Healing in Primary Care - Literature review Example

?Critical literature review: Healing in primary care Introduction The field of medicine is insufficient without the use of evidence based practices. Due to its ever increasing complexities and ever increasing new and complex diseases, time requires the need to carefully and sufficiently understand the medical problems and suggest more effective cures. However, theoretically, there can be many ways to learning medicine, reading books, listening lectures and discussing medical jargons with colleagues can be of a limited use. Such learning only increases knowledge not understanding that is more needed than cramming dozens of medical jargons. This insufficiency of theory based knowledge undoubtedly brings the importance of evidence based learning and understanding. In the field of medicine, healing is vastly defined. Many authors have not been able to limitise its definition and concept within a few representative sentences. This brings the presence of vast dimensions within the process of healing. It is not only linked with the physical parts of human body, but also finds its application in psychology and spirituality as well. And many researchers have tried to define healing in patients with chronic illness, disability, pain and at the end of life (Kigler, 2004; Marshall et al. 2004; Geller et al., 2004; Cherkin & Sherman, 2004; Waters, 2006; Farber, 2002; Silver, 2004). Additionally, various other fields such as nursing and anthropology have also identified it to be a useful part of their practices. As we are critically analysing two articles-Healing in Primary Care: A vision shared by patients, physicians, nurses and clinical staff and Understanding healing relationship in primary care, it is more appropriate to define healing, which is defined as a multidimensional process with emotional, physical and spiritual dimensions (Hsu et al., 2008). This definition of healing is sufficiently consistent with the healing definition in other literatures (Hsu et al. 2008,Egnew, 2005, Dossey, 2003; Wendler, 1996) Each article has a different summary. In the article Healing in primary care: a vision shared by patients, physicians, nurses and clinical staff, the fundamental focus of the focused groups was to obtain understanding of the fundamental concept of healing among patients, physicians, nurses and clinical staff; also, what they consider as facilitators and barriers to promoting healing in primary care were discussed. In this article, for the purpose of learning via evidence based, the instrument of focused group is used; in which nine focused groups were arranged with 84 participants, 28 patients, 23 primary care physicians (19 family physicians), 11 licensed practical nurses, 20 registered nurses, and 2 medical assistants. On the other hand, in the article understanding healing relationship in primary care, much emphasis is given to highlight and understand the development and maintenance of healing relationships between patients and clinicians. Here, the method of interview was used to serve the objectives of healing relationships with three processes resulted as fostering healing relationships-valuing non-judgmental emotional bond, working in a way to serve the maximum facilitation for patients and displaying a caring attitude towards patients. Critical evaluation of these articles serves the objectives of this literature review. The methods, data, outcomes and theories enlisted in both articles are going to be made part of this process of assessment with a critical look. Have these two articles really served the way for which they were planned? Have these objectives provided something useful towards the process and practice of healing? These are the fundamental questions are discussed further below. Critical evaluation: Healing in primary care: A vision shared by patients, physicians, nurses and clinical staff Healing is a fundamental part of medical science, yet its role is insufficiently understood in the modern health care system (Brody, 1992; Lown, 1996; Cassell, 1991). In this article, many participants unanimously agreed that healing is not limited to physical problems rather it goes beyond this limit to encompass the spiritual, emotional and mental dimensions. Undoubtedly, these are fundamental aspects that should be addressed. However, it seems that the participants look more concerned with physical wellness in the first instance rather than emotional or mental aspect. Today, the medical science has reached to that level where it can easily cure faster and properly any physical injury. Instead of focusing on more emotional and mental aspects in the process of healing, the emphasis was largely on physical aspect. Majority of medical professionals do not disagree that more challenging aspect in the case of trauma or any other big medical problem is the management of emotional and mental care; it is the function of human mind to remain normal and at pre-trauma condition level. But; this focus seems to be missing. Additionally, in the article, it is mentioned that the patient as a whole person, rather than addressing a physical problem must be taken care of; it is termed as a ‘holistic’ approach. There is no point to disagree on this point. Unfortunately, in the article, the much needed sequence of treating a patient is not mentioned. What should be the first step to handle a patient? We all understand that if the patient has suffered physically, without any doubt, it would be taken care of accordingly. But, what comes next and what should come next was not answered nor highlighted in the article. Also, in the article, the role of helpers such as family members, spiritual guides, therapists, loved ones is acknowledged as facilitators of healing rather than as the agents. In other words, their role is downgraded and undermined. However, in certain medical cases, such as a person suffering from coma cannot be recovered back to mental and physical normalcy without the aid of family members, friends, relatives and other people considered important by the coma patient. Furthermore, in this article it is mentioned that with the agreement of patient participants that the patient bears the central responsibility for healing. If the central responsibility is taken by the patients, it would be reasonable to argue about the role of physicians and clinicians towards the entire process of healing! A patient does not come to pass days in clinics or hospitals nor are established for such purposes; the moment patient is registered in the records of a hospital; he or she has shown her ultimate consent for the purpose of healing, with the substantial and sufficient assistance of clinicians and other medical staff. If the patient is to central responsibility for healing, then, the patient would no need to go to clinics and rather prefer to have treatment at home. Methodology The field of research extends with the use of appropriate methodology. Mostly, two types of research methods are used- quantitative and qualitative research method. The quantitative method uses quantitative tools and experimental methods to test hypothetical generalizations (Hoepfl, 1997) based on the concept of objectivity; which assumes that reality is objective; it exists and it is independent of the researcher. The quantitative researcher assumes that the researcher must not allow his or her personal views and ideas to tamper with, become part of the objectivity of reality. Additionally, the deductive types of logic, hypothesis and theories are fundamentally used to analyse and understand the cause and effect relationship (Denzin and Lincoln, 1998). Additionally, the quantitative research, which is enhanced by the positivist, directs our understanding to consider the world as made up of measureable and observable facts (Glesne & Peshkin, 1992, p.6) . Crocker and Algina (1986) have further put some light on the notion of ‘measurement’; they explain measurement as the an educational issue with the performance of operation on the physical world by the observer. The basic advantage of quantitative research is to segregate and put a limit to phenomena into measurable categories applicable to all the subjects (Winter, 2000). On the other hand, the qualitative research is defined as any kind of research that generates findings not arrived at by means of statistical procedures or other ways of quantification (Strauss and Corbin, 1990, p.17). Instead, the research kind is producing findings arrived from the settings of real-world where the phenomenon of interest naturally unfold (Patton, 2001, p.39). In the qualitative research, the researchers can use instruments such as interviews, focus groups for the purpose of attaining the research objectives. Additionally, qualitative research is based on context, the researcher arranges the participants to discuss a particular issue. During that discussion, the participants are asked to share their views over the selected topic and, the researcher doesn’t participate in that most of the time, the work of researcher is to carefully listen, understand, record the different views of the participants, all this is done in the focus group discussions. Methodology is based on certain assumptions in the article. First, a variety of medical professionals were given a chance to discuss their personal experience, views, ideas, and suggestions over the entire process of healing; second, it was assumed that comprehending the healing concept is not a simple medical task rather complex. Third, outside the domain of conventional medical practice, it was assumed that the patients would consider healing in the non-conventional contexts such as alternative and spiritual practices. To test such assumptions, the instrument of focus group was used. In which patients and clinicians were recruited to participate in the discussions of focus groups. Mostly, they belonged to the Seattle and Tacoma, Wash, metropolitan areas. Samples A random sample selection method was used to select an appropriate sample. The basis of selecting samples was age, sex and medical conditions. Additionally, letters were posted to patients asking them to participate in a study” to better understand how a patient’s personal experiences with their health care team may affect his or her ability to heal,” and were requested to participate “in a discussion group...to share their thoughts about how the patient-provider relationship can help or hinder healing” (Hsu et al. 2008). Also, via email invitations, clinical team members and physicians were recruited from the primary care clinics in the study regions. Aggregately 9 focus groups were arranged to discuss on the above mentioned topic. Each group was participated with different number of participants based on sex. From July to August 2005, this entire process was carried out. Data Collection During July to August 2005, data was collected with the help of 2 independent professional facilitators; with the use of discussion guide, they led the groups by clearly defining concepts and definitions of healing, possible barriers to healing and facilitators to the process of healing. After the discussion, the group with consensus made a definition of healing and the audio recordings were used to record such discussions. At the biweekly meetings of the research teams, the content of the focus group discussion was analysed. For the validity and reliability of the data, the participation of clinic trainers and clinicians sufficiently helped. Finally, key themes were used by the use of immersion approach (Borkan, 1999). Analysis Analysis suggests the response of neutral person towards information. The given article is based on the concept of healing in primary care. The entire process of healing is explained from the side of each person involved in it. Basically, patients and clinicians are mostly involved to attain and maintain the objectives of healing process besides defining healing. Much of the focus is given on the role of patient towards attaining healing and less is expected from the role of clinicians. Although patients need healing, yet they come to clinics to expect clinicians to play the role as healers for them. Ethical issues Conducting a focus group research requires an appropriate consideration for certain ethical issues. Particularly when the participants are patients as they have different physical and psychological condition than the ordinary humans. Consequently, some additional ethical standards must be put in place to cater and complete the entire process of research successfully. First, like in this focus group discussion, an informed consent must be obtained from the potential participants before the start of discussion. Second, any unethical or inappropriate method must be avoided, for instance, the steps like forcing the participants to provide a certain type of comments or views, or stopping them to raising any particular issue, must not be part of the research work. Third, a polite and friendly manner must be adopted while communicating information to the participants. Fourth, an appropriate compensation must be offered to the participants as they share their views and give their valuable time in attaining the research objectives. The compensation must be given in advance so that the participants can participate with full interest. Fifth, it must be ensured that they are given full and appropriate information about the entire process of research; they must be fully informed about the research objectives and the subsequent research activities must be shared with them. Sixth, an appropriate and congenial environment must be provided to them so that they can comfortably express, hear; discuss their ideas, views, and experiences. Seventh, a due and proper care must be felt by the participants. As in this case, the participants were mostly patients, and they have a different physical and psychological condition in comparison with other ordinary healthy humans. Understanding healing relationship in primary care The relationship between clinicians and patients is given a chance to be fully and carefully understood with the help of interviews. Some interesting results were come. First, in the article, healing relationship is identified as a process in which the role of healer is played by a clinician. During in the interview, one physician explained this process as I try to love every single patient and especially try to love those I initially hate (Scott et al., 2008). If a physician instead of caring for patients, mentions comments like this one, validity and continuity of healing relationship as process would be considerably challenged. Consequently, the clinicians and physicians would find it difficult to play their role in the entire process of healing as much of the part is played by them. Additionally, it is worth mentioning that the physician, according to the above sentence, tries to love every patient. Do a patient need that love? Of course not! The patient needs professional care that can ensure his quick recovery to the normal physical and mental condition. Furthermore, in the same sentence, the physician has also mentioned about his hate towards patients. It would be nearly impossible to play the role of healer when the physician and clinicians holds such views and perceptions regarding patients. Additionally, in the discussion part of this article, it is mentioned that the locus of healing is neither in patient nor in healer, but rather in the space generated by connections of the two, and the same is termed by William Desmond (1995)-“The Between.” However the notion of the in-between does not highlight anyone to play the active role towards the attaining healing with the help of healing relationship. When a person is registered as a patient, that moment also highlights the patient intent to bring back to his or her normal state of level. He or she has put full unconditional consent in that healing relationship. This requires a clinician to play an active role in the healing relationship. Conclusion Healing is defined as a process of getting back to a normal level after suffering from any mental or physical condition. Two articles are critically discussed to assess and understand the concept of healing held by the patients, clinicians and other members who are either directly or indirectly linked with the process of healing. In the first article, a focus group discussion was arranged among patients, physicians, nurses, and clinical staff. After the discussion, some results were obtained after the process of analysis; some key themes like caring and connection, knowing the patient, continuity of care, time, patient behaviour, office function and social support were gathered and concluded. And subsequently, their facilitators and barriers on the process of healing were attached with each theme separately. Additionally, physical aspect of healing was emphasised and was given more focus. And the participants agreed on the importance of spiritual, mental, physical, emotional aspects of the process of healing. And they agreed that the central responsibility in the healing process is on the shoulders of patient rather than anyone else. And, the participants did not highlight the much needed significance of helpers in the healing process. On the other hand, in the second article, an attempt was made to understand healing relationship by interviewing with different patients, and primary care clinicians. Relevant to the healing, three key processes were emerged nurturing the entire process of healing, such as creating emotional attachment with the patients by the clinicians, managing clinician power in a way to benefit the patient, realising the importance of commitment towards the cause of caring for patients over time. Recommendations Recommendations serve the fundamental objective of this critical literature review. First, although the focus group participants agreed the significance of spiritual, physical, mental and emotional aspects of healing process, yet they did not provide the much needed sequence determining which aspect should come first, second or so on. So, it is important to have a sequence in the process of healing, this would clear the direction and much time would be saved and healing would be quickly achieved. Second, the participants in the focus group put the central responsibility on the patients rather than on the clinicians. This must not be the case. The moment patient is registered into a clinic, he or she has shown her full commitment towards the healing process. He or she has no intention, in most of the cases to remain hospitalised. This provides an insight suggesting the central responsibility must be shared by the clinicians rather than the vice versa. Third, helpers must not be given insufficient significance in the healing process. The focus group discussion undermines the role of family members, friends, loved ones and other relevant members. In this century, many of the physical injuries can be promptly healed with the availability of different cures. However, the mental and emotional aspects of healing process cannot be attained without the help of the above mentioned helpers. So, they must be given an appropriate role towards attaining healing. References 1. Egnew TR2005. The meaning of healing: transcending suffering. Ann Fam Med.;3(3):255-262. 2. Dossey L. Samueli, 2003, conference on definitions and standards in healing research: working definitions and terms. Altern Ther Health Med. ;9(3)(Suppl):A10-A12 3. Wendler, MC1996. Understanding healing: A conceptual analysis. J Adv Nurs.;24(4):836-842 4. Brody, H1992. The Healer’s Power. New Haven, CT: Yale University Press; 5. Lown, B1996. The Lost Art of Healing. Boston, MA: Houghton Miffl in; 6. Cassell E1991. 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