Andrea Charise

Dying, death, and mortality: towards thanatosensitivity in HCI

What happens to human-computer interaction when the human user is no longer alive? This exploratory paper uses insights from the critical humanist tradition to argue for the urgent need to consider the facts of mortality, dying, and death in HCI research. Using an interdisciplinary approach, we critically reflect upon how the intersection of death and computing is currently navigated and illustrate the conceptual and practical complexities presented by mortality, dying, and death in HCI. Finally, we introduce the concept of thanatosensitivity to describe an approach that actively integrates the facts of mortality, dying, and death into HCI research and design.

But I see old people everywhere: dispelling the myth that eldercare is learned in nongeriatric clerkships.

Purpose To test the assumption that knowledge, attitudes, and skills (KAS) in geriatrics are learned via exposure to elderly patients in nongeriatric clerkships. In the developed world, the proportion of adults ≥65 years old will soon surpass the proportion of children <14. However, clinical clerkships containing geriatric rotations are not mandated by the Liaison Committee for Medical Education. Method The authors assessed differences in geriatrics-focused KAS between medical students who completed a rotation in eldercare and those who completed a traditional nongeriatric clerkship. Over two academic years, the authors randomly assigned 263 clinical clerks to a clerkship year that did (eldercare group) or did not contain a two-week rotation focused on geriatrics. All students completed questionnaires that assessed their knowledge of and attitudes toward geriatric patients before and after their clerkships. Before graduation, all students completed an objective structured clinical examination (OSCE) including a clinical station focused on geriatrics. Results Questionnaire and OSCE station response rates were 74.8% and 100%, respectively. The eldercare group had significantly higher knowledge scores (P = .004). Students attitudes toward older adults worsened over the clerkship year in both groups, but slightly less in the eldercare group; that group had significantly higher OSCE geriatric station scores and overall pass rates (both: P < .001). Conclusions Geriatrics is often regarded as a nonessential discipline. This study showed, however, that a clerkship year containing a specialized geriatric rotation is significantly more effective than a traditional clerkship year in preparing students to care for an aging population.

Questioning context: a set of interdisciplinary questions for investigating contextual factors affecting health decision making

Objectiveu2002 To combine insights from multiple disciplines into a set of questions that can be used to investigate contextual factors affecting health decision making.

Old News: Why the 90‐Year Crisis in Medical Elder Care?

North American and European demographic projections indicate that by 2030, persons aged 65 and older will outnumber those younger than 15 by a ratio of 2:1. Curiously, principles of geriatric care have not taken strong hold among nongeriatric specialties, even as we approach the time of greatest need. To explore historical precedents for the current crisis in elder care, this article revisits the prescriptions of G. Stanley Halls Senescence: The Last Half of Life (1922), a text widely recognized as one of the founding texts in the medicalized study of aging. It presents in brief three of Halls major concerns—paucity of knowledge of nongeriatric specialists, the need for individualized care of elderly adults, and the prevalence of attitudinal obstacles in medical professionals caring for older persons—to demonstrate how little the language and content of modern appraisals have evolved since 1922. This disconcerting sense of paralysis is presented as an opportunity to advance important questions aimed at stimulating a more‐comprehensive research agenda for addressing the future of medical elder care.

The Tyranny of Age: Godwin's St. Leon and the Nineteenth-Century Longevity Narrative

This essay reads William Godwins novel St. Leon (1799) in relation to contemporaneous medicalizing discourses concerned with the elimination of old age. I argue that in St. Leon, a speculative case study of a disastrously unbounded life, Godwin recants his earlier paean to immortality in Enquiry Concerning Political Justice (1793-98) by undermining the solitary subject for whom senescence is a symptom of political tyranny. St. Leon therefore signals an acute transitional moment between late eighteenth-century thought and incipient Romanticism, and marks the first example of the nineteenth-century longevity narrative, wherein the finitude of individual lifespan exists in strained reciprocity with the perpetual succession of species.

Exploring the Realities of Curriculum-by-Random-Opportunity: The Case of Geriatrics on the Internal Medicine Clerkship Rotation

Background While major clerkship blocks may have objectives related to specialized areas such as geriatrics, gay and lesbian bisexual transgender health, and palliative care, there is concern that teaching activities may not attend sufficiently to these objectives. Rather, these objectives are assumed to be met “by random opportunity”.(1) This study explored the case of geriatric learning opportunities on internal medicine clinical teaching units, to better understand the affordances and limitations of curriculum by random opportunity. Methods Using audio-recordings of morning case review discussions of 13 patients > 65 years old and the Canadian geriatric core competencies for medical students, we conducted a content analysis of each case for potential geriatric and non-geriatric learning opportunities. These learning opportunities were compared with attendings’ case review teaching discussions. The 13 cases contained 40 geriatric-related and 110 non-geriatric-related issues. While many of the geriatric issues (e.g., delirium, falls) were directly relevant to the presenting illness, attendings’ teaching discussions focused almost exclusively on non-geriatric medical issues, such as management of diabetes and anemia, many of which were less directly relevant to the reason for presenting to hospital. Results The authors found that the general medicine rotation provides opportunities to acquire geriatric competencies. However, the rare uptake of opportunities in this study suggests that, in curriculum-by-random-opportunity, presence of an opportunity does not justify the assumption that learning objectives will be met. Conclusions More studies are required to investigate whether these findings are transferrable to other vulnerable populations about which undergraduate students are expected to learn through curriculum by random opportunity.

Narrative Training as a Method to Promote Nursing Empathy Within a Pediatric Rehabilitation Setting

Purpose: Empathy is deemed essential to nursing, yet interventions that promote and sustain empathy in practicing nurses within healthcare organizations are limited. We tested the feasibility and perceived impact of an arts‐based narrative training intervention involving pediatric rehabilitation nurses for the purpose of promoting nursing empathy. Design and Methods: One‐group qualitative repeated‐measures design at an urban Canadian pediatric rehabilitation hospital. Eight nurse participants attended six 90‐minute weekly group narrative training sessions and two in‐depth interviews pre‐ and post‐intervention. Results: The intervention positively impacted participants in three primary domains: Empathy for Patients and Families, Empathy Within Nursing Team, and Empathy for the Self. Major findings included: increased value placed on patients and families backstory, identification of “moral empathic distress” (MED), enhanced sense of collaborative nursing community, and renewal of professional purpose. Conclusions: This study is the first of its kind conducted in the pediatric rehabilitation nursing context. Results indicate that arts‐based narrative training enhances nursing empathy and contributes to a supportive nursing culture. Practice Implications: In addition to enhancing empathy in clinical domains, nurses who participated in narrative training reported improved team collaboration, self‐care practices, and renewed professional purpose. The results from the intervention are encouraging and future research needs to explore its utility in other settings with larger and more diverse sample. Highlights:The study demonstrated positive impacts of arts‐based narrative training for nurses.Narrative training improved nursing collaboration and therapeutic relationships.Narrative training is an innovative way to reduce adverse work‐related outcomes.“Moral empathic distress” was identified in this study and may be an emerging phenomenon in this nursing context.

Site, Sector, Scope: Mapping the Epistemological Landscape of Health Humanities

This essay presents a critical appraisal of the current state of baccalaureate Health Humanities, with a special focus on the contextual differences currently influencing the implementation of this field in Canada and, to a lesser extent, the United States and United Kingdom. I argue that the epistemological bedrock of Health Humanities goes beyond that generated by its written texts to include three external factors that are especially pertinent to undergraduate education: site (the setting of Health Humanities education), sector (the disciplinary eligibility for funding) and scope (the critical engagement with a program’s local context alongside an emergent “core” of Health Humanities knowledge, learning, and practice). Drawing largely from the Canadian context, I discuss how these differences can inform or obstruct this field’s development, and offer preliminary recommendations for encouraging the growth of baccalaureate Health Humanities—in Canada and elsewhere—in light of these factors.