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"Building through the grief": vicarious trauma in a group of inner-city family physicians.

https://arctichealth.org/en/permalink/ahliterature119128
Source
J Am Board Fam Med. 2012 Nov-Dec;25(6):840-6
Publication Type
Article
Author
Susan Woolhouse
Judith Belle Brown
Amardeep Thind
Author Affiliation
South Riverdale Community Health Centre, Toronto, Ontario, Canada. swoolhouse@srchc.com
Source
J Am Board Fam Med. 2012 Nov-Dec;25(6):840-6
Language
English
Publication Type
Article
Keywords
Adaptation, Psychological
Adult
Attitude of Health Personnel
Burnout, Professional - psychology
Death
Empathy
Female
Grief
Health Care Surveys
Humans
Interprofessional Relations
Interviews as Topic
Male
Middle Aged
Ontario
Physician-Patient Relations
Physicians, Family - psychology
Qualitative Research
Substance-Related Disorders
Urban Health Services
Abstract
Vicarious trauma is an understudied phenomenon among Canadian family physicians.
This phenomenological study set out to explore the experiences of a group of inner-city family physicians caring for women using illicit drugs.
Ten family physicians working in Toronto and Ottawa, Canada, participated in in-depth interviews. The data were analyzed using an iterative and interpretive process.
The first major theme emerging from the data analysis was the emotional impact of the work. Participants shared the challenges, sorrows, and joys they experienced as they struggled to care for their patients. The sub-themes identified were as follows: tragedy and death, difficult behaviors, and isolation from mainstream medical community. The second major theme identified was coping strategies. Participants were open, thoughtful, and eloquent as they reflected on the three primary coping strategies reported: adaptation and evolution of practice style, teamwork, and modification of expectations.
Participants, narratives of loss, grief, and compassion were consistent with vicarious trauma and therefore participants risked developing compassion fatigue--a specific form of burnout. These are new and important findings. Further research exploring vicarious trauma as a possible contributor to burnout among family physicians is warranted.
Notes
Comment In: J Am Board Fam Med. 2012 Nov-Dec;25(6):756-823136311
PubMed ID
23136324 View in PubMed
Less detail

Caring for seriously mentally ill patients. Qualitative study of family physicians' experiences.

https://arctichealth.org/en/permalink/ahliterature189862
Source
Can Fam Physician. 2002 May;48:915-20
Publication Type
Article
Date
May-2002
Author
Judith Belle Brown
Barbara Lent
April Stirling
Jatinder Takhar
Joan Bishop
Author Affiliation
Centre for Studies in Family Medicine, 100 Collip Circle, Suite 245, London, ON. jbbrown@uwo.ca
Source
Can Fam Physician. 2002 May;48:915-20
Date
May-2002
Language
English
Publication Type
Article
Keywords
Attitude of Health Personnel
Bipolar Disorder - therapy
Community Mental Health Services - organization & administration
Family Practice - organization & administration
Humans
Interprofessional Relations
Interviews as Topic
Models, organizational
Ontario
Schizophrenia - therapy
Abstract
To examine family physicians' experiences in caring for patients with serious mental illness and their expectations of a shared mental health care (SMHC) model.
Qualitative method of in-depth interviews.
London, Ont.
Purposive sample of 11 full-time family physicians providing ongoing care for patients with serious mental illness.
Eleven interviews were conducted to explore family physicians' experiences. All interviews were audiotaped and transcribed verbatim. Analysis was done using a constant comparative approach and was carried out concurrently rather than sequentially. Researchers read all interview transcripts independently before comparing and combining their analyses. Final analysis involved examining all interviews together to discover relationships between and among emerging themes.
Findings reflected three main themes: what family physicians perceive they bring to care of seriously mentally ill patients (i.e., whole-person approach to care); challenges family physicians face in participating in shared care of these patients (i.e., communication and access issues); and family physicians' expectations of a SMHC model (i.e., guidance and feedback).
As seriously mentally ill patients are moved out of institutions, the need for an effective and efficient SMHC model becomes imperative. Our findings suggest that family physicians could be an important part of SMHC models but only if systemic barriers are removed and collaborative practice is encouraged.
Notes
Cites: Psychosomatics. 1994 May-Jun;35(3):268-788036256
Cites: Can Fam Physician. 1998 May;44:1028-349612588
Cites: Psychiatr Serv. 1997 Dec;48(12):1586-89406270
Cites: Can Fam Physician. 1996 Jul;42:1319-268754701
PubMed ID
12053636 View in PubMed
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Choosing family medicine. What influences medical students?

https://arctichealth.org/en/permalink/ahliterature183436
Source
Can Fam Physician. 2003 Sep;49:1131-7
Publication Type
Article
Date
Sep-2003
Author
John Jordan
Judith Belle Brown
Grant Russell
Author Affiliation
Department of Family Medicine, University of Western Ontario. jjordan@uwo.ca
Source
Can Fam Physician. 2003 Sep;49:1131-7
Date
Sep-2003
Language
English
Publication Type
Article
Keywords
Adult
Decision Making
Education, Medical
Family Practice - education
Female
Humans
Interviews as Topic
Male
Mentors
Ontario
Students, Medical
Abstract
To explore factors that influence senior medical students to pursue careers in family medicine.
Qualitative study using semistructured interviews.
University of Western Ontario (UWO) in London.
Eleven of 29 graduating UWO medical students matched to Canadian family medicine residency programs beginning in July 2001.
Eleven semistructured interviews were conducted with a maximum variation sample of medical students. Interviews were transcribed and reviewed independently, and a constant comparative approach was used by the team to analyze the data.
Family physician mentors were an important influence on participants' decisions to pursue careers in family medicine. Participants followed one of three pathways to selecting family medicine: from an early decision to pursue family medicine, from initial uncertainty about career choice, or from an early decision to specialize and a change of mind.
The perception of a wide scope of practice attracts candidates to family medicine. Having more family medicine role models early in medical school might encourage more medical students to select careers in family medicine.
Notes
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Cites: J Gen Intern Med. 1997 Jan;12(1):76-79034952
Comment In: Can Fam Physician. 2003 Dec;49:159214708922
Comment In: Can Fam Physician. 2003 Sep;49:1065, 106914526852
PubMed ID
14526865 View in PubMed
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Compassion fatigue within double duty caregiving: nurse-daughters caring for elderly parents.

https://arctichealth.org/en/permalink/ahliterature146377
Source
Online J Issues Nurs. 2011 Jan;16(1):4
Publication Type
Article
Date
Jan-2011
Author
Catherine Ward-Griffin
Oona St-Amantr
Judith Belle Brown
Author Affiliation
Family School of Nursing at the University of Western Ontario, London, Ontario, Canada. cwg@uwo.ca
Source
Online J Issues Nurs. 2011 Jan;16(1):4
Date
Jan-2011
Language
English
Publication Type
Article
Keywords
Adaptation, Psychological
Aged
Burnout, Professional - prevention & control - psychology
Caregivers - psychology
Empathy
Family - psychology
Fatigue - prevention & control - psychology
Female
Humans
Models, Nursing
Models, Psychological
Nurse-Patient Relations
Nurses - psychology
Occupational Diseases - prevention & control - psychology
Ontario
Risk factors
Stress, Psychological - psychology
Time Management
Workload
Abstract
This article examines compassion fatigue within double duty caregiving, defined here as the provision of care to elderly relatives by practicing nurses. Using qualitative data from our two studies of Canadian double duty caregivers, we identified and interviewed 20 female registered nurses whom we described as "living on the edge." The themes of context, characteristics, and consequences emerged from the findings. In this article, we argue that being both a nurse and a daughter leads to the blurring of boundaries between professional and personal care work, which ultimately predisposed these caregivers to compassion fatigue. We found that the context of double duty caregiving, specifically the lack of personal and professional resources along with increasing familial care expectations, shaped the development of compassion fatigue. Nurse-daughters caring for elderly parents under intense and prolonged conditions exhibited certain characteristics, such as being preoccupied and absorbed with their parents' health needs. The continual negotiation between professional and personal care work, and subsequent erosion of those boundaries, led to adverse health consequences experienced by the nurse-daughters. The study findings point to the need to move beyond the individualistic conceptualization and medical treatment of compassion fatigue to one that recognizes the inherent socio-economic and political contextual factors associated with compassion fatigue. Advocating for practice and policy changes at the societal level is needed to decrease compassion fatigue amongst double duty caregivers. In this article we review the compassion fatigue literature, report our most recent study methods and findings, and discuss our conclusions.
PubMed ID
21800935 View in PubMed
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The experience of living kidney donors.

https://arctichealth.org/en/permalink/ahliterature156973
Source
Health Soc Work. 2008 May;33(2):93-100
Publication Type
Article
Date
May-2008
Author
Judith Belle Brown
Mary Lou Karley
Neil Boudville
Ruth Bullas
Amit X Garg
Norman Muirhead
Author Affiliation
Department of Family Medicine, Centre for Studies in Family Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, Canada.
Source
Health Soc Work. 2008 May;33(2):93-100
Date
May-2008
Language
English
Publication Type
Article
Keywords
Decision Making
Emotions
Family
Female
Humans
Interview, Psychological
Kidney
Male
Ontario
Social Work
Tissue Donors - psychology
Abstract
This article describes the experiences, feelings, and ideas of living kidney donors. Using a phenomenological, qualitative research approach, the authors interviewed 12 purposefully selected living kidney donors (eight men and four women), who were between four and 29 years since donation. Interviews were audiotaped, and transcribed verbatim, and the analysis of the data was both iterative and interpretive. Three key themes emerged. The first was how witnessing their loved ones' experience of illness and the threat of losing the recipient influenced the participants' decision to donate. The second focused on intrapersonal (philosophy of life) and interpersonal factors (comprehensive social support networks) that influenced the decision to be tested as a potential donor and the actual process of donation. The third was the impact of giving the gift of life, which was emotional and life changing. This article provides a rich description of the experiences of living kidney donors, revealing the multiple factors influencing the decision to donate, and provides insight on how social workers and other health care professionals need to identify and address the psychosocial needs of living kidney donors and their families from the process of decision making through after donation.
PubMed ID
18510123 View in PubMed
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Experiences of family medicine residents in primary care obstetrics training.

https://arctichealth.org/en/permalink/ahliterature126327
Source
Fam Med. 2012 Mar;44(3):178-82
Publication Type
Article
Date
Mar-2012
Author
Sudha Koppula
Judith Belle Brown
John M Jordan
Author Affiliation
Department of Family Medicine, University of Alberta, Edmonton, Alberta. koppula@ualberta.ca
Source
Fam Med. 2012 Mar;44(3):178-82
Date
Mar-2012
Language
English
Publication Type
Article
Keywords
Alberta
Attitude of Health Personnel
Career Choice
Family Practice - education
Female
Focus Groups
Humans
Internship and Residency - organization & administration
Male
Obstetrics - education
Questionnaires
Abstract
Obstetrical practice by family physicians has been declining rapidly for many reasons over the past number of decades. One reason for this trend is family medicine residents not considering intrapartum care as part of their future careers. Decisions such as this may be related to experiences during obstetrical training. This study explored the experiences of family medicine residents in core primary care obstetrics training.
Using qualitative approaches, focus groups of family medicine residents were conducted. The resulting data were audiotaped and transcribed verbatim. Independent and team analysis was both iterative and interpretive.
Data obtained from the focus groups revealed findings relating to the following categories: (1) perceived facilitators to practicing primary care obstetrics, (2) perceived barriers to practicing primary care obstetrics, and (3) learner experiences at the fulcrum of career decision making.
Family medicine residents were encouraged by favorable learning experiences and group shared-call arrangements by their primary care obstetrics preceptors. Some concerns about a career including obstetrics persisted; however, positive experiences, including influential fulcrum points, may inspire family medicine residents to pursue a career involving primary care obstetrics.
PubMed ID
22399480 View in PubMed
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Exploring family physician stress: helpful strategies.

https://arctichealth.org/en/permalink/ahliterature152091
Source
Can Fam Physician. 2009 Mar;55(3):288-289.e6
Publication Type
Article
Date
Mar-2009
Author
F Joseph Lee
Judith Belle Brown
Moira Stewart
Author Affiliation
Centre for Family Medicine, 25 Joseph St, Kitchener, ON N2G 4X6. joelinda1@rogers.com
Source
Can Fam Physician. 2009 Mar;55(3):288-289.e6
Date
Mar-2009
Language
English
Publication Type
Article
Keywords
Adult
Aged
Female
Humans
Incidence
Interpersonal Relations
Male
Middle Aged
Occupational Exposure - adverse effects
Ontario - epidemiology
Physicians, Family - psychology
Quality of Life
Questionnaires
Retrospective Studies
Stress, Psychological - epidemiology - prevention & control - psychology
Abstract
To explore the nature of professional stress and the strategies used by family physicians to deal with this stress.
Qualitative study.
Kitchener-Waterloo, Ont.
Ten key-informant family physicians.
In-depth interviews were conducted with key informants. A total of 40 key informants were identified, based on selected criteria; 24 provided consent. The potential participants were rank-ordered for interviews to provide maximum variation in age, sex, and years in practice. Interviews were conducted, audiotaped, transcribed verbatim, and analyzed until thematic saturation was reached, as determined through an iterative process. This occurred after 10 in-depth interviews. Immersion and crystallization techniques were used.
The participants described professional stresses and strategies at the personal, occupational, and health care system levels. Personal stressors included personality traits and the need to balance family and career, which were countered by biological, psychological, social, and spiritual strategies. Occupational stressors included challenging patients, high workload, time limitations, competency issues, challenges of documentation and practice management, and changing roles within the workplace. Occupational stressors were countered by strategies such as setting limits, participating in continuing medical education, soliciting support from colleagues and staff, making use of teams, improving patient-physician relationships, exploring new forms of remuneration, and scheduling appropriately. Stressors affecting the wider health care system included limited resources, imposed rules and regulations, lack of support from specialists, feeling undervalued, and financial concerns.
Family physicians face a multitude of challenges at personal, occupational, and health care system levels. A systems approach provides a new framework in which proactive strategies can augment more than one level of a system and, in contrast, reactive strategies can have negative inputs for different system levels.
Notes
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PubMed ID
19282541 View in PubMed
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Family physicians' roles in cancer care. Survey of patients on a provincial cancer registry.

https://arctichealth.org/en/permalink/ahliterature179322
Source
Can Fam Physician. 2004 Jun;50:889-96
Publication Type
Article
Date
Jun-2004
Author
Jeffrey J Sisler
Judith Belle Brown
Moira Stewart
Author Affiliation
CancerCare Manitoba. jeff.sisler@cancercare.mb.ca
Source
Can Fam Physician. 2004 Jun;50:889-96
Date
Jun-2004
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Anecdotes as Topic
Attitude of Health Personnel
Family Practice - standards
Female
Humans
Male
Manitoba
Middle Aged
Neoplasms - therapy
Patient Education as Topic - methods
Patient Participation - statistics & numerical data
Patient Satisfaction - statistics & numerical data
Patient-Centered Care - organization & administration
Physician's Practice Patterns - statistics & numerical data
Physician's Role
Physician-Patient Relations - ethics
Questionnaires
Referral and Consultation
Registries
Abstract
To describe cancer patients' experience of the role of family physicians (FPs) in their care.
Mail survey of a random sample of patients from the Manitoba Cancer Registry.
Manitoba.
Two hundred two adults, 6 to 12 months after diagnosis.
Proportion needing different kinds of help from FPs and their rating of FPs' response; FACT-G quality-of-life score.
Response rate was 56.6%; two thirds of the sample were in the follow-up phase. Most (91%) had an FP involved in their care, but FP involvement decreased after diagnosis. The most frequently needed kinds of help (with general medical problems, quick referrals, taking extra time, and quick office appointments) were well provided by FPs, but family support was not. Higher quality-of-life scores were associated with more help with general medical problems, more provision of cancer-related information, and more emotional support of patients and their families.
Family physicians respond well to the most common needs of cancer patients and should be proactive in offering their support to both patients and families.
Notes
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PubMed ID
15233372 View in PubMed
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Genetic susceptibility to cancer. Family physicians' experience.

https://arctichealth.org/en/permalink/ahliterature186532
Source
Can Fam Physician. 2003 Jan;49:45-52
Publication Type
Article
Date
Jan-2003
Author
June C Carroll
Judith Belle Brown
Sean Blaine
Gord Glendon
Patricia Pugh
Wendy Medved
Author Affiliation
Family Healthcare Research Unit, Department of Family and Community Medicine, University of Toronto, Ont. june.carroll@utoronto.ca
Source
Can Fam Physician. 2003 Jan;49:45-52
Date
Jan-2003
Language
English
Publication Type
Article
Keywords
Adult
Attitude of Health Personnel
Attitude to Health
Education, Medical, Continuing
Family Practice - education
Female
Focus Groups
Genetic Testing
Humans
Male
Neoplasms - genetics - prevention & control
Ontario
Abstract
To explore family physicians' experiences in dealing with genetic susceptibility to cancer.
Qualitative study using focus groups.
Four Ontario sites: northern, rural, urban, and inner city.
Forty rural and urban FPs participated in four focus groups: 28 were male; average age was 41.
Focus groups using a semistructured interview guide were audiotaped and transcribed. The constant comparative method of data analysis was used. Key words and concepts were identified. Data were sorted using NUD*IST software.
Participants realized the escalating expectations for genetic testing and its effect on family practice. They explored an expanded role for themselves in genetic testing. Possible activities included risk assessment, gatekeeping, and ordering genetic tests. They were concerned about the complexity of genetic testing, the lack of evidence regarding management, and the implications for families.
We must help FPs struggling to integrate genetics into their practices, by addressing their concerns, enhancing the way they communicate information on genetics, and developing appropriate educational tools.
Notes
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PubMed ID
12602842 View in PubMed
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Interdisciplinary primary health care research training through TUTOR-PHC: the insiders' view.

https://arctichealth.org/en/permalink/ahliterature151503
Source
J Interprof Care. 2009 Jul;23(4):414-6
Publication Type
Article
Date
Jul-2009

34 records – page 1 of 4.