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This chapter discusses the spirituality of healthcare professionals in providing care at the end of life. It explains how one might cultivate a spiritual sensibility in medical practice that will be credible in the twenty-first century. These include deepening one's spiritual life within his or her religion, the development of specific and personal practices in relation to medicine, and finding other healthcare professionals with whom to engage on these sorts of questions.

Extensive research has shown that cancer, and the treatment thereof, can interfere with healthy sexual functioning. Indeed, sexual dysfunction is frequently cited as one of the top adverse effects of cancer treatment. However, while healthcare professionals routinely discuss quality-of-life issues with cancer patients, the literature suggest that too often this does not include an assessment of sexual concerns. The responsibility to initiate discussion on sexuality rests with the healthcare professional. Establishing the sexuality information needs of the cancer patient can sometimes be difficult and it becomes more so when healthcare professionals make erroneous assumptions concerning sexuality. Whether or not to assess sexuality is no longer an issue; it must be a routine part of cancer care. While there are several different models of intervention for patients suffering from sexual difficulties, the PLISSIT model is frequently used in cancer centres and can easily be adapted to various types of practice. The model describes four progressive levels that can be used to guide assessment and intervention: permission, limited information, specific suggestions, and intensive therapy.

In the last two decades, communication skills training programmes, designed for healthcare professionals working in cancer care, have been the focus of several of the research endeavours of the Brussels research group. The efficacy of these programmes has been tested in studies using a controlled design. Studies varied in the type of healthcare professional, the type of teaching method, the length of training, and the outcome measures. As a result, research efforts have focused on communication skills to be taught and on training techniques to be used. The aim of the randomised controlled trials was to determine the optimal duration of a training programme in order to ensure training effects. The choice of the skills taught was based on results of studies indicating the positive impact of using specific communication skills on cancer patients' disclosure of concerns. The results confirm the usefulness of communication skills training programmes for healthcare professionals working in cancer care.

The stage-one participants' experiences of treatment were examined in Chapter Four. This identified a number of treatments that they had been offered, and examined how they perceived such treatment in relation to their wider health interactions. This chapter examines the treatment options that the participating healthcare professionals identified as central to their own clinical practice. It identifies how healthcare professionals are competent at identifying physical injuries, in some cases psychosomatic ones. The reluctance of practitioners to acknowledge the domestic-violence origins of para-suicide is worrying, but is consistent with international research that has examined domestic violence and health.

From the outset, this research has contextualised the health interaction between women who experience domestic violence and healthcare professionals within the wider help-seeking activities of the stage-one participants. This chapter examines how the participating healthcare practitioners considered their interactions with other non-health professionals. Results from the domestic violence and health questionnaire found that only 14 per cent of the respondents had been involved in multi-agency work. The chapter begins by examining domestic-violence multi-agency collaborations generally, before examining specific interactions that take place between healthcare professionals and a number of other agencies.

This chapter examines a range of practical tools that can be utilised in both training and clinical practice. If a general practitioner perceives his own role in relation to the other services offered by their less-respected colleagues, then collaboration with those individuals is likely to be more productive. This is evident in new training approaches, which are attempting to implement changes in undergraduate medical training, from a biomedical/wound-led hospital approach to one that is community based and holistically located. In light of such considerations, the chapter begins by examining medical training generally, before considering the concept of community-based and holistic training methods. Returning to the specific issue of domestic violence, it also addresses the impact of multi-agency training, before examining the concept of specialised training on domestic violence for healthcare professionals.

Part Two of this text focuses on the perceptions of healthcare professionals. This chapter focuses on definitions of domestic violence suggested by stage-two participants. This question was asked to ascertain whether any of the healthcare professionals worked to guidelines or a strategic definition of domestic violence. All the stage-two participants were asked ‘How would you define domestic violence?’. Asking this question, in conjunction with questions about the general role of specific healthcare professionals, was intended to examine how participants located domestic violence within medical discourse, both theoretically and in relation to their clinical practice.

This chapter examines how healthcare professionals perceive patients who present with domestic-violence-related injuries. While some of these perceptions come from clinical experience, they demonstrate how practitioners consider domestic violence beyond the individual medical (health) encounter. Groups of participants discussed within various contexts what they considered to be the causes of domestic violence. These responses included: blaming or questioning the role of ‘the victim’ within the domestically violent situation; the personality traits of both the ‘victim’ and ‘perpetrator’; biological and hormonal explanations; cycle-of-abuse theories; individual characteristics of the perpetrator; environmental factors; social, economic, and cultural explanations; and patriarchal analyses of domestic violence.

Part One identified the experiences of the stage-one participants in relation to their clinical interactions with healthcare professionals. A number of issues were acknowledged, including the extent of physical and non-physical injuries that the participating women ascribed to the domestic violence they were experiencing. This chapter addresses those concerns from the perceptions of the stage-two participants. As such, it addresses the identification and diagnosis of physical and non-physical injuries within a number of contexts. The chapter considers psychosomatic complaints and para-suicide.

This chapter aims to enhance the understanding of social policy academics and practitioners with regard to the homosexuality of older men, with whom they may interact on a professional basis or write about through their research without actively and consciously considering how sexuality can substantially influence aspects of daily living. It begins by outlining research to date on the size of the older gay male population, in order to argue that this is significant enough to warrant more wholehearted interest from policy makers and service providers. Then, the discourse of sexual citizenship is discussed. Finally, the substantive sections of the chapter introduce the research and the participants, before exploring decision making regarding coming out in a healthcare setting and the implications of different scenarios for the well-being of older gay men. It is argued that healthcare professionals require greater information in order to recognise the wider relevance of knowing a person's sexual orientation and to gain a better understanding of how best to discuss such subjects with patients who might be reluctant to access care and discuss their sexuality and relationships.

This chapter takes a detailed look at the way in which one healthcare professional resists and negotiates his personal and professional identity in the context of a modernisation discourse that creates dilemmas for him through its categorical assumptions concerning ‘older’, male Asian GPs. It begins by considering the ways in which the professional and the social intertwine in public sector modernisation, and in particular how this plays out in the construction of the ‘old’ and the ‘new’ professionalisms in primary care. The bulk of the chapter is devoted to a feminist psychosocial analysis of Navneen's narrative, through which the chapter demonstrates the difference between what he says about gender, race, and generation, and what he feels about them.

This chapter discusses the transition from a curative to a palliative approach in patients with haematological malignancies. It focuses on the challenges faced by the patients, families, and healthcare professionals by illustrating clinical scenarios, and also explores the rationale behind these difficult situations such as lack of communication, emotional strain, and ethical issues. The chapter also provides ways of improving the situation, including frameworks that would stimulate thought and discussion rather than definitive solutions. Apart from discussing transition challenges posed by the change of approach from curative to palliative care, it also provides an overview of the different stages of cancer, from active curative to active palliative to terminal phase, to give an idea of what is to be expected in each of the stages of the disease in terms of services provided to the patients.

Pain is a significant cause of suffering for cancer patients. The onset of pain can herald a host of fears of death, disability, disfigurement, dependence, and distress. The role of healthcare professionals is to offer competent pain management with compassion and commitment to excellence, central to which is facilitating communication with the patient. Pain is not an event in isolation. It occurs in a personal and physical environment influenced by the social, cultural, spiritual, and biological inheritance of the patient. Thus, the experience of pain has a unique impact on, and meaning for, each individual. At the time of assessment, factors such as associated fatigue, depression, and anxiety may result in the pain becoming overwhelming. Assessing the pain involves not only measuring the level of pain and determining the nature of the pain, so as to diagnose the aetiology and mechanism of pain, but also exploring the ‘deeper level of pain experience’. Failure to do so can result in poor pain control and a lost opportunity for transformation of the experience and healing of the individual.

This chapter looks at the wider help-seeking activities of the participating women. It focuses on the police, social services, teachers, and the criminal-justice system. The importance of inter-agency fora is stressed throughout this text, as it is crucial that healthcare professionals understand that women access them for assistance as part of wider help-seeking strategies which involve other professionals.

This chapter analyzes the various ethical issues that arise in psychiatric treatment and research settings. These range from enduring concerns over compulsory treatment and the questions of consent that occur in treatment and research settings alike, to recently encountered dilemmas over drug treatment and psychiatric genetics. The chapter also explores broader questions, including the appropriate ethical framework for treatment and research ethics, the relationship between psychiatric and other biomedical ethics, and the current dominance of the autonomy principle.

This chapter studies Hong Kong’s response to the Covid-19 pandemic. Hong Kong’s experience with the Severe Acute Respiratory Syndrome (SARS) epidemic in 2003 helped to prepare the health system for a pandemic, allowing it to avoid a complete lockdown of the city. Social-distancing measures, aggressive testing, and contact tracing have also been critical in controlling the local transmission of the disease. However, when historians and health policy researchers look back at the early days of the outbreak, they are likely to cite the impact of the five-day strike of healthcare professionals in February 2020 as a critical turning point in Hong Kong’s initially hesitant response. The chapter then focuses on this strike and the role of the healthcare profession in shaping public health policy. It argues that the striking healthcare professionals used their standing in Hong Kong to revive the city’s collective memory of the SARS outbreak, mobilizing public action, and possibly triggering a stronger public health intervention by the government.

Doctors and nurses globally are feeling unloved and underappreciated. Clinicians are expensive to train and it takes years, and once lost, they are not easily replaced. Yet we lose people from their first day in the job. They might quit because of the job itself or through personal circumstances. But if health systems want to retain people throughout their working lives, they are going to have to support them through life events—births, deaths, parenthood, sickness, caring, older age. They will also have to support them through every stage of their career too, from first job, through promotion and into retirement. They are also, like any other industry, going to have to meet legitimate expectations of a healthy, happy relationship with work. In this chapter, Mark Britnell argues that most companies spend time and effort understanding exactly what their customers want and need of them, and that it now is high time healthcare providers started asking the same about their workforce.

This chapter looks ‘outside’ the Hospice at issues of the organization’s image. The authors talked to staff, volunteers, and members of the general public, as well as to a number of key stakeholders in the local healthcare community, in order to gauge their views on the host organization. The analysis examines the problems associated with the image of hospices and discusses attempts of staff and volunteers to ‘dispel the myths’ about the nature of hospice care work—a form of labour which potentially runs the risk of being characterized as ‘dirty work’. The chapter then examines how the Hospice is seen in the eyes of other healthcare professionals and discusses the choice of palliative medicine as a career for junior medics. Finally it discusses a degree of ‘confusion’ that staff and volunteers claim exists in the minds of GPs and consultants in specialist cancer hospitals about the role of hospices.

This chapter explores the interactions of voluntary, professional and state provision in the field of mental health throughout the period 1870 to 1970, focusing on the Mental After Care Association: the only voluntary group in this sector whose history spans the entire period under study. This long, unbroken chronology offers an unrivalled opportunity to explore how it affected, and was in turn affected by, other agents in the field of mental health, illuminating the interconnections between state provision, healthcare professionals, patients/service users, the public and voluntarism. The chapter explores how the Association represented mental illness when trying to solicit public support, and demonstrates how professional groups worked through the Association to advance their objectives. The strategies adopted by the Association in different eras are contextualising by drawing a comparison to the path taken by the National Association for Mental Health.