudes of correctional healthcare providers to inefficient and underdeveloped protocols oftentimes render these paths to ‘dying well’ ineffective at accomplishing their aim. Thus, this study seeks to summarize both what it means to ‘die well’ as well as the major approaches and barriers to providing compassionate and high-quality end-of-life care to the American prison population. Additionally, this study will examine existing end-of-life care programs and practices with the hopes of informing the future of a more compassionate model of end-of-life care for the incarcerated.

 


Olivia Jazbutis - Cognition and Emotion: The Role of Emotional Intelligence in Patient-Centered Care

Olivia Jazbutis

Our lives are infused with emotions, which play an integral role in the cognitive processing of information, decision-making, and memory formation. Neuroscience demonstrates that cognition and emotion are inherently intertwined, and clinical work requires both cognitive and emotional components. Patient-centered care is enacted when a clinician self-monitors how he or she is both relating to patients and adjusting to patient needs. To adequately practice patient-centered care, clinicians must learn to strike a balance between being emotionally underinvested and overinvested with patients. Training clinicians to be aware of their own emotions, to regulate their emotions, to recognize patient emotions, and to pick up on cues from patients has the potential to change how emotions are understood and utilized in healthcare. Emotional intelligence may ultimately act as a vehicle for guiding a clinician’s competency to the patient’s best interests. Emotionally intelligent care is not only correlated with better patient outcomes, but it also fosters protective features for the clinician. It should therefore actively be promoted and cultivated on both an individual and an organizational level when implementing a compassion-centric paradigm of healthcare. Individual ways to cultivate emotional intelligence include journaling, daily meditation, positive visualization, appreciative inquiry, thought before action, and empathic listening. Emotionally intelligent care is already used on an individual level by some clinicians, but little formal training exists in terms of learning effective emotional regulation techniques for dealing with the emotional aspects of working in healthcare. With a tendency to focus on objectivity and developing expertise with technical procedures, there is still much work left to be done with training emotional intelligence to achieve and sustain a compassion mindset. RULER, which stands for recognizing, understanding, labeling, expressing, and regulating, is an evidence-based approach to social-emotional learning developed by the Yale Center for Emotional Intelligence that embeds emotional intelligence into norms, routines, policies, instruction, and relationships in K-12 schools. Given that the RULER approach mirrors the competencies of emotionally intelligent care in the healthcare field, and its efficacious implementation in schools, it may potentially be modified to cater to the social, emotional, and cognitive aspects of clinicians. Further, active implementation of the CERB framework, which is comprised of cognitive, emotional, relational, and behavioral emotionally intelligent strategies, along with additional personal feedback is an alternative approach for the healthcare field to implement emotionally intelligent care. Ultimately, training clinicians’ emotional intelligence may function as a realistic long-lasting solution that addresses the neuroscience of compassion as well as the increasing pressures clinicians continue to face in healthcare. 

 


Kelly Kolleck - Challenges to Physician Compassion During COVID-19 

Kelly Kolleck

The science of compassion is an emerging field, and thus unlikely to be a high priority of physicians facing challenging conditions during the COVID-19 pandemic. However, compassion offers tools which can help the physician to better connect with and care for their patients, ultimately improving patient satisfaction and physician fulfillment. The clinician compassion mindset is an invaluable tool used to ensure compassion is the organizing factor in all patient interactions. Clinicians that were most strongly affected by pandemic stressors might have relied upon a compassionate mindset to better care for patients in the face of adversity. But the pandemic did present myriad challenges which might have overwhelmed these mindsets. Direct tolls, such as cognitive uncertainty, fear of transmission, and overwhelming work hours, in addition to indirect tolls, including moral injury, compassion fatigue, and increased burnout, all contributed to grueling work conditions. Polyvagal theory and empathic distress fatigue help to explain why employing a compassion mindset at certain times was nearly impossible. These pandemic were imposed upon a backdrop of high national physician burnout rates and betrayal by the public. Thus, physicians had countless challenges stacked against them. This paper seeks to determine which stressors unique to the pandemic have affected clinician compassion and offers a forward-looking perspective to compassion recovery as the pandemic continues. Time dedicated to compassion recovery and reconnecting with families will be crucial to help physicians heal post-pandemic.

 

 


Kathryn Kostolansky - Compassion-etics: The Necessity for Compassion in Genetic Counseling

Kathryn Kostolansky

The field of genetic counseling is expected to grow over 20% from 2019 to 2029 (U.S.  Bureau of Labor Statistics, 2020). With an extreme increase in number of genetic counseling  professionals to come in the next decade, it is of the utmost importance that compassionate care  in medicine is understood and practiced. Compassion is not only a concept, but a hard science  and should be taught to genetic counseling students in order to provide them with necessary  skills for their career. Compassion, which involves a combination of neural bottom-up  processing with mirror neurons and top-down processing, is based on evolutionary biology and  serves as a protective mechanism against compassion fatigue and burnout. Furthermore, the use  of compassion in the practice of genetic counseling aids the genetic counselor in efficiency,  patient interactions, and job satisfaction, which in an ever fast paced and technological age,  allows for better patient experience due to increased trust between a counselor and client due to  compassionate care.

 


Joseph Lazzara - The Neuroscience of Exercise and its Role in Combating Burnout and Cultivating Compassionate Physicians

Joseph Lazzara

Burnout is characterized by “emotional exhaustion, depersonalization, and a decreased sense of personal accomplishment caused by work-related stress” (Dimou, 2016, p.1). It occurs to some extent in every profession but is even more prevalent among those in the medical field. Physicians are at an increased risk for burnout due to long work hours, difficulty maintaining work-life balance, and challenges associated with constantly caring for others who are ill. Burnout has been linked to depression, and many theorize clinicians experiencing burnout are predisposed to declining mental health. Further, burnout can lead to changes in appetite, disengagement, insomnia, and anxiety (Moalem, 2017). The consequences of such factors can be quite severe and include divorce, strained personal relationships, and in some cases suicide. Burnout poses a serious threat for all physicians, and a variety of methods have been developed to combat its effects. Many of these solutions are centered around reducing stress, improving work-life balance, and developing better relationships with colleagues. However, the literature often oversimplifies methods like physical activity, placing them into one of these categories. Exercise is frequently viewed as a method of stress reduction that works for some people, but not others. The literature suggests a negative correlation between physical activity and burnout but calls for further analysis regarding its method of action. This capstone project seeks to develop a deeper understanding of the benefits of exercise in the context of burnout and demonstrate its ability to cultivate compassionate and caring physicians. 


Monique Le Tran - Compassion in the NICU: The Importance of Responding to the Psychosocial Needs of Parents of Very Preterm Infants

Monique Le Tran

The purpose of this study is to explore the different psychosocial and logistical issues that parents reported having with nurses and other staff members while their child was in the neonatal intensive care unit (NICU), ways that nurses can provide the compassionate support that parents need, and how burnout in the NICU/ICU can interfere with this caregiving. It is crucial that nurses are educated on how to respond empathetically to the needs of parents and to help them cope with the hospitalization of their child. Some common themes of psychosocial needs that parents have reported include emotional support, trust in the healthcare provider, and privacy. To respond to these needs, nurses and other healthcare professionals should receive specific training in communication skills and family-centered care, as it will allow them to empathetically support both parent and child during their stay at the hospital. However, as the NICU is a high stress environment, burnout and compassion fatigue is especially prevalent, which can interfere with the quality of care infants receive. In addition to this, interacting with worried and upset parents can also be emotionally taxing for nurses, especially when they are not trained to handle situations like this. When nurses are not able to provide compassionate care, parents are less satisfied with their NICU experience and are less confident in their roles as parents. Therefore, responding to parents with understanding and empathy will encourage parents to cope with their situation


Maura Lee - Organizational Methods of Compassionate Care: Caring for Doctors So That They Can Care for Patients

Maura Lee 

 The Physician Foundation discovered in their “2016 Physician Survey” that 78% of clinicians are experiencing sensations of burnout and that 50% of doctors are completely burnt out (2016, p. 7).  Burnout, or experiencing emotional exhaustion, depersonalization, and a lack of personal accomplishment (i.e. the feeling that your efforts achieve nothing), is expensive for physicians, patients, and health systems (Maslach & Leiter, 1997).  Johns Hopkins estimates that burnout costs the United States billions of dollars and hundreds of thousands of lives each year (Johns Hopkins Medicine, 2016, p. 1).  A new movement in the scientific literature proposes compassion – not simply a sentiment but rather a body of science based on neuroscience, biology, and evolution – as a solution to sensations of burnout.  During every encounter with a suffering patient, the physician automatically undergoes the “Clinician Compassion Mindset Process” (CCMP), which determines how emotions of empathy and mirror neuron firing will impact the physiology of the doctors’ brain as they continue to practice medicine (Vachon, 2020, p. 102).  Unhealthy processing of these intense emotions is an accurate predictor of sensations of burnout.  Doctors cannot give of themselves to care for their patients if the healthcare systems in which they work do not care for them.  Organizations must show compassion for doctors first, taking responsibility for the overall health and well-being of their physicians by cultivating a culture of compassionate care.  Included in this capstone project are literature-reviewed methods through which healthcare administrations can work to reduce burnout by showing compassion for their clinicians: employing emotionally intelligent and supportive immediate superiors, taking physician feedback into consideration when making new policies, implementing a professional practice model, re-introducing community into the workplace, re-inspiring clinicians’ internal motivations, and giving doctors some freedom in treating their patients.  This paper also seeks to explain how organizations intentionally taking steps to build a culture of compassion can prevent and protect against burnout at the point of care, allowing physicians to more successfully engage with their CCMP.  Although many healthcare organizations are taking steps to combat the prevalence of burnout in their workforce, a fundamental paradigm shift is necessary to ensure a culture of compassion in medicine is the norm, not an added benefit for those who can afford it.


Allison LeHanka - The Shift to the Shared Decision-Making Model in Medicine

Allison Lehanka

 In the 1970s, American healthcare systems began to move away from a paternalistic approach in the patient-physician relationship towards the shared decision-making model. While the paternalistic approach focuses on a physician’s expertise and authority in making medical decisions, the shared decision-making model grants new power to the patient in their own care. The shared decision-making model is characterized by clinician and patient collaboration on medical decision-making, where the doctor supplies their medical training, clinical experience, and knowledge of current treatments and research and the patient expresses their values and personal preferences relevant to the decision at hand. This model can be broken down into a five-step process in which partnership is built, a choice is explicitly identified, options with their corresponding risks and benefits are discussed, and a decision is ultimately made. The shared decision-making model not only satisfies patient demands for autonomy in care, but also can improve patient outcomes, especially in the affective-cognitive realm. Further benefits of the shared decision-making model remain to be seen as correct implementation of the model continues to increase across the US.


Chelsea Logo - Applying the Science of Compassion to the Delivery of Bad News: Can Teaching Unemotional Physicians to Be More Emotionally Regulated Facilitate This Process?

Chelsea Logo

Though physicians are responsible for breaking bad news, a majority of practicing physicians have reported receiving no formal training in effectively communicating bad news. Since bad news in and of itself can cause suffering, the way bad news is delivered can have a significant impact on patients’ perspectives of their illness and their relationship with their healthcare provider. For patients, bad news can threaten their identity and challenge their sense of meaning, and patients can become more distressed when physicians deliver bad news in an inappropriate manner. Thus, teaching physicians how to deliver bad news well is an important area of study. Currently, medical schools are using strategies like the SPIKES protocol and the ABCDE mnemonic to teach physicians how to deliver bad news well. While these strategies are effective, I propose the application of the science of compassion to the delivery of bad news with three types of physicians in mind: physicians who are emotionally detached, physicians who are emotionally over-involved, and physicians who are emotionally inexpressive. Emotional regulation plays a very important role in the delivery of bad news, particularly because bad news often elicits a profound emotional response from the patient and triggers an equal emotional response in the physician who has to deliver the news. By understanding the role of emotions and empathy in healthcare, I highlight the possibility that teaching physicians to be emotionally regulated is a means by which the science of compassion can be used to assuage the burden of delivering bad news.


Emma Mazurek - Narrative Medicine: Bridging the Gap Between the Biomedical and Biopsychosocial Models of Medical Practice

Emma Mazurek

The medical field is experiencing a paradigm shift from the biomedical to the biopsychosocial model of health. Narrative-based medicine (NBM) is a key factor in completing the transition from a detached stance to a more holistic and interdisciplinary practice of medicine. Focusing on the narrative and illness experience of the patient returns autonomy and agency to the sufferer, augments the physician-patient relationship, and allows healing to continue. Ultimately, NBM improves health outcomes in patients with chronic illnesses and is a useful tool to enhance trust between physician and patient in other specialties. While more extensive research is needed, especially in specialties outside primary care, medical curricula should include medical humanities and holistic caring models in their education in order to train competent future physicians. By implementing a narrative approach, medicine will remain in touch with the demands of the public and will see higher efficacy among its patients. Narrative medicine is necessary to transition fully to the biopsychosocial model of health, and it provides a means to practice the art of medicine.

 


Megan McCabe - Addressing the Barriers that Pediatric Rare Disease Patients and their Families Face when Receiving Medical Care, and Application of the SPIKES Protocol for Healthcare Professionals to Reduce these Barriers

Megan Mccabe

“Rare disease” is an umbrella term for a variety of rare and neglected disorders. For a pediatric patient with a rare disease, a main part of their life will be receiving medical care from physicians, nurses, therapists, or other healthcare professionals. Due to a lack of awareness and compassion for pediatric patients with rare diseases and their family members, they often face many barriers when trying to receive medical care. The goal of this capstone project is to first outline the many barriers that pediatric rare disease patients and their families face in the medical field. Some of these barriers and difficulties that they face include the diagnostic process, a lack of healthcare provider competence, psychosocial needs, or the doctor-patient relationship itself. Next, a common technique used in the medical community called the SPIKES protocol will be used to suggest a framework that healthcare professionals can use to approach pediatric rare disease patient visits. The SPIKES protocol stands for setting up the interview, assessing the patient’s perceptions, obtaining the patient’s invitation, addressing patient emotions with empathetic responses, and strategy and summary. The rationale for using SPIKES is to use a protocol that is already well-known in the medical community for the pediatric rare disease patient and family member population who is much less well-known. After a detailed analysis of how the SPIKES protocol can be used for pediatric rare disease medical visits, a set of resources will be presented that both healthcare professionals and the rare disease community can use to increase education, awareness, and advocacy for rare diseases. Some of these resources include the National Organization for Rare Disorders, the Boler-Parseghian Center for Rare and Neglected Diseases, Young Adult Representatives of RDLA, Developmental-Behavioral Pediatrics, Medical Genetics, and support groups. Through discussing barriers, the SPIKES model, and these resources, this capstone paper will express the needs of the pediatric rare disease community in the medical field, and make specific suggestions to address these needs


Monica Mesecar  -  Compassionate Care in Neurology: The Importance of Practicing Primary Neuropalliative Care

Monica Mesecar

This paper will first define what neurology is, followed by a discussion of what neurologists treat. Then after emphasizing the global importance of neurological disorders, the most significant problem facing neurology will be revealed as the “diagnose and adios” mentality. This phrase refers to the approach of simply diagnosing the patient and following-up with treatment with little to no emphasis on helping the patient live well with their condition. After exploring the significance of this problem, the solution of implementing the science of compassionate care will be generally proposed. Following this section, this paper will argue that in neurology, using this approach means practicing primary neuropalliative care. Primary neuropalliative care refers to utilizing the principles and practices of palliative care in routine, daily practice in a way that is specific to patients living with long-term neurological conditions. Next, after defining neuropalliative care, this paper will discuss the unique challenges to practice posed by patients with long-term neurological conditions, followed by a practical approach to implementation. This paper will then conclude with a discussion of why practicing neuropalliative care is beneficial with an emphasis on the improvement of patient outcomes, as well as its potential to buffer against the ever-growing problem of neurologist burnout.

 


Christian Oakley - Systemic, Institutional, and Individual-level Factors Influencing the Adoption and Efficacy of Mindfulness-based Stress Reduction Interventions in Surgical Residents

Christian Oakley

Surgical residents experience significant emotional and logistical stressors that can increase their susceptibility to burnout and compassion fatigue. The numerous systemic, institutional, and individual-level factors influencing the adoption and the efficacy of mindfulness-based stress reduction (MBSR) interventions are unclear. Moreover, the effects of MBSR interventions on surgical residents remain uncertain. To better understand these factors and the effects of MBSR on surgical residents, a comprehensive literature search strategy was performed on PubMed and Google Scholar to find studies that 1) discussed the factors influencing the adoption and efficacy and MBSR interventions or 2) evaluated the effect of MBSR interventions on resident and physician burnout, empathy, mindfulness, stress, executive functioning, mood, or surgical performance. Multiple studies examining the factors influencing the adoption and efficacy of MBSR interventions were identified. Surgeon stoicism, expectations of emotional resilience by attendings, long work hours, and a lack of understanding of MBSR interventions were identified as systemic factors, while hospital profitability and residency administrative structures were identified as institutional factors. Leadership attitudes and individual-resident qualities were discussed as individual-level factors. The search also returned four randomized clinical trials and one single-arm cohort study examining the effects of MBSR interventions on physicians or surgical residents. Findings from these studies suggest that MBSR interventions are associated with decreased burnout and perceived stress and increased mindfulness, empathy, and mood regulation in the short and long-term. From these findings, it is clear that there are numerous systemic, institutional, and individual factors affecting MBSR intervention use and success. While studies suggest that MBSR interventions are efficacious, larger randomized controlled trials with increased statistical power are needed to better discern the effects of MBSR interventions on surgical residents.


Mairead Pfaff - Diagnosis of Chronic Illness in Pediatric Patients: Distinctions in Clinical Practices and Importance of Quality Communication from Physicians

Maireed Pfaff 1

Pediatric patients have distinct needs from adults in a clinical setting; children often require simpler explanations of medical jargon, with more analogies being used. The job of the physician is more difficult since they must cater to the patient as well as the parents or guardians present. The parents will have different types of questions from their child, and each party may expect a different style of communication from the physician. Parents of children with a chronic illness often experience a major change in lifestyle after the diagnosis of their child. The memory of the physician delivering news of the illness to the parent and child often remains clear for years following the diagnosis. These moments can be categorized as “flashbulb memories”; the parent and child’s predisposition to remember details of the diagnosis conversation makes this moment highly important for quality communication by the physician. Most research shows that parents want to be shown “empathy” or “compassion”, but few studies outline what that means for the physician in practice. Furthermore, the diagnosis of chronic illness in pediatric patients has the potential to affect the child for the rest of their life. In cases of chronic illness, as the child grows older, they will assume more responsibility for their own health. The way a pediatric patient is treated at the beginning of their journey with chronic illness can impact the way the child progresses towards taking an active role in their own care. It is important to recognize the perspectives of the child, parents, and physician during these conversations. Focusing on the diagnosis is important for the remainder of the child’s relationship with their illness. To minimize the parent and child’s trauma from the experience, the physician must be compassionate towards both parties and recognize their individual and mutual needs. Best practices to act in a compassionate manner during difficult diagnoses are not clearly outlined for pediatric physicians, and current published guidelines on communication do not delve into the complexities of distinctive disease scenarios. This research describes the importance of the specific moment of diagnosis for a pediatric patient with a chronic illness. The perspectives of the parents, the child, and the physician are explored; each party’s specific needs are outlined as they have been currently described in the literature. Recommendations are made to standardize these practices for clinicians in clinical practice. The purpose of this research is to demonstrate a need for physicians to focus on compassionate communication during the diagnosis of a child with any chronic illness.


Keegan Riggs - Burnout Disproportionately Affects the Emergency Department: Is Compassion a Solution?

Keegan Riggs

Physicians experience higher rates of burnout than any other profession with a 48.5% prevalence nationwide. In the emergency department specifically, the prevalence is 68%, the highest out of any specialty (Shanafelt et al. 2012). The disproportionately high level of burnout in the ED has historically been attributed to the long hours and inconsistent schedules. However, recent data shows that despite having a higher percentage of burnout than other specialties, emergency medicine has above average satisfaction with work-life balance. So, why does burnout continue to plague emergency departments nationwide? There are factors specific to the ED beyond the tough schedule that result in the high percentage of burnout. Many specialties encounter suffering, but none in as fast-paced of an environment as the emergency department. Emergency physicians rarely have time cope with the tragedies they witness. Much of health care has become business-oriented, but no specialty has been affected by a profit-driven workplace more than the ED. Physicians are rewarded for seeing as many patients as fast as possible, frequently at the expense of establishing a strong patient-clinician relationship. These key factors, along with many others, can be detrimental to the clinician compassion mindset. There is a positive correlation between burnout and depersonalization, workplace fragmentation, and other aspects of non-compassionate health care culture. Decreasing hours, offering stress workshops, and requiring mandatory wellness training have been unsuccessful at decreasing burnout in emergency departments nationwide. Just as a band-aid cannot patch a gunshot wound, these “simple fixes” cannot rid the emergency department of the issues deeply rooted in the workplace culture. To solve the burnout crisis in the ED, health care organizations need to strive for widespread shifts towards a compassionate culture. Compassion has been studied to improve both physician well-being and patient satisfaction, but a compassionate mindset is only sustainable if shared amongst the whole organization. Hospitals will have to reorganize their departments for better collaboration, encourage development of compassionate relationships amongst colleagues, and remove the pressure to provide quick and profitable treatment. The ED can never be ridden of suffering, tragedy, and hard work, but changing the approach towards these hardships can improve outcomes for physicians, patients, and medicine as a whole.


Justin Roy - iCare: Maintaining Compassionate Care Practices in the Throes of the Digital Age 

Justin Roy

The dawn of the digital age has sparked rapid innovation throughout all sectors of society. These improvements have afforded many improvements in convenience, including in healthcare – electronic health records, faster system organization, telehealth. Yet, there are still discrepancies that present issues in maintaining compassionate care in medicine in conjunction with technological advancement. Digitalization has taken away personal and humanistic aspects of healthcare, leading patients to feel as though they are talking to a computer as opposed to interacting with their clinician, both in person and through telehealth. As a result, websites like WebMD have created a resource for patients to self-diagnose, which has formed nuances in care in which the patients try to diagnose themselves, resulting in potential differing views with experienced, knowledgeable clinicians. In addition, pushback from healthcare workers on the lack of user-friendly technology – or lack of willingness to learn – creates a further rift which hampers the efficacy of compassionate, caring attitudes and interactions that should be seen between clinicians and their patients. Medicine cannot be made convenient in ways that online shopping and streaming services are. Rather, with the ushering in of a digital age to the healthcare sphere, there becomes a glaring necessity for clinicians to evolve and adapt simultaneously as opposed to feel hindered by new technological options. Examining the scope of healthcare technology and its flaws in compassionate care allows clinicians to enhance their compassion techniques in order to mitigate the rift between patients and clinicians. First and foremost, expanding digital literacy among clinicians presents a strong foothold in bridging the gap of compassionate care through educational sessions, digital workshops, and also EMR improvements. In addition, research notes that clinicians – and patients, alike – must continue to build empathic awareness in technological media to enhance correspondence, appointment efficiency, and caring, communicative mindsets. Healthcare can facilitate these efforts by emphasizing education of the youth, who are not only the future of medicine, but also future patients and administrators as well. Roadblocks to the zone of compassionate care in medicine are perpetuated by a stagnancy in efforts and education. Thus, further research toward methods in which clinicians can create a duality of compassionate care with the evolution of technology will pilot medicine into more effective health outcomes and a healthier future.

 


Michael Shannon - Investigating the Role of Burnout and Compassion in Organ Donation and Transplantation

Michael Shannon

Pioneered in the mid-twentieth century by the work of Dr. Thomas Starzl and bolstered by advances in surgical technology, organ donation and transplantation have seen drastic evolution over the years. The medicine of this field is a highly integrated process and involves coordination between providers serving in several specialized roles. Working in the realm of transplantation is rife with exposure to psychological challenges. These may include caring for terminally ill patients, difficulty in procuring organs for needy recipients, and facing the ethical challenges associated with organ allocation. Broadly, the healthcare field is currently burdened by an epidemic of clinician burnout. This phenomenon is characterized by symptoms of emotional exhaustion, reduced personal accomplishment, and depersonalization. Given their unique selection of stressors, the nurses, doctors, and transplant coordinators working in organ transplantation may be at an elevated risk to succumb to burnout. To date, research on burnout in these professions suggests tangible levels o­­­f burnout and compassion fatigue. Factors that influence the prevalence of this malady include a surplus of roles and responsibilities, missed opportunities as a result of career choice, and feelings of inadequate compensation. However, research into clinical burnout has also managed to elucidate several strategies that may assist in buffering against its manifestation. Namely, the nascent science of compassion may hold many important implications for enabling clinicians to stave off burnout, maintain a healthy and balanced lifestyle, and preserve their ability to deliver optimal patient care. Methods to continually reinvigorate a compassionate mindset include mind-training techniques, meditation, and adequate leisure time for decompression. Additionally, incorporating these considerations into training for clinicians may help prepare them to retain a compassionate mindset throughout their experiences with mental and emotional taxation. Overall, more research is needed in order to determine the exact nature of burnout in this field, as well as the effectiveness of different strategies in preventing its occurrence. However, the importance of compassion is prominent, and should remain a subject of discussion in seeking to improve clinician well-being, patient outcomes, and the healthcare system as a whole.


Kelly Straub - A Case Study on Compassionate Care Manifestation in Organ Transplantation and How Treatment is Perceived by the Patient and Loved Ones

Kelly Straub

Compassion shown in health care is an emerging concept that is gaining momentum in the field. It was once thought that providers should “cut straight and care less,” but now it is apparent that caring is an important part of the healing process. Organ transplantation illustrates the significance of compassion and empathy’s impact on clinicians, patients, and loved ones. The fundamentals of organ transplantation, including ethics and biases, display how compassionate care is necessary in health care. Using the case study of a double organ transplant patient, compassion and empathy were shown to have a major impact on the patient, clinicians, and loved ones. Assessors determining who gets on the transplant list, surgeons, nurses, and PAs all uniquely demonstrate compassion to both the patient and loved ones; in return, this rejuvenates the clinician, buffers against burnout, and creates a helpful relationship with the patient. Additionally, the patient perceives the clinicians’ efforts toward him or her as either compassionate or uncompassionate. Patients also exemplify compassion towards physicians using techniques to build relationships, thus helping the clinician treat the patient more holistically. Finally, loved ones also perceive a clinician’s responses to the patient’s pain as well as employ their own techniques to show compassion towards their sick loved one. As compassionate care continues to permeate into the health care culture, it is important for clinicians to learn and become aware of compassion’s influence in order to use its benefits both to optimally treat a patient and maintain a patient-centered mindset.   


Tanner Tarkelson - Managerial Changes in Emergency Medicine to Improve the Patient and Clinician Experiences

Tanner Tarkleson

The science of compassion is a new and rapidly expanding field of study. Within a healthcare setting, implementing the suggestions that come from this research can have implications for health outcomes, administrative organization, finances, etc. While the science of compassion is often seen as a “soft subject”, there exists plentiful hard evidence for the benefits that empathetic resonance followed by action to relieve suffering (a shortened definition of compassion) can have. Emergency medicine is one of the most difficult sectors of healthcare to manage. This struggle arises from the division’s fast-paced nature, variety in patient conditions, and consistent need to be prepared for crisis. With these facets in mind, the patient and clinician experiences are an aspect of emergency medicine that is oftentimes overlooked. However, the specific administrative changes within the emergency department needed to create an environment of compassion and improve the patient and clinician experiences have not yet been succinctly organized. Here, suggestions are made to emergency department administrations in order to improve their patient and clinician experiences. Namely, the suggestions made to improve the patient experience (the first part of this thesis) include (1) creating a more compassionate environment for healthcare professionals and patients, (2) improving upon teaching styles and techniques, and (3) reducing the language barriers that are so common in the emergency department. Suggestions made to improve the clinician experience (the second part of this thesis) include (1) molding the facility’s mission around compassion, (2) encouraging emotion regulation techniques, and (3) utilizing team-based care. The results demonstrate the practicality of implementing the suggestions generated from a study of the science of compassion. It is anticipated that this thesis will provide a groundwork for emergency department administrations to use in terms of improving the experience, and consequently health and financial outcomes, of everyone within their facility. This thesis is additionally one of the first to analyze the tri-layer network between patients, clinicians, and administrators within the emergency department. Further work is necessary to fully examine the intricacies of such relationships and to create solutions to reduce the friction between them. 


Olivia Venvertloh - Presence Amidst Emotional, Physical, and Structural Problems: A Case Study in the Compassionate Mindset of Elderly Caregiving

Olivia Venvertloh

As the baby boomer generation ages and the fertility rate declines,  the number of people dependent on caregivers will only continue to rise in the coming years. The United Nations reports that one in six people will be over the age of 65 by 2050. The healthcare system, already strained by a global pandemic, a shortage of healthcare workers and clinician burnout, will continue to be impacted as more elderly need assistance in long-term care facilities. The only way out of this predicament is training healthcare workers in the compassion mindset, which applies compassion to all stages of patient interactions. By maintaining an inner motivation to care for others and mitigating organizational challenges faced at work, resilient elderly caregivers who utilize the compassion mindset will become an example for other caregivers. This paper will explore the compassion mindset through a series of interviews conducted with an elderly healthcare professional as a part of an IRB-approved study investigating mental performance in high stress specialties. Dedication to providing top quality care through physical, emotional, and spiritual presence while implementing the compassion mindset is a powerful example for future caregivers navigating systemic difficulties.