Emotional and Interpersonal Dimensions of Health Services

Emotional and Interpersonal Dimensions of Health Services: Enriching the Art of Care with the Science of Care

LAURETTE DUBÉ
GUYLAINE FERLAND
D.S. MOSKOWITZ
Copyright Date: 2003
Pages: 232
https://www.jstor.org/stable/j.ctt8187h
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  • Book Info
    Emotional and Interpersonal Dimensions of Health Services
    Book Description:

    Contributors examine the degree to which the provision of health care is influenced by characteristics of the health service organization, such as the administrative structure and the human resources available. They demonstrate that job satisfaction and conditions play an important role in shaping the quality and effectiveness of care and discuss the emotional support health care providers need to avoid long-term exhaustion and ensure well being. The contributors identify qualities of the client-provider interaction that lead to positive health care outcomes, such as providing information, responding to patient concerns, facilitating interactions with the health care system, and encouraging participation in personal health care and offer examples of innovative conceptual and analytical approaches to better health care practices. Contributors include Heather Boon (University of Toronto), Laurette Dubé, Carole A. Estabrooks (University of Alberta), Guylaine Ferland, Arlie Russell Hochschild (University of California, Berkley), Diane M. Irvine Doran (University of Toronto), Terrence Montague (Merck Frosst Canada), D.S. Moskowitz, Richard W.J. Neufeld (University of Western Ontario), Gilbert Pinard (McGill University), Debra L. Roter (John Hopkins Blooomberg School of Public Health), Dana Gelb Safran (New England Medical Center), and Krista K. Trobst (York University).

    eISBN: 978-0-7735-7118-1
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-2)
  3. INTRODUCTION

    • 1 Integrating the Art and Science of Care into the Everyday Delivery of Health Services: Challenges for Research and Practice
      (pp. 3-11)
      LAURETTE DUBÉ, GUYLAINE FERLAND and D.S. MOSKOWITZ

      Technological and biomedical breakthroughs have given us a remarkable and diverse array of tests, machines, drugs, and procedures for diagnosing and treating diseases ever more effectively, which has translated into improved health status and longevity in modern societies. Such advances have been made possible by the development of a solid theoretical understanding of health, diseases, and medical interventions, supported by a relentless quest for innovation and by extensive, provenly efficacious empirical testing of any new diagnostic or therapeutic intervention. In sharp contrast, modern medicine and professional health practice in general have not taken such strides when it comes to the...

  4. PART ONE THE ART OF CARE, ORGANIZATIONAL CONSTRAINTS, AND PATIENT AND PROVIDER OUTCOMES

    • 2 Measuring the Quality of the Primary Care Relationship
      (pp. 12-44)
      DANA GELB SAFRAN

      From the earliest definitions of the term primary care to the most recent, all have stressed that primary care is predicated on a sustained relationship between patients and the clinician(s) who care for them (Institute of Medicine 1978, 1996; Millis 1966; Alpert and Charney 1973; Starfield 1992). Similarly, a distinctive feature of primary care is its focus on the whole person in the context both of patients’ personal and medical histories and of their life circumstances, rather than a focus on particular diseases, organs, or systems. And finally, the primary physician has a distinctive role with respect to integrating the...

    • 3 The Emotional and Interpersonal Dimensions of Health Care and Their Impact on Organizational and Clinical Outcomes: Building an Integrative, Action-Oriented Research Agenda
      (pp. 45-54)
      CAROLE A. ESTABROOKS

      This chapter centres around an international study of hospital organization and nurse outcomes presently being conducted in five countries, including Canada. The purpose of this study is to determine the impact of hospital organization and staffing on patient and nurse outcomes. The international study was launched in response to widespread hospital restructuring and work redesign, as well as to changing hospital staffing patterns – all of which were undertaken without empirical evidence of their effects on patient and system outcomes. The five participating countries are Canada (represented by British Columbia, Ontario, and Alberta), the United States (represented by Pennsylvania), England,...

    • 4 Measuring and Monitoring Patient Outcomes
      (pp. 55-66)
      DIANE M. IRVINE DORAN

      The measurement of outcomes has gained in importance as health care organizations focus on the areas of cost and quality, effectiveness of care, and organizational performance. All practitioners in the health field are being challenged to find ways to demonstrate that the care they provide leads to improved outcomes for the recipients of that care. To do so, health care practitioners are attempting to identify relevant outcomes that can be linked in a meaningful way to their practices.

      Nursing, like the other health disciplines, has responded to this challenge through a number of initiatives, such as the American Nurses’ Association...

  5. PART TWO THE SCIENCE OF CARE:: FOCUS ON EMOTIONAL PROCESSES

    • 5 Behind Every Great Caregiver: The Emotional Labour in Health Care
      (pp. 67-72)
      ARLIE RUSSELL HOCHSCHILD

      Although I am a sociologist by training, my approach is an anthropological one. I interview and observe people over a fairly long period of time. It was on the basis of such a research approach that I introduced the term “emotional labour” to capture the emotional dimension of what is produced in most service industries (Hochschild 1979, 1983, 2003a; see Ashforth and Humphrey 1993 for a review of applications of the concept). While my early work focused on the emotional labour of airline employees, my current research is based on interviews with nannies, elderly care workers, and “ritual workers” –...

    • 6 Patient Emotions in a Clinical Context: Coping with Anxiety and Depression and Other Negative Emotions
      (pp. 73-83)
      GILBERT PINARD

      Emotions impact on all aspects of people’s health care: the rapidity with which they consult, the ease with which they speak of symptoms, their adherence to treatment regimens, their satisfaction with their interactions with the health care system, and, indeed, the very disorders they experience. In this chapter, I will address, from a clinical perspective, some of these considerations that I have encountered not only as a psychiatric consultant in a first-line community clinic, but also as a teacher and researcher in a university hospital clinic specialized in cognitive behavioural therapy. This approach highlights the links between cognition, emotions, and...

    • 7 Patient Emotions and the “Engineering” of Provider Responses for More Effective Care
      (pp. 84-97)
      LAURETTE DUBÉ

      Positive and negative emotions are feeling states that signal the occurrence of events that are relevant to important goals, motivating those who feel them to act in a certain manner and others to respond in a given way. Most of the time, episodes of illness are emotionally charged events, and ideally patients want professionals to consider their emotions when providing health care. Unfortunately, the full and systematic integration of patient emotions into the design and everyday delivery of health services seems to be a luxury that societies cannot afford given the exclusive focus on operational efficiency in the recent restructuring...

  6. PART THREE THE SCIENCE OF CARE:: FOCUS ON INTERPERSONAL PROCESSES

    • 8 Interpersonal Processes in the Patient-Physician Relationship
      (pp. 98-104)
      DEBRAL L. ROTER

      As I reflect on the current state of the patient-physician relationship, Norman Rockwell’s portrait of the family doctor examining a little girl’s doll springs to mind. It is an iconic reflection of a long-lost era when doctor-patient relationships were intimate, humane, thoughtful, engaging, and sensitive. In this portrait, the little girl is looking straight at the doctor, but his eyes are averted in concentration while listening to the stethoscope placed on the doll’s heart. Closer inspection of the image reveals something amiss: the posture of deep concentration, with eyes averted, is one in which communication has been supplanted by technology...

    • 9 Patient-Practitioner Communication in Conventional and Complementary Medicine Contexts
      (pp. 105-114)
      HEATHER BOON

      Every patient knows that the experience of communicating with a health care provider can have a profound effect on how he or she feels. This intuitive knowledge is supported by an increasing amount of research documenting that patient-practitioner communication influences (both positively and negatively) a variety of objective and subjective health outcomes. This chapter begins with an overview of the effects that different physician communication styles may have on patient satisfaction, adherence to treatment protocols, and health outcomes in a conventional medicine context. This is followed by a review of patient-practitioner communication in a complementary medicine context. The perception that...

    • 10 An Interpersonal Social Support Approach to Understanding the Patient-Practitioner Relationship
      (pp. 115-129)
      KRISTA K. TROBST

      The practice of medicine has probably always been concerned with enhancing the diagnosis and treatment of what ails us. However, more interpersonal considerations of “quality of care” seem to be primarily a product of the last few decades – at least from a research, rather than from a merely intuitive, standpoint. In fact, relatively recent times have been witness to a blossoming of research examining the interpersonal quality of patient-practitioner¹ (or patient-physician, or patient-provider) relationships, including considerations not only of what patients like in their practitioners, but also of how patients’ health might benefit from good relationships with their practitioners....

  7. PART FOUR CHALLENGES IN INTEGRATING THE ART AND SCIENCE OF CARE INTO HEALTH RESEARCH AND PRACTICE

    • 11 Dynamic Conceptions of Dimensions in the Interpersonal Domain
      (pp. 130-137)
      D.S. MOSKOWITZ

      Many of the methodologies, conceptual frameworks, and general issues raised in psychology can be applied to the study of health care providers and health care receivers. I will offer some insights into how both our feelings and our behaviours fluctuate, the factors that impact on them, and how knowing about these dynamics and employing them can be useful in the health care field.

      Both how we feel and how we behave fluctuate. How we feel can change rapidly or slowly in the course of minutes, or hours, or days. Behaviour also fluctuates. We tend to speak of others as being...

    • 12 Methodological Challenges to Capturing Dynamical Aspects of Health Care Acquisition
      (pp. 138-150)
      LAWRENCE R. LEVY, RICHARD W.J. NEUFELD and WEIGUANG YAO

      At a psychological level, dynamics is the study of the manner in which a system, such as an individual, interacts over time with his/her environment while engaging in cognitive and emotional activity. According to physicists, dynamics examines the effects of interdependent forces on the behaviour of a system as time unfolds and the way in which the system searches for overall patterned states of stable behaviour (Barton 1994). Analogously, as individuals cognitively and emotionally transact with their surroundings on a daily basis, they quickly reach stable interpersonal, emotional, and mental states. Hence non-linear dynamical systems theory, commonly known as chaos...

    • 13 Outcomes in Health Care: Motivation, Measures, and Drivers at the Population Level
      (pp. 151-161)
      TERRENCE MONTAGUE

      In the biomedical and pharmaceutical domains, breakthroughs have been made possible by the development of a solid theoretical understanding not only of health and diseases, but also of medical and pharmaceutical interventions. Breakthroughs have also been supported by a relentless quest for innovation and by extensive empirical testing of the efficacy of any new diagnostic or therapeutic intervention. I contend that a similar approach will have to be developed in the more human aspects of care like emotion and interpersonal processes if these are to become integral parts of health service research and practice. In this chapter, I first review...

  8. References
    (pp. 163-186)
  9. Contributors
    (pp. 187-194)
  10. Back Matter
    (pp. 195-200)