Bakgrund: Forskning tyder på att en vård som bygger på en personcentrerad grund bidrar till en högre kvalitet av vården och har en positiv påverkan på patienter samt hälso- och sjukvårdsprofessionen. Samtidigt pekar studier på att hälso- och sjukvården står inför en mängd utmaningar för att kunna införa ett personcentrerat förhållningssätt i den dagliga vården. Syfte: Att beskriva vilka barriärer som hindrar sjuksköterskan att arbeta personcentrerat i mötet med patienten. Metod: Studien har genomförts som en litteraturöversikt, där resultatet är baserat på 16 vetenskapliga artiklar. Resultat: Flera faktorer som kan utgöra svårigheter för sjuksköterskan att arbeta personcentrerat i vårdmötet med patienten identifierades och genererade fyra kategorier: Samarbete och teamwork, Attityd och kultur, Tid och resurser samt Kommunikation och Patient berättelsen. Resultatet tyder på samarbetssvårigheter mellan olika professioner inom hälso- och sjukvården, motsträvande attityder samt rutiner som inte vilar på vetenskaplig grund. Brist på utbildningsmöjligheter och bristande kunskap kring vad personcentrerad vård innebär och hur ett personcentrerat förhållningssätt kan tillämpas i klinisk praxis. Hög arbetsbelastning och brist på tid påverkade sjuksköterskans möjlighet till att skapa en relation till patienten, samt var en bidragande faktor till stress och känslor av otillräcklighet. Konklusion: Sammantaget tyder litteraturöversikten på att det finns ett flertal barriärer som försvårar för sjuksköterskan att arbeta personcentrerat i mötet med patienten. För att ett personcentrerat förhållningssätt ska praktiseras krävs aktivt arbete individuellt och kollektivt på olika nivåer inom en organisation för att bli en del av den dagliga praktiken. / Background: Research suggests that care based on a person-centered basis contributes to a higher quality of care, and has a positive impact on the patients and the healthcare profession. At the same time, studies point out that health care is facing a variety of challenges in order to introduce a person-centered approach into daily care. Aim: To describe which barriers prevent the nurse to work person-centered in the healthcare meeting with the patient. Methods: The study was conducted as a literature review, the result is based on 16 scientific articles. Results: Several factors that may constitute difficulties for the nurse to work personcentered in the healthcare meeting with the patient were identified and generated four categories: Collaboration and Teamwork, Attitude and Culture, Time and Resources, and Communication and The patient Narrative. The result indicates cooperation difficulties between different health care professions, contradictory attitudes and routines that not lie on a scientific basis. Lack of educational opportunities and knowledge about what person centered care means and how a person-centered approach should be applied in clinical practice. High workload and lack of time affected the nurse's ability to establish a relationship with the patient, and contributed to stress and feelings of inadequacy. Conclusion: Summary the literature study indicates that there are several barriers that make it difficult for the nurse to work person-centered in the meeting with the patient. In order for a person-centered approach to be practiced, active work is required individually and collectively at different levels within an organization to become part of the daily practice.

The objectives of the work The objective of this work has been set as the mapping of degree of patient's contentment/ rate of patient's satisfaction in view of the nurse's approach within the scope of the post-thoracic operation care and the evaluation/ assessment whether the needs of the aforementioned patients have been satisfied. Another objective of the research enquiry has been set as finding out the level of the nurse's awareness regarding the ways and possibilities of the subsequent care. Methodology For the purpose of the research enquiry the form of qualitative research has been chosen and adopted, which has been applied and performed by means of using a method of interviewing i.e. putting questions which have been prepared beforehand, well in advance. Research array of patients consisted of 10 patients from one hospital (which is not going to be specified in this work) as well as 8 nurses whose job was to take care of the post-operative patients/ the post-thoracic operation patients. The results of the research have been processed by applying the method of open coding, pencil-paper method. Assets and Benefits of this Work The research enquiry has showed certain level of absence of desirable knowledge as well as ignorance of the staff taking care of the patients regarding the ways of subsequent care. Nurses should be educated about the possibilities of home care, hospice care as an integral part of their profession. The results gained by research enquiry process could be presented at seminars, conferences aimed at the subsequent care.

Thesis (Ph.D. in Nursing) -- University of Colorado Denver, 2007. / Typescript. Includes bibliographical references (leaves 190-197). Free to UCD affiliates. Online version available via ProQuest Digital Dissertations;

Thesis (Ph.D. in Nursing) -- University of Colorado Denver, 2008. / Typescript. Includes bibliographical references (leaves 192-203). Free to UCD Anschutz Medical Campus. Online version available via ProQuest Digital Dissertations;

Thesis (Ph.D. in Nursing) -- University of Colorado Denver, 2008. / Typescript. Includes bibliographical references (leaves 113-132). Free to UCD Anschutz Medical Campus. Online version available via ProQuest Digital Dissertations;

The overall development of scientific and technical disciplines has enabled the introduction of minimally invasive surgical techniques in cardiac surgery practice. Implementation of minimally invasive cardiac surgery brings many positive effects for patients and healthcare. At the same time, however, it requires for the nurses to have appropriate knowledge, skills and experience to effectively provide comprehensive nursing care. The thesis is divided into theoretical and empirical parts. A total of four objectives were set. The first goal determines the specifics of nursing care of the patient before and after minimally invasive cardiac surgery. The second mapping the differences in nursing care in minimally invasive cardiac surgery from heart surgery classical approach. The third objective determines the role of nurses in patient awareness of minimally-invasive cardiac surgery. The fourth objective is focused on the needs and feelings of patients undergoing minimally invasive cardiac surgery. The results of qualitative research showed that preoperative and postoperative nursing care for minimally invasive cardiac surgery is similar to nursing care before and after cardiac surgery by standard median sternotomy approach. Nurses often wipe away differences associated with nursing care of standard and minimally invasive surgery, differences arose mainly after analysis of the data obtained. The differences include shorter hospital stay, shorter duration of mechanical ventilation, lower incidence of postoperative confusion, differences in invasive inputs, rehabilitation and awareness. For the majority of respondents from the ranks of the patients minimally invasive heart surgery technique had clearly positive impact on their mental condition.

Orientador: Gastão Wagner de Sousa Campos / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Enfermagem / Made available in DSpace on 2018-08-23T23:38:37Z (GMT). No. of bitstreams: 1 Bueno_FloraMartaGiglio_D.pdf: 3835227 bytes, checksum: 81c456ac3eeb5cc69e4d8783f561aeb6 (MD5) Previous issue date: 2013 / Resumo: Este estudo buscou compreender como se dá a inserção do enfermeiro na gestão hospitalar, a partir de um contexto de mudanças do modelo assistencial e de gestão que vinha ocorrendo no local do estudo. Utilizou os conhecimentos da filosofia para destacar o saber fazer da enfermagem (téchne), mais precisamente do enfermeiro no processo do cuidar e, buscando entender a atuação do enfermeiro na gestão. Realizou-se uma reflexão teórica, utilizando o conceito de Gramsci de "intelectual orgânico" e a busca pela hegemonia cultural no processo de gerenciar o cuidado na enfermagem. Desenvolveu-se uma construção dialética entre cuidado e gestão em saúde, utilizando-se referenciais de planejamento em situação de governo de Carlos Matus e a organização da assistência de enfermagem de Florence Nighitingale, além de discutir possibilidades de reformulação do papel gerencial do enfermeiro e refletir sobre a aplicação e impacto dos novos desafios na gestão das pessoas que produzem o cuidado. Participaram dessa investigação, profissionais enfermeiros não docentes que atuam como Diretores Técnicos de Serviço de Enfermagem (cargos de representação) das áreas assistenciais e supervisores de seção de um hospital público universitário do Estado de São Paulo. Trata-se de um estudo de abordagem qualitativa e as técnicas empregadas para a coleta e organização dos dados envolveram a elaboração de um questionário auto-aplicado com questões estruturadas e semiestruturadas, utilizando a técnica de tabulação dos dados para identificação de algumas variáveis. Para a análise de conteúdo das respostas obtidas, as mesmas foram tratadas, organizadas e interpretadas no intuito de apreender os seus significados. Constatou-se que os gerentes de enfermagem tem adequada concepção sobre suas responsabilidades tanto na dimensão assistencial quanto gerencial, porém na execução de suas atribuições não se notam estratégias de ação bem definidas para atuarem como "intelectuais orgânicos", bem para que se reconheça que o espaço do cuidado é o eixo central de sua téchne e que o mesmo existe e está institucionalizado e que suas ações no âmbito gerencial tem como finalidade a qualidade do cuidado, vislumbrando o indivíduo com necessidades de recuperação da saúde e as pessoas que realizam a assistência de enfermagem, articulando-as de forma eficiente com os demais membros da equipe de saúde. Os resultados e análises permitiram sugestões, reflexões e considerações relevantes para os enfermeiros gerentes, bem como para os gestores da área hospitalar, assim como poderão influenciar nos objetivos de ensino formal e desenvolvimento profissional na área da saúde. / Abstract: This study aims to understand the nursing professionals entered in hospital management process,from context changes of assistance model and management that occurs at the study site. To highlight the nursing expertise (téchne), philosophy knowledge are used, more precisely about the nurse practitioner care process, attempting to understand the nursing professionals's management function. This paper develops a theoreticalreflection about Gramsci's conception "organic intellectual" and the search of cultural hegemony in nursing care process. It also intends to develop a dialectical construction between care and health management using Carlos Matus's government situation benchmarks and Florence Nighitingale's nursing assistance organization, besides of discuss reformulation possibilities of management nurse function and to reflect about the application and impact people management of care production's new challenges. This investigation counted with the participation of 37 non-teaching nurses who act as Technical Directors of Nursing Services (representative positions) of assistance areas and are section supervisors of São Paulo state public university hospital. It is qualitative study and the techniques adopted to collect and the organizing of data involved the creation of a self-administered questionnaire with structured and semi-structured questions, using the technique of data tabulation to identify some variables. For the analysis of the responses obtained, they were treated, organized and interpreted in order to grasp their meanings. It was found that nursing managers have adequate conception of their responsibilities both in care responsabities dimension and management experience, however in the execution of their duties there are no action strategies well defined to act as "organic intellectuals", trying to understand that the care space, téchne core element, exists and is institutionalized, as well as to understand that their management sphere actions aims to care quality, seeing the needs of health recovery and people who perform nursing care, and better articulating with other members of the healthcare team. The results and analyzes allowed suggestions, reflections and relevant considerations to nursing managers as well as care area managers, and may influence the goals of formal education and health professional development. / Doutorado / Enfermagem e Trabalho / Doutora em Enfermagem

Syfte: Syftet med studien var att beskriva skötares uppfattningar av specialistsjuksköterskans kompetens i psykiatrisk vård. Metod: För att analysera detta fenomen gjordes en intervjustudie med kvalitativ design och en fenomenografisk analys tillämpades. Semistrukturerade intervjuer genomfördes där nio skötare verksamma i den psykiatriska vården vid tiden för intervjutillfället deltog. Med avsikt att finna variation bland uppfattningarna bearbetades och analyserades det transkriberade materialet i en analys omfattande sju steg. Resultat: Fyra kategorier av skötarnas uppfattningar identifierades: Osynlig kompetens, otydlig kompetens, synlig kompetens och tydlig kompetens. Relationen mellan dessa kategorier förhöll sig hierarkiskt i förhållande till i vilken grad specialistsjuksköterskans kompetens uppfattades. Slutsats: Skötarens uppfattningar ger uttryck för att det finns ett starkt behov av specialistsjuksköterskans kompetens samtidigt som man inte kan se hur den urskiljer sig från skötarens egen kompetens. Områden i specialistsjuksköterskans kompetens som har stor betydelse för och kompletterar skötarens egen kompetens värdesätts särskilt, såsom specialistsjuksköterskans arbetsledarroll, samarbetsförmåga, somatiska kunskap och helhetsbild av psykiatrin i övrigt. / Aim: The aim of this study was to describe how psychiatric aides’ understand the competence of specialist nurses in psychiatric care. Methods: In order to analyze this phenomenon, a phenomenographic interview study with qualitative design was carried out. Semi-structured interviews were conducted with nine psychiatric aides, working in psychiatric in-patient care at the time of the interview. In order to find the variation among the understandings, the transcribed material was processed and analyzed through an analyze method including seven steps. Results: Four categories of understandings were identified: invisible competence, unobvious competence, visible competence and obvious competence. The relationship between these different categories took a hierarchical structure in relation to the degree of which the specialist nurse competence was understood. Conclusions: The understandings of the psychiatric aides expresses the dependence of the specialist nurse's competence while at the same time one cannot see how it distinguishes itself from the psychiatric aides’ own competence. Areas of the specialist nurse competence that are of great importance for the psychiatric aides and complement their competence are especially valued, such as: the specialist nurse’s leadership, ability to cooperate, somatic knowledge and overall knowledge of psychiatry.

Bakgrund: Sjuksköterskans uppgift i hälso- och sjukvården är att värna om patientens styrkor i omvårdnaden. Personcentrerad omvårdnad innebär att ett holistiskt synsätt och förhållningssätt till patienten praktiseras i omvårdnaden. Orems egenvårdsteori innebär att patientens hälsa främjas av att bedriva egenvård. Autonomi innebär självständighet och självbestämmande. Patientautonomi försummas inom omvårdnaden och det är därför väsentligt att undersöka patientens uppfattning av autonomins betydelse. Syfte: Att beskriva äldre och medelålders patienters upplevelse av autonomins betydelse vid omvårdnad. Metod: En litteraturöversikt där (n=16) kvalitativa artiklar söktes i databaserna PubMed och CINAHL. Analysen har skett genom att hitta teman och subteman utifrån likheter/skillnader i artiklarnas resultat. Resultat: Äldre och medelålders patienter upplevde att autonomi vid omvårdnad påverkade deras värdighet och identitet. Dessa påverkade patienternas välbefinnande och livskvalitet. Sjuksköterskan hade en betydande roll för möjligheten till autonomi, där tidsbrist, respekt för patienten och egna attityder kunde påverka autonomin. Majoriteten av patienterna upplevde inte autonomi vid omvårdnad. Konklusion: Både sjuksköterskan och patienten upplever att patientautonomi försummas vid omvårdnad vilket påverkar patientens välbefinnande och livskvalitet negativt. Tidigare forskning i ämnet är begränsat och det behövs vidare forskning kring ämnet. / Background: The nurse's role in the health-care is to defend the patient's abilities. Person-centred care refers to the practice of a holistic approach towards the patient in the nursing care. Orem's theory of self care intends that patients' health benefits from practicing self care. Autonomy means independency and self-determination. Patient autonomy is found in previous research to be neglected in the nursing care, which makes it essential to further investigate the patient's experience of the meaning of autonomy. Aim: To describe elderly and middle-aged patients' experience of the meaning of autonomy in nursing care. Method: A review of the literature where (n=16) qualitative articles were searched for in the databases PubMed and CINAHL. The analysis focused on finding themes and subthemes in the similarities/differences of the articles' results. Results: Elderly and middle-aged patients experienced that the autonomy in nursing care affected their dignity and identity, which also affected their well-being and quality of life. The nurse had a significant role in terms of the opportunity to autonomy, their time restraints, respect for patients, and attitudes could influence the autonomy. The majority of the patients did not experience autonomy. Conclusion: Both nurses and patients experience that patient autonomy is neglected, which influences the patient's well-being and quality of life negatively. Few studies describes the patients' experience of autonomy in nursing care, so further research in this area is needed.

This study uses a descriptive survey design to describe and examine the relationship among school nurses’ level of education, years of experience, knowledge of asthma and identification of the school nurse’s level of proficiency based on Benner’s (1984) model of Novice to Expert. A convenience sample of school nurses employed in public schools within the state of Massachusetts with an RN degree (registered nurse) were sampled. The demographic data revealed that of the 325 participants who participated in the study, the majority of school nurses were female ranging in age from 40 to 50 (M=47.0). The majority of nurses had a bachelor’s degree in nursing and were employed in the nursing profession on an average of twenty-two years and in school nursing for ten years. Since the majority of the school nurses did not have a master’s degree, they were not certified by a national certifying body. The majority of participants indicated that they had received certification through the Board of Education in Massachusetts. Most school nurses worked full time in a public school and were responsible for between six hundred and a thousand students. The majority of nurses indicated that they did not have a school-based clinic on site, nor did they have a school-based health center or clinic to refer students. There was little variability among sample characteristics with school nurses employed in Massachusetts being a fairly homogenous group. Those surveyed were sent a packet containing four questionnaires including one on demographics, as well as an asthma questionnaire, a questionnaire assessing chronic health problems in the schools, and a self-reporting questionnaire based on Benner’s (1984) model. Further results of this study revealed that the majority of the school nurses had an average to above average knowledge of asthma. The three most common interventions performed by school nurses as well as non medical personnel for those students with chronic illness are nebulizations, inhalers, and peak flow meters. Based on the self-report model of Benner’s (1984), these same nurses viewed themselves as expert in their level of practice. Mezirow’s Adult Learning Theory as well as Benner’s (1984) model of Novice to Expert were used to support the nurses level of practice based on experience, intuition and a constellation of meaning schemes developed from previous exemplars. Results of the study indicated that although the nurses surveyed were expert in their knowledge of basic nursing concepts, none had advanced practice level courses in advanced health assessment or clinical decision making in order to effectively manage the complexities of chronic illness such as ADHD, diabetes, and epilepsy, as well as asthma, the most common chronic illness in schools today.