Article Figures & Data
Tables
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 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 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) 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
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.