Made available in DSpace on 2016-07-27T14:19:51Z (GMT). No. of bitstreams: 1 Ceres Regina Dias Fernandes.pdf: 381666 bytes, checksum: df04db79c06dc0f4eb6943aac484b29f (MD5) Previous issue date: 2005-06-29 / This study emphasizes the importance of the doctor-patient relationship as a group of multiple influences, besides being a predictive factor for the good results of the treatment and adherence of HIV patients to anti-retroviral medicines. It enhances the importance of analyzing the behavioral patterns presented in this relationship to make it possible for the patients to get a broader understanding of the treatment and cares they should take. The goals of the present study were to describe the doctor role when preparing the patient for the treatment and to identify the functions of these acts by analyzing the verbal reports and non-verbal behaviors found out in their different forms of occurrence. Four dyads doctor-patient, from a reference hospital for this type of treatment, participated in this research. This study has an exploratory character and it is an empiric investigation of the doctor-patient relationship, through actions that occur in an ambulatory context, a circumstance in which descriptive methodology is used to analyze this relationship as to the multiple influences in the ambulatory/hospital context. Among the results it was possible to highlight that the participant doctors guided the patients enlightening them about the risks of contamination by HIV via sexual intercourse without preservative and about the side effects of the medicines, and also informed them about the health services. The verbal and non-verbal behaviors that facilitate adherence, emitted from both doctors and patients, were investigated and the behavioral patterns presented in the doctor-patient relationship were also analyzed in their different functions. The results were discussed in terms of applied methodology. The data obtained in the present study alert to the importance of the doctor role when explaining to the patient the behaviors needed in the adherence to anti-retroviral medicines, as well as the benefits of this therapy to the quality of life of HIV positive patients. / Este trabalho enfatiza a importância da relação médico-paciente como um conjunto de múltiplas influências, além de ser um fator preditivo para os bons resultados no tratamento e adesão dos pacientes portadores do vírus HIV aos medicamentos antiretrovirais. Ressalta a importância de analisar os padrões comportamentais apresentados na relação para possibilitar que esses pacientes tenham maior compreensão sobre o tratamento e os cuidados que devem ter. Os objetivos deste estudo foram descrever a atuação do médico no preparo do paciente para o tratamento e em identificar as funções desta atuação a partir da análise dos relatos verbais e comportamentos não-verbais encontrados em suas diferentes formas de ocorrência. Participaram desta pesquisa quatro díades médico-paciente provenientes do ambulatório de um hospital de referência para este tipo de tratamento. Este estudo possui caráter exploratório e é uma investigação empírica da relação médico-paciente por meio das ações que ocorrem em contexto ambulatorial, circunstância em que se faz uso de metodologia descritiva para a análise desta relação no que diz respeito às múltiplas influências no contexto ambulatorial/hospitalar. Foram analisados os padrões comportamentais apresentados pelo médico durante o atendimento ao paciente em suas diferentes funções verbais: informar sobre a transmissão e a não transmissão do HIV, investigar comportamentos de risco, preparar para os efeitos dos medicamentos anti-retrovirais, entre outros. Dentre os resultados foi possível destacar ainda que os médicos participantes orientaram os pacientes sobre os riscos da contaminação pelo HIV por via sexual sem preservativo e sobre os efeitos colaterais dos medicamentos e os informaram sobre os serviços de saúde. Foram investigados os comportamentos verbais e não-verbais facilitadores de adesão, tanto dos médicos quanto dos pacientes, e também foram analisados os padrões comportamentais apresentados na relação médico-paciente em suas diferentes funções. Os resultados foram discutidos em termos de metodologia aplicada. Os dados do presente estudo alertam para a importância da atuação médica ao explicar ao paciente os comportamentos necessários na adesão ao tratamento com os anti-retrovirais, bem como os benefícios desta terapia para a qualidade de vida do portador de HIV.

Constitui objeto do presente trabalho o estudo da relação entre médico e paciente, com especial atenção ao problema da capacidade de que este último deve gozar quando instado a participar de atos e negócios que, referentes ao tratamento médico que lhe é proposto, possam repercutir sobre sua personalidade, especialmente considerada em seu aspectofísico. A fim de delimitar nossa pesquisa, consideraremos essa relação unicamente no âmbito dos tratamentos médicos que visem proporcionar ao paciente uma oportunidade de cura, isto é, de recondução ao estado anterior ao da doença, a qual constitui, por assim dizer, a causa final da relação entre médico e paciente. Portanto, não abordaremos, ao menos não profundamente, a relação havida entre o médico, enquanto pesquisador responsável por estudo ou ensaio clínico de novos medicamentos ou procedimentos, e o paciente, considerado sujeito de pesquisa. Tampouco trataremos da relação médico-paciente em sentido lato, assim consideradas as relações\' tipicamente de consumo, nas quais o paciente assume nitidamente a posição de contratante de serviços de saúde, geralmente prestados por hospitais ou clínicas das mais variadas especialidades médicas, entidades às quais perfeitamente se pode atribuir a definição de fornecedor de serviços, conforme o artigo 3° do Código de Defesa do Consumidor . / Sem resumo.

Made available in DSpace on 2016-04-26T20:22:51Z (GMT). No. of bitstreams: 1 Patricia Rizzo Tome.pdf: 956478 bytes, checksum: 8b7745d8862516a4b7bf24746a07067a (MD5) Previous issue date: 2014-04-22 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / Our research aims to analyze the liability of the physician for injuries caused on account of errors made during his/her professional practice. These errors may result from their own acts or third parties ones, such as injuries caused by nurses working in compliance with doctors' demands. In this dissertation, the study of the contractual relationship of compromise established between doctor and patient is essential. Of special note here is the approach for full compliance of medical duties. This refers especially to the duty to provide full and clear information on an individual basis, considering each patient and his/her respective sickness. Thus, patients would be made fully aware about their particular situation and would be able to better decide whether they consent on performing surgeries or risky treatments / Nossa pesquisa tem por objetivo analisar a responsabilidade civil do médico por danos efetivamente causados em virtude de erros cometidos durante a atuação profissional. Erros estes que podem decorrer de atos próprios ou de atos de terceiros, como é o caso de danos ocasionados por enfermeiros que atuam em cumprimento de ordens médicas. Nesta dissertação, o estudo da relação contratual de meio estabelecida entre o médico e o paciente é fundamental. Destaca-se, sobretudo, o enfoque do cumprimento integral dos deveres médicos, em especial, o dever de prestar a informação completa e transparente de maneira individualizada, considerando cada paciente em relação a sua doença, para que as pessoas possam daí sim, amplamente esclarecidas, consentirem sobre a realização de cirurgias ou tratamentos de risco

O presente trabalho construiu-se a partir dos novos paradigmas que permeiam a relação médico-paciente. Se o profissional não mais se encontra em uma posição de superioridade (ao menos do ponto de vista fático) em face de seu paciente, que por sua vez está mais sensível em virtude das transformações oriundas da sociedade de massa, o elemento informação ganhou contornos importantíssimos, inserindo-se no núcleo principal da prestação, ao lado dos cuidados relativos à saúde propriamente ditos. Nesse contexto, foi proposta uma nova visão do dever de informar na relação médico-paciente, tratando a informação como uma obrigação autônoma, que gera de per se em caso de ausência ou vício responsabilização civil. A reparação, em tal perspectiva, surge a partir da violação do direito à liberdade: se a autodeterminação é um atributo da personalidade do paciente, a afronta a esse direito acarreta danos indenizáveis. Os limites do dever de informar, assim, desempenham relevante papel, pois demarcam a tênue linha que distingue a informação viciada (que ensejará responsabilização civil) daquela transmitida diligentemente. Assim, o conteúdo e a extensão da informação foram abordados, confrontando-se aspectos subjetivos, objetivos e buscando uma solução ao mesmo tempo viável (do ponto de vista prático), jurídica e justa. Como o trabalho trata essencialmente do dever de informar na relação médico-paciente e das consequências jurídicas derivadas do inadimplemento dessa obrigação, foram destrinchados todos os elementos que compõem esse complexo vínculo, passando por sua evolução histórica, pelos princípios, valores e direitos que permeiam e iluminam esta relação e, finalmente, pelos sujeitos que a compõem. Aspectos processuais atinentes à prova do cumprimento do dever de informação foram, ainda, examinados. Diversas questões polêmicas, tais como recusa de tratamento, direito a não saber, privilégio terapêutico, dentre outros, foram também debatidos. / This study is based on the new paradigms that permeate the doctor-patient relationship. If the medical professional no longer holds a superior position (at least from the factual point of view) vis a vis the patient who, on the other hand, is more aware to changes originating from doctor-patient relationship in the mass society, information availability has gained highly important contours, inserting itself into the core of services rendered, together with health care services themselves. In this context, this study proposes a new vision of the duty to inform in a doctor-patient relationship, treating information as an autonomous obligation, that, per se, results in liability in the case of its absence or flaws. The compensation, in such perspective, arises from breach of the right to autonomous choice: if self-determination is a characteristic of the patients personality, the disrespect of this right results in damages subject to indemnification. Therefore, the limits of the duty to inform perform a relevant role since they demarcate the fine line that distinguishes flawed information (that can incur liabilities) from that transmitted diligently. Thus, the contents and the extension of the information were addressed, comparing subjective and objective aspects and seeking a solution at the same time viable (from the practical viewpoint), legal and just. Since this study essentially deals with the duty to inform in the doctorpatient relationship and of the legal consequences derived from noncompliance of this duty, all factors that compose this complex link were carefully examined, reviewing its historical evolution, the principles, values and rights that permeate and elucidate this relationship and, finally, the parties involved. Legal evidential procedures related to fulfillment of the duty to inform were also examined. Various controversial topics such as the refusal to undergo treatment, the right to not be informed, therapeutic privilege, among others, were also discussed.

This qualitative research study examined the patient education experience from the point of view of health care professionals, namely doctors of chiropractic in the Greater Toronto Area practicing for up to ten years. Health care professionals’ views and beliefs of this important aspect of health care have not been well studied. Patient education is defined as, “the process by which patients learn or acquire knowledge about his/her health status or condition and may involve learning in the cognitive, affective, and/or psychomotor domains.” The study explored eight participants’ views on the nature of patient education in their early and current practices by examining their feelings, beliefs, and use of patient education, its role in their practices, as well as the perceptions of their roles as patient educators. Two semi-structured interviews were conducted with each of the participants. The transcribed interviews underwent detailed qualitative analysis to determine response trends and consensus. The key findings revealed that the participants felt that, while they were well prepared in their undergraduate curricula to diagnose and treat patients, they were not as well prepared to be effective patient educators when they entered practice. Early in their careers, they did not understand or appreciate patient education’s importance and value as a component of their practice. Over time, their beliefs and understanding of patient education changed and participants reported that with experience, they began to value patient education to a greater extent. Changing values reflected changing behaviours. For example, participants increased their time and efforts related to patient education with increased clinical experience. A variety of teaching aids were used with wall charts/posters, three dimensional anatomical models, printed materials and images from textbooks being among the most common. Most of the teaching described by the participants would be characterized as transmission with a one-way flow of information from the doctor to the patient. To a great extent, patient education involved speaking with individual patients. Participants reported encountering, throughout their careers, intrinsic and extrinsic barriers that interfered with the effectiveness of their patient education. The findings suggest that curricular planners for health care professional programs, and specifically for chiropractors, might consider developing content aimed at improving students’ patient education knowledge and skills.

This qualitative research study examined the patient education experience from the point of view of health care professionals, namely doctors of chiropractic in the Greater Toronto Area practicing for up to ten years. Health care professionals’ views and beliefs of this important aspect of health care have not been well studied. Patient education is defined as, “the process by which patients learn or acquire knowledge about his/her health status or condition and may involve learning in the cognitive, affective, and/or psychomotor domains.” The study explored eight participants’ views on the nature of patient education in their early and current practices by examining their feelings, beliefs, and use of patient education, its role in their practices, as well as the perceptions of their roles as patient educators. Two semi-structured interviews were conducted with each of the participants. The transcribed interviews underwent detailed qualitative analysis to determine response trends and consensus. The key findings revealed that the participants felt that, while they were well prepared in their undergraduate curricula to diagnose and treat patients, they were not as well prepared to be effective patient educators when they entered practice. Early in their careers, they did not understand or appreciate patient education’s importance and value as a component of their practice. Over time, their beliefs and understanding of patient education changed and participants reported that with experience, they began to value patient education to a greater extent. Changing values reflected changing behaviours. For example, participants increased their time and efforts related to patient education with increased clinical experience. A variety of teaching aids were used with wall charts/posters, three dimensional anatomical models, printed materials and images from textbooks being among the most common. Most of the teaching described by the participants would be characterized as transmission with a one-way flow of information from the doctor to the patient. To a great extent, patient education involved speaking with individual patients. Participants reported encountering, throughout their careers, intrinsic and extrinsic barriers that interfered with the effectiveness of their patient education. The findings suggest that curricular planners for health care professional programs, and specifically for chiropractors, might consider developing content aimed at improving students’ patient education knowledge and skills.

Previous research has examined patients’ level of satisfaction with the care, in an attempt to develop health care services that match patients’ expectations and needs. Nevertheless, there is still considerable debate among researchers over conceptual and methodological issues. This research programme investigated factors that contribute to patient satisfaction with health care in two fairly different European health care systems (the UK’s NHS and Greece’s ESY). A further aim was to develop a scale to assess patient satisfaction and health care evaluations within these two cultural contexts. In order to achieve those aims, a sequential exploratory strategy incorporating, qualitative and quantitative designs was used to explore patient health care evaluations, patient satisfaction, expectations, health care experiences, interpersonal qualities of the doctor-patient relationship and health care contextual factors at both micro and macro level. Three studies were conducted: Studies 1a and 1b examined levels of patient satisfaction with health care delivery in Greece and the UK respectively. More similarities than differences were found between the two samples, but aspects of health system evaluation differed. The data obtained from this study informed the development of the Patient Expectation and Satisfaction Scale (PESS). The psychometric properties of the preliminary version of the scale were subsequently tested in non clinical populations in Greece and the UK (Studies 2a and 2b). The pilot testing of the PESS was based on a proposed theoretical framework suggesting that patients’ expectations depend on the nature of past experiences and current expectations. The variable that influences some of the differences between the two countries is health culture in terms of contextual health care differences. Although findings revealed similarities between the two cultures, differences were found relating to dissatisfaction, health care evaluations, expectations and the quality of the doctor-patient relationship. A revised version of the PESS, based on these findings, was administered to hospital outpatient populations in both countries (Study 3). The Patient Satisfaction and Expectation Model that emerged from this analysis incorporated three levels of patient satisfaction: at the micro level, the macro level and the interpersonal level. The importance of patients’ understanding of professional competence and its salience as a predictor of the effectiveness of the doctor-patient relationship was highlighted. The quality of the doctor-patient relationship emerged as an important determinant of patient satisfaction and adherence. The overall findings of this research programme suggest that patient satisfaction is multidimensional; despite contextual differences between the two health care systems, a universal concept exists that includes health care expectations, health care experiences, interpersonal qualities and aspects relating to operational and organisational structures at both micro and macro level.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

Situado no contexto da qualidade em saúde, este estudo versa sobre a decisão clínica e autonomia do paciente. Parte-se da premissa que, demais da competência técnica profissional e utilização de tecnologia adequada, o respeito aos direitos dos pacientes é atributo essencial à boa qualidade do atendimento médico. Tomando como exemplo a abordagem terapêutica do climatério, foi feita análise qualitativa do processo de decisão clínica, com base nas informações obtidas através de entrevistas semi-estruturadas com médico ginecologistas e com pacientes em fase de climatério. O propósito foi buscar apreender os valores dos médicos e dos pacientes e tentar compreender a lógica de seus comportamentos e atitudes, no que se refere especificamente aos papéis desempenhados por eles nesse processo. Com base nos resultados da análise, discute-se a complexidade da aplicação do princípio da autonomia na prática clínica e apresenta-se uma reflexão sobre a acreditação, como estratégia possível de contribuição a esse processo e à melhoria da qualidade do atendimento médico, por sua grande identificação como os aspectos relativos aos direitos dos pacientes, aos processos de educação permanente e à melhoria contínua da qualidade. / This research is set in the context of quality in health care. The object of the study was the patients role in clinical decision-making, considering that assuring good quality of clinical care requires respect to patients rights, as much as good technology. In order to study the decision process, we chose hormonal replacement therapy in the climacteric through qualitative analysis, based on non-structured interviews with gynecologists and postmenopausal women. The main purpose was the understanding of the values, attitudes and the reasoning employed by physicians and patients. The complexity of application of the bioethical principal of autonomy in daily clinical practice is discussed. The contribution of accreditation to these processes is examined, stressing the relevance of the functions related to patients rights, continuous education and continuous quality improvement.

Made available in DSpace on 2015-04-17T15:02:12Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 2478876 bytes, checksum: de000c510d706f6a04c4191278376fd4 (MD5) Previous issue date: 2013-07-26 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / The purpose of this study was to analyze the influence of religiosity in 139 patients between 25 and 75 years old which being treated for arterial hypertension in a family health program located in the city of Pedras de Fogo, Paraíba, in the period between December, 2011 and December, 2012. The sample included two groups: the Study Group, with 73 people that accepted to be part of the research, in which the religious activities were intensified; and the Control Group, with 66 patients that did not have any religion or did not accept the intensification of their religious activities. All of them had signed an informed consent for participation in the study and the clinical medical routine in both groups was maintained. It was applied: a clinical social-demographic questionnaire with a personal profile and the Scale Religious Attitude (Aquino, 2005) at the start and end of the nine months period. The analysis of the data was made in the program Statistical Package for the Social Sciences, version 18. Although there have been no significant reductions in the blood pressure in the subjects of the research, there was in the Study Group a decrease in the use of sedatives and antidepressants. Correlating some complaints that was reduced in a percentage in the Study Group with the intensification of religious activities, it was observed that: there is an inverse proportional relationship between prayer and chest pain (r = -0,259; p < 0,01), fear of death (r = -0,189; p < 0,05), and cold hands (r = -0,195; p < 0,05). Bad feelings (r = -0,235; p < 0,01) occurred less in the patients that took the communion and the recitation of the Rosary may have contributed to reduce dizziness (r = -0,217; p < 0,05). It was also observed a direct correlation between forgiveness and humor among the people who were the most religious of the sample (r = 0,233; p < 0,05) in the first step of the study. The evaluation of the reports points out mutual religiosity as a fator that improves the doctor-patient relationship. We have concluded that religiosity benefits people health in general, strengthening the trust of the patient in the doctor, and can be used as a therapeutic tool also in the field of mental health. / Este estudo teve como objetivo analisar a influência da religiosidade sobre a pressão arterial em 139 pacientes hipertensos com idades entre 25 e 75 anos, em uma unidade do Programa Saúde da Família, no município de Pedras de Fogo, Paraíba, no período de dezembro de 2011 a dezembro de 2012. A amostra foi composta por dois grupos: o Grupo de Estudo com 73 pessoas que aderiram ao protocolo da pesquisa, intensificando a atividade religiosa; e o Grupo Controle, com 66 pacientes que não tinham religião ou não aderiram à intensificação de suas atividades religiosas. Todos assinaram o Termo de Consentimento Livre e Esclarecido e mantiveram a rotina clínica de acompanhamento. Foram aplicados: um questionário clínico sócio-demográfico com dados pessoais e clínicos e a Escala de Atitude Religiosa (Aquino, 2005) no início e ao fim do período de nove meses. A análise dos dados foi realizada no programa Statistical Package for the Social Sciences, versão 18. Embora não tenha havido reduções significativas da pressão arterial nos sujeitos da pesquisa, foi encontrada no Grupo de Estudo uma diminuição do uso de antidepressivos e de indutores do sono. Ao correlacionar algumas queixas que reduziram percentualmente no Grupo de Estudo com as práticas religiosas que haviam sido intensificadas, foi verificado que: a oração foi inversamente proporcional à dor no peito (r = -0,259; p < 0,01), ao medo da morte (r = -0,189; p < 0,05) e às mãos frias (r = -0,195; p < 0,05). Os maus pressentimentos (r = -0,235; p < 0,01) ocorriam menos nos que comungavam e a reza do terço pode ter contribuído para reduzir as tonturas (r = -0,217; p < 0,05). Foi verificada correlação direta entre o perdão e o humor referido entre os mais religiosos da amostra (r = 0,233; p < 0,05) na primeira etapa do estudo. A avaliação dos relatos aponta a religiosidade mútua como fator que melhora a relação médico-paciente. Concluímos que a religiosidade traz benefícios à saúde geral das pessoas, fortalecendo a confiança do paciente para com o médico, podendo ser usada como ferramenta terapêutica complementar inclusive no campo da saúde mental.