Arlene M. Katz

Active patient involvement in the education of health professionals

Context  Patients as educators (teaching intimate physical examination) first appeared in the 1960s. Since then, rationales for the active involvement of patients as educators have been well articulated. There is great potential to promote the learning of patient‐centred practice, interprofessional collaboration, community involvement, shared decision making and how to support self‐care.

Close encounters: exemplars of process-oriented qualitative research in health care

Qualitative and quantitative research approaches reflect different ‘world views’ and raise different questions for inquiry. In this article, we map several prominent features of the landscape of qualitative research by presenting a range of research exemplars in the fields of medicine and health care that focus on process, that is, on ‘What’s going on?’. We include studies of: clinical encounters between patients and health care providers; patients’ lived experiences in their social and cultural settings; institutional changes in training and practice; and public health care policy. Our approach is intended to show that there are many ways to do qualitative research, with exemplars chosen so as to be relevant to the specific questions asked and to the stance of the researcher. The diversity of topics, approaches and methods represented may help practitioners, educators, and researchers specify, clarify, elaborate and refine their domains of concern, and guide them in choosing appropriate and context-sensitive methods for their own inquiries.

Acknowledging the Otherness of the Other

There are certain special kinds of involved, reciprocally responsive, meetings with others which, when they occur, can give rise to special and distinctive feelings in us, feelings which can ‘tell’ us something about the unique nature of an other’s ‘inner world’, and which can thus shape our responses to them in ways that matter to them. In a moment, below, we would like to try to describe the special nature of such meetings or engagements, and also, to spend some time outlining some of the prior attitudes and expectations that can prevent such engaged meetings from ever taking place. For it seems to us that certain orientations—often to do with demands made on us by our training as professionals—can lead us to impose already existing demands and requirements on all our meetings, externally,and it is just these external impositions that can prevent these special kinds of involvement from ever emerging.

Assessment of Physical Illness by Mental Health Clinicians During Intake Visits

OBJECTIVES This study explored how mental health clinicians assess and respond to physical illness among patients presenting for mental health intake evaluations. METHODS A total of 129 adults were seen for a mental health intake visit. The intake visits were videotaped and involved 47 mental health clinicians from eight clinics who provided outpatient mental health and substance abuse treatment. A total of 120 videos of patient-provider interactions were coded using an information checklist containing 21 physical illness items. Twenty-eight intake visits exemplifying in-depth physical illness assessments were selected and transcribed for qualitative analysis. RESULTS Physical health was discussed in most intake visits (87%). Clinicians elicited information on physical health in 79 visits (66%), and patients volunteered such information in 80 visits (67%). Frequency of assessment differed by clinician discipline (p<.05) and by patient ethnicity (p=.06). Qualitative analysis revealed characteristics of appropriate assessments, such as formulating the contribution of physical conditions in the psychiatric differential diagnosis, noting physical side effects of medications, adjusting treatment plans, encouraging patient contact with primary care providers, and promoting physical health care. CONCLUSIONS Assessment of physical illness is relatively common among mental health clinicians but was lacking in one-third of the cases in this study, until raised by patients. Because frequency of assessment differed by clinician discipline and patient ethnicity, innovations in patient assessment and clinician education are needed to address disparities in management of physical illness among individuals with mental illness.

Influencing everyday activities in a nursing home setting: A call for ethical and responsive engagement

This study focuses on influence that older adults, living in nursing homes, have over everyday activities. Everyday activities are key to sustain a sense of stability, predictability, and enjoyment in the local world of peoples everyday and therefore a critical dimension of the person‐centeredness framework applied within gerontology. This narrative ethnographic study aimed to shed light on how influence can be situated contextually, and how it can emerge through activities as well as how it is negotiated in everyday by frail older adults living in a nursing home. Residents, staff members, and significant others from one nursing home in an urban area of Sweden participated in this study. Data were gathered through fieldwork, including participant observation and formal and informal conversations during a period of 6 months. Data were analyzed through a narrative interpretative approach. The findings are presented in narrative form as exemplars. The exemplars—Craquelures as justification, Seeking a place for other life worlds and An almost perfect trip—reveal a gap between the client‐centeredness framework and lived experiences regarding older adults’ influence in everyday activities. The role of everyday activities in the context of frailty is discussed in terms of ethical and responsive engagement, and implications for health‐care practices are considered.

Altering the boundaries of everyday life in a nursing home context

Abstract Background: Despite global and local policy frameworks that explicitly aim to privilege participation and active engagement of older adults living in nursing homes, this group often has limited possibilities to engage in occupations and to have influence in their everyday lives. Aim: To explore how older adults’ engagement and influence in an occupation can emerge in everyday life in a nursing home setting. Material and methods: A participatory qualitative approach was applied. Older adults living in a nursing home participated in a Book Club that was created collaboratively between researchers, residents, and the nursing home community. Findings: The analysis identified qualities of altering the boundaries of everyday life and addressing the uncertain conditions for influence and engagement as processes actualized by the residents when engaging in the Book Club. Further analysis identified how these processes involved ordinariness, familiarity, fellowship, and connectedness. Conclusion and Significance: Engagement and influence in occupation in a nursing home is possible when enabling partnerships and resourcefulness among the residents. However, such enablement is not guaranteed and needs to be actively upheld by the nursing home community in order to build practices aligned with policy frameworks of participation.

How patients and clinicians make meaning of physical suffering in mental health evaluations.

Clinicians in community mental health settings frequently evaluate individuals suffering from physical health problems. How patients make meaning of such “comorbidity” can affect mental health in ways that may be influenced by cultural expectations and by the responses of clinicians, with implications for delivering culturally sensitive care. A sample of 30 adult mental health intakes exemplifying physical illness assessment was identified from a larger study of patient–provider communication. The recordings of patient–provider interactions were coded using an information checklist containing 21 physical illness items. Intakes were analyzed for themes of meaning making by patients and responses by clinicians. Post-diagnostic interviews with these patients and clinicians were analyzed in similar fashion. Clinicians facilitated disclosures of physical suffering to varying degrees and formulated them in the context of the culture of mental health services. Patients discussed their perceptions of what was at stake in their experience of physical illness: existential loss, embodiment, and limits on the capacity to work and on their sense of agency. The experiences of physical illness, mental health difficulties, and social stressors were described as mutually reinforcing. In mental health intakes, patients attributed meaning to the negative effects of physical health problems in relation to mental health functioning and social stressors. Decreased capacity to work was a particularly salient concern. The complexity of these patient–provider interactions may best be captured by a sociosomatic formulation that addresses the meaning of physical and mental illness in relation to social stressors.