Background: Caring for patients with serious illness may severely strain clinicians causing distress and probable poor patient outcomes. Unfortunately, clinician distress and its impact historically has received little attention. Research purpose: The purpose of this article was to investigate the nature of clinician distress. Research design: Qualitative inductive dimensional analysis. Participants and research context: After review of 577 articles from health sciences databases, a total of 33 articles were eligible for analysis. Ethical considerations: This study did not require ethical review (...) and the authors adhered to appropriate academic standards in their analysis. Findings: A narrative of clinician distress in the hospital clinician in the United States emerged from the analysis. This included clinicians’ perceptions and sense of should or the feeling that something is awry in the clinical situation. The explanatory matrix consequence of clinician distress occurred under conditions including: the recognition of conflict, the recognition of emotion, or the recognition of a mismatch; followed by a process of an inability to feel and act according to one’s values due to a precipitating event. Discussion: This study adds three unique contributions to the concept of clinician distress by (1) including the emotional aspects of caring for seriously ill patients, (2) providing a new framework for understanding clinician distress within the clinician’s own perceptions, and (3) looking at action outside of a purely moral lens by dimensionalizing data, thereby pulling apart what has been socially constructed. Conclusion: For clinicians, learning to recognize one’s perceptions and emotional reactions is the first step in mitigating distress. There is a critical need to understand the full scope of clinician distress and its impact on the quality of patient-centered care in serious illness. (shrink)

It is no secret that there are problems within hospitals and other healthcare settings across the United States that have been simmering for some time. With the emergence of the deadly SARs-CoV-2 v...

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In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:After the Future. The Paradoxes of Postmodernism and Contemporary Russian CultureDmitry KhaninAfter the Future. The Paradoxes of Postmodernism and Contemporary Russian Culture, by Mikhail Epstein; translated with an introduction by Anessa Miller-Pogacar; xvi & 394 pp. Amherst: University of Massachusetts Press, 1995, $55.00 cloth, $19.95 paper.Mikhail Epstein, a renowned Soviet critic—his books in Russian include Paradoxes of the New (1988) and Faith and Image: The Religious Subconscious (...) in [End Page 508] Twentieth Century Russian Culture (1994)—emigrated to the U.S. in 1988. After the Future is the first collection of his major essays (written from 1986 to 1991) in English translation. It begins with the article “New Currents in Russian Poetry: Conceptualism, Metarealism, and Presentism,” which first introduced to the Soviet reader a group of postmodernist poets, just coming out (with the advent of glasnost) from the literary underground. Other articles (“Avant-Garde Art and Religion,” “After the Future: On the New Consciousness in Literature”), though first published in Russian literary journals, were shipped to Russia from “the other shore” (to use Alexander Herzen’s description of emigre writers’ whereabouts vis-à-vis their homeland). The latest studies (“Relativistic Patterns in Totalitarian Thinking: The Linguistic Games of Soviet Ideology,” “The Origins and Meaning of Russian Postmodernism”) were not only sent from the other shore but apparently produced for the other shore. Instead of analyzing the recent Russian literary crop and emerging aesthetic sensibilities, Epstein focuses on Russian historic experience in its entirety, which he somewhat didactically clarifies for the foreign reader.Despite its shifting perspectives, After the Future features a distinctive approach toward Russian postmodernism, its bona fide subject matter. Following Jean Baudrillard, Epstein defines postmodernism as simulation (“the production of reality as a series of plausible copies”) that engenders some new hyperreality and in so doing supplants “reality itself, which then becomes irrecoverable” (p. 189). The originality of Epstein’s position lies, however, in his claim that Russia as a historic and cultural entity is a postmodernist phenomenon in its own right that simulates and masterminds reality. Epstein’s claim that postmodernism is ingrained in Russian tradition is pitted specifically against those who doubt that Russia is ready to enjoy its own postmodernist bash since (contrary to the West) it never went through prior modernist phases. To prove that Russia foreshadowed postmodernism, Epstein draws on a number of historic illustrations. He cites the forceful adoption of Christianity under Prince Vladimir in 988, Peter the Great’s building of Petersburg in the “Finnish swamp” and Prince Potemkin’s infamous make-up villages as examples of the Russian tendency to forfeit the status quo for the sake of trumped-up, ersatz realities.However, Epstein’s arguments to the effect that Russia, and not the West, is the birthplace of postmodernism are not very convincing since (in accordance with his own premise) other countries can claim such a dubious distinction as well. (“Russia is the motherland of elephants”—the Russians joke about claims by zealous patriots that all great discoveries were known in their country before they appeared elsewhere.) Elsewhere, the building of the Chinese wall and the ensuing Chinese policies of isolationism, draconian enclosures of peasant land in England that led to a speedy transition to capitalism, drastic economic and social reforms after the French Revolution, and the racist policies of the Third Reich were just as arbitrary, and yet transformative of prior realities, as any of [End Page 509] Russia’s most foolhardy experiments. Ironically, Epstein’s claim that Russia is the motherland of postmodernism harks back to the turn-of-the-century controversy as to whether it is pertinent to apply Marxist theory to rustic Russia. Lenin argued that Russia can claim Marxism as its own because all of its long-suffering history was an anticipation of Marxism and leading toward it. Epstein analogously contends that there is a special, indigenous Russian route to postmodernism, a statement that evokes similar pronouncements ingrained in Russian philosophical tradition: Epstein’s thesis that Russia is “irreal” reminds one of Peter Chaadaev’s contention that Russia does not have a history; his idea that Russia is on the threshold of a cultural synthesis with the... (shrink)