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Группа авторов. ABC of Clinical Resilience
Table of Contents
List of Tables
List of Illustrations
Guide
Pages
ABC of Clinical Resilience
Contributors
Preface
CHAPTER 1 Why resilience? Why now?
OVERVIEW
Introduction
‘First, do no harm’
Box 1.1 Suicide whilst under GMC's fitness to practise investigation: were those deaths preventable?
Increasing patient expectations, complaints and litigation
Why now?
Equality, diversity and inclusion in healthcare resilience
Box 1.2 Proportion of Covid‐19 related death in UK healthcare workers from BAME background
Box 1.3 Access to personal protective equipment (PPE) in UK healthcare workers from BAME background
Box 1.4 Story of Consultant Urologist, Mr Abdul Chowdhury
Box 1.5 The role of the active bystander
Conclusion
Further reading/resources
CHAPTER 2 Emotional Impact of Working in Healthcare
OVERVIEW
Introduction
The cost of caring
Box 2.1 Definition of terms
Box 2.2 The cost of caring
Burnout
Moral distress
Compassion fatigue
Box 2.3 Case study 1 – moral distress
Vicarious trauma
Effects of erosion of empathy, compassion and disengagement
Box 2.4 Example 1 of disengagement
Box 2.5 Example 2 of disengagement
Disengagement
Media reports on healthcare
The joy of practice
Compassion satisfaction
Box 2.6 Joy of practice – case history
Box 2.7 Compassion satisfaction vignette
Box 2.8 Compassion satisfaction vignette
Empathy
Reducing risk and burnout
Conclusions
Further reading/resources
CHAPTER 3 Resilience and Cognitive Performance
OVERVIEW
Introduction
Clinical reasoning
Biases and contextual factors
Box 3.1 Case study: effect of fatigue on clinical performance
Box 3.2 Case study: limited access to sustenance during shifts
Burnout and cognitive function
Box 3.3 ‘Thinking‐in‐the‐moment’ and cognitive control
The negativity bias
Box 3.4 The consultant who held my bleep
Effect of experience
Training needs
Conclusions
Further reading/resources
CHAPTER 4 Practising Self‐care
OVERVIEW
Introduction
Self‐aware not self‐critical
Box 4.1 Physician Heal Thyself (??)
Box 4.2 The imposter syndrome
Box 4.3 The reflective practitioner. How professionals think in action
Resilience through the career cycle
The healthcare student
Avoiding negative coping strategies
Box 4.4 Balint groups
Box 4.5 Collaboration
The first five years of qualification
Box 4.6 The foundation doctor
Work–life balance
Box 4.7 Vignette (positive coping strategy)
The established clinician
When healthcare does not go as expected: The second victim
The last five years
Conclusions
Further reading/resources
CHAPTER 5 The Physiology of Resilience and Well‐being
OVERVIEW
Introduction
The physiology of stress and well‐being
The physiological impact of stress today
Box 5.1 How thoughts influence our physiology: a familiar scenario
‘Challenge stress’ versus ‘threat stress’
Measuring stress and well‐being: heart rate variability and coherence
Cortical inhibition and facilitation
Making a shift: influencing HRV and coherence
The physiology of emotion
Becoming aware of a perception change
Box 5.2 Practical application of metacognition on the night shift
Making the shift back to well‐being
Conclusion
Box 5.3 The Quick Coherence Technique for self‐regulation
Box 5.4 Case study: Successful application of self‐regulation
Further reading/resources
Websites
CHAPTER 6 Intelligent Kindness: A Systemic Perspective on Resilience
OVERVIEW
Resilience and recovery – definitions and questions
Reflection and self‐care
The emotional costs of caring
Box 6.1 Overcoming natural reactions
Box 6.2 Experiences in the time of Covid‐19
Box 6.3 Demands and reality
Box 6.4 Disrespect for practitioner experience and needs
Kinship
A therapeutic alliance
The benefits of compassion and kindness
Box 6.5 Trust and the therapeutic alliance
Cultivating intelligent kindness
Factors that undermine the work
Box 6.6 Simple examples of distraction or skewing of attention
Box 6.7 Looking over one’s shoulder
A healthy ‘relational’ system
Conclusion
Box 6.8 Five qualities of a therapeutic environment, presented as a developmental sequence
Further reading/resources
CHAPTER 7 Kindness in Healthcare Teams
OVERVIEW
Introduction
Kindness in teams
Box 7.1 Georgia’s jar of coffee
Civility
Box 7.2 B.U.R.N.O.U.T. – An acronym to prevent burnout
Box 7.3 Civility in teams
Effects of rudeness and incivility
Kindness in leadership
Box 7.4 Effects of incivility on workers
Communication in teams
Box 7.5 Compassionate governance
Box 7.6 Effects of poor communication – lack of kindness – on patients
Schwartz Rounds
Box 7.7 Training in a team
Bullying in the workplace and the toxic individual
Avoiding Toxic workplaces
Box 7.8 Recognising a toxic individual
Conclusion
References
Further reading/resources
Websites
CHAPTER 8 Organisational Kindness
OVERVIEW
Introduction
The effects of moral injury
Levels of organisational kindness
The interface with the wider healthcare system
Box 8.1 Development of moral injury in a clinician
Optimising resources
Maintaining the organisation’s reputation and values
Improving joy at work
Conclusions
Further reading/resources
CHAPTER 9 Resilience in Practice
OVERVIEW
Introduction
Individual resilience and practice
What is 'team resilience'?
The impact on patient care
Box 9.1 Team‐based care
Box 9.2 Case study – ‘Who do I listen to?’
Hierarchy and conflict
Box 9.3 Case study – ‘Who do you think I am?’
The student experience
Box 9.4 Case study – ‘Not another interprofessional learning session!’
Perception vs intention: bridging the interpersonal gap
Most respectful interpretation
Box 9.5 Case study – The most respectful interpretation
Moral courage and psychological safety in teams
Box 9.6 Case study – ‘Are you okay?’
Conclusion
Box 9.7 Think about…
Further reading/ resources
CHAPTER 10 Can We Really Teach Resilience, Intelligent Kindness and Compassion?
OVERVIEW
Introduction
Personal factors
Box 10.1 Personal factors
Interpersonal factors
Contextual/environmental factors
Developing the curriculum
Personal level
Examples of interventions focusing on the personal level
Box 10.2 Teaching self‐care
Interpersonal level
Box 10.3 Recommended interventions based on the personal level of resilience
Box 10.4 Example of intervention focusing on the personal level using the SMART program
Box 10.5 Examples of peer mentoring
Box 10.6 Suggestions on developing resilience during clinical supervision
Examples of interventions focusing on both personal and interpersonal levels
Box 10.7 Stress and support: how to keep balance
Box 10.8 Recommended interventions based on interpersonal levels of resilience
Box 10.9 The MaRIS model for developing medical students’ human capabilities and personal resilience
Contextual level
Box 10.10 Contextual/ environmental factors
Examples of a model focusing on all personal, interpersonal and contextual levels
Assessment of resilience
Box 10.11 Recommended interventions based on contextual levels of resilience
Box 10.12 Updated Multi‐System Model of Resilience (MSMR)
Conclusion
Box 10.13 Four phases in assessing resilience interventions
Box 10.14 Key factors in the development of a ‘resilience curriculum’
Further reading/ resources
Recommended Books, Articles and Websites. For students and teachers
Academic
Websites (all accessed November 2020)
Index
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