With one in two women delivering surgically, Iran has one of the highest rates of cesarean section (CS) worldwide. CS overuse in low-risk pregnancies potentially exposes women to Maternal Near-Miss (MNM) morbidity with minimal health benefits. This thesis studied obstetric care quality and MNM at hospitals with high rates of CS in Tehran, Iran. In Study I, we investigated whether audits of CS indications and feedback influenced CS rates at a general hospital. Subsequent to the audit, a 27% reduction in the risk of primary CS was found. In Study II, characteristics of MNM were investigated at university hospitals between 2012 and 2014. During a 26-month period, 82 MNM cases were identified using the WHO MNM approach. Severe postpartum hemorrhage (35%), severe preeclampsia (32%), and placenta previa including abnormally invasive placenta (10%) were the main three causes of MNM. Iran has a huge influx of migrants from Afghanistan. Women with antepartum CS and those who lacked health insurance, almost all Afghans, had increased risk of MNM. In Study III, audits examined whether MNM care quality differed between 54 Iranians and 22 Afghans and whether near-miss events were preventable. A majority of MNM cases (62%) arrived at hospital in a moribund state and obstetric care was more suboptimal for Afghans than Iranians (adjusted odds ratio 5.1, 95% confidence interval 1.2–22.6). Moreover, MNM was commonly (71%) potentially preventable and professionals with suboptimal practice were involved in 85% of preventable cases. In Study IV, a qualitative interview study was conducted to explore care experiences of Afghan MNM survivors. Discrimination, insufficient medical attention, and ineffective counseling were the main experiences. To a lesser extent, poverty and low education were perceived as contributing factors to delays in accessing care. This thesis emphasizes the importance of high-quality care for preventing undesirable maternal outcomes. The audit method along with interviews was useful to determine quality and equity gaps in care provision. Policymakers and professionals should consider these gaps when structuring programs to reduce adverse maternal outcomes.

Background: Patient experience has become an essential quality indicator in healthcare. Purpose: The purpose of this thesis was to conduct a concept analysis of the patient experience. Methods: Walker and Avant’s methodology served as the framework for this concept analysis. Data were retrieved from seven databases and one search engine. The literature search used keywords related to "patient experience" and included articles published at any time up until March 2018. A total of 257 articles and organizational websites were included in the analysis after meeting the inclusion criteria. Results: Twenty attributes were found to define the patient experience: communication, respect for patients, information/education, patient-centered care, comfort/pain, discharge from hospital, hospital environment, professionalism/trust, clinical care/staff competency, access to care, global ratings, medication, transitions/continuity, emotional dimension, outcomes, hospital processes, safety/security, interdisciplinary team, social dimension, and patient dependent features. Conclusion: The results of this study will guide and clarify the critical concepts towards an explicit definition of the patient experience.

Background: Patients who waiting for a surgery can feel fear, which increases the risk of more concern and anxiety. Patients need a clear information and communication that includes openness and hope in the preoperative care. Aim: The aims of this study are to investigate patients' experiences of the perioperative care in connection with an operation and with questions about the patients experience regarding information, communication, satisfaction and anxiety. Method: A quantitative descriptive study in the form of questionnaires conducted. The study participants were all patients who had undergone elective surgery at a hospital in central Sweden during week 10-11 in 2015. It was attended 50 patients, 30 men and 20 women between 20-86 years from five different surgical divisions. Results: The patient has high confidence of nurses and doctors professional competence, however more than half of the patients reported that the experienced anxiety before surgery. The preoperative meeting with the anesthesiologist experienced positive without reducing their anxiety. Patients felt that communication with a nurse anesthetist is easier compared to an anesthesia doctor, according to descriptive data. The majority of patients that the experienced unexpected situations in the operating room, and 28% wanted more information on how the surgery would go to. Conclusion; Lack of information is extensive in the preoperative care of patients who waiting for an operation. Most patients felt unexpected situations during the hospital stay, spite that the 100% of patients had high confidence in the nurse anesthesia and anesthesia doctor’s professional competence. / Bakgrund: Patienter som väntar på en operation kan uppleva rädsla vilket ökar risken för oro och ångest. Det önskas av patienter tydlig information och kommunikation som innehåller öppenhet och hopp i den preoperativa vården. Syfte: Syften med denna studie är att undersöka patienters upplevelse av den perioperativa vården i samband med en operation med frågeställningar om patienters upplevelse angående information, kommunikation, tillfredställelse och oro/ångest. Metod: En kvantitativ deskriptiv studie i form av enkäter utfördes. Studiedeltagarna var alla patienter som hade genomgått en elektiv operation vid ett sjukhus i Mellansverige under vecka 10-11 år 2015. Det deltog 50 patienter, 30 män och 20 kvinnor mellan 20-86 år från fem olika kirurgiska verksamheter. Resultat: Patienter har högt förtroende på sjuksköterskan och läkarens yrkeskompetens. Däremot angav mer än hälften av patienterna att de upplevde oro eller ångest inför operationen. Den preoperativa mötet med anestesiologen upplevdes positivt utan att minska deras oro och ångest. Patienter upplever att kommunikation med en anestesisjuksköterska är lättare jämfört med en anestesiolog enligt beskrivande data. En Majoritet av patienterna angav att de upplevde oförutsedda situationer i operationssalen och 28 % önskade mer information om hur operationen skulle gå till. Slutsats: Brist på information är omfattande i den preoperativa vården för patienter som väntar på en operation. De flesta patienter kände oberäknade situationer under sin sjukhusvistelse trots det hade 100 % av patienter högt förtroende för anestesisjuksköterskan och anestesiologens yrkeskompetens.

本研究試圖探究走過家庭照顧歷程決定成為照顧服務員這群女性勞動者，從這群女性勞動者的生命圖象中，分析這兩種角色之差異性，並進一步探討研究對象對於這兩種角色轉換之轉換歷程與因應策略。 本研究使用質性取向的研究方法，以半結構式的深度訪談進行資料蒐集，有效受訪對象共訪談8位曾有家庭照顧經驗之照顧服務員，年齡介於44歲～63歲之間，教育程度則以高中職為主。婚姻狀況單身3名、單親2名、已婚育有子女3名。照顧關係中女兒照顧者與媳婦照顧者各半。家庭照顧期間從1年到16年皆有，照顧服務員工作年資則從2年到13年不等。 本研究首先歸納整理女性成為主要照顧者的原因，並整理當照顧情境改變時家庭照顧者重返勞動市場之考量因素。研究發現，家庭照顧者在成為照顧服務員的過程當中，受服務經驗扮演相當重要的中介角色，受服務經驗是這群中年婦女在求職過程的一個重要催化劑，轉而投入照顧服務工作。接著耙梳照顧服務員在職場的工作困境，研究發現照顧服務員所面臨到的工作困境相當多元，本研究分從個人面、互動面、實務面及制度面四個層面加以說明。 研究最後統整了兩種照顧經驗之比較，研究發現家庭照顧者成為照顧服務員之後，因照顧對象的不同，隸屬於不同的關係中，佔據不同的位置，扮演不同的角色，並依循此角色之責任義務規範行事。兩種照顧經驗的差異展現在照顧角色轉換的經驗感受、照顧基礎的差異以及照顧過程中照顧者的自主性三個面向上。同樣的照顧工作，一是無酬一是有酬，一是親屬關係一是專業服務關係，一是基於責任一是基於契約提供照顧，一是在家庭成員共識認可下照顧，一是依循科層組織規章在契約的規範下照顧，兩者在不同的面向上呈現相當不同的景象。然而，具有家庭照顧經驗的照顧服務員，對日後的照顧工作是有影響的，其關連性主要包括在下列三個部分：照顧的知識技巧、同理以及情感轉移上。其照顧與互動的技巧是可以透過反覆的實作而熟能生巧，照顧技巧的經驗累積可以視為是一種延續。 私領域的家庭照顧者與公領域的照顧服務員間之兩種照顧經驗，在照顧的任務（care for）上其實大致相同，但在照顧者對他人個感受（care about）上卻大相逕庭。因為照顧關係與照顧基礎的不同，親屬關係的家庭照顧承載著較多的感受狀態，家庭照顧者需時時刻刻、盡己所能地回應失能者所有需求，關注受照顧者的福祉，也因此照顧者會感受到較大的照顧壓力。反觀照顧服務員的照顧本質，對於情感的指涉相對較低，關係建立僅是互動的基礎，互動的時間也多在服務的時數範圍內，對受照顧者而言，更多的關注是在照顧任務是否精確完善的被執行。因此，一樣照顧兩樣情，相似的照顧工作，在不同的照顧場域中，照顧技巧的經驗會延續，但照顧歷程的差異感受卻是呈現相當多元的樣貌。 / This research aims to investigate female laborers who decide to become care workers owing to the experience of being family caregivers. It analyzes the difference between the two roles as well as the transformation and strategies that are taken. With the qualitative approach, the data were collected by semi-structural in-depth interviews.There are 8 valid once-family-caregiver interviewees who are now care workers aged 44 to 66, with the educational background of senior or vocational high schools. Among these interviewees, three are single, 2 are single mothers and 3 are married and have children. Four of whose family roles are daughters, four daughters- in- law. They have 1-16 years of experience of being family caregivers respectively and 2-13 years of being care workers. The study starts with a generalization of reasons that makes females as main caregivers and factors of their returning to the labor market when care-taking conditions change. It discovers that the experience of having been taken care of plays a crucial role in the transformation—from family caregivers to domestic ones. The experience serves as an important catalyst for these middle-aged women to become care workers. The study, then, scrutinizes the predicament these care workers encounter, followed by an analysis of their mutiple predicament derived from four respectives: personal conditions, interactive relationship with their patients, care-taking practice and public system. The study wraps up with a comparison-- after becoming care workers, these once-family-caregivers make adjustments according to different relationship and roles. The diversity between the two experience presents upon three dimensions: relationship with patients, different care-taking basis and autonomy of patients. Although both family caregivers and domestic ones are responsible for taking care of patients, the formers are unpaid; doing the job out of familial affection and obligations with the consensus of other family members, while the latters are paid workers, looking after their patients on the basis of profession and contracts under relevant regulations. Each unfolds quite disparate views in front of us. As divergent as they are, the experience of family care-taking has impact on the domestic caregiving work in terms of relevant knowledge and skills, compassion and communication abilities. The accumulation of similar experience can be extended and easily applied. The mission of 'caring for' patients is generally identical for both private-domain family cargivers and public-domain care workers, nevertheless, the extent of “caring about” patients varies. Family caregivers carry more affection and emotions; they have to do their best all all times to respond every need and well-being of the disables, which generates much stress. Care workers, however, are less affection-expected; their relationship with the patients is contract-based and they serve their patients in work hours. Instead of emotionally dependent, patients focus more on whether and how the tasks are being done. Two different perspectives are revealed which give us more lights on the care-taking work.

Bakgrund: Enligt Patientlagen skall patienten ses som en resurs i sin egen vård och förväntas vara delaktig i beslut och resonemang. Patienten har rätt till självbestämmande och får själv avgöra vilken grad av delaktighet som önskas. Ökad kunskap om vad som påverkar viljan till delaktighet krävs, för att kunna främja ett bemötande från vårdpersonalen som gynnar patienten och ger en bättre vårdupplevelse. Syfte: Syftet var att beskriva vilka faktorer som påverkar patientens delaktighet.  Metod: En litteraturöversikt baserad på 12 vetenskapliga artiklar med kvalitativ ansats utförs och analyseras med ett induktivt synsätt utifrån Fribergs femstegsmodell. Dessa 12 artiklar är hämtade från CINAHL, PsycINFO samt manuella sökningar. Resultat: Litteraturöversiktens resultat presenteras i två kategorier och fem underkategorier. Den första kategorin är Patienten med underkategorierna Delaktighet på eget initiativ, Patientens ålder och Anhörigstöd. Den andra kategorin är Vårdpersonal med underkategorierna Bemötande från vårdpersonal och Tid för patienten. Slutsats: Delaktighet leder till bättre vårdupplevelse. Eget initiativ, stöd och bekräftande bemötande är faktorer som påverkar patientens delaktighet. / Background: According to the Swedish patient law, the patient is to be regarded as a resource in his or her own care and is expected to be participating in reasoning and decisions. The patient is entitled to self-determination and have the right to decide the level of participation that he or she wishes. Increased knowledge of what affects the willingness to participate is required to promote a response from healthcare professionals who will benefit the patient and provide a better healthcare experience. Purpose: The purpose was to describe which factors that affect the patient's participation. Method: A literature review based on 12 scientific articles with a qualitative approach was made and analyzed with an inductive approach based on Friberg's five-step model. These 12 articles are taken from CINAHL, PsycINFO and manual searches. Result: The result is presented in two categories and five subcategories. The first category is the Patient with the subcategories Self-Initiative, Confidence in Health Care, Patient Age and Family Support. The other category is Healthcare Personnel with the subcategories Treatment from healthcare professionals and Investing time for the patient. Conclusion: Participation leads to better care experience. Own initiatives, support and affirmative treatment are factors that affect the patient's participation.

1 ABSTRACT The diploma thesis is focused on experience with self-reflection of social workers who supporting foster families. It is divided into two parts - theoretical and empiric. Aim of the thesis was to find out what kind of experience with self-reflection has social workers of organizations supporting foster families. The theoretical part has five chapters. The first chapter shows to readers what profession of a social worker is about - at first it looks at social work in context of helping professions, then it defines expert studies, abilities, and personality of social worker, and it also mentions possible motivation for working in this field. The second chapter brings topic of foster care and a definition of supporting; it describes supporting organizations for foster families and role of social worker in it. In the third chapter there can be found definition of self-reflection (in narrow meaning it brings nearer parts of self-reflection such as self-approach, self-knowledge, or self-regulation); further there can be found consideration of what importance self-reflection has for social workers and which tools to reach it they can use. The fourth chapter is aimed at view of influence which can affect self-reflection, such as emotion of worker, projection, topic of power and powerlessness, work with...

Dans le contexte de vieillissement de la population, un déclin potentiel du nombre des aidants familiaux et le déficit de care qui en résulte, la prise en charge des personnes âgées est restée un sujet presque invisible pour les politiques publiques et la recherche au Chili. Le gouvernement chilien a commencé à prêter attention au sujet, mais beaucoup reste à faire pour une bonne prise en charge. Cette thèse adopte le point de vue des aidant-e-s qui consacrent leur vie à aider un parent âgé en perte d’autonomie. Le care est abordée dans une perspective microsociologique en explorant la vie quotidienne et les dimensions qui façonnent l'intensité des expériences de ceux qui prennent en charge un parent âgé. Cette thèse aborde aussi le niveau des politiques du care, en décrivant et analysant comment le care aux personnes âgées est distribué au Chili et le rôle du gouvernement dans cette responsabilité. L'étude identifie les principales étapes de cette politique, ainsi que les défis à relever pour les gouvernements pour garantir une répartition plus équitable du care aux personnes âgées. Pour l’aspect macro, la thèse utilise des méthodes mixtes. Elle s'appuie sur l’analyse secondaire de données nationales disponibles, une revue de la littérature et des entretiens réalisés avec des informateurs clés. Pour étudier le care dans une perspective micro, cette thèse adopte une méthodologie qualitative en profondeur. La thèse souligne que la répartition sociale du care aux personnes âgées au Chili, en dépit des efforts déployés par le gouvernement pour le soutenir, continue de relever d’un régime de « familialisme par défaut ». Ceci signifie que la responsabilité est assumée presque exclusivement par les familles et par les femmes, avec des implications importantes pour les inégalités de genre et les inégalités sociales. La thèse explicite en quoi être aidant d'un proche âgé est une expérience complexe. L'intensité de cette expérience est en partie déterminée par les tâches spécifiques qu'ils accomplissent et le temps qu'ils consacrent aux care mais son intensité est aussi largement modulée par leur histoire personnelle, leurs relations avec les personnes âgées et leurs autres proches, par la façon dont ils perçoivent leur rôle d’aidants et leurs attentes en matière de care. L'intensité de l'expérience du care est alors le résultat d'une combinaison de facteurs objectifs, de contextes différents et de perspectives subjectives présidés par la dimension émotionnelle du care. / In the context of an ageing population, a potential decline of family caregivers and the resulting potential care deficit, elderly care has remained an almost invisible subject for public policy and research in Chile. The Chilean government has begun to pay attention to the issue of elderly care, but it is currently moving too slowly. This thesis unveils the voices of the carers who dedicate their lives to providing care to an elderly relative. It studies care from a micro perspective by exploring the daily lives of caregivers and the intensity of their care experience. This thesis also studies care from a macro perspective, describing and analysing how elderly care is distributed in Chile and the government’s role in this responsibility. The study identifies the major steps taken, as well as the challenges that lie ahead with a stronger governmental role and a fairer distribution of elderly care. To study care from a macro perspective, the thesis uses a mixed methods approach. It relies on large-scale surveys, on a literature review and interviews with key informants. To study care from a micro perspective this thesis adopts an in-depth qualitative methodology. The thesis finds that the Chilean social distribution of elderly care, despite all policy efforts to support elderly care, remains drawn towards a “familialism by default” care regime. This means that the social responsibility for elderly care is taken up almost exclusively by families, and by women therein, with important implications for gender and social inequality. The study also finds that caring for an elderly parent is a complex experience. The intensity of the care experience is partly determined by the specific tasks caregivers carry out and the amount of time they spend on care, and it is largely shaped by their personal history, their relationships with the elderly and their other relatives, from how they perceive their caring role and their expectations of care. The intensity of the care experience is then the result of a combination of objective factors, different contexts and subjective perspectives adjudicated by the emotional dimension of the care.

No description available.

The problem with which this study is concerned is the inclusion of actual critical care experience in generic nursing curricula in the United States. A survey instrument was sent to faculty representatives selected by the dean of each of 312 generic baccalaureate nursing programs.

Les expériences de soin vécues par les infirmières de soins intensifs auprès des patients cérébrolésés et de leurs proches alors que l’arrêt de traitement devient une option confrontent les infirmières à des défis qui surgissent particulièrement lors de l’instauration de la relation de soin, infirmière-patient, et lors de la mise en action de leur rôle d’avocate. Parmi les théories en sciences infirmières, celle du Human Caring de Watson (1979/1985/2008/2012) positionne la relation avec le patient, une relation transpersonnelle, comme un idéal moral. Dès lors, lorsqu’elles sont confrontées à des défis pour développer cette relation, les infirmières remettent en question tant leur pratique, que la conception qu’elles ont de la nature du soin, centre d’intérêt de leur discipline. Toutefois, à ce jour, très peu d’études ont eu pour objet de recherche la compréhension de cette expérience de soin vécue par des infirmières auprès de patients cérébrolésés et de leurs proches alors que l’arrêt de traitement devient une option. Cela, même si les défis, et les questionnements qu’ils suscitent chez les infirmières peuvent avoir d’importantes répercussions pour les personnes soignées dans un environnement de soins intensifs. Instruite par le constructivisme projectif, la pensée complexe de Morin et la philosophie de la compréhension de Ricœur, notre étude a eu pour but précisément de chercher à décrire et comprendre l’expérience de soin vécue par des infirmières de soins intensifs auprès de patients cérébrolésés et leurs proches lorsque l’arrêt de traitement devient une option. Cette recherche a été réalisée à partir d’un devis descriptif interprétatif, tirant ses origines de la discipline infirmière, en s’inspirant du Narrative Inquiry, méthode qui a pour visée d’étudier l’expérience (Chase, 2005; Clandinin & Connelly, 2000). Onze infirmières provenant des régions de Montréal et de Québec ont participé. La chercheuse a rencontré chaque participante à trois reprises pour effectuer le recueil des données à partir desquelles les récits de recherche ont été co-construits, et le premier niveau d’analyse a été réalisé. Cette analyse qui demeurait descriptive s’est poursuivie par questionnement analytique (Paillé & Mucchielli, 2012) de conception complexe en dialogue avec les 11 récits de recherche. Les connaissances construites en deux étapes, une phase descriptive et une phase interprétative sur cette expérience de soin ont constitué les fondements de notre réflexion pour activer la conception de nouvelles connaissances disciplinaires sur l’ontologie du soin. Nous avons interprété que le soin, que nous qualifions d’humanéthique, peut être conçu dans le construit d’un système complexe ouvert, comportant : une finalité, la vie bonne avec et pour un patient heureux; une écologie dans laquelle il s’organise, où l’environnement social est prépondérant; une évolution temporelle se déployant dans un espace-temps; une reliance indicible, la dimension relationnelle essentielle au soin; mais aussi une part d’incertitude. Une modélisation du soin humanéthique, un système perçu complexe, est présentée à travers un récit s’inspirant de la pratique infirmière. Dans cette étude, le récit s’est révélé être un outil pertinent, car la narrativité a non seulement contribué à questionner et réfléchir la pratique lors du recueil des données, et de l’analyse; mais elle a aussi permis de réaliser une représentation dynamique et pragmatique des résultats empiriques et théoriques. Ainsi, notre projet à travers l’approfondissement d’expériences vécues en pratique par des infirmières a conduit à l’avancement d’un nouvel éclairage théorique sur le soin. De plus, à travers un récit, nous avons proposé des leviers qui puissent être actionnables en pratique par les infirmières, quel que soit le contexte dans lequel le soin se déroule. Des pistes de réflexion et des implications en ont résulté pour les secteurs de la pratique clinique, de la formation, de la gestion et de la recherche en sciences infirmières. Dès lors, cette étude orientée vers la pratique a non seulement la faculté de pouvoir soutenir la pratique infirmière, mais aussi d’être à l’origine de nouveaux questionnements sur la nature du soin, permettant ainsi de poursuivre son développement. / The care experiences of critical care nurses with brain-damaged patients and their loved ones as withdrawing treatment becomes an option confront nurses with challenges that arise particularly when establishing the nurse-patient care relationship and when putting their advocacy role into action. Among the nursing theories, Watson's Human Caring (1979/1985/2008/2012) positions the relationship with the patient, a transpersonal relationship, as a moral ideal. Therefore, when faced with challenges in developing this relationship, nurses question both their practice and their understanding of the nature of care, which is the focus of their discipline. However, to date, very few studies have focused on understanding nurses' experience of caring for brain-damaged patients and their loved ones as withdrawing treatment becomes a care option. This is despite the fact that the challenges, and the questions they raise for nurses, can have important implications for those being cared for in a critical care environment. Based on projective constructivism, Morin's complex thinking and Ricoeur's philosophy of understanding, the purpose of our study was precisely to seek to describe and understand the care experience of critical care nurses with brain-damaged patients and their families when withdrawing treatment becomes an option. This research was carried out from an interpretative descriptive specification, drawing its origins from the nursing discipline, inspired by the Narrative Inquiry, a method that aims to study the experience (Chase, 2005; Clandinin & Connelly, 2000). Eleven nurses from the regions of Montreal and Quebec City participated. The researcher met with each participant three times to carry out the data collection from which the research narratives were co-constructed, and the first level of analysis was carried out. This analysis, which remained descriptive, continued through analytical questioning (Paillé & Mucchielli, 2012) of complex design in dialogue with the 11 research narratives. The knowledge built up in two stages, a descriptive phase and an interpretative phase on this experience of care constituted the foundations of our reflection to activate the conception of new disciplinary knowledge on the ontology of care. We have interpreted that the care, which we call “humanethical”, can be designed in the construction of a complex open system, with: a purpose, a good life with and for a happy patient; an ecology in which it is organized, where the social environment is preponderant; a temporal evolution unfolding in space-time; an unspeakable relatedness , the relational dimension essential to care; but also an element of uncertainty. Modelling the “humanethical” care, a complex system, is presented through a narrative inspired by nursing practice. In this study, storytelling proved to be a relevant tool, as narrativity not only helped to question and reflect on practice during data collection and analysis, but also provided a dynamic and pragmatic representation of empirical and theoretical findings. Thus, our project through the deepening of experiences lived in practice by nurses has led to the advancement of a new theoretical perspective on care. In addition, through a narrative, we have proposed levers that can be operated in practice by nurses, regardless of the context in which the care takes place. This led to a number of reflections and implications for clinical practice, education, management and research in nursing. Therefore, this practice-oriented study not only has the potential to support nursing practice, but also to raise new questions about the nature of care, thus enabling its further development.