A Narrative Study of Patient Encounter Accounts of Physicians, Nurses, and Medical Receptionists after Two Decades of a Paradigm of Patient-Centered Care

Despite recent well-known advancements in patient care in the medical fields, such as patient-centeredness and evidence-based medicine and practice, there is rather less known about their effects on the particulars of clinician-patient encounters. The emphasis in clinical encounters remains mostly on treatment and diagnosis and less on communicative competency or engagement for medical professionals. The purpose of this narrative study was to explore interactive competencies in diagnostic and therapeutic encounters and intake protocols within the context of the physicians’, nurses’, and medical receptionists’ perspectives and experiences. Literature on narrative medicine, phenomenology and medicine, therapeutic relationships, cultural and communication competency, and non-Western perspectives on human communication provided the guiding theoretical frameworks for the study. Three data sets including 13 participant interviews (5 physicians, 4 nurses, and 4 medical receptionists), policy documents (physicians, nurses, and medical receptionists) and a website (Communication and Cultural Competency) were used. The researcher then engaged in triangulated analyses, including N-Vivo, manifest and latent, Mishler’s (1984, 1995) narrative elements and Charon’s (2005, 2006a, 2006b, 2013) narrative themes, in recursive, overlapping, comparative and intersected analysis strategies. A common factor affecting physicians’ relationships with their clients was limitation of time, including limited time (a) to listen, (b) to come up with a proper diagnosis, and (c) to engage in decision making in critical conditions and limited time for patients’ visits. For almost all nurse participants in the study establishing therapeutic relationships meant being compassionate and empathetic. The goals of intake protocols for the medical receptionists were about being empathetic to patients, being an attentive listener, developing rapport, and being conventionally polite to patients. Participants with the least iv amount of training and preparation (medical receptionists) appeared to be more committed to working narratively in connecting with patients and establishing human relationships as well as in listening to patients’ stories and providing support to narrow down the reason for their visit. The diagnostic and intake “success stories” regarding patient clinical encounters for other study participants were focused on a timely securing of patient information, with some acknowledgement of rapport and emapathy. Patient-centeredness emerged as a discourse practice, with ambiguous or nebulous enactment of its premises in most clinical settings.

Experiential Learning: Creating Meaningful Opportunities

This study examined the practice and implementation of undergraduate student internships in Ontario, Canada. A literature review revealed that implementation of internships at the undergraduate level in Ontario varies within campuses by faculty and department and also across the university spectrum, partly due to a lack of consistency and structure guiding internship practice in Ontario. Moreover, a lack of general consensus among participating stakeholders concerning the philosophy and approach to internship further complicates and varies its practice. While some departments and universities have started to embrace and implement more experiential learning opportunities into their curriculum, the practice of undergraduate internships is struggling to gain acceptance and validity in others. Using the theory of experiential learning as presented by Dewey (1938) and Kolb (1984) as theoretical frameworks, this research project developed an internship implementation strategy to provide structure and guidance to the practice of internships in Ontario’s undergraduate university curriculum.

Arthur A. Schmon fonds

Arthur Albert Schmon was born in 1895 in Newark, New Jersey. During his studies at Barringer High School in Newark, he met Eleanore Celeste Reynolds who was to become his wife in August of 1919. Mr. Schmon studied English literature at Princeton and graduated with honours in 1917. That same year, Mr. Schmon joined the United States Army where he served under Colonel McCormick as an adjutant in field artillery in World War I. In 1919, he was discharged as a captain. Colonel McCormick (editor and publisher of the Chicago Tribune) offered Schmon a job in his Shelter Bay pulpwood operations. Mr. Schmon accepted the challenge of working at this lonely outpost on the lower St. Lawrence River. Schmon was promoted to Woodlands Manager in 1923. In 1930, he became the General Manager. This was expected to be a seasonal operation but the construction of the mill led to the building of a town (Baie Comeau) and its power development. All of this was accomplished under Schmon’s leadership. In 1933, he was elected the President and General Manager of the Ontario Paper Company. He later became the Chairman and Chief Executive Officer. Arthur Schmon made his home in St. Catharines where he played an active role in the community. Schmon was a member of the Founders’ Committee at Brock University and he was a primary force behind the establishment of a University in the Niagara Region. The Brock University Tower is named after him. He also served as Chairman of the St. Catharines Hospital Board of Governors for over 15 years, and was responsible for guiding the hospital through a 3 million dollar expansion program. He was a Governor of Ridley College and an Honorary Governor of McMaster University in Hamilton. Mr. Schmon died of lung cancer on March 18, 1964. He had been named as the St. Catharines’ citizen of the year just one week earlier. Mr. Schmon had 2 sons Robert McCormick Schmon, who was chairman of the Ontario Paper Co. Ltd., St. Catharines, Canada, and the Q.N.S. Paper Co., Baie-Comeau, Canada. He was also director of a Chicago Tribune Co. He died at the age of 61. Another son, Richard R. Schmon, was a second lieutenant in the 313th Field Artillery Battalion, 80th Infantry Division in World War II. He was listed as missing in action on November 5, 1944.

Interprofessional Collaboration: The Experience of Nursing and Medical Students’ Interprofessional Education

In this hermeneutic phenomenological study, we examined the experience of interprofessional collaboration from the perspective of nursing and medical students. Seventeen medical and nursing students from two different universities participated in the study. We used guiding questions in face-to-face, conversational interviews to explore students’ experience and expectations of interprofessional collaboration within learning situations. Three themes emerged from the data: the great divide, learning means content, and breaking the ice. The findings suggest that the experience of interprofessional collaboration within learning events is influenced by the natural clustering of shared interests among students. Furthermore, the carry-forward of impressions about physician–nurse relationships prior to the educational programs and during clinical placements dominate the formation of new relationships and acquisition of new knowledge about roles, which might have implications for future practice.

The Lived Experience of Nursing Students With Formative Assessment Formally Embedded in Clinical Courses: A Transcendental Phenomenological Study

The potential of formative assessment (FA) for informing learning in classroom-based nursing courses is clearly established in the literature; however, research on FA in clinical courses remains scarce. This inquiry explored the lived experience of nursing students using transcendental phenomenology and described the phenomenon of being assessed in clinical courses. The research question guiding the study was: How is the phenomenon of assessment experienced by nursing students when FA is formally embedded in clinical courses? Inherent in this question were the following issues: (a) the meaning of clinical experiences for nursing students, (b) the meaning of being assessed through FA, and (c) what it is like to be assessed when FA is formally embedded within clinical experiences. The noematic themes that illuminated the whatness of the participants’ experience were (a) enabled cognitive activity, (b) useful feedback, (c) freedom to be, (d) enhanced focus, (e) stress moderator, and (f) respectful mentorship. The noetic themes associated with how the phenomenon was experienced were related to bodyhood, temporality, spatiality, and relationship to others. The results suggest a fundamental paradigm shift from traditional nursing education to a more pervasive integration of FA in clinical courses so that students have time to learn before being graded on their practice. Furthermore, this inquiry and the literature consulted provide evidence that using cognitive science theory to inform and reform clinical nursing education is a timely option to address the repeated calls from nursing leaders to modernize nursing education. This inquiry contributes to reduce our reliance on assumptions derived from research on FA in nursing classrooms and provides evidence based on the reality of using formative assessment in clinical courses. Recommendations for future research are presented.