Healing in Primary Care: A Vision Shared by Patients, Physicians, Nurses, and Clinical Staff

Clarissa Hsu; William R. Phillips; Karen J. Sherman; Rene Hawkes; Daniel C. Cherkin

doi:10.1370/afm.838

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Table 1.

Description of Focus Group Participants

Group	Participants	Number	Female	Male
LPN=licensed practical nurse; MA=medical assistant; RN=registered nurse.
Note: Mixed groups were made up of all participant types.
1	Patients	12	7	5
2	Patients	9	5	4
3	Physicians	9	5	4
4	Physicians	10	6	4
5	RNs	11	11	0
6	RNs s	6	6	0
7	LPNs; MAs	10	10	0
		9 LPNs
		1 MA
8	Mixed group	10	6	4
		4 Patients
		2 Physicians
		2 RNs
		2 LPNs
9	Mixed group	7	4	3
		3 Patients
		2 Physicians
		1 RNs
		1 MA
Totals, No. (%)		85 Total	60 (71)	24 (29)
		28 Patients
		23 Physicians
		20 RNs
		11 LPNs
		2 MAs

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Table 2.

Definition of Healing by Focus Groups

Group	Participants	Definition of Healing
LPN=licensed practical nurse; MA=medical assistant; RN=registered nurse.
Note: Mixed groups were made up of all participant types.
1	Patients	The process of regaining wellness
2	Patients	Restoring a sense of well-being
3	Physicians	The process of helping a person restore mental, spiritual, and physical health by removing barriers for optimum functioning
4	Physicians	Assisting a person to reach his/her full potential and full function
5	RNs	A pathway between personal sense of illness and wellness, integrating the spiritual, mental, physical, and relational
6	RNs	The process of helping an individual achieve a state of wellness
7	LPNs - MAs	Treating the whole person spiritually, emotionally and physically, not just their ailment (improvement in condition)
8	Mixed group	The process of moving toward balance and well-being that implies making changes and the blending of the physical, mental, and spiritual
9	Mixed group	The restoration of health with caring, acceptance, and understanding

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Table 3.

Themes on Healing and Example Quotations From Patient and Clinician Groups

Theme	Speaker
LPN=licensed practical nurse; MA=medical assistant; RN=registered nurse.
Note: Mixed groups included a variety of patients and clinician types.
1. Healing is multidimensional and holistic
Healing is more mental than physical. It’s holistic, spiritual, emotional, and physiologic	Patient (group 2)
I think healing for me is a very complex kind of concept…. There is a mental part, there is a physical part, there is a spiritual part	Physician (group 3)
[Wholeness] I think that’s a wonderful word for it. I don’t believe it’s lack of illness, I believe it goes further than that...to include peace of mind. Peace: body, mind, and spirit	RN (group 5)
It’s not an organ system. It’s the entire person. The mind, body, spirit, relationships, community, the whole person	LPN/MA (group 7)
2. Healing is a process, a journey
[Healing is]…going through a process of emotions to get over something extremely traumatic that happened	Patient (group 1)
Maybe you should call it a path of restoring, so that maybe you don’t get to the end point	Physician (group 3)
…sometimes there is going to be two steps forward and one step back, but it’s the journey and skills that they learn along the way, that seems to help the people move and get unstuck and make some steps forward. I think patients need to realize that	RN (group 6)
As a doctor, if I can…recognize that healing is this process…. You may not be able to solve the problem that particular day.… That it might take time, that we’re going to have a follow-up. I’m really listening. We only got these 3 things discussed, but I know there’s many…. So, you are establishing a framework that’s open ended	Physician in mixed group (group 8)
3. The goal of healing is recovery or restoration
It’s a restorative process. Regenerative. Restoring something that was lost or the sense of well-being	Patient (group 2)
[Healing is] the process of restoring a person’s mental, spiritual, and physical health, which is their suffering part, and removing barriers to the level possible, and then to optimum	Physician (group 3)
4. Healing requires the person to reach a place of personal balance and acceptance
[Healing is] being OK with what you are right now. Acceptance. Living in the day	Patient (group 2)
Acceptance and understanding… [I]t’s trying to work toward or move toward having the person be as happy and as functional as they can possibly be, given their problems. Balance when I have sought health care	Physician (group 3)
…from my own personal patient experience, I have felt healed. I have felt that something that was amiss or out of balance was brought back in	Individual from mixed group (group 8)
Healing is living successfully with whatever challenges you have	Individual in mixed group (group 8)
5. Relationships are essential to healing
Healing is the interpersonal relationships at my clinic and the nurses that took care of me when I was there. It has less to do with the pain and more to do with personal attention	Patient (group 2)
It means that it’s just like “Cheers”; people want to go where people know your name	Physician (group 3)
I feel that good healing process is when the patient comes familiar with that nurse. Because that trust thing, and plus that they expect we have become like family. I know my patients	LPN/MA (group 7)

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Table 4.

Themes on Facilitators and Barriers to Healing

Theme	Facilitator	Barrier
Caring and connection	Ability to make the patient feel heard and cared for Communicating warmth	Lack of respect for patients
		Distractions
	Responsiveness to patient needs	Poor listening
Knowing the patient	Clinicians having an in-depth knowledge of their patient’s history	Poor medical records
	Clinician’s ability to intuitively assess the patient’s desired level of personal connection, information, and involvement in care planning	Poor interpersonal communication skills
Continuity of care	Relationship over time with one clinician or a team	Lack of communication systems among clinicians
	Contributes to “knowing the patient”	Inattention to the medical record
		Clinician turnover
Time	“Time to heal”	Time pressures
	Quality time during appointments to get needs met
	Seeing one clinician over a period of months or years (continuity of care)
Social support	Having friends, family and extended communities that are supportive	Isolation
		Lack of social support
Office function	Ease and pleasantness of arranging, receiving, and providing care	Poor front desk experience
		Scheduling difficulties
		Staff unhappiness
		Lack of resources
		Poorly designed roles
Patient behavior	Patient’s attitudes toward health and motivation for healing	Unrealistic expectations on part of patients
		Difficulty of behavior change.
		Unhealthy behaviors (smoking, drinking, etc)

Additional Files

Tables

Supplemental Appendixes

Supplemental Appendix 1. Sampling Methods and Recruitment Results; Supplemental Appendix 2. Focus Group Discussion Guide.

Files in this Data Supplement:

Supplemental data: Appendix 1 & 2 - PDF file, 2 pages, 87 KB
In Brief

Healing In Primary Care: A Vision Shared by Patients, Physicians, Nurses, and Clinical Staff

Clarissa Hsu , and colleagues

Background There has been little published research on how patients in primary care define healing, how healing might be improved, and how doctors and other members of primary health care teams see their roles in healing. This study explores what healing means to patients, doctors, nurses, and other members of the primary care team.

What This Study Found Patients and health care team members share a vision of healing and agree on ways to enhance the healing process in primary care. According to this definition, healing is a dynamic process of recovering from a trauma or illness by working toward realistic goals, restoring function, and regaining a personal sense of balance and peace. There are physical, emotional, and spiritual dimensions to healing.

Implications

This study provides new information about healing by asking patients and clinicians what they think. There is strong agreement about healing among patients and clinicians in primary care settings.
According to this definition of healing, medical care, though important, is only one contributor to healing, and healing is only one element of what goes on in medical care.