Trata-se de uma investigação de desenvolvimento metodológico cujo objetivo foi construir e validar um instrumento para medir a satisfação da comunicação do paciente após a laringectomia total e avaliar a qualidade de vida deste, através do instrumento validado por Sawada (2002). A metodologia utilizada baseou-se em procedimentos teóricos, empíricos e analíticos propostos por Pasquali (1998) para a elaboração de instrumentos psicométricos e da comunicação (Berlo, 1979). O instrumento foi submetido à análise da adequação semântica e conceitual dos itens, por três peritos, seguido do pré-teste. Os procedimentos empíricos compreenderam a aplicação do mesmo a uma amostra de 52 laringectomizados, entre julho de 2002 a janeiro de 2003, realizadas no GARPO–Laringectomizado, Ribeirão Preto-SP. Os analíticos compreenderam a análise da validade do construto (análise fatorial com extração de 15 fatores) e da confiabilidade (Alpha de Cronbach total de 0,97 e nos domínios, variando de 0,95 a 0,96). Este estudo resultou na criação de um instrumento composto por 94 itens e dois domínios, com índices de confiabilidade altamente satisfatórios. Os resultados revelam a importância do método de vocalização atualmente utilizado e avaliado pelo próprio indivíduo. Para os laringectomizados que utilizam a voz de bochecho, os gestos/mímica labial e escrita, como forma de comunicação alaringeal, a boa qualidade de vida não é sinônimo de boa satisfação da comunicação atual. Entretanto os que utilizam a prótese traqueoesofágica forneceram dados que mostram que a boa qualidade de vida é sinônimo de boa satisfação da comunicação atual. Contudo, os estudos sobre mensuração da satisfação da comunicação do paciente após a laringectomia total ainda são incipientes em nosso meio e esta investigação pode ser entendida como um ponto de partida para outras dessa natureza. / This methodological development study aimed to construct and validate a scale to measure satisfaction levels with patients’ communication after total laryngectomy and to evaluate their quality of life, through the scale validated by Sawada (2002). The applied methodology was based on theoretical, empirical and analytical procedures proposed by Pasquali (1998) for elaborating psychometric and communication scales (Berlo, 1979). The scale was submitted to an analysis of the items’ semantic and conceptual adequacy, carried out by 3 experts, followed by a pretest. Empirical procedures covered the application of this scale to a sample of 52 laryngectomized patients, from July 2002 to January 2003, realized at the GARPO–Laryngectomized patients, Ribeirão Preto-SP, Brazil. Analytical procedures included construct validity analysis (factorial analysis with extraction of 15 factors) and reliability analysis (total Cronbach’s Alpha 0,97 and varying from 0,95 to 0,96 in the dominions). This study resulted in the creation of a scale that consists of 94 items and 2 dominions, with highly satisfactory reliability rates. Results disclose the importance of the vocalization method that is currently used and evaluated by the proper individual. The laryngectomized patients who use voice the mouth, gestures/lip mimics and writing as a form of alaryngeal communication do not consider good quality of life as synonymous with high satisfaction with current communication. Patients who use tracheo-esophageal prosthesis, on the other hand, supplied data indicating that good quality of life is synonymous with high satisfaction with current communication. However, studies measuring satisfaction with patients’ communication after total laryngectomy are still in an initial stage in our area. This research can be considered a starting point for other studies of this kind.

published_or_final_version / Nursing Studies / Master / Master of Nursing in Advanced Practice

No description available.

This ethnographic nursing home study explores the meaning which residents make of being old and in care. Its primary focus is on the role of social and communicative interactions in maintaining residents’ sense of self. Throughout the thesis I argue that the self is socially constructed, narratively communicated and is continuous throughout the life span. This narrative, relational self is diminished in old age by bereavement and the loss of social networks, and threatened by the loneliness and isolation of the institutional environment. Nonetheless, despite the stripping of relational layers entailed in the loss of the people with whom the younger self was constructed, there is a continuing core of self which, while bending, does not break. I argue that the nursing home can be a site of recovery for this vulnerable, diminished self, offering support and the opportunity to take on new roles and form new relationships, and through these relationships, new layers of self. / Staff are key players in the healing process, and staff-resident relationships important new sources of meaning for the relational self. The ageing, marginalised self is strengthened through empathetic communication which recognises the individual person and the importance of that individual’s life, acknowledges residents’ adult status, and enhances self-esteem by enhancing personal control. For residents, telling their stories and remembering their past lives provides a means of making sense of where and who they are in the present, and of envisaging a future. Consequently, it is vital that residents have opportunities to speak and be heard, and to be recognised and spoken to. These opportunities are sometimes adequately provided by families, friends, church and other visitors and volunteers, but frequently they are not. Staff then become the main source of resident support. / The capacity of individual staff to meet residents’ communication needs is dependent on many factors including the legislative framework and funding of the aged care system, the philosophy of the individual provider organisation (translated into work routines, staffing practices, and the training, mentoring and support available to staff) and the individual personalities and communication skills of staff themselves. Continuity of staffing is a vital factor, with “Know your resident” identified by staff in this study as the most important element in understanding and recognising the needs of residents withcognitive and communicative impairment, and in building relationships which support residents and enhance their autonomy.

Increasing the education of nursing staff is a society-wide issue, influenced by continuous development of medicine and medical technologies. The provision of nursing care is rightly demanding. The only way to keep up with new trends is lifelong nursing education. Nursing education in a particular workplace primarily aims at addressing current problems of the department and nurses? needs. The theoretical part deals with the influence of education on the quality of nursing care. We present a structure of education of paramedical professions. We define and clarify terms such as pedagogy, didactics, education and learning. We deal with the specifics of education, didactic principles and principles of adult education. In addition, we specify instructional strategies for nursing staff. For the purposes of this thesis, four objectives were set. In the first one we wanted to find out what the system and process of nursing education in the department looks like. The research showed that educational events are held in all departments. The organizing departments mostly report irregular or monthly frequency. The aim of the second objective was to obtain an opinion on the effectiveness of education in the department. We found disparity between the views of ordinary nurses and head nurses. The third objective was to answer the question of whether the organized educational events are initiated by the nurses? requests. Based on the answers of head nurses and ordinary nurses, we found out that this is not always the case. The last objective was to determine whether nurses implement the knowledge and skills gained to routine nursing care. The questionnaires showed that ordinary nurses try to incorporate the knowledge and skills to routine nursing care. For the purposes of this thesis, the combination of qualitative and quantitative research was selected. In order to carry out the qualitative part of the research, the method of questioning, using the technique of semi-structured interview with open questions was chosen. For the issue of quantitative research, the method of questioning, using the questionnaire technique with closed and semi-closed questions was used. For qualitative research, we set two research questions. In the first research question we wanted to find out what impetus the management uses when planning education in the hospital and the department. We found out that most often it is initiated by head nurses and ward nurses. In the second research question, we examined what obstacles the management sees to the effectiveness of education and implementation of the knowledge and skills gained into practice. Head nurses identify a problem in the actual participation in education in the department. For quantitative research, we set five hypotheses. Hypothesis 1 was: Nursing education in the workplace is an activity organized by the management regardless of the ordinary nurses? requests. The hypothesis was not confirmed. Hypothesis 2 was: Management, unlike ordinary nurses, sees the effectiveness of education in the workplace positively. The hypothesis was not confirmed either. The third hypothesis was: Education is seen as a necessary, routine activity, not as motivating factor for improving the quality of nursing care. The hypothesis was not confirmed. The last hypothesis was: Implementation of the knowledge gained from the educational events into nursing care is monitored by the management. The hypothesis was not confirmed, the implementation of knowledge is monitored, but not to the extent we expected. When evaluating the results we came across other very interesting facts, which we believe deserve more attention. Finally, it is surprising that the organization of educational events does not reflect nurses? shifts. One of the reasons for this might be the fact that some head nurses do not prepare the plan and time schedule for nursing education. We tried to propose the time schedule of nurses education in deparments.

Trata-se de uma investigação de desenvolvimento metodológico cujo objetivo foi construir e validar um instrumento para medir a satisfação da comunicação do paciente após a laringectomia total e avaliar a qualidade de vida deste, através do instrumento validado por Sawada (2002). A metodologia utilizada baseou-se em procedimentos teóricos, empíricos e analíticos propostos por Pasquali (1998) para a elaboração de instrumentos psicométricos e da comunicação (Berlo, 1979). O instrumento foi submetido à análise da adequação semântica e conceitual dos itens, por três peritos, seguido do pré-teste. Os procedimentos empíricos compreenderam a aplicação do mesmo a uma amostra de 52 laringectomizados, entre julho de 2002 a janeiro de 2003, realizadas no GARPO–Laringectomizado, Ribeirão Preto-SP. Os analíticos compreenderam a análise da validade do construto (análise fatorial com extração de 15 fatores) e da confiabilidade (Alpha de Cronbach total de 0,97 e nos domínios, variando de 0,95 a 0,96). Este estudo resultou na criação de um instrumento composto por 94 itens e dois domínios, com índices de confiabilidade altamente satisfatórios. Os resultados revelam a importância do método de vocalização atualmente utilizado e avaliado pelo próprio indivíduo. Para os laringectomizados que utilizam a voz de bochecho, os gestos/mímica labial e escrita, como forma de comunicação alaringeal, a boa qualidade de vida não é sinônimo de boa satisfação da comunicação atual. Entretanto os que utilizam a prótese traqueoesofágica forneceram dados que mostram que a boa qualidade de vida é sinônimo de boa satisfação da comunicação atual. Contudo, os estudos sobre mensuração da satisfação da comunicação do paciente após a laringectomia total ainda são incipientes em nosso meio e esta investigação pode ser entendida como um ponto de partida para outras dessa natureza. / This methodological development study aimed to construct and validate a scale to measure satisfaction levels with patients’ communication after total laryngectomy and to evaluate their quality of life, through the scale validated by Sawada (2002). The applied methodology was based on theoretical, empirical and analytical procedures proposed by Pasquali (1998) for elaborating psychometric and communication scales (Berlo, 1979). The scale was submitted to an analysis of the items’ semantic and conceptual adequacy, carried out by 3 experts, followed by a pretest. Empirical procedures covered the application of this scale to a sample of 52 laryngectomized patients, from July 2002 to January 2003, realized at the GARPO–Laryngectomized patients, Ribeirão Preto-SP, Brazil. Analytical procedures included construct validity analysis (factorial analysis with extraction of 15 factors) and reliability analysis (total Cronbach’s Alpha 0,97 and varying from 0,95 to 0,96 in the dominions). This study resulted in the creation of a scale that consists of 94 items and 2 dominions, with highly satisfactory reliability rates. Results disclose the importance of the vocalization method that is currently used and evaluated by the proper individual. The laryngectomized patients who use voice the mouth, gestures/lip mimics and writing as a form of alaryngeal communication do not consider good quality of life as synonymous with high satisfaction with current communication. Patients who use tracheo-esophageal prosthesis, on the other hand, supplied data indicating that good quality of life is synonymous with high satisfaction with current communication. However, studies measuring satisfaction with patients’ communication after total laryngectomy are still in an initial stage in our area. This research can be considered a starting point for other studies of this kind.

The health care industry is currently experiencing many changes. Managed care is altering the way health care is delivered through advances in technology and new approaches in financing. As part of this transition, importance will be placed on patients becoming better consumers and participants in determining their health care service needs. The focus of this study is on the non-compliant patient and the many factors that revolve around this topic.

The objective of this study is to evaluate the impact of the Diabetes Nurse Care Manager on an at-risk diabetic population using a Primary Group Visit Model in Outlying Medical Offices within the Kaiser-Permanente Health Care System upon the process and outcome of care in this population.

Este estudo teve como objetivo caracterizar referenciais de competências comunicativas interpessoais e propor bases teórico-metodológicas para o aprendizado da comunicação interpessoal no ensino da Enfermagem. Abordando questões norteadoras sobre competência em comunicação interpessoal, utilizou-se referencial teórico de comunicação e método de análise de conteúdo em 13 discursos de professores de Enfermagem, especialistas em comunicação. Os resultados obtidos representam que a competência em comunicação é um processo interpessoal que deve atingir o objetivo dos comunicadores, pressupor conhecimentos básicos de comunicação, ter consciência do verbal e do não-verbal nas interações, atuar com clareza e objetividade, promover o autoconhecimento e, conseqüentemente, ter a possibilidade de uma vida mais autêntica. Os sujeitos relatam que a expressão da competência comunicativa está, necessariamente, no vivenciar o cotidiano profissional e pessoal, ouvindo o outro, prestando atenção na comunicação não-verbal, validando a compreensão das mensagens, sendo capaz de eliminar as barreiras impostas à comunicação, demonstrando afetividade e investindo no autoconhecimento. O desenvolvimento da competência comunicativa verifica-se pelo estímulo recebido desde a graduação, pelas leituras de aprofundamento do tema, pela prática profissional e realização de pesquisas e publicações na área. O ganho alcançado com a competência em comunicação interpessoal resulta em relações profissionais e pessoais mais significativas, maior autoconsciência e aceitação das diferenças do outro, ampliação dos caminhos do ensino e da pesquisa e conquista de um bem-estar. Os teóricos mais citados como referenciais, pelos sujeitos do estudo, foram: Stefanelli MC., Silva MJP., Travelbee J., Littlejohn SW., Davis F., Rogers CR., Sullivan HS., Ruesch J., Peplau HE., Bales RF. e Moscovici F. As bases metodológicas propostas para o aprendizado e ensino da comunicação interpessoal em Enfermagem, são: assumir a comunicação como base para o cuidar, ensinar os fundamentos teóricos da comunicação no início da graduação, desenvolver a competência de todos os professores em comunicação, vincular a prática assistencial com o ensino da comunicação, acompanhar a progressão da competência comunicativa no aluno e vivenciar a comunicação efetiva com as pessoas na escola. Os resultados que emergiram deste estudo permitem considerar a competência em comunicação interpessoal, como uma habilidade fundamental a ser adquirida pelo enfermeiro, sabendo que esta lhe possibilitará um cuidar consciente, verdadeiro e transformador. / This study aimed at characterizing references of interpersonal communicative competence and proposing theoretical methodological bases for interpersonal communication learning on nursing teaching. Through guiding questions about competence on interpersonal communication, the theoretical reference of communication and the method of the content analysis in thirteen communication expert nursing teachers’ speeches were used. The results show that competence in communication is an interpersonal process which must reach the communicator’s objectives, require basic knowledge of communication, have verbal and non-verbal perception in the interactions, act clearly and objectively, develop self-knowledge and, therefore lead to the possibility of a more legitimate life. The subjects report that the communicative competence expression is necessarily, in the living of the professional and personal every day life, listening to the other, perceiving nonverbal communication, validating the message understanding, being able to break communication barriers, showing affection and developing self-knowledge. The development of a communicative competence has been reached by the stimulus received since the undergraduation course, by reading deeply the theme, by professional practice and by accomplishing research as well as publishing in the field. The benefits originated from competence in interpersonal communication lead to a more significant professional and personal relationship, a better self-knowledge and acceptance of the other’s differences, a widening on ways of teaching and researching as well as an achievement of welfare. The most cited theorists as reference by the study subjects were as follows: Stefanelli MC., Silva MJP., Travelbee J., Littlejohn SW., Davis F., Rogers CR., Sullivan HS., Ruesch J., Peplau HE., Bales RF. E Moscovici F. The target methodological bases for interpersonal communication learning and teaching in nursing are: assuming communication as the basis for caring, teaching the communication theoretical principles in the beginning of the undergraduation course, developing the communication competence of all teachers, linking assistance practice to communication teaching, following the student communicative competence progression and living the effective communication with people in the school. The results coming out from this study allow us to consider competence in interpersonal communication as a major ability to be acquired by the nurse, being aware that it will enable a conscious, true, and transforming care.

Economic changes have made the immigration of women to the United States part of major political and social issues. Women from Latin America frequently immigrate alone and without legal documentation, leaving their children in the care of relatives or friends, thus becoming transnational mothers in the process. Hispanic/Latino groups comprise the largest minority in the U.S., and Latina women account for 48.9% of the total Latino population. This demographic trend is expected to continue, and Hispanic/Latino groups are projected to experience the largest population increase in the coming decades (Marshall, Urrutia-Rojas, Soto-Mas & Coggin, 2005). The separation from their family has a strong impact on the health and well-being of these women, rendering them vulnerable to health care barriers and health disparities. This qualitative research study explored the experiences of Latinas living transnational motherhood. Individual semi-structured interviews were conducted with eight Latin as living transnational motherhood between the ages 21- 39. The findings in this study describe the lived experience of Latina transnational mothers within their social, economic and cultural context. The narrative was analyzed using van Manen's (1990) interpretative hermeneutic phenomenological approach to narrative analysis. Findings indicate that Latinas experiencing transnational motherhood find meaning in mothering from afar through sacrifice, suffering, and hopefulness for a better life for their children, and for family reunification. Findings from this study inform nurses of the health care barriers that these Latinas living transnational motherhood encounter as they experience hardship in order to support their families abroad as well as themselves. / Nurses caring for women who immigrate without their children are presented with professional and ethical challenges that require nurses to be knowledgeable about these women's pre- and post-immigration experiences findings of this study help narrowing the gap of information regarding lived experiences of Latinas transnational mothers. This knowledge offers guidance to the development of care that is compassionate, ethical and culturally appropriate. / by Rosa Maria Sternberg. / Thesis (Ph.D.)--Florida Atlantic University, 2009. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2009. Mode of access: World Wide Web.