Trata-se de um estudo transversal de natureza compreensiva. Teve como objetivo discutir os aspectos comunicacionais da relação enfermeiro-usuário na atenção básica, tendo em vista o princípio do vínculo. Teve como base as produções científicas sobre comunicação terapêutica em saúde. O método utilizado foi a triangulação de métodos. O processo compreendeu três momentos distintos: no primeiro, a aplicação do Inventário de Problemas Éticos na Atenção Primária à Saúde (IPE-APS) para uma primeira visão dos enfrentamentos e conflitos nas relações entre os enfermeiros e usuários, e que serviu para a triagem das unidades/sujeitos para a etapa seguinte; no segundo, a observação do atendimento de enfermagem com base em um roteiro sobre os aspectos comunicacionais (verbais e não-verbais); e no terceiro, entrevista aberta, com as enfermeiras cujo atendimentos foram observados, na sequência da observação. A análise permitiu evidenciar o uso da comunicação terapêutica pela enfermeira através da utilização de seus elementos como a empatia, a escuta receptiva, respeito e o acompanhamento do paciente em suas reflexões discutidos no marco teórico desta pesquisa. Em vista do que foi percebido nas condutas das enfermeiras, desvela-se que a comunicação deve ser percebida como base para o cuidar em enfermagem mas, entretanto, por alguns momentos, é apenas entendida como algo inerente à prática e como processo mútuo de troca de informações técnicas a fim de estabelecer um plano terapêutico ao paciente. / It is a comprehensive research that aimed to discuss communicational aspects of primary-care patient-nurse relationship, focusing on bond and therapeutic communication. Data collection used a triangulation of methods with distinct stages: (i) application of the Inventory of Ethical Problems in Primary Health Care (IPE-APS) to an overview of ethical issues in nurse-patient relation and to select the services and nurses for observation of nursing care actions. The observation focus was communication aspects (verbal and nonverbal) during the care action. After observation, nurses should talk about their communication in the action. The analysis used the elements of therapeutic communication: empathy, receptive listening, respect and accomplish of patients in their thoughts, feelings, fear, and believes. The results pointed out that the nurses realize the importance of communication for their actions, however, they consider it inherent to nurse practice and as an exchange of technical information to get patients accomplish to treatments.

This study presents the process of creating a performance ethnography of my family’s narratives about familial chronic illness and disability. I label this process performing narrative medicine. By documenting and granularly analyzing the process of my performance ethnography, the following chapters provide a step-by-step discussion of how families communicate about chronic illness/disability through storytelling and humor, and how/what performance does as a method, metaphor and object of study to further our current communicative practices and understandings of chronic illness and disability in families. I argue that performing narrative medicine is a heuristic for families living with chronic illness and disability, and a method that may be used and applied outside the context of my own family. The chapters in my dissertation directly address the following questions: How does my performance work as embodied knowledge to gain greater understanding of the lived experience of familial disability/chronic illness? How does the use of humor as a communicative construct, and performance ethnography work as a practice of “performing narrative medicine?” What are our scholarly stakes in performing narrative? How too might binding narrative medicine to performance inform how we do qualitative research? How do the respective motions of narrative medicine and research practices/principles of performance ethnography converge and cross-fertilize each other? Does a work like narrative medicine endow storytelling and performance with a consequentiality? This performance ethnography of familial disability and chronic illness contributes to understandings of families dealing with chronic illness/disability, extends narrative medicine as a theoretical construct, and speaks to a long tradition of the practice of performance ethnography. Overall, performing narrative medicine reveals the underlying communication competencies at work in families living with chronic illness and disability. Through the use of humor and performance as a communication practice, I reveal the power of empathy. The power in realizing our own human capacities to relate to one another across differences, and continue the work of “living well.” This dissertation emphasizes the power of performance to constitute alternative ways of performing and understanding familial chronic illness, by emphasizing the work of creating, implementing and studying performance.

The Zika virus is associated with the devastating birth defect microcephaly, and while a vaccine was not yet available in early-2017, several were under development. It is imperative to identify effective communication strategies to promote uptake of a new vaccine, particularly among women of reproductive age. Moreover, though the Zika outbreak has received much social media attention, little is known about these conversations on Instagram. The purpose of this dissertation, therefore, was to understand current Zika-focused communication on Instagram and to inform effective communication strategies to promote future Zika vaccine uptake intent. The study aims were: (1) explore Zika conversations on Instagram; (2) determine effective message characteristics to increase Zika vaccine uptake intent; and (3) explore salient demographic, healthcare, and psychosocial factors related to Zika vaccine uptake intent. A content analysis of 1,000 Zika-focused Instagram posts, found that these messages primarily focus on perceived threat constructs, yet they elicited little engagement. In addition, 10% of all Instagram posts mentioned conspiracy theories, and these messages elicited high engagement. A 2x2 online experiment tested the effect of message framing and visual type on Zika vaccine uptake intent. The 339 participants – all women of reproductive age – each were exposed to one of four messages (gain vs. loss-framed, and infographic vs. photo). There was no interaction effect of framing and visual type (p=.116), nor main effect of either framing (p=.185) or visual type (p=.724) on vaccine uptake intent. When testing the effect of these variables on those known to be predictors of behavioral intent, gain-framed messages were associated with higher subjective norms, perceived benefits, and self-efficacy. Data from the same online survey was used to examine whether demographics, healthcare-related variables, and psychosocial variables predict Zika vaccine uptake intent. Attitude (p<.001), subjective norms (p=.002), perceived benefits (p=.001), self-efficacy (p=.031), perceived susceptibility (p=.030), and cues to action (p=.020) were predictive of higher Zika vaccine uptake intent, as was being African-American (p=.042). In summary, messages promoting the Zika vaccine should be designed to complement the high perceived threat of Zika while activating positive social norms and perceived benefits in order to allow the public to respond efficaciously.

A qualitative approach was used to explore the influence of mass media campaigns on Black women’s perceptions of breast cancer. The primary purpose of this study was to address the high breast cancer mortality rate among young Black women, thus informing strategies to increase awareness of risk and encourage prevention activities. Black women have higher incidence rates before age 45 and are more likely to die from breast cancer at every age. Although the breast cancer mortality variance has been linked to socioeconomic status, studies have shown that differences in cancer knowledge and beliefs persist even when educational and socioeconomic measures are statistically controlled. Because little is known about how various ethnic group members form ideas about breast cancer in the U.S., semi-structured interviews were conducted with 27 Black women between the ages of 30 and 40 to determine their knowledge and beliefs about breast cancer, as well as their personal perceptions of susceptibility to being diagnosed with breast cancer, in order to illuminate the interplay of culture and health belief systems on participants’ understanding of breast cancer messaging. To explore the potentially complex dynamics involved in how young Black women come to construct meanings about breast cancer, a theoretical framework that coupled Cultural Models Theory with the Risk Perception Attitude framework was used to address how health campaigns influence the behaviors and breast cancer detection experiences of Black women. Findings from the study revealed that young Black women’s perceptions of breast cancer are primarily driven by personal experiences, as opposed to mass media influences. The Black women in this study had a lack of knowledge of risk and prevention factors and did not perceive themselves to be affected by breast cancer due to their young age. In spite of cultural taboos against discussing health issues with family and friends, the women in this study tended to take responsibility for their health and were proactive in seeking and acting on health information.

This project examines user-generated health narratives through corpus analysis of 246 reviews posted on Midwestern Hospital’s Yelp page. Understanding how different stakeholders act and interact within online health communities models a shift in new conceptions of health, and provides evidence of health ecologies’ ability to determine patient perceptions of care. Documents produced by users in these health communities represent health narratives comprised of a user’s health experience, that user’s treatment perceptions, and the community’s perceptions of the user’s experience. Author uses corpus methods to interpret user trace data and rhetorical moves embedded in health narratives. Findings suggest that users who interact with the Yelp community produce different health narratives than less engaged users. Understanding how different stakeholders act and interact within online health communities models a shift in new conceptions of health, and provides evidence of health ecologies’ ability to determine patient perceptions of care.

Lymphoedema is a chronic health condition characterized by the accumulation of lymphatic fluid in the subcutaneous tissues resulting in arm swelling and can significantly affect physical and psychological health and QOL. Although significant research on lymphoedema has developed over the past decade, the literature reveals that there are gaps in knowledge on framing the illness, communication, and effective practices to improve the QOL for individuals living with lymphoedema. This research contributes to this growing field of research through a qualitative investigation of twelve women's reported understandings, experiences, and perceptions of lymphoedema using Brown’s (1995) theory of framing disease and illness. Semi-structured interviews were conducted with women living with lymphoedema to determine the impact of health messaging, to explore the ways in which these women made sense of conflicting messages on exercise, and to better understand how barriers to the effective adoption and integration of good management practices can be overcome.

Social media have become increasingly useful in identifying conversations during a crisis, particularly on Twitter where discussion tends to be public, accessible, and extensive. Through social media, individuals engage in social interaction and dialogue, making social media platforms a place where crisis coping activities may be identified, tracked and evaluated. This study examines crisis response of two separate crisis events, the terror attacks in Paris (2015) and in Barcelona (2017). Using semantic network analysis, this study examined dialogue surrounding each crisis over three days following the original crisis events, marked by the hashtags #Paris (24,728 tweets) and #Barcelona (27,338 tweets). Results show that the most dominant dialogue in the Paris and Barcelona terror attacks demonstrated central themes of information distribution, emotional expression, sense of community, and calls to action. More specifically, results show that the emotional connections trend positive in expressing community and unity. While most of the literature on crisis emphasizes negative response, this study shows that positivity during a crisis is a significant theme of discussions. Furthermore, this study showed resilience in efforts to seek positivity, build community, and create new normals, suggesting that social media engagement might help facilitate resilience.

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This overview was made to discuss coping with families who have lost a child/sibling, specifically children in preschool and elementary school. This subject can be daunting and difficult to navigate for parents however, understanding the importance of communication, involvement, and proper coping techniques is vital to the child’s development and perception of death. This educational poster discusses ways to tackle the issues that come when losing a child and give parents further insight into young minds dealing with tragedy. We look at Family Stress Theory to further explain assumptions about families, how families manage conflict and stress, stressors family systems undergo, and other related concepts.