Healthcare and Listening: A Relationship for Caring

The optimal relationship between healthcare provider and patient is one of trust. This therapeutic relationship is dependent on the ability of the healthcare provider to communicate effectively with the patient. Research indicates that when healthcare providers listen to patients, there is more compliance with medical regimens, patient satisfaction is increased, and physicians are less vulnerable to malpractice lawsuits. Within the last few decades, the relationship between physician and patient has been reconceptualized from a paternalistic relationship to a partnership between provider and patient. This change is demanding a shift in how healthcare providers communicate and, in particular, listen to patients. To address this need, medical organizations such as the Accreditation Council for Graduate Medical Education has emphasized improved training and competence in communication skills of physicians. Effective communication and listening also is critical to the ethical treatment of patients and their families. This paper will discuss the critical component of listening within the healthcare context.     

The Use of Common Humanity Scenarios to Promote Compassion in Healthcare Workers

ABSTRACT

The importance of compassion in healthcare is universally acknowledged. However, the factors that enhance compassion are not well understood. The perception of common humanity has been proposed as a prosocial perspective that leads to unbiased universal compassion. There has been a lack of research into the relationship between common humanity and compassion. This study examined the use of common humanity scenarios to promote compassion in healthcare workers. Seventy-five healthcare workers were randomly assigned to two groups and shown a different common humanity scenario. The healthcare workers were asked what effect viewing the videos had on their perception of common humanity and compassion. Thematic analysis was used to identify themes. Four main themes emerged: (a) common bonds; (b) people have the same needs; (c) no one wants to suffer; (d) seeing strangers helping others is motivating. Healthcare workers reported feelings of care, concern, and compassion after viewing common humanity scenarios.

IMPLICATIONS

• Viewing common humanity scenarios appears to lead to enhanced feelings of connection to others and compassion in healthcare workers.

• Using common humanity scenarios may be a useful compassion training strategy in healthcare.

• Further research is necessary to gain a better understanding of how viewing common humanity material influences compassion.

     

Healthcare for the uninsured: is mandation the answer?

The 37 million people in the United States who have no healthcare insurance pose a major social problem, but is legislation that requires employers to provide a minimum amount of healthcare coverage for employees the solution?     

Healthcare Access among Older Rural Women Veterans in Utah*

Using gender and life course frameworks attuned to overlapping roles and statuses, this exploratory case study highlights the experiences of older, rural female veterans in Utah with accessing Veterans Administration and other healthcare. Based on three focus groups with 22 women, findings show that these veterans experienced similar healthcare access obstacles to female veterans in other contexts. Most also experienced invisibility and discrimination in the military, which carried over as they became veterans. However, while these older, rural women veterans voiced new concerns about their own healthcare in later life course stages, they also described extensive experience with coordination of services and advocacy for other veterans, family and rural community members. Thus, these women veterans acted as healthcare advocates in a complex, bureaucratic, strained system. Feeling largely excluded from the male veterans' networks and organizations, they perceived the need to create new networks that could assist veterans in need.     

Disparities in Healthcare Utilization in China: Do Gender and Migration Status Matter?

Using a multi-stage cluster sampling approach, we collected healthcare and demographic data from 531 migrants and 529 local urban residents aged 16–64 in Shanghai, China. Logistic regressions were used to analyze the relationship between gender-migration status and healthcare utilization while controlling for predisposing, enabling and needs factors. Other things equal, female migrants and male locals had significantly lower actual healthcare utilization rates, compared to female locals. Female migrants were more likely to report “no money” as a reason for not seeking care, while male locals were more likely to report “self-medication” as a reason. Considering established gender differences in healthcare utilization, we conclude that female migrants as a group face the most healthcare access barriers among all groups.     

Healthcare Experiences of Latinos in a Nontraditional Destination Area

The purpose of this study was to describe the health and healthcare experiences of immigrant Latinos compared to USA-born Latinos, Whites, and African Americans in Greater Cincinnati, Ohio, a nontraditional immigrant destination area. Immigrant Latinos had significantly worse physical and mental health than other groups and significantly more barriers to healthcare. Latinos rated the degree to which their town is socially accepting of Latinos. Lower social acceptance was correlated with worse mental health and more barriers to healthcare. Geographic information system (GIS) mapping techniques revealed geographic patterns in the association between social acceptance of Latinos and health outcomes.     

Perceived Cultural Distance in Healthcare in Immigrant Intercultural Medical Encounters

This article responds to the paucity of empirical research on the impact of patient-provider ethno-cultural distance and providers' cultural competence on the quality of healthcare service in migrant intercultural medical encounters in Australia. A cross-sectional study was conducted with 447 patients, consisting of 195 Caucasian and 252 non-Caucasian patients from six outpatient clinics in New South Wales, Australia. Structural equation modelling was used for data analysis. The findings demonstrated that cultural distance is an influential factor in perceived quality of outpatient care. Caucasian and non-Caucasian patients' perception of cultural distance between their physicians and themselves affected their service quality ratings of their physicians' professionalism, empathy and expertise. This is the first study on healthcare service quality in outpatient clinics in Australia for Caucasian and non-Caucasian patients. Policy implications suggest intervention strategies and the need for cultural competence education in medical and health curricula in medical schools and clinical practices.     

Adverse Childhood Experiences and Healthcare Costs in Adult Life

ABSTRACT

The current study aims to present the prevalence of adverse childhood experiences and examine the healthcare costs associated with primary, allied, and specialist healthcare services. The Australian Longitudinal Study on Women’s Health is a general health survey of four nationally representative age cohorts. The current study uses 20 years of survey and administrative data (1996–2015) from the cohort born 1973–1978. Overall, 41% of women indicated at least one category of childhood adversity. The most commonly reported type of childhood adversity was having a household member with a mental illness (16%), with the most commonly reported ACES category being psychological abuse (17%). Women who had experienced adversity in childhood had higher healthcare costs than women who had not experienced adversity. The healthcare costs associated with experiences of adversity in childhood fully justify a comprehensive policy and practice review.     

Healthcare for men and women with learning disabilities: understanding inequalities in access

Healthcare for men and women with learning disabilities (known internationally as intellectual disabilities) has risen up the political agenda in the United Kingdom, propelled by a report from the charity Mencap. This report has resulted in renewed efforts, set out in Valuing People Now, to ensure that people with learning disabilities receive the healthcare they are entitled to. This paper, drawing upon experience in England, describes the challenges of providing healthcare to men and women with learning disabilities; reviews Death by Indifference and the reports produced in its aftermath; presents findings from a small-scale study of access to healthcare undertaken in the East of England; and concludes with a discussion of whether the policies in Valuing People Now will improve healthcare for men and women with learning disabilities.     

Under What Conditions do Lesbians Disclose Their Sexual Orientation to Primary Healthcare Providers? A Review of the Literature

Under what conditions do lesbians disclose their sexual orientation to primary healthcare providers? A review of the literature was undertaken to answer this question and to provide insight into the ways healthcare professionals can play an active role assisting their lesbian patients in “coming out.” Thirty empirical studies met the inclusion criteria and were reviewed. Collectively, these separate studies have found that a myriad of internal (patient attributes) and external (healthcare context, patient–provider relationship) factors influence disclosure. The discussion highlights the critical role of healthcare professionals in supporting disclosure.     

Improving healthcare for children entering foster care

Despite the fact that children in foster care are, perhaps, the most vulnerable children, healthcare for them has been lacking woefully for many years. A growing body of research has documented the need for such care as well as the failure of child welfare agencies to make major improvements in providing healthcare to foster children. Nonetheless, current efforts are being made to change this situation. This article reports on one effort to improve the provision and timeliness of health exams for children entering care. One rural and one urban county served as project treatment sites, with two additional rural and urban counties serving as control sites. The treatment sites achieved a statistically significant improvement in their rate of exam completion as compared to the control sites. The study finds that despite an existing policy for healthcare for children entering foster care, legislation mandating additional efforts, shortened time frames, and provision for judicial oversight are needed for improvement.     

Noncitizen Employment and the Wages of Healthcare Support Workers in the US

This study examines the relative wages of citizens and noncitizens employed as healthcare support workers as well as examines the effect of noncitizen support worker employment on the wages of citizen support workers. Relative wage findings reveal noncitizen support workers with less than eight years of US residency receive a noncitizen-citizen wage discount statistically significantly greater than the legal maximum of 5% below the local prevailing wage. These low relative wage levels could contribute to lower wages for citizen support workers, however elasticity of substitution findings suggest noncitizen support workers are not close substitutes for healthcare support workers who are US citizens. In addition, wage effect findings do not reveal a negative influence of noncitizen employment on the wages of native born US citizen support workers, while these findings reveal a relatively small wage decline for naturalized support workers. These findings are consistent with the citizen status job heterogeneity hypothesis. Nonetheless, finding noncitizen-citizen wage differences does not allow for ruling out the possibility of weak enforcement of prevailing wage legislation and possible employment of undocumented workers.     

日本公共医疗保险制度的互助共济机制

在世界上老年人口抚养比较高的国家之中,日本公共医疗保险制度的医药费支出占GDP的比例相对较低。本文详尽地介绍日本独特的、完整成熟的跨年龄、地区和职业的医保互助机制及其背景和理念。因职业、年龄等不同,每个人所参保的制度不同,但是在待遇方面,所有的制度对于医药服务的种类和报销政策都相同。患者可以在任何时候、选择任何医院就诊。筹资模式因制度不同而不同,当一个制度所覆盖的群体主要是低收入者时,政府用财政的一般预算收入来资助。由于年龄分布不同所造成的各个制度的医药费支出负担的不同,本着公平的原则进行了调整。调整了年龄差距之后的人均医药费支出总额相同的话,不管在哪个地区,收入相同的人应当缴纳相同数额的保费。     

Nursing a Grievance? The Role of Healthcare Assistants in a Modernized National Health Service

The complex division of labour in health care has encouraged the analysis of occupational boundary disputes between separate professions. Less attention has been directed at the divisions in individual occupational groups but in a context of intensive health sector workforce reform there has been a growth in lower status occupations. This article extends debate about lower status occupations by exploring the manner in which nurses and healthcare assistants engage in boundary work to advance their occupational interests. The UK government's modernization agenda has encouraged a more prominent role for healthcare assistants and the findings confirm that this agenda has reinforced occupational boundary disputes between nurses and healthcare assistants. Tensions between nurses and healthcare assistants took particular forms influenced by gendered notions of caring work. The consequences of these boundary management strategies in terms of work undertaken, pay and status are also explored.     

Evaluation of Social Work Communication Skills to Allow People with Aphasia to be Part of the Decision Making Process in Healthcare

The purpose of this paper is to examine how social workers are trained to interact with individuals with communication barriers in healthcare. Consent to treatment and the right to decide upon a discharge destination are enshrined in law. However, barriers such as aphasia (a communication disorder commonly resulting from a stroke) can mask competency and exclude people from the decision making process. Social workers play a vital role in the healthcare system, providing advocacy, case management, counselling, addressing capacity and assessing the patient as a whole person. But they need to be taught specialized communication skills to carry out this complex role with individuals with aphasia. A literature search and survey of universities revealed that the majority of training in supported communication is taking place in the field and driven by aphasia centres. But does the training meet the needs of social workers and their patients with aphasia, especially when someone needs a healing conversation? Results from two pilot projects show that teaching a set of skills is not sufficient; adaptation of present communication techniques is also needed to ensure that the human worth and dignity of those with communication barriers is maintained and human rights in healthcare are being met.     

The Effect of Age and Childhood Social Class on Preference for New Healthcare Practices

Bourdieu theorized that habitus structures and is structured by experiences in the social world, with childhood experiences having the strongest influence. Habitus can yield rewards in specific fields through dispositions to enact certain practices. Healthcare provides an opportunity to assess how age and childhood social class interact to produce preferences in a changing field. Are people who developed their habitus in higher social classes as children more likely to report preferences that reflect new practices? Is there greater inequality at older ages? We find that parents’ educational attainment and occupational prestige does not have a direct effect on respondents’ preferences to be involved in their healthcare decisions. However, there is a significant interaction with age, with larger gaps by childhood social class among older respondents. Results suggest that when valued practices change, socially advantaged groups can most quickly adapt. The findings have implications for the replication of class inequality.     

Missing Teeth: Reviewing the Sociology of Oral Health and Healthcare

Both the US Surgeon General and the World Health Organization have called for further social scientific research on the social determinants of oral health. Oral disease can have detrimental effects on quality of life, having been linked with physical, mental, and social impairments. This article reviews the recent literature pertaining to the sociology of oral health and healthcare. The purpose of this review is to summarize and revive a necessary field. In order to maintain a focus on the United States and expand into other social science disciplines, relevant anthropological works were also included. The review discusses five key areas in both the sociology and anthropology of oral health. Of the 25 included articles, research maintained a focus on the dental profession, the construction of oral health, the mouth and the social self, social factors in dental care, and cultural assumptions of oral health. While the reviewed studies have aided in closing the gap, much of the research has been conducted outside of the United States, has used oral health as a case study for larger arguments, and has not considered the role of social inequality. Future research is necessary to more fully frame oral health and healthcare in society.     

The Politics of Expanding Healthcare Access to the Poor and Informal Sectors

How do the politics of agenda setting and policy adoption operate in the arena of healthcare reform in the industrializing world? Literature on the twenty‐first‐century developmental state emphasizes the role of democratic competition and civil society in causing political parties to take up new agendas, while power resources theory stresses the role of left‐wing political parties and labor unions in policy adoption. Yet, core tenets of these theories have not been considered extensively in light of dynamics in the industrializing world. This article examines the politics of policy adoption in countries that have recently aimed to provide healthcare access and financial protection to the poor and people in the informal sector in Mexico and Turkey. In line with literature on the twenty‐first‐century developmental state, we find democratic competition to play an important role in causing political parties to take up new agendas. However, examination of the cases illuminates surprising dynamics that challenge important elements of sociological theory: right‐leaning political parties played important roles in adoption, while labor unions and left‐wing parties oppose reform in the cases. Public health‐minded physicians leading change teams played important roles in agenda setting and leading the process of implementation.     

Healthcare providers' treatment of college smokers

About 28% of college students smoke tobacco, and many will continue smoking into adulthood. Although little is known about how to help college students quit smoking, 1 promising strategy is healthcare providers' advice. To estimate their life-time receipt of brief advice and to identify characteristics that predict who may receive that advice, 348 college students completed a survey about their smoking and related practices. Seventy-seven percent of the smokers (73% of the students) were asked about smoking. Of those smokers, 57% were advised to quit, 22% were given advice about quitting, 5% were helped with setting a quit date, and 4% were offered follow-up. Occasional smokers were less likely than daily smokers to be advised to quit. Although 36.2% of the smokers did not report their smoking accurately, smokers who were accurate were more likely to be advised to quit and to be given advice about quitting.