2022 Capstone Projects
Jack Bryan - Gender in Healthcare
Gender plays a critical role in human interaction with women gaining an increasing role in society as it pertains to the workforce, education, and leadership. The effects of gender on the shifting landscape of the healthcare system are unclear yet must have an impact. Even in my coursework as a pre-med student, I have noticed an increase in female classmates to the point where they are the majority. Thus, I wanted to determine how gender could affect my effectiveness as a physician due to patient perception, aptness to care, and other gender stereotypes. I investigated the trends of gender in today’s world by looking at healthcare system demographics. This consisted of an extensive review studying treatment modalities by gender, effects of gender concordance, effects of gender on patient outcome, gender in residency, and gender interactions between coworkers. I concluded that balanced compassionate caring could help diminish negative gender differences in the healthcare system. We can all learn and grow in our careers, following best practices when demonstrated by women and likewise when demonstrated by men.
Cole Carpenter- The Application of Compassionate Care to the Care of Patients with Dementia and Their Families
As people worldwide live longer and have improving access to life-preserving healthcare, the number of older adults with dementia continues to rise. As this disease becomes more and more common in our aging population, personally affecting millions of Americans each year, it is critical that the methods of compassionate care necessary to provide adequate care for these individuals are researched and communicated. My decision to research this topic is personal, as I have lost multiple family members to dementia in recent years. IN this paper, I describe, using support from empirical research, how important compassionate care is for patients who suffer from, family members who bear the burden of, and clinicians who treat dementia. Considerations of compassionate care are made for patients, patient families, and clinicians. Directions for future research are explored.
Ava DeLonais-Dick - Compassionate Care and the Native American Health Care System
Native Americans face chronic and deep-rooted health disparities. This is driven by promises broken by the United States government, previous abuse of Native communities, poverty, and underfunding of Indian Health Care programs. These systemic problems that cause the health disparities experienced by Native Americans are not going away any time soon and have led to cracks in the patient physician relationship. There is justifiably a lack of trust in the physician, education, and Western medicine within Native American communities. Unfortunately, this lack of trust results in gaps in medical knowledge for the patient, a sense of hopelessness, and lack of motivation when it comes to dealing with their illness and the prospect of recovery. For the doctors, this leads to frustration and burn out. Ideally, these problems would already be fixed, however, there are things physicians can do to help bridge the gap and rebuild the trust of Native American communities. This lack of trust must be addressed by understanding the significance of Native American historical trauma and their culture. Once this has been addressed and Native culture has been incorporated into Western Medicine, clinics have seen significant improvements in patient understanding, adherence, and trust of their physicians. Application of Motivational Interviewing has also been shown to be an effective method of rebuilding trust in the patient physician relationship within Native communities. Beyond the external relationship there are also implicit biases of the physician that can unintentionally play a role in the maltreatment of Native American patients. However, these implicit biases can be overrun by paying explicit attention to the patient as an individual and positive thinking.
Mary Clare Donnelly - Applying the Compassion Science Model for Transgender Patients Experiencing Pregnancy
Transgender individuals likely represent between 0.3 and 0.5% of the U.S. population. Throughout history, they have traditionally faced pervasive discrimination and invisibility, but in recent years, transgender people have experienced significant advances in societal acceptance of their identity (Obedin-Maliver). However, in healthcare, most providers still assume that all people who have uteruses and ovaries are women (Rainbow Health Ontario) . People who do not identify as women still can become pregnant, intentionally and unintentionally, even after undergoing gender-affirming processes and treatments. Many patients are interested in future pregnancy and parenthood at different ages and stages in their transition process. However, there is currently little clinical guidance for fertilization, prenatal, during childbirth, and postpartum care. The relationship between the doctor and the patient has the potential to cause adverse or harmful effects on patient outcomes, especially for patients who are not cis-gender women going through pregnancy. The compassionate science model provides a unique lens for analysis on both the patient and physician experience when treating this vulnerable patient population. We can use this model and principles of trauma informed care to find and implement compassionate care that facilitates positive doctor/patient interactions.
Rosie Dunn - Ableism in Medicine and Its Harmful Effects on Patients and Providers
Disability is a part of human diversity and is the largest minority group in the United States-approximately a quarter of Americans live with a disability. Unfortunately, there is still ableism in all aspects of our society, causing people with disabilities to be excluded from active participation in society. Medicine is not exempt from ableist actions and attitudes. Ableism in medicine affects the health of many people with disabilities through receiving unequal access to care and having assumptions and negative attitudes portrayed about them by healthcare professionals. Ableism in medicine also limits the amount of healthcare providers who have disabilities themselves and perpetuates dangerous stigmas about mental healthcare among medical students and other healthcare professionals. Disabled people bring a unique and valuable perspective to medicine, as they often have extensive experience as patients themselves and have experiences of illness and injury that can not be taught or learned without experiencing it firsthand. Physicians and all who work in healthcare should become aware of how disability and medicine intersect to provide informed and compassionate care. Through the inclusion of people with disabilities in healthcare, revision of ableist and outdated technical standards, and the promotion of support groups and networks for disabled healthcare practitioners, ableism in medicine can be reduced so healthcare can become more inclusive, diverse, and effective.
Chloe Dunseath - From Diagnosis to Discharge: Special Considerations in Pediatric Bone Marrow Transplant Units
From diagnosis to discharge, a hematopoietic stem cell transplantation (HSCT), or commonly known as bone marrow transplant (BMT), is a grueling yet rewarding treatment that often provides a life-long cure to otherwise devastating diseases. Pediatric bone marrow transplants are especially complex due to the involvement of parents or guardians as the final decision-makers of their child’s care. The stepwise and detail-oriented nature that HSCT treatment requires to be successful means that patients and their families become inpatients in the hospital over the many weeks to months it takes for the treatment to work. During this time, and for many, even after leaving the hospital, there are issues that patients and their families encounter of psychosocial, financial, and informational nature. On the other side of treatment, healthcare providers experience problems regarding burnout, increased employee turnover, and predicted shortages in the field that can impact the treatment of BMT patients. Compassionate caring strategies and technologies have been employed to counter some of the issues inherent in the BMT process. This paper ultimately seeks to outline the pediatric BMT process, identify key problems patients and providers face during BMT, and to address solutions that have been employed in real-time settings.
Carly Hall - The Role of Compassion in Delivering Bad News to Cancer Patients
Cancer patients face an undue burden in healthcare as they must navigate through the mental and physical suffering of the disease, as well as the many uncertainties of their care. They interact extensively with healthcare providers throughout their treatment, and are subject to psychological effects of care that far surpass just the disease itself. Thus, it is an essential component of compassionate care for clinicians to be skilled in the delivery of bad news to these vulnerable patients. There is a need to explore research-based aspects of delivering bad news, specifically from the perspective of cancer patients themselves. The strategies and techniques outlined in this paper serve to reduce emotional distress of cancer patients regarding their diagnosis and improve satisfaction in the doctor-patient relationship. Despite efforts to effectively communicate in the delivery of bad news, there are common barriers that clinicians face, specifically when the patient’s and their families’ emotional needs and desires differ from the clinician's. Regardless of these challenges, there are effective, empirically researched strategies for delivering bad news that clinicians must utilize to be compassionate advocates for their patients. The way in which clinicians deliver news is critical to patients’ understanding of their disease and their emotional state and can provide needed strength and support for their patients.
Cormac Huyen - Fostering a Compassionate Relationship with Patients Who Have a Language Barrier
In the current state of modern medicine, patients who do not speak the same language as their medical provider experience worse health outcomes. This is only becoming a more pressing issue in the medical field as there are more interactions hindered by a language barrier. With the United States becoming more diverse and more American clinicians participating in humanitarian work in the developing world, there will only be more medical interactions hindered by a language barrier between clinician and patient. A comprehensive medical literature search was performed using Pub med to see if with compassionate care these negative health outcomes can be mitigated by clinicians through employing simple language, effectively using a medical interpreter, displaying positive nonverbal cues, and adapting to cultural differences. This paper proposes solutions on how to mitigate the negative health outcomes associated with patients who have a language barrier.
Olivia Krumweide - Compassionate Care and Miscarriage in the Emergency Department
Women who experience miscarriage in the emergency department often leave their encounters with healthcare professionals feeling negatively about the emotional care that they received. Evaluating feedback from women who received care for a miscarriage in the emergency department as well as feedback from providers who provide this emergency care illuminates the gaps in care present in the current system of miscarriage treatment. The issues most commonly reported by these women were feeling as if their loss is minimized by emergency department staff, having too little information provided, a lack of access to privacy and a sense of dignity, and a lack of follow up care. Implementing structural changes to the healthcare system as well as teaching and implementing the compassionate care mindset for emergency department staff can help meet the emotional needs for women undergoing the trauma of miscarriage while providing positive effects on the job satisfaction of the healthcare worker.
Mark Kurpatti - Patient Advocacy and Compassionate Care for Rare Disease Patients
In the present moment, about 25 million Americans with rare diseases are navigating an isolating and emotionally draining life-or-death journey. Overall, while individual rare diseases impact a small fraction of society, the cumulative impact of about 7,000 known rare diseases is devastating. Unfortunately, rare diseases face being neglected in many fields, including the biomedical research field, the pharmaceutical industry, and the medical field. Although there have been improvements over time, the biomedical research and pharmaceutical field continue to overlook R&D for rare diseases due to practical limitations, limited funds, and a lack of financial incentive. Furthermore, in the clinical world, there is inadequate attentiveness to rare disease complexity and the mental health of rare disease patients and their caregivers. Over the past several decades, patient advocacy organizations have played an instrumental role in pushing for policy reform, connecting patient families with indispensable resources and other patient families, educating physicians, funding rare disease research endeavors, and making expensive treatments more affordable. The application of patient advocacy to healthcare culture can connect rare disease patients and their families with essential resources and improve diagnostic accuracy and treatment outcomes. However, there are organizational, financial, and cultural barriers preventing the implementation of patient advocacy in the clinical world. As such, the present research report argues for the framing of patient advocacy within the larger compassionate care paradigm. A comprehensive literature search using PUBmed was employed to evaluate the role of compassionate care and patient advocacy in the overall treatment of rare disease. Prior literature demonstrates compassionate care successfully improves outcomes at the physician-patient and organizational levels. Therefore, compassionate care united with patient advocacy in the healthcare setting has the power to transform the psychosocial health, diagnostic accuracy, and treatment outcomes of patients with rare diseases.
Charlie Lemkuil - The Heart of Cardiological Care: A Review of How Aspects of Cardiological Care Affect Patient Outcomes
The human heart has been the subject of study by poets, cardiologists, and everyone in between for thousands of years. While there have been many great advances in cardiological care technology, cardiovascular disease still remains the leading cause of death in the United States. If our technology is improving, shouldn’t patient outcomes be improving as well? This paper analyzes the different aspects of care provided by a cardiologist in order to see which have the greatest impact on patient outcomes. The patient outcomes before the onset of the COVID-19 pandemic for diagnostic testing, lifestyle change counseling, prescribing medications, and performing interventional procedures were compared to patient outcomes after the onset of the COVID-19 pandemic. Results revealed that the use of lifestyle change counseling through telehealth visits during the COVID-19 pandemic led to significantly increased patient outcomes even when diagnostic testing and interventional procedures were unavailable. This was shown through dramatic increases in patient adherence that correlated with improved patient outcomes. Cardiologists were shown to be able to increase patient adherence to prescriptions and lifestyle changes through the use of motivational interviewing. By incorporating motivational interviewing into patient visits, cardiologists could weaken cardiovascular disease’s grip on the United States.
Ethan Low - The Importance of Compassionate Care in Elderly Population
As the world continues to age and healthcare costs increase, it is important for healthcare professional to implement compassionate caring as a fundamental aspect of providing quality cost-efficient elderly care. This present paper first identifies 4 major themes of compassionate care in long term care facilities: 1) Expression of innate virtues 2) Seeking an understanding of the patient and their needs 3) Patient communication 4) Actions aimed at addressing patient needs beyond medical needs. The paper continued the discussion of compassion by examining compassion and empathy skills interventions that were shown to improve patient-level outcomes, caregiver empathy scores, and caregiver attitudes towards elderly. Further, this paper defines compassionate care in the unique context of treating dementia patients with diminish cognitive abilities. The research suggests that the following themes are essential for compassionate dementia care: 1) Understanding the patient’s situation and struggles 2) Recognizing the person’s dignity and humanity 3) Responding to suffering through kindness and non-judgmental support of the patient. Lastly, this paper bolsters the need for compassionate care by detailing unique barriers to quality healthcare that disproportionately affect elderly patients.
Emma Nowak - Family Caregiving and the Transition of a Loved One into a Skilled Care Facility
Family caregivers have a challenging yet rewarding role that evolves over time. The decision to transition a loved one into a care facility is a difficult one that depends upon an assortment of interpersonal, familial, cultural, and emotional factors. Health care professionals often recommend care facility placement based upon the level of care the family can provide and the needs of the patient. Family caregivers often view care facilities as last resorts and delay the admission of their loved ones for as long as possible. It is important, however, that families proactively plan for possible care home placement, so the wishes of the older adult in question can be considered. When the older adult is included in the decision-making process about the timing and placement location, it increases both caregiver and older adult satisfaction following the transition. Family caregivers often feel guilty and experience a sense of failure and role loss after their loved one moves into a care facility. However, the family members continue to play important roles in caring for their loved ones by providing emotional support, surveilling their care, and providing hands-on assistance. The care facility staff should empower family members in their new caregiving roles and provide space for them to express their concerns and questions. Ultimately, each person will have a unique experience in caring for their loved one, and the support of health care professionals, family members, and friends plays a critical role in the caregiver’s mental, emotional, and physical well-being.
Claire Noyes - Intersectionality of Poverty, Race, and the Black Maternal Mortality Rate in the United States
The United States is one of the only developed countries where maternal mortality rates continue to rise. Black mothers are disproportionately affected; they are two to three times more likely to die during pregnancy and childbirth compared to their white counterparts. This paper is focused on the intersectionality of the black maternal mortality rate as it relates to both race and poverty. Studies show physicians’ implicit biases towards ethnic minorities are expressed in patient interactions through nonverbal cues and behaviors. Patients perception of physicians’ biases impacts the communication and strength of the physician-patient. Racial biases are also built into the healthcare system making diagnosis and care of ethnic minorities more difficult. Poverty creates its own set of implicit biases in physicians and impacts access to healthcare resources and insurance. Black mothers are likely to be impacted by both their socioeconomic status and racial bias and barriers in healthcare, and in effect, experience healthcare disparities related to both identities. Black mothers receive less diagnoses and management of chronic pre-existing health conditions and lack proper prenatal care due to the confines of poverty and race. These factors considered together contribute to the disproportionate composition of the maternal mortality rate by black mothers. In response to the poverty and racial factors contributing to the black maternal mortality rate, this paper also explores methods of addressing these disparities through the lens of compassionate care in medicine. Proposed solutions include improving quality of care for black mothers within hospitals, addressing physician biases early in their careers, and expanding access to resources through expanded insurance coverage.
John Pape - Facilitating the Care of Blind and Visually Impaired Patients
Those who are blind or visually impaired face a number of barriers when it comes to receiving healthcare, in areas such as basic respect, communication with their caregivers, access to the hospital or clinic, acquiring health information, experiencing feelings of isolation, and having to advocate for their own care. Thus, caregivers must use certain communication skills in order to provide quality care for their blind and visually impaired patients. For instance, clinicians must help their blind and visually impaired patients get used to their surroundings and work to keep it safe. Moreover, clinicians can communicate better with their blind and visually impaired patients by using techniques like reading aloud what gets put into the medical record and directly talking to their patient instead of a person with sight in the room. Caregivers can also assist their blind and visually impaired patients by helping them ambulate. Furthermore, providers should ask their blind and visually impaired patients how they want their health materials provided, such as through a recording, large print, or email. Even in the pharmacy, pharmacists can help their blind and visually impaired patients by methods like putting three rubber bands on a pill bottle that must be taken three times a day. Yet, while all of these communication skills have a use in helping blind and visually impaired patients feel cared for in either a hospital or a clinic, they mainly involve one-on-one conversations between caregivers and their patients. As a result, the hospital or clinic where these providers work needs to encourage a compassionate caring ethic of blind and visually impaired patients throughout the entire medical setting. Hospitals have already started to take up this call, such as St. David’s North Austin Medical Center in Austin, Texas, where nurses made toolboxes with useful items for the daily care of their visually impaired patients. Other hospitals, such as Johns Hopkins Medicine in Baltimore and the University of Miami Health System’s Bascom Palmer Eye Institute, work to assist the blind and visually impaired patients that enter their buildings. In fact, the story of Marcus Engel showcases what caring for a blind person looks like in real life. Overall, this paper seeks to provide guidance in how caregivers can properly care for their blind and visually impaired patients.
Matthew Papiernik - Pediatric Palliative Care
As medical innovations continue to progress, the need for pediatric palliative care has become even more evident. The main goal of pediatric palliative care is to provide the pediatric patient in need with the opportunity to have an overall higher quality of life when compared to the continuation of intensive medical treatment. Pediatric palliative care focuses on a holistic form of medicine that accounts for not only the physical symptoms of a pediatric patient but also emphasizes the importance of relieving the corresponding psychosocial and spiritual aliments of both the patient and family in end-of-life decisions. Throughout pediatric palliative care treatment, communication and the role of religion are core aspects of the treatment that can better the holistic treatment that pediatric palliative care strives to achieve. Ethical issues must also be taken into consideration when proceeding with this method of treatment to ensure that the pediatric patient receives care in their best interest. A comprehensive literature search using PubMed was performed to evaluate the role of compassionate care and religion in pediatric palliative care. Data from 30 journal articles pertaining to pediatric palliative care were analyzed to compile this paper.
Gabriella Patiño - Solutions to and Sources of Burnout and Compassion Fatigue in Pediatric Palliative Care
Pediatric palliative care (PPC) involves caring for patients to help improve their quality of life and provide relief from the symptoms and stresses of a serious illness. PPC can lead to incredible personal growth and be a rewarding field for physicians. However, it can also take a toll on a health care provider’s well-being because of the emotionally demanding nature of the specialty. There are many complexities that contribute to the higher rates of burnout such as the physician-patient-parent triadic relationship. The physician’s own health can affect the delivery of care and outcomes for the patient. Burnout demands to be addressed in the medical field. There are solutions that can be implemented on every level of the healthcare system. In this paper, the current state of pediatric palliative care is discussed and the neuroscience behind empathy and compassion is explained. The distinct neural pathways of compassion are important to understand to better implement trainings and interventions in the workplace. The major sources of burnout and compassion fatigue in PPC are identified and possible solutions are suggested on the individual, interpersonal, organizational, and policy level. Ultimately, further research is needed to better investigate the sources of compassion fatigue and develop proper solutions that can be implemented in all care facilities.
Adriana Pérez Negrón - Improving Sensory Disabled Patient Experience at Medical Visits
Despite the fact medicine has greatly improved through time, it still has a long way to go to achieve its maximum potential. Compassion and caring are fundamental values of a patient-centered, relational model of health care. With compassion at the center of medicine, patients feel safer and more relaxed which allows them to open up and talk about their history, values, as well as what they are going through physically and emotionally. With this information, clinicians can make a better diagnosis that is not only suitable for the patient’s health and economic situation but also the patient’s values. How the clinician interacts and communicates with the patient during a medical visit can contribute to such a social engagement environment. Even though there has been an increase in prioritizing patient welfare and safety during medical visits, little information is known regarding the equivalent for people with sensory disabilities such as blindness and deafness. After providing context regarding people with disabilities and the importance of the Polyvagal Theory, this paper will start by addressing the concerns patients with sensory disabilities have, such as problems with physical touch, miscommunication, lack of descriptive comments throughout the visit, and systemic problems. Finally, it is important to also address how clinicians should improve, not just extrinsically during their medical visits, but also intrinsically concerning their attitudes.
Quinn Retzloff - Physician Clinical Attitudes in High-Stress Clinical Specialties: A Qualitative Interview Study
This study is an examination of the actual clinical attitudes physicians report they practice in the high-stress clinical specialties of intensive care, emergency medicine and surgery. Compassionate Care in Medicine (CCIM) thrusts one into the most captivating aspects of the doctor-patient relationship, applying a balanced model of compassion to not only heal patients but simultaneously care for physicians. At its core, the science of compassion stresses caring for the whole person: the biological, spiritual, social and psychological aspects. The very heart of this practice often manifests itself in a generalized “caring attitude” physicians hope to employ to advocate for, diagnose, cure and accompany their patients. Most clinicians enter the medical arena with high aspirations to help others, contribute to medical excellence, be a force for good in society and display unconditional service to a diverse patient population. While some may keep these attitudes alive, many unfortunately succumb to the pressures and stress of the hospital setting, a culture that has unrealistic expectations, a sentimental view of caring and toxic institutional work environments, as well as the stresses for caring for patients with COVID-19 (Vachon, 2020). However, a rather grim outlook places its hope in modeling the attitudes physicians actively practice to maintain resilience and keep their compassionate fervor in medicine. This study highlights clinical attitudes from fourteen physicians regularly utilized to ensure maximal patient care and presence with their patients. Secondarily, this data provides strength to CCIM models such as the Clinician Compassion Mindset (Vachon, 2020), Balanced Compassionate Caring (Vachon, 2020), the Patient-centered approach (Mead & Bower, 2000), Relationship-centered caring (McCormack, 2012), Watson’s theory of caring (Watson, 2012; as seen in Smith et al., 2013) and the Planetree model (Stone, 2008). Purposive semi-structured interviews were conducted using appreciative inquiry, drawing out raw techniques used from the specialties of emergency medicine, critical care and surgery. Transcripts were independently coded and collectively analyzed by a five-member research team using a grounded theory approach. Results highlight a broad range of attitudes that are patient-centered, self-care-centered, personal, and institutional. Research findings will be used to share, circulate and educate current and future physicians. Most importantly, this study hopes to normalize conversation regarding positive clinical attitudes, capitalizing on institutionalized settings that foster open communication and collegial support among not only physicians but all medical staff. Exposing a doctor’s mind, this data allows one to enter into the rawness and grit of real medicine. Even though physically and emotionally exhausted, with compassion, a doctor’s heart remains full.
Kathryn Robinson - The Intersectional Effects of Poverty & Race/Ethnicity on Access to & Quality of Healthcare Within the US Latino Population
Latinos are the largest and fastest growing minority group in the United States, projected to account for only 1 in 4 people by 2060. The Latino populations, specifically immigrants, struggle disproportionately with barriers to proper healthcare and health insurance coverage. The multitude of eligibility restrictions and dissatisfaction finding primary care providers results in significantly higher rates of obesity, diabetes, tuberculosis, and HIV. Compassionate care in medicine, associated with higher patient satisfaction and improved health outcomes, has not been investigated in different socio-cultural contexts. The aim of this essay is to explore the intersectional effects of poverty and race/ethnicity on access to and quality of healthcare within the United States Latino population and how providers can mitigate these barriers through a compassion mindset. The most common barriers to proper healthcare in the Latino community were found to be difficulty navigating the healthcare system, lack of cultural competency among the providers, and improper use of translators. Physicians can take steps to create a safe atmosphere from immigration enforcement by knowing their rights as physicians to protect and educate their patients on healthcare policies. While more physicians of color are needed, the Latino culture can still be represented by incorporating alternative medicine practices and understanding core values such as personalismo and familismo. The improper use of translators or using ad hoc translators results in decreased patient satisfaction and reduced health outcomes, but techniques to further personalize interactions with translators and providing bilingual materials mitigates these issues. Finally, proven compassionate care in medicine techniques such as the polyvagal theory and the teach-back technique should be further studied in Latino patients.
Sebastian Sewera - Opening the Door to More Compassionate Care for patients with Intellectual and/or Developmental Disabilities (IDD)
Patients with intellectual and developmental disabilities consistently face difficulties in accessing adequate medical care. Within the healthcare system, they are subjected to lower standards of patient-centered care. Though this underserved patient population should receive increased support to overcome challenges to high-quality healthcare, healthcare providers instead often raise additional barriers. These barriers stem from communication difficulties between
patients and providers, a lack of clinician familiarity with IDD patients, and providers’ negative perceptions of the IDD patient community that are brought on by this lack of familiarity. Studies have shown that patients, their family members or caregivers, and clinicians all support the inclusion of higher patient-centered care standards for those with intellectual and developmental disabilities. However, the implementation of systematic improvements in training and care to realize this goal is currently lacking. A comprehensive literature search was employed using Pubmed to evaluate the role of compassionate care in the care of patients with IDD. Efforts to provide more compassionate care for IDD patients should focus on the use of specialized communication styles, improved provider understanding of when to include patients in the decision-making process, and dedicated clinician training programs that will familiarize them with the needs of IDD patients prior to entering the workforce. Through these additions, and others, healthcare providers will have the tools to provide patients who have intellectual and developmental disabilities with the high-quality compassionate health care that they deserve.
Kacie Shannon - Compassion as an Instrument for Social Justice in Medicine
Considering recent events that have brought the realities of disproportionate suffering, systemic racism, and social inequity to the forefront, the necessity of social justice (SJ) has dominated conversation. When examined through the lens of Catholic Social Teaching, SJ’s encirclement of expanded equity, opportunity, and treatment for all persons is perfused with a particular sensitivity towards those in greatest need. Within medicine, a healing sector devoted to the health and well-being of humanity, healthcare institutions feel the pressure to enact socially-just practices given the increasing diversity of patient demographics, the various presentations of suffering, and the vulnerabilities inherent to clinician-patient relationships. SJ in medicine translates to the delivery of fair and appropriate treatment which can aid in eliminating disparities and optimizing patient health outcomes. Clinicians are key actors in effectuating greater SJ in medicine. One instrument critical to this process is compassion, an animating spirit that shapes a clinician’s behavior by influencing internal attitudes and external actions. The spirit of compassion entails qualities that are integral to SJ activism, thereby guiding and empowering clinicians to practice medicine rooted in virtue, equity, and sensitivity. Furthermore, self-compassion buffers the burnout frequently experienced within helping work and social activism. Pedagogical efforts to incorporate SJ training and compassion cultivation into medical school curricula are already underway. Medical specialties that have historically embraced a social justice ethos and relationship-centered care serve as valuable prototypes for widespread initiation of this caring paradigm. Overall, both a theoretical framework and empirical research provide support that a clinician grounded in compassion bears the necessary instruments to work towards social justice and promote human flourishing.
Jasmine Sindelar - Implicit Biases Based on SES and Race Harbored by Healthcare Providers
Stigma and systemic oppression are known forces that negatively affect patient health. Implicit bias from a healthcare provider perpetuates these problems within the healthcare field, without the provider even realizing it. Implicit bias is heavily present when physicians are treating people of different socioeconomic groups than their own and when treating people of different races than themselves. These biases can cause strain within the patient-provider relationship before a relationship has been properly established. Reduction of implicit biases has been shown to increase patient satisfaction with their care and patient compliance, however, little has been published on physician implicit bias training programs. Mindfulness meditation training appears to be the most promising training program, as it increases awareness and acceptance of implicit biases, increases the ability to control responses if implicit biases arise, increases compassion towards oneself and the patient, and helps physicians reduce internal sources of stress and the likelihood of burnout.
Shannon Steines - Applying the Science of Compassionate Care to Mitigate Healthcare Disparities for Limited-English Proficient Patients
There are over 25.5 million limited English Proficient (LEP) patients interacting with physicians in a plethora of cases in the U.S. every day. Within these encounters, LEP patients are receiving subpar care that is creating negative healthcare outcomes resulting in the healthcare disparities being experienced by such populations. Over half of LEP patients have no interpreter use during their inpatient clinical encounters despite evident barriers to communication. The system of the status quo has resulted in worse medical outcomes and higher rates of medical errors for LEP patients when compared to their English-speaking counterparts. Through the application of the science of compassionate care in medicine, some of these negative externalities of the current handling of LEP patients can be mitigated. Applying compassionate care to the issue at hand, it is essential that physicians are particularly aware of their non-verbal and facial cues when dealing with LEP patients to promote a feeling of safety through neuroception, and that effective communication between physician and patient is also emphasized. The best practices for promoting effective patient-physician communication for LEP patients are in this order: either (1a) true physician language concordance or bilingualism or (1b) hospital-trained in-person interpreters, (2) professionally trained video interpreters, (3) professionally trained over-the-phone interpreters, and (4) ad-hoc interpreters.
Megan Sullivan - Federally Qualified Health Centers: Burnout Reduction and Prevention Strategies for Physicians
Physicians in Federally Qualified Health Centers (FQHCs) experience disproportionate rates of burnout compared to providers working in other settings. Several strategies currently exist for combating burnout in medical professions, but these are not tailored to the unique struggles providers in FQHC settings experience. Extracting the components of current burnout reduction strategies and examining why they are effective provides useful insight to the mechanisms by which burnout is ultimately reduced. Taking these larger components and combining them with the knowledge of the challenges FQHC physicians face, novel strategies can be proposed to target this specific population of providers in reducing burnout. This paper will use literature reviews and studies to examine root causes of burnout in FQHC’s on both an individual and organizational level. In addition, the steps of the clinician compassionate mindset process will be reviewed in relation to burnout buffering and compassion fatigue. Several strategies are proposed to increase the compassion satisfaction for physicians serving in underserved areas. A more sustainable long-term approach includes structural shifts in low-income societies to address patient needs through policy changes, along with an organizational recognition of burnout and support for FQHC physicians. In addition, medical programs should shift towards implementing the lessons learned about burnout and prevention strategies into training. Education and awareness of the steps in the clinician compassionate mindset process for those in helping professions work may buffer against large numbers of burnout in the future. Understanding the signs of falling out of a compassionate mindset can bring awareness to the need for a provider to re-center and engage in other compassion recovery behaviors. Ultimately, the most effective current approach to combating burnout should focus on the individual mindset and self-care of physicians. Adjusting expectations for the populations FQHC physicians serve can help to shift their focus towards patient advocacy rather than be defeated by the structural barriers their patients face in society which disproportionately effect health outcomes.
Brian Villa - Motivation in the Healthcare Professions: A dynamic force throughout a career in medicine
In a profession that involves interacting with intense amounts of suffering, healthcare workers need to be in touch with what motivates them to do their job sustainably. While research has been able to describe what motivation looks like, there has been little work on what specifically motivates medical professionals. Within this limited body of medical motivation research, studies mainly observe physician motivation at three specific times in their careers (training, practice, and retirement). Due to recent work in the field of compassion science, there is an association that some processes appear to morph, grow, and change over the entirety of one’s career, not just in those three specific times. In being closely tied to compassion, motivation is a process that warrants this new approach. This new perspective of motivation suggests that it is actually a dynamic force that influences a healthcare worker over the course of his/her entire life. The significance of now viewing motivation as a lifelong dynamic psychological process should further indicate the need for longitudinal studies that can highlight the importance of intrinsic motivators (satisfaction, independence, etc.) as opposed to the current overemphasis on extrinsic motivators (money, benefits, etc.) in the lives of healthcare workers.
Elena Wernecke - The Grey’s Effect: How Medical Media Impacts Expectations
The advent of television brought with it the ability to artistically represent real-life
scenarios with heightened drama that can touch souls and even teach lessons. This has been especially true for medical television, which has increasingly devoted itself to clinical and social accuracy. Through a systematic qualitative review of select episodes of Grey’s Anatomy, The Good Doctor, and Scrubs, this essay attempts to assess how these series depict different parts of healthcare, including the life of the physician, difficult communication, and the doctor-patient
relationship. Further, the paper considers how these portrayals might influence the expectations of people encountering medicine. With respect to clinician life, these shows offer an understanding of a cutthroat, exhausting culture in which doctor-doctor relationships are fraught with competition but also filled with support. Audiences gain a glimpse into the emotions associated with healthcare work and the coping mechanisms used to attend to them. On the communicative side of the medicine, audiences witness difficult conversations with patients in
only small snippets that partially replicate the standard protocol for these discussions, such as the S.P.I.K.E.S. protocol for breaking bad news or the multiple recommended techniques for behavior change counseling. Lastly, the shows portray the multifaceted nature of the doctor-patient relationship, how it can be well-developed and well-maintained, and how a doctor’s level of investment in the patient impacts care. Overall, the essay contributes to the literature surrounding these shows as sources of information for their viewers.
Emily Wilt - Improving Compassionate Care in Emergency Departments
The emergency department presents a unique set of stressors for physicians and patients.With urgent medical conditions that require immediate care, heavy workloads for physicians, and overcrowding, emergency departments can often feel void of compassion. Patients frequently feel as though they are just another medical case to get through rather than an actual human being who is suffering. While the science of compassion is a relatively new phenomenon, plenty of evidence has been collected to demonstrate its importance in the medical field. Research into patient perceptions of care has shown a serious lack of perceived compassion in emergency departments. Patients have cited many areas of care which they feel must be improved in order for the patients to feel as though they are being cared for with compassion. Despite the field being relatively new, studies have been conducted which have shown compassion training during medical education to be effective in raising patient satisfaction in emergency departments. In order to ensure complete compassionate care is implemented in emergency departments, creating a comprehensive training program for all physicians which addresses the patient-cited areas for improvement and incorporates training methods which have already been shown to be effective is essential. Implementing these training programs would not only provide obvious benefits to patients but will likely provide benefits to physicians as well As providing compassionate care has beneficial outcomes for both patients and physicians, this capstone aims to provide a comprehensive plan to improve the implementation of compassionate care in emergency departments.
Nicole Wisniewski - Identifying and Addressing Pandemic-Related Burnout in Physicians
Physician burnout has been an exceptionally burdensome epidemic across healthcare systems in the twenty first century. Although numerous studies have taken to understanding the causes, effects, and possible remedies for it, a novel, lesser-studied sect of burnout has arisen during the COVID-19 pandemic: physician pandemic-related burnout. Analyzing an ongoing, IRB approved qualitative study by Dr. Dominic Vachon and the Hillebrand Center for Compassionate Care in Medicine research team, this paper seeks to identify the ways in which pandemic-related burnout has exacerbated the causes of general burnout: excessive workload, lack of efficiency at work, disruption to work-home balance, loss of control, and loss of purpose. Additionally, a number of physician and organizational level techniques to mitigate burnout, utilized both before and during the pandemic, are presented in this paper, with emphasis on compassionate care as an effective remedy. The research reported in this paper is meant to initiate continued study in the area of burnout, particularly as it relates to the COVID-19 pandemic, with hopes of better addressing a critical need among physicians.
Anabelle Wondrasch - Porges' Polyvagal Theory in Veterinary Medicine
In the medical field, in order for a productive physician/patient relationship to develop, trust must exist as the forefront component of the interaction. It increases patient transparency, compliance, and adherence, enhancing the value of the exchange for all parties involved. But how is trust established in a relationship with a significant language barrier? More specifically, how does this occur without the use of words? Because of the primarily nonverbal nature of animal medicine, everyday veterinarians work to communicate safety to their patient through behavior rather than linguistics. And they must undertake this challenge before any social engagement between the two can occur. Despite the importance of this interaction, veterinary schools currently do not teach their students about how to wordlessly convey safety to an animal, exposing a significant gap in the curriculum. This may be able to be remedied, though. The polyvagal theory, proposed in 1994 by Stephen Porges, states how the physiological state of a mammal can influence their affective experience. Following an unconscious assessment of the situation, one of the two branches of the autonomic nervous system is mobilized, either promoting the “rest and digest” state of social engagement or the “fight or flight” state of survival. Thus, by improving our understanding of how certain non-verbal cues and behaviors may be perceived by an animal, we may be able to develop a meaningful educational tool within the field of veterinary medicine.
Avery Wright - The Relationship Between COVID-19 and Compassionate Care
COVID-19 affected the health and well-being of hundreds of thousands of people. In the United States, between January 21, 2020 and March 19, 2022, there have been 79,522,906 total SARS-CoV-2 cases and 4,577,492 hospitalizations due to SARS-CoV-2 (CDC, 2022). But even more people were affected in some other way, especially the health care professionals taking
care of COVID-19 patients. When an unknown disease starts to spread, such as SARS-CoV-2, it is important for healthcare organizations to return the basics of care, including compassionate care, while gathering more information about the pathogen and its effects. But SARS-CoV-2 has affected clinicians’ ability to deliver compassionate care to patients and has impacted the
healthcare system as a whole. On the other hand, compassionate care has the potential to combat COVID-19 and produce improved health outcomes for COVID-19 patients due to its benefits for patients, clinicians, and entire healthcare organizations. It is essential to evaluate the ways in which compassionate care has been negatively affected by COVID-19 in order to be able to regain clinician’s compassion so they are better able to deliver compassionate care to patients in need. Compassionate care should be delivered by healthcare professionals in all situations and to all patients, but it is especially essential during the SARS-CoV-2 pandemic when people are suffering both physically and mentally.
Julia Zappa - Preserving Compassionate Care in the COVID-19 Pandemic
COVID-19 has resulted in a global health emergency that has significantly affected healthcare workers. The stresses of the pandemic have resulted in staggering numbers of medical providers experiencing mental health conditions such as anxiety, depression, and burnout. Specifically, pandemic challenges such as insufficient knowledge concerning COVID-19, shortages of personal protective equipment, and lack of necessary medical devices have created
stressful working conditions that are contributing to poor provider mental health. Similarly, systemic changes in healthcare workers’ job descriptions, difficulties dealing with unvaccinated patients, and new challenges associated with long-term COVID-19 have forced providers into unknown and uncomfortable positions. All these conditions created by the pandemic have ultimately placed strenuous and burdensome responsibilities on providers that threaten their
ability to persist in their roles as compassionate caregivers. However, there are proven strategies to support medical workers. Employing techniques and practices such as Balint groups, palliative care, proper communication, and patient-centered care can enable healthcare providers to combat these obstacles and remain in a compassionate caring mindset. Thus, despite the challenges introduced by the COVID-19 pandemic, there are various solutions that can help healthcare workers to persevere in their work and ultimately continue to compassionately care for their patients.
Emily Ziliak - Applying A Multifaceted Approach to Compassionate Genetic Medicine: A Synthesis of Determinants and Resolutions
In 2018, it was found that 80% ofBRCAmutation carriers were unaware of its existence. What is perhaps more troubling, and what may explain this deficit, is that 70% of OB/GYNs claimed they did not possess the skills nor knowledge necessary to provide genetic counseling, specifically in regard to cancer. This figure is one example of the systematic lack of genetic medicine comprehension among primary care providers. Inevitably, this scarcity of awareness leads to missed opportunities for early detection and the possibility of preventative care.Fortunately, a review of the literature presents distinctive critiques, as well as approaches for improvement. Despite enhancement at the primary care level, there are indeed many other obstacles to genetic screening and counseling, namely socioeconomic and psychosocial concernments, which generally affect low-income or minority populations. Some of these include unequal access to high-quality medical care, expenses, linguistic barriers, and religious objections. As more attention is being placed on these matters, researchers have developed methods to minimize their burden. Many of the difficulties in obtaining genetic care begin prior to meeting with a genetic counselor; however, equal analysis should be given to the role of the genetic counselor, specifically in how to maintain a compassionate approach in response to patient suffering and grief. This capstone attempts to analyze the aforementioned components while providing numerous suggestions for advancement.
