How care holds humanity: the myth of Cura and theories of care

Modern medicine has often struggled to grasp the cultural aspects of interpersonal care. The medical humanities, on the other hand, have struggled to grasp the embodied, intimate character of care. In a recent appeal to the medical humanities, Julia Kristeva et al argue that care can be a point of crossing between these two ‘ontological domains’. They evoke the myth of Cura, referring to previous utilisations by such diverse thinkers as Heidegger and Kleinman, as well as Kristeva’s previous work. This study adds to these bodies of work by using the original text from Hyginus in much greater detail. Textual analysis, theoretical discussions and autotheoretical work unpack care as (1) a fundamental aspect of the human condition, (2) a holding-together of different domains of knowledge, (3) a withholding from these domains and (4) the site of intimate knowledge that both ‘ontological domains’ struggle to grasp.

Associations between emergency department crowding and perceptions of interpersonal care in patients presenting with suspected acute coronary syndrome

BackgroundEmergency department (ED) crowding is associated with numerous healthcare issues, but little is known about its effect on psychosocial aspects of patient-provider interactions or interpersonal care. We examined whether ED crowding was associated with perceptions of interpersonal care in patients evaluated for acute coronary syndrome (ACS).MethodsPatients presenting to a quaternary academic medical centre ED in New York City for evaluation of suspected ACS were enrolled between November 2013 and December 2016. ED crowding was measured using the ED Work Index (EDWIN), which incorporates patient volume, triage category, physician staffing and bed availability. Patients completed the 18-item Interpersonal Processes of Care (IPC) survey, which assesses communication, patient-centred decision-making and interpersonal style. Regression analyses examined associations between EDWIN and IPC scores, adjusting for demographics, comorbidities and depression.ResultsAmong 933 included patients, 11% experienced ED overcrowding (EDWIN score >2) at admission, 11% experienced ED overcrowding throughout the ED stay and 30% reported suboptimal interpersonal care (defined as per-item IPC score <5). Higher admission EDWIN score was associated with modestly lower IPC score in both unadjusted (β=–1.70, 95% CI –3.15 to –0.24, p=0.02) and adjusted models (β = –1.77, 95% CI –3.31 to –0.24, p=0.02). EDWIN score averaged over the entire ED stay was not significantly associated with IPC score (unadjusted β=–1.30, 95% CI –3.19 to 0.59, p=0.18; adjusted β=–1.24, 95% CI –3.21 to 0.74, p=0.22).ConclusionIncreased crowding at the time of ED admission was associated with poorer perceptions of interpersonal care among patients with suspected ACS.

Comunicação como instrumento de enfermagem no cuidado interpessoal do usuário

O objetivo é realizar um levantamento sobre os achados científicos quanto ao uso da comunicação como instrumento de enfermagem no cuidado interpessoal do usuário no período de 2015 a 2019. Realizou-se uma busca nas bases de dados BVS, Science Direct, Scopus e Pubmed. Selecionaram-se artigos na íntegra; em português, inglês e espanhol; publicados entre 2015 a 2019. Utilizou-se o CASP para análise de elegibilidade dos estudos, analisando-os de maneira descritiva. Os termos de pesquisa utilizados foram: “comunicação”, “relações interpessoais” e “enfermagem”. Treze artigos foram selecionados para este estudo. Mostrou-se, pelos resultados desta revisão, que o uso da comunicação pode influenciar positivamente no cuidado de enfermagem, com a explicitação de alguns elementos que efetivam a comunicação interpessoal entre os profissionais e o usuário, além de demonstrar que existem desafios e obstáculos encontrados pelos profissionais para efetivá-la, mas que podem ser superados pela adoção de ações e medidas necessárias na prática assistencial.Descritores: Comunicação, Relações Interpessoais, Enfermagem, Cuidados de Enfermagem. Communication as a nursing instrument in user's interpersonal careAbstract: The objective is to carry out a survey on the scientific findings regarding the use of communication as a nursing instrument in the user's interpersonal care in the period from 2015 to 2019. A search was conducted in the BVS, Science Direct, Scopus and Pubmed databases. Full articles were selected; in Portuguese, English and Spanish; published between 2015 to 2019. CASP was used to analyze the eligibility of studies, analyzing them in a descriptive manner. The search terms used were: “communication”, “interpersonal relationships” and “nursing”. thirteen articles were selected for this study. It was shown, through the results of this review, that the use of communication can positively influence nursing care, with the explanation of some elements that effect interpersonal communication between professionals and the user, in addition to demonstrating that there are challenges and obstacles encountered by professionals to carry it out, but which can be overcome by the adoption of actions and measures necessary in care practice.Descriptors: Communcation, Interpersonal Relations, Nursing, Nursing Care. La comunicación como instrumento de enfermería en el cuidado interpersonal del usuarioResumen: El objetivo es realizar una encuesta sobre los hallazgos científicos sobre el uso de la comunicación como instrumento de enfermería en el cuidado interpersonal del usuario en el período de 2015 a 2019. Se realizó una búsqueda en las bases de datos VHL, Science Direct, Scopus y Pubmed. Se seleccionaron artículos completos; en portugués, inglés y español; publicados entre 2015 y 2019. Se utilizó CASP para analizar la elegibilidad de los estudios, analizándolos de manera descriptiva. Los términos de búsqueda utilizados fueron: "comunicación", "relaciones interpersonales" y "enfermería". Se seleccionaron trece artículos para este estudio. Se demostró, a través de los resultados de esta revisión, que el uso de la comunicación puede incidir positivamente en el cuidado de enfermería, con la explicación de algunos elementos que inciden en la comunicación interpersonal entre los profesionales y el usuario, además de demostrar que existen desafíos y obstáculos encontrados por profesionales para llevarlo a cabo, pero que puede superarse mediante la adopción de acciones y medidas necesarias en la práctica asistencial.practice.Descriptores: Comunicación, Relaciones Interpersonales, Enfermaría, Atención de Enfermaria.

Perspectives on Interpersonal Care Among People Who Obtain Abortions Through Clinical and Accompaniment Models in Argentina

Introduction: Little is known about how people who obtain abortion services perceive quality and what aspects of interpersonal care matter to them. This qualitative study aimed to understand preferences among people seeking abortions at a reproductive health clinic and an accompaniment model of self-managed abortion in Argentina. Study Design: We conducted 24 in-depth interviews with people who obtained abortion care in Neuquén and Buenos Aires, Argentina. We iteratively coded transcripts using a thematic analysis approach based on interpersonal domains present in current quality of care frameworks. Results Participants described high-quality abortion care as feeling acompañamiento and contención from their providers – terms that imply receiving kind, caring, compassionate and emotionally supportive care throughout their abortions. They described four key elements of interpersonal interactions: attentive communication from providers and accompaniers, clear and understandable information provision, non-judgmental support, and individualized options for pain management. Conclusions People obtaining abortions in two distinct models of care in Argentina consistently identified receiving compassionate and supportive care throughout an abortion as a key aspect of care. The findings have implications for incorporating client perspectives in the development of care guidelines, training of providers, and monitoring and improving of services. This is particularly important as the government of Argentina prepares to expand legal access to abortion.

Client perceived quality of the postnatal care provided by public sector specialized care institutions following a normal vaginal delivery in Sri Lanka: a cross sectional study

Background Majority of the maternal and neonatal adverse events take place during the postnatal period. Provision of high-quality care during this period can minimize these events. Assessment of mothers’ perceptions of the quality of care received by them provides valuable feedback to improve the care and ultimately outcomes. Methods A cross sectional survey was conducted in specialized institutions of Colombo district, Sri Lanka, to assess the maternal perceptions of the quality of regular postnatal care and its correlations, using an interviewer administered questionnaire. The questionnaire contained 23 items distributed under three main domains: technical and information domain, interpersonal care domain and ward facilities and cleanliness domain. Each item was given a score from 1 to 5 and total scores were calculated for the total questionnaire and for each domain. Descriptive statistics were used to assess the perceptions and multivariate analysis was conducted to assess the significant correlates of positive perceptions. Results The median score obtained for the questionnaire was 108, (Inter Quartile Range 96–114). The median scores of the technical care and information domain, interpersonal care domain and ward facilities and cleanliness domain were 43 (IQR 38–45), 33 (IQR 30–35) and 32 (IQR 28–35) respectively. Attending teaching/ specialized hospitals (aOR=1.6, p < 0.001), 20–35 age group (1.8, p = 0.024), and services such as initiation of breast feeding within 1 h of delivery (2.1, p = 0.009), pain relief during episiotomy suturing (2.2, p < 0.001), practicing Kangaroo Mother Care (1.4, p = 0.035), receiving health advices by doctors or midwives (2.1, p < 0.001) were significant correlates of positive perceptions. Conclusions Majority of mothers had favourable perceptions of the quality of care received by them. However, the ward facilities and environment domain has obtained lower ratings compared to technical and interpersonal care domains. Several services were significantly associated with favourable perceptions. Authorities should consider these findings when attempting to improve care quality. Further, this assessment should be carried out regularly to obtain more current data.

Client perceived quality of postnatal care following a normal delivery provided by public sector specialized care institutions in Sri Lanka: A cross sectional study

Background: Majority of the maternal and neonatal adverse events take place during the postnatal period. Provision of high-quality care during this period can minimize these events. Assessment of mothers’ perceptions of the quality of care received by them provides valuable feedback to improve the care and ultimately outcomes. Methods: A cross sectional survey was conducted in specialized institutions of Colombo district, Sri Lanka, to assess the maternal perceptions of the quality of regular postnatal care and its correlations, using an interviewer administered questionnaire. The questionnaire contained 23 items distributed under three main domains: technical and information domain, interpersonal care domain and ward facilities and cleanliness domain. Each item was given a score from 1 to 5 and total scores were calculated for the total questionnaire and for each domain. Descriptive statistics were used to assess the perceptions and multivariate analysis was conducted to assess the significant correlates of positive perceptions. Results: The median score obtained for the questionnaire was 108, (Inter Quartile Range 96-114). The median scores of the technical care and information domain, interpersonal care domain and ward facilities and cleanliness domain were 43 (IQR 38-45), 33 (IQR 30-35) and 32 (IQR 28-35) respectively. Attending teaching/ specialized hospitals (1.6, p<0.001), 20-35 age group (aOR=1.8, p=0.024), and services such as initiation of breast feeding within one hour of delivery (2.1, p=0.009), pain relief during episiotomy suturing (2.2, p<0.001), practicing Kangaroo Mother Care (1.4, p=0.035), receiving health advices by doctors or midwives (2.1, p<0.001) were significant correlates of positive perceptions. Conclusions: Majority of mothers had favourable perceptions of the quality of care received by them. However, the ward facilities and environment domain has obtained lower ratings compared to technical and interpersonal care domains. Several services were significantly associated with favourable perceptions. Authorities should consider these findings when attempting to improve care quality. Further, this assessment should be carried out regularly to obtain more current data. Key words: Client perceptions, Postnatal care, Quality of care, Client perceived care, institutional postnatal care

Client perceived quality of the postnatal care provided by public sector specialized care institutions following a normal vaginal delivery in Sri Lanka: A cross sectional study

Background: Majority of the maternal and neonatal adverse events take place during the postnatal period. Provision of high-quality care during this period can minimize these events. Assessment of mothers’ perceptions of the quality of care received by them provides valuable feedback to improve the care and ultimately outcomes. Methods: A cross sectional survey was conducted in specialized institutions of Colombo district, Sri Lanka, to assess the maternal perceptions of the quality of regular postnatal care and its correlations, using an interviewer administered questionnaire. The questionnaire contained 23 items distributed under three main domains: technical and information domain, interpersonal care domain and ward facilities and cleanliness domain. Each item was given a score from 1 to 5 and total scores were calculated for the total questionnaire and for each domain. Descriptive statistics were used to assess the perceptions and multivariate analysis was conducted to assess the significant correlates of positive perceptions. Results: The median score obtained for the questionnaire was 108, (Inter Quartile Range 96-114). The median scores of the technical care and information domain, interpersonal care domain and ward facilities and cleanliness domain were 43 (IQR 38-45), 33 (IQR 30-35) and 32 (IQR 28-35) respectively. Attending teaching/ specialized hospitals (1.6, p<0.001), 20-35 age group (aOR=1.8, p=0.024), and services such as initiation of breast feeding within one hour of delivery (2.1, p=0.009), pain relief during episiotomy suturing (2.2, p<0.001), practicing Kangaroo Mother Care (1.4, p=0.035), receiving health advices by doctors or midwives (2.1, p<0.001) were significant correlates of positive perceptions. Conclusions: Majority of mothers had favourable perceptions of the quality of care received by them. However, the ward facilities and environment domain has obtained lower ratings compared to technical and interpersonal care domains. Several services were significantly associated with favourable perceptions. Authorities should consider these findings when attempting to improve care quality. Further, this assessment should be carried out regularly to obtain more current data. Key words: Client perceptions, Postnatal care, Quality of care, Client perceived care, institutional postnatal care

Client perceived quality of postnatal care following a normal delivery provided by public sector specialized care institutions in Sri Lanka: A cross sectional study

Background Majority of the maternal and neonatal adverse events take place during the postnatal period. Provision of high-quality care during this period can minimize these events. Assessment of mothers’ perceptions of the quality of care received by them provides valuable feedback to improve the care and ultimately outcomes. Methods A cross sectional survey was conducted in specialized institutions of Colombo district, Sri Lanka, to assess the maternal perceptions of the quality of regular postnatal care and its correlations, using an interviewer administered questionnaire. Descriptive statistics were used to assess the perceptions and multivariate analysis was conducted to assess the significant correlates of positive perceptions. Results The median score obtained for the questionnaire was 108, (96-114). The median scores of the technical care and information domain, interpersonal care domain and ward facilities and cleanliness domain were 43 (38-45), 33 (30-35) and 32 (28-35) respectively. Attending teaching/ specialized hospitals (1.6, p<0.001), 20-35 age group (aOR=1.8, p=0.024), and services such as initiation of breast feeding within one hour of delivery (2.1, p=0.009), pain relief during episiotomy suturing (2.2, p<0.001), practicing KMC (1.4, p=0.035), receiving health advices by doctors or midwives (2.1, p<0.001) were significant correlates of positive perceptions. Conclusions Majority of mothers had favourable perceptions of the quality of care received by them. However, the ward facilities and environment domain has obtained lower ratings compared to technical and interpersonal care domains. Several services were significantly associated with favourable perceptions. Authorities should consider these findings when attempting to improve care quality. Further, this assessment should be carried out regularly to obtain more current data.

“Women and 2spirits”: On the Marginalization of Transgender Indigenous People in Activist Rhetoric

The phrase “women and 2spirits” has become increasingly popular in Indigenous gender-related activism, often noted through the expansion of the hashtag for missing and murdered Indigenous people to #MMIWG2. This article uses the phrase as a jumping-off point to think about how transgender Indigenous people remain marginalized even in feminist, queer, and Indigenous activist spaces. Emphasizing the scholarship of Indigenous trans women, the article argues that rhetorical exclusion has tangible negative impacts on transgender Indigenous people. The writing and activism of such individuals offers solutions that center decolonial love and interpersonal care work as sites for transforming gender relations in Indigenous communities.