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Last week, we addressed the collision of royalty and depression. Even a King! We also addressed the collision of spirituality and depression. Perhaps this glance could provide further explanation to his struggle with discouragement. David had enemies.

My group health donna swanberg

My group health donna swanberg

You are invited to take an active position in these dialogues and to make a brief contribution — be it on your practice, your research or the challenge you are facing in relation to your organisation and the positions for leadership created in it. There are also regular bus services My group health donna swanberg Putney, Wimbledon and Hammersmith which all have underground stations direct to central London. We often point to the fact that Joseph prepared his own tomb for Jesus, or the fact that these men boldly exposed their love for Christ by coming for his body in the middle of the day. He had been attending a bible study where he met people who claimed they had overcome depression without medications. I will use a specific organisational setting to open up discussion about the skills needed to work with powerful emotional states My group health donna swanberg can emerge in a variety of situations in which threat and risk rouse defensive responses. In the clinic, both patients and providers feel pressure from operational constraints, such as time. Working in interest groups and Squeeze titty while doging the ass on emergent learning and interests.

Pictures of teenage friends. INTRODUCTION

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In a qualitative study of home visits with patients and family caregivers, we found that patients withhold information from providers when communicating about what they deem important to their health and well-being.

  • We are inviting you to join this four day collaborative event which will be focused on development, learning and sharing of systemic organisational practice, with inputs from key note speakers and participants.
  • Group Health Cooperative of Eau Claire was born and raised in the Chippewa Valley and we are proud to be part of and contribute to our local communities.
  • Sadasivam, Kathleen M.

In a qualitative study of home visits with patients and family caregivers, we found that patients withhold information from providers when communicating about what they deem important to their health and well-being. We examine the various motivations and factors that explain communication boundaries between patients and their healthcare providers.

Our findings revealed limitations of existing approaches to support patient-provider communication and identified challenges for the design of systems that honor patient needs and preferences.

Patients with multiple chronic conditions often encounter competing and conflicting demands for care. For instance, someone who wants to control complications of diabetes through exercise might have difficulty due to pain from arthritis or shortness of breath from lung disease [ 8 ]. Competing demands present barriers to effective self-care for patients and their caregivers. For example, providers tend to orient health goals toward the management of individual conditions, whereas patients focus on their capabilities to engage in meaningful activities [ 3 , 25 ].

Numerous technologies have been designed to improve patient-provider communication and enhance encounters both in and out of clinical settings [ 3 , 14 , 44 , 49 ]. Along with forums to outline opportunities for future work [ 49 , 50 ], the development of new patient-centered communication tools indicate a growing interest in supporting collaboration between patients and providers. However, little is known about how to improve communication in the context of care for patients with multiple chronic conditions.

To strengthen communication between patients and their providers, we sought to understand how patients perceive and communicate about what is important to them. Our work reveals factors that influence how patients perceive and enact communication boundaries.

We begin with a review of related work, including patient-provider communication, self-disclosure in the clinical context, and patient preferences for sharing health information. We then describe our methods, present findings, and discuss implications of our findings. Effective communication between patients and providers is associated with positive patient-centered health outcomes [ 27 , 42 ]. Disagreement between patients and providers on care priorities can lead to worse health outcomes and loss to follow-up [ 10 , 17 ].

In a study measuring patient-provider concordance and the prioritization of care, researchers observed lower concordance for patients who had poor health status or non-health demands that conflicted with treatments [ 51 ]. Efforts to enhance patient-provider communication have included new tools and approaches to care in the clinic to connecting care at home. Asynchronous communication tools, such as patient portals, telehealth technologies, and personal health records [ 3 , 37 , 40 , 45 ] have created new opportunities for patients and providers to communicate.

In chronic illness care, researchers have designed patient-center platforms that visualize their observations of daily life [ 14 ] in an effort to support both the everyday work of self-management and communication with clinicians. Communication tools directed at patients for use in clinical settings have been shown to improve interactions with clinicians and positively affect health outcomes [ 44 ]. However, studies have investigated whether too much technology can create barriers or reduce the quality of face-to-face interactions [ 15 , 16 ].

The adoption of new communication systems can affect transformations in patient-provider communication and displace rich in-person interactions [ 7 ]. Important questions remain about how best to design these tools, given the changes they introduce to the work of patients, caregivers, and providers across clinical and nonclinical settings.

Physicians sharing about their personal lives sometimes had no perceivable effect, was seen as distracting [ 32 ], and at times violated perceived boundaries between the clinician and the patient [ 33 ]. While these studies have laid the groundwork for understanding the importance of self-disclosures in clinical settings, the motivations and factors that influence patient self-disclosures are still largely unexplored.

Prior work has found that patients conceal physical signs of their illnesses. Some go to lengths to conceal or disguise health objects from visitors to their homes. For example, patients use false cases or hide medications in discreet locations around the home [ 6 , 38 ]. Benjamin et al. Previous work in personal health information management has studied the sharing preferences of patients and other stakeholders. Involvement in self-care often necessitates that patients manage and share personal health information with providers [ 45 ] and caregivers, who are typically family members [ 6 , 39 ].

Privacy is often the top concern among older patients considering the use of health information management technologies [ 12 ]. This is consistent with technology preferences among patients who want to be able to control the content shared with their caregiving networks [ 24 , 39 ].

Some patients choose not to share health information to reduce burdens on family members, though these preferences may change over time [ 43 ]. In a study comparing the health information sharing preferences among cancer patients, doctors, and caregivers, researchers found participants to be misaligned [ 26 ]. As shown in a recent study regarding patient-generated data, patients and providers may not align on their expectations for patient-provider interactions about health information [ 19 ].

Good communication is necessary for shared decision-making [ 36 ] and for improving health outcomes for patients with multiple chronic conditions. We focus on identifying communication boundaries patients perceive with providers. Study procedures were approved by the institutional review board at Group Health Research Institute.

We recruited 24 patients P1-P24 with multiple chronic conditions from an integrated healthcare system in Washington State. All participating patients had diabetes and at least two of the following common chronic conditions: depression, osteoarthritis, and coronary artery disease.

These conditions were selected because they all require a high degree of self-management to achieve optimal health outcomes. Many of the self-management activities for these conditions overlap while others are likely to compete.

For example, recommendations for physical activity to improve outcomes for diabetes and coronary artery disease may be limited by the demands of arthritis. The medications that treat these conditions are often associated with significant side effects that can impact daily activities. Home visits included a semi-structured interview aided by photo elicitation and a home tour.

We used photo elicitation to help build an understanding of each participant. We sent the cameras prior to scheduled interviews to allow time for participants to reflect and actively participate. We started each interview asking participants to describe each photo and why they included it. Participants described how these were interrelated and connected to their care.

The semi-structured interview allowed for uniformity and for new issues to arise from participants. Informed by previous work in chronic care, including the dimensions of self-management work defined by Corbin and Strauss [ 20 ] and the Chronic Care [ 48 ] and Collaborative Care models [ 47 ], we structured the interview guide around a set of three broad domains: 1 self-management activities, 2 demands and tradeoffs in chronic care, and 3 information sharing with caregivers and healthcare providers.

The home tour typically began three quarters of the way into the visit. We asked participants to show us objects that supported their health and well-being. Tours were helpful for surfacing new information, providing follow-up details about artifacts or spaces referenced during interviews, and contextualizing daily activities in situ. We audio recorded the interviews, which were then professionally transcribed verbatim. Our analysis was grounded in the data to identify emergent qualitative themes.

Two researchers independently coded transcripts line by line to develop an initial set of codes. We then compared the codes for consistency and iteratively discussed, edited, and consolidated codes until a codebook was established. By writing memos, we were able to track decisions for merging or editing codes, draw conceptual links between codes, and group them together thematically.

All members of the research team discussed emergent themes to ensure consistency and rigor in the interpretation of the data. Participants varied widely on whether they communicated with providers about what is important to their well-being. We found that participants maintained communication boundaries with providers by withholding or filtering information about what was important to them. To describe our findings, we explain communication boundaries through three themes: patient disclosure practices, factors that influence communication boundaries, and how interpersonal relationships with providers affect what patients choose to share.

By characterizing different disclosure prac-tices we reveal how patients perceived communication boundaries with providers and the factors that influenced barriers to sharing. During clinical encounters, participants acknowledged filtering details about non-health aspects important to their well-being.

We found that participants omitted this information because they focused on describing symptoms when sharing health concerns with providers.

When P18 and his wife CG18 retired, the couple built a woodshop behind their home to construct various wooden objects and furniture they sold, donated to charity, or gave as gifts to family and friends. P18 and CG18 illustrated how participants communicated their concerns by reducing them to a set of symptoms. Details like the importance of spending time in the wood-shop may provide context that is critical for patients and providers to discuss how best to manage symptoms that might allow patients to return to meaningful activities or, if that is not possible, explore alternatives.

We found patients made specific requests, reflecting the everyday work done by patients and caregivers, who adopt increasingly active roles in managing chronic conditions [ 31 , 41 , 46 ]. Patients sought information about their conditions, explored alternatives to their current treatments, consulted with friends and family, and examined their own behaviors.

However, the amount of work involved in this process was not visible to providers because details were often condensed into specific requests. They took the binder to the pharmacist and asked about side effects. They discussed this with their doctor, who agreed to the adjustment, and the couple felt this change was effective. However, as previously described, their doctor was not made aware that the concern for feeling tired was linked to the loss of working in the woodshop and possibly depression.

Participants made some requests after they explored alternatives to their prescribed treatments. For example, P13 wanted to discontinue depression medication he had been taking since his retirement. He had been attending a bible study where he met people who claimed they had overcome depression without medications.

However, he did not share that the decision was important to his spirituality, and instead showed deference to the doctor, who appeared too busy discussing other matters. Despite the positive outcomes of these cases, these examples uncovered the negotiations that occur as part of the work of self-care, which is often carried out by both patients and their family caregivers.

Patients do not always reveal how specific requests relate to the importance of their belief systems or other meaningful activities, limiting the information available for providers to consider when making care recommendations.

In many cases, participants described how they prioritized family obligations over care recommendations from providers. These choices seemed so obvious to participants, they did not take much time to deliberate over options. Well, Sunday was Christmas…My mom and dad are in town. I have kids. Taking care of this baby right now is going to be my priority at the moment. For both P24 and CG11, the decision was simply about prioritizing family over medical procedures.

In comparing these examples, participants dictated when and how they communicated priorities with providers. While P24 candidly told his doctor about his reasons to postpone the surgery, CG11 did not intend to notify her provider despite her knee pain disrupting daily activities and her ability to exercise. Instead, CG11 planned to discuss treatment options on her own timeline. In addition to healthcare providers, participants turned to friends, family, and faith leaders to discuss concerns, challenges, and decisions about their health and well-being.

She worried about continuing the physical work of transporting and serving the food, and she had already scheduled days of rest in between days of activity to recover from exhaustion and pain caused by arthritis in her knees. She was concerned that giving up the activity would leave a void that could affect her well-being.

P2 explained her process for making this decision:. Walk on it, a decision, you know…pray over it, then mention it gradually. Not as detailed as I just did, to somebody I trust. But, my friends.

Kevin Barge I am interested in how communication can be viewed as a designed activity where leaders invite others into particular patterns of communication to move organizational activities and goals forward. The format of this four day developmental journey is one of collaborating, co-creating, learning and exchange on multiple levels. Rose, Ryan Schuetzler, John R. The Systemic Organisational Practice Dialogues are a platform to develop your relationships within the community of systemic practitioners and with systemic thinking and practice concepts, and to make concepts and experiences relevant to your practice, your team or your organisation. To begin to understand this phenomenon, a descriptive study is used to lay a With the conference format of practice dialogues we are aiming to engage practitioners such as organisation development consultants , executive coaches , organisational leaders, managers, clinicians , social workers , researchers , religious and community leaders , who are interested in the application of systemic and social constructionist practice in relation to organisational emergence. Initially causing problems due to her wild ways Jenny soon finds a place in the home forming a friendship with Kelly.

My group health donna swanberg

My group health donna swanberg

My group health donna swanberg

My group health donna swanberg

My group health donna swanberg

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We are inviting you to join this four day collaborative event which will be focused on development, learning and sharing of systemic organisational practice, with inputs from key note speakers and participants. This conference is a collaborative space for leaders, consultants, clinicians, practitioners to share and develop resources for moving their organisational practice and contributing to client systems. The overall programme of multiple exchanges, key note inputs, participant presentations, plenary dialogues and group performances will be facilitated by Christine Oliver and Martin Miksits.

With the conference format of practice dialogues we are aiming to engage practitioners such as organisation development consultants , executive coaches , organisational leaders, managers, clinicians , social workers , researchers , religious and community leaders , who are interested in the application of systemic and social constructionist practice in relation to organisational emergence.

The format of this four day developmental journey is one of collaborating, co-creating, learning and exchange on multiple levels. Participants will learn in relation to individual aims, plenary discussions and workshops, but also from groups of practitioners with related aims and interests to process and develop learning. These practitioner groups will be invited to share and exchange their work throughout the conference.

The Systemic Organisational Practice Dialogues are a platform to develop your relationships within the community of systemic practitioners and with systemic thinking and practice concepts, and to make concepts and experiences relevant to your practice, your team or your organisation.

It is also a place to share your practice with others and to talk about what you are doing, what has been successful and also what you are hoping to develop.

There will be space for such dialogical exchanges in plenary sessions and in small group work. The conference dinner on day 1 at a nearby pub is optional and not included with the course fee. The conference starts with an orientation — to each other, to our individual and collective aims, to how we wish to relate to and achieve specific and emergent outcomes. This includes the formation of small groups of participants who will provide stability for learning, reflecting with and supporting its members over the four day conference.

People in organisations need to experience partial influence over the outcome of their coordinating, of their being in organisation together. To that end, organisational design conversations are practical means for inviting transparency and accountability to what people in organisations will make. The choices involved in organisational design are meant to set binding contexts for coordination, standards for meaning making and acting.

Inevitably this raises issues for how power is used in design processes and the implications of design for organisational members. We will propose, and illustrate through experience and practice, how systemic sensibilities can usefully inform practitioners in their positioning and contributing in design conversations; and how the design of dialogue can implicate the outcome of such conversations.

Working in interest groups and reflecting on emergent learning and interests. I am interested in how communication can be viewed as a designed activity where leaders invite others into particular patterns of communication to move organizational activities and goals forward.

A new metaphor of leaders as designers of communication can be used to elaborate existing discursive and social constructionist approaches to leadership. Building on recent trends from the literature and practice on communication as design, we will explore the power of design thinking for co-creating forms of joint action that facilitate accomplishing important organizational activities and goals. Communication as design will be presented as a useful perspective for working through the co-creation of conversational episodes as well as large sequences and flows of communication associated with larger organizational processes such as strategic planning, organizational development, and organizational change.

This consultant story is about an assignment aimed at supporting a management team to start functioning in order for them to succeed in the much needed development process in which everyone in the organisation needed to be involved.

The organisation had grown over the years, both in numbers of employees, and also in complexity of their mission. There had been several organisational changes that had not settled, and the management team had some serious problems working together as a team against the backdrop of organisational and external challenges.

This work is still in progress. I will share the systemic approach and methods that were helpful in building the trust needed to start the work with the management team, and also the initial workshops that have now brought them together to a collaborating team highly motivated to succeed in their mission.

I will also share some experiences about a workshop with them connecting with their next level of managers to make them involved in their part of the developmental process. Promoting systemic, intelligent and thoughtful practice in this challenging period of chaos and change Claire Holman. This workshop will address the challenges currently faced by the Hackney Recovery Community Mental Health Teams CMHT and invite you to design a meeting that will assist us with our next period of chaos and change.

I will explain how we have weathered the storms of adversity as funding cuts have reduced our staff numbers and forced us to move from our office base with little notice or involvement in these decisions. I will move on to explaining the next challenge that the team faces and the FACT Fast Assertive Community Treatment model that has been suggested as a useful means by which the CMHTs can manage forthcoming changes to the culture and practice of the team.

I will then invite participants in groups to design an alternative approach — with an alternative acronym — that the CMHTs could use to promote systemic, intelligent and thoughtful practice in this challenging period of chaos and change.

There will be time in the morning and afternoon for practitioner groups to reflect on learnings and develop thinking in relation to participant aims and group purpose. I will use a specific organisational setting to open up discussion about the skills needed to work with powerful emotional states that can emerge in a variety of situations in which threat and risk rouse defensive responses.

The risks are high. Video material of both ordinary baby development and babies trapped in situations of emotional constraint will highlight how in my specific clinical work and other systemic situations it is worthwhile to design conversational capacities to manage raw emotions without becoming rigidly defensive.

The subject matter is emotionally challenging and arousing and dialogues that ensure we can find a way of speaking about difficult and painful matters without being harsh or cowardly need to happen. In the three situations, the thread of how defensive processes risk thwarting progress will be highlighted alongside ways to try and prevent this happening by constructing emotionally authentic relationships and interactions with the different micro and macro systems involved.

These experiences can provide insight for leaders, consultants and all organisational members, facilitating the integration of emotional and thinking responses into the often difficult conversations we need to have in our organisational lives. An organisational framework for integrity: An approach exploring authentic experiences of relationships in times of change. Organisational stories can sometimes reference a uni-verse without accounting for how this has come about and what has been discarded and relegated to achieve this.

In the workshop we will offer facilitative spaces to reflect on and explore the emergence of new stories of organisational discourse. This will be achieved through considering the positioning of dialogical practices within the boundaries of organisational practices.

This workshop will elaborate on various domain models, such as the CMM model developed by Oliver and Miksits as well as others connected to the work of Maturana to help us think about the value of transparency in reflective and reflexive discussions for enabling empowerment of organisational members. The workshop will offer contexts for: — Reflection, learning and development — Curiosity and learning — Articulating purpose for facilitating explicit dialogical exchange — Developing newer narratives while acknowledging existing narratives.

There are multiple contexts inviting and requiring change in public services. Inherent in this process is a request that our partner agencies, i. We therefore have to develop difficult and uncomfortable conversations in the context of cultural change. Sharing and integration of the process and outcome of group work. Groups are invited to present, perform, or otherwise share their learning in their own unique or creative ways. In a final plenary session, participants are invited to share reflections and learnings on what has been created and how individual aims could be achieved or progressed, thus creating another level of integration and learning.

You are invited to take an active position in these dialogues and to make a brief contribution — be it on your practice, your research or the challenge you are facing in relation to your organisation and the positions for leadership created in it. We have planned for sessions of an hour for these contributions including some time for reflections and dialogue. He is also a member of the planning team for the Aspen Conference, a community of engaged organizational communication scholars focused on developing practical theory and collaborative research that bridge academic-practitioner interests.

When emergent medical attention is needed. Major injuries, infections, severe sickness or allergic reaction. Founded and located in Altoona, Wisconsin, the Cooperative offers an extensive provider network, a live person to answer every time you call and the personal service you deserve.

We don't believe in one-size-fits-all health care benefits. We will work with you to build a health plan that suits the need of your company and employees. Group Health Cooperative has been very responsive to our needs as an employer. As a local company, their administration and staff are flexible and friendly. They offered us creative solutions to the challenges of increasing health care costs that were not available from other plans.

Born and Raised Group Health Cooperative of Eau Claire was born and raised in the Chippewa Valley and we are proud to be part of and contribute to our local communities. Best For: Non-emergent conditions such as cold and flu symptoms, bronchitis, allergies, poison ivy, sinus or ear infections.

Scheduled doctor visits with your primary care provider. Best For: Immunizations, yearly checkups or physicals, questions or concerns about lingering conditions and symptoms that can likely wait for a scheduled appointment. Medical attention past regular office hours for moderate-to-severe conditions.

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Last week, we addressed the collision of royalty and depression. Even a King! We also addressed the collision of spirituality and depression. Perhaps this glance could provide further explanation to his struggle with discouragement. David had enemies. He had stress. He had overwhelming life situations and traumas. David had legitimate oppressors. Anything from wild animals to nations, David was often fighting with, or running from, someone or something.

There were times in which he lived with great fear and anxiety. David often got stuck on his toxic thoughts. He frequently got stuck on hopeless, defeating thoughts about God, about himself, and about his situation.

He would be the first to acknowledge that he wrestled with his thoughts. It is nearly impossible to avoid discouragement in the presence of destructive ruminations, and David sometimes struggled to pull himself out of his personal darkness. David made reference to his bones hurting, his fatigue and weariness. He could have suffered injuries, diseases, vitamin deficiencies, or chemical imbalances. We are whole physically, mentally, emotionally, and spiritually — so when our emotions hurt, our bodies hurt.

And when our bodies hurt, our emotions hurt. David was no exception, and his physical challenges had a ripple effect. David had a terrible fall. He misused his power as king, had an affair with a woman, and followed that affair with the murder of her husband.

What a mess! In Psalm 51, following a conversation with a respected friend, David wrote a reflection on what is sometimes referred to as the darkest day of his life. He was broken and disgusted with himself. His regret created deep sadness. Can you relate to David? Do you live under the yoke of stress? Are you enduring a tough situation or trauma?

Do you have enemies? Do you sometimes get stuck on negative thoughts about God, about yourself, about others, or about your situation? Do you have physical challenges? A chronic condition? Do you have personal regrets? Are you suffering the tough consequences of an immoral choice? You are in the company of royalty. You are in the company of one who loved God.

Reach out today to a trusted friend, pastor, or counselor for help! Donna has authored numerous other books, her blogs are frequently shared in various media outlets, and she is commonly featured on radio broadcasts across America, and occasionally internationally as well. Depression impacts hundreds of millions of individuals across the world.

If depression is that common, then any of us are susceptible… a teenager, a mom, a dad, a senior adult, a person of any race or occupation. Your neighbor. Your co-worker. Perhaps even a King! I enjoyed an invitation to speak to a local church some time ago regarding the topic of depression. Their specific request was that I address the possibility of depression in the life of David, the writer of many of the Psalms.

Who was David? As a boy, he was the youngest of his siblings. As a young man, he had a simple job of taking care of sheep. After a series of amazing events, David was ultimately appointed King of Israel. David became head of the royal family! Or follow the news of the recent royal birth? What a display of power, infamy, wealth, and lavishness!

As King, David too experienced the extravagance of this lifestyle. But can someone who lives like that possibly experience depression? Someone who never has a financial care? Someone who never has to cook their own meal, or cut their own grass?

Someone with access to the very best of all that life offers? Is it possible that even someone with this ultimate grandiose lifestyle could be vulnerable to the symptoms we identified above? He was far from perfect, but he had a rich spiritual life.

As the deer pants for streams of water, so my soul pants for you, O God. My soul thirsts for God, for the living God. When can I go and meet with God? My tears have been my food day and night. Why have you forgotten me? Why must I go about mourning, oppressed by the enemy? My bones suffer mortal agony. My thoughts trouble me and I am distraught…. My heart is in anguish within me…. Oh that I had the wings of a dove! I would fly away and be at rest. How long, O Lord? Will you forget me forever?

How long will you hide your face from me? How long must I wrestle with my thoughts, and every day have sorrow in my heart? How long will my enemy triumph over me? Yes, David lived the life of royalty. Yes, David was a man of God. And, David met the criteria for depression. He felt downcast and distraught. He wrestled with his thoughts. He had ruminations. He had crying spells. He had spiritual disconnect.

He had physical symptoms of pain. He wanted to run away from everything and everybody. He desperately wanted to escape. He grew agitated and impatient. Can you relate? If you also wrestle with depression, I want you to take comfort in this: depression really is common. No one is immune.

No one is insulated from pain. Whether through a genetic predisposition, a vitamin deficiency, a thyroid issue, a hormone imbalance, or a fiery trial of life, we are all vulnerable. Even me and you. If you are wrestling in your thoughts today, know that you are in good company. Rest in knowing that you are not alone! And then reach out for help. The wedding was beautiful. Lifelong hopes and dreams became a reality as the vows were spoken and the couple was introduced to those in attendance.

The bride and groom started down the aisle, full of aspirations for a hope-filled, joyous life together.

My group health donna swanberg

My group health donna swanberg

My group health donna swanberg