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Sammanfattning Bakgrund: Skolsköterskan ska arbeta hälsofrämjande och sjukdomsförebyggande. Detta görs till stor del genom att samtala med elever om mående och hur hälsa kan förbättras och sjukdom förebyggas. Studier visar att skolsköterskan ofta styr hälsosamtalet vilket försvårar elevens interaktion och skolsköterskans personcentrerade förhållningssätt utmanas.  Syfte: Syftet med studien var att beskriva skolsköterskans erfarenheter av att genomföra hälsosamtal med grundskoleelever utifrån ett personcentrerat perspektiv.  Metod: En kvalitativ intervjustudie med deduktiv ansats tillämpades, utgångspunkt var den personcentrerade modellen. Genom ändamålsenligt urval intervjuades 13 kvinnliga skolsköterskor via digital plattform. Data analyserades med kvalitativ innehållsanalys på manifest nivå.  Resultat: Resultatet presenterades i tre kategorier: Partnerskap vid hälsosamtal i skolan, elevens berättelse om sin hälsa och skolsköterskans dokumentation. Skolsköterskan behövde skapa förutsättningar för att elevens berättelse skulle framträda och vara en aktiv lyssnare som bjöd in eleven till delaktighet i partnerskapet. Det var viktigt med ett bra bemötande där samtalet skedde på elevens villkor. Dokumentationen skulle genomsyras av elevens berättelse som dokumenterades med hänsyn och med elevens delaktighet.  Slutsats: Studien ökade förståelsen för vilka förhållningsätt, egenskaper och förutsättningar som främjade skolsköterskans personcentrerade arbete vid hälsosamtal. Om ett personcentrerat förhållningssätt eftersträvades kunde elevens förtroende vinnas. Skolsköterskan kunde då lättare hjälpa eleven att förbättra sin hälsostatus och guida eleven till en hälsosam livsstil. / Summary Background:  The school nurse shall work on health promotion and disease prevention. This is  mainly done by talking to pupils about well-being and how health can be improved and disease prevented. Studies show that the school nurse often controls the health dialouges, which makes it difficult for the pupils to interact and the person-centered perspective challenged. Aim: The aim of the study was to describe school nurses’ experiences of conducting health dialogues with primary school pupils from a person-centered perspective.  Method: A qualitative interview study with a deductive reasoning was applied, based on the person-centered model. Through purposive sampling, 13 female school nurses’ were interviewed by video conferencing. Data was analyzed with qualitative content analysis at a manifest level. Results: The results were presented in three categories: Partnership in school health dialouges, pupil narratives about thier health and school nurses’ documentation. The school nurse needed to establish conditions for the pupil's story to emerge and be an active listener who invited the pupil to participate in the partnership. It was important to have a good reception, where the conversation took place on the pupil's terms. The documentation would be permeated with the pupil's narrative, which was documented with consideration and participation. Conclusion: The study increased the understanding of which approach, characteristics and conditions that promoted the school nurse's person-centered work when she implemented health dialogues. If a person-centered approach is sought, the pupil's trust can be gained. The school nurse could then more easily help the pupil improve their health status and guide the pupil to a healthy lifestyle.

Bakgrund: Våra levnadsvanor har en stor inverkan på vårt hälsotillstånd och regelbunden fysisk aktivitet verkar positivt på flertalet av kroppens organ. Den svenska metoden Fysisk aktivitet på recept, FaR, togs fram för 20 år sedan och används inom svensk hälso- och sjukvård för att stödja patienter till ökad fysisk aktivitet. FaR bedöms vara en underutnyttjad metod och följsamheten till FaR efter ett år är omkring 50 procent. Motiv: En ökad förståelse för distriktssköterskors erfarenheter av patientmötet skulle kunna synliggöra vad samtalet om fysisk aktivitet och FaR innebär samt förbättra kunskapen kring distriktssköterskors strategier i patientmötet och öka användningen av metoden FaR. Syfte: Syftet med studien är att undersöka distriktssköterskors erfarenheter från patientmötet vid samtal om fysisk aktivitet och FaR. Metod: Individuella, semistrukturerade intervjuer med distriktssköterskor genomfördes. Data analyserades med kvalitativ innehållsanalys. Resultat: Analysen av intervjuerna resulterade i fyra kategorier och åtta subkategorier. Kategorierna är Engagerar sig för att framställa allvaret i situationen, Förhåller sig korrekt men är lyhörd, Försöker förstå patientens tankar om situationen, och Anpassar stödet för ett gemensamt mål. Konklusion: Distriktssköterskor försöker balansera mellan att skapa en god vårdrelation, öka motivation, åberopa på fakta för att medvetengöra och delge patienten kunskap vid patientmötet. HBM kan vara ett bra verktyg för att förstå patientens tankar och förändringsbeteenden, men det är det personcentrerade förhållningssättet som verkar vara avgörande när man ska stödja patienten i en förändringsprocess. Att förändra ett beteende är en tids- och resurskrävande process som sällan sker under ett besök. Distriktssköterskor har en betydande roll i den process patienten genomgår vid förändring mot ökad fysisk aktivitet. Att stödja patienten i dessa situationer kräver skicklighet inom motivationsstrategier, kommunikationsfärdigheter och bemötande. Behov av stöd till livsstilsförändringar förekommer ofta i den kliniska vardagen varav förstärkt kunskap och kompetens inom området behöver prioriteras. / Background: Our lifestyle has a great impact on our health, and frequent physical activity has a positive effect on several of our organs. Sweden implemented physical activity prescriptions (PAP) 20 years ago, and it is used to encourage patients to increase their physical activity. PAP is considered to be underused, and adherence to PAP is around 50%. Motive: Increased understanding of the district nurses’ experiences of the patient-meeting could visible what the conversation about physical activity and PAP means, improve knowledge of district nurses' strategies in the patient meeting and increase the use of the PAP method. Aim: The aim of this study is to investigate the district nurses experiences from the patient meeting during conversations about physical activity and PAP. Methods: Individual, semi-structured interviews were performed with district nurses. The interviews were analyzed using qualitative content analysis. Result: The analysis of the interviews resulted in four categories and eight subcategories; Engaging to present the seriousness of the situation, Behaving correctly but being responsive, Trying to understand the patient's thoughts about the situation, and Adapting the support for a common goal. Conclusion: District nurses are trying to balance between creating a good relationship, increasing motivation, showing facts to raise awareness and imparting knowledge to the patient during the patient-meeting. HBM can be used to understand the patient's thoughts and change-behaviors, but it is the person-centered approach that seems to be crucial when supporting the patient in a change process. Changing a behavior rarely happens during a visit. Nurses’ have a significant role in the process the patient undergoes in the event of a change towards increased physical activity. Supporting these situations requires skill in motivation-strategies, communication and coping. Support lifestyle changes often occurs in everyday clinical practice, of which enhanced knowledge and competence in this area need to be prioritized.

Submitted by Biblioteca da Faculdade de Farmácia (bff@ndc.uff.br) on 2018-01-11T13:15:59Z No. of bitstreams: 1 RANIERI CARVALHO CAMUZI.pdf: 15172783 bytes, checksum: 659642cc2290ea484c112a926143aed9 (MD5) / Made available in DSpace on 2018-01-11T13:15:59Z (GMT). No. of bitstreams: 1 RANIERI CARVALHO CAMUZI.pdf: 15172783 bytes, checksum: 659642cc2290ea484c112a926143aed9 (MD5) / Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro / A insuficiência cardíaca (IC) é uma síndrome prevalente que, apesar dos avanços no tratamento, acarreta significativa morbidade e mortalidade. Estudos demonstram que a não adesão ao tratamento é uma importante causa de resultados insatisfatórios na terapia, descompensação no quadro clínico, internação e óbito. Acreditando-se que a efetiva inserção do farmacêutico na assistência, mesmo na dispensação convencional, seria capaz de promover maior adesão, tevese por objetivo avaliar como dois modelos de atuação farmacêutica impactam sobre a adesão à farmacoterapia em pacientes com IC com fração de ejeção reduzida assistidos em dois centros clínicos especializados da rede pública de saúde. O trabalho foi organizado em duas partes. A primeira parte foi um estudo prospectivo com análise transversal de dados de pacientes com ICFER acompanhadas por uma equipe multidisciplinar, no momento da inserção do profissional farmacêutico nessa equipe e após 4 meses, com orientação farmacêutica por demanda do paciente. A segunda parte é a análise transversal de um estudo prospectivo que realizou acompanhamento farmacoterapêutico com pacientes de outro centro clínico especializado, por 4 meses. Foram incluídos respectivamente 38 e 31 pacientes. Nos dois grupos, observou-se maioria de homens, com predomínio de IC leve a moderada, polimedicados e tratando duas ou mais comorbidades, utilizando combinação de betabloqueador, inibidores da enzima conversora da angiotensina e/ou antagonistas dos receptores da angiotensina, antagonista da aldosterona e diurético. Na primeira parte do estudo, observou-se associação de maior número de comorbidades, maior gravidade e polifarmácia com boa adesão. Na segunda parte, verificou-se associação de idade maior, viver sem cônjuge e com menor número de pessoas no mesmo lar, razão de posse de medicamentos e razão para não tomar o medicamento com a adesão. Os resultados sobre adesão melhoraram nos dois grupos, ao final do estudo, embora sem significância estatística. Na segunda parte observou-se melhora estatisticamente significante no nível de conhecimento da prescrição, na razão de posse de medicamentos e na autoavaliação de saúde. Não foi possível observar melhora significativa na adesão, porém verificaram-se melhorias significativas em fatores associados à boa adesão. O limitado número amostral exigirá cautela na extrapolação dos resultados / Heart failure (HF) is a prevalent syndrome that, despite advances in treatment, causes significant morbidity and mortality. Studies show that nonadherence to treatment is an important cause of unsatisfactory results in therapy, decompensation in the clinical condition, hospitalization and death. Believing that the effective insertion of the pharmacist into the patient care would be able to promote greater adherence, even in the conventional dispensation, the objective of this study was to evaluate how two models of pharmaceutical services impact on adherence to pharmacotherapy in patients with HF with reduced ejection fraction, assisted in two specialized clinical centers of the public health network. The study was organized in two parts. The first was a prospective study with cross-sectional of data from patients assisted by a multidisciplinary team, at the time of insertion of the pharmacist in this team and after 4 months, with pharmaceutical orientation by patient demand. The second part is a cross-sectional analysis of a prospective study that carried out pharmacotherapeutic follow-up with patients from another specialized clinical center for 4 months. Thirty-eight and 31 patients were included respectively. In the two groups, was observed majority of men, with a predominance of mild to moderate HF, polymedicated and treating two or more comorbidities, using a combination of beta-blocker, angiotensin converting enzyme inhibitor and/or angiotensin receptor antagonist, aldosterone antagonist and diuretic. In the first part of the study, we observed an association of higher number of comorbidities, greater severity and polypharmacy with good adherence. In the second part, there was an association of older age, living with no spouse and with fewer people in the same household, reason for possession of medications and reason for not taking the drug with high adherence. The adherence level was improved in both groups at the end of the study, although without statistical significance. In the second part, there was a statistically significant improvement in the level of prescription knowledge, in the drug possession ratio and in the health self-assessment. It was not possible to observe a significant improvement in adherence, but there were significant improvements in factors associated with good adhesion. The limited sample size will require caution in extrapolating the results