Bakgrund: Obesitas har ökat med nästan 50 procent sedan 1980 och idag lever uppskattningsvis 500 miljoner vuxna människor med obesitas. Enligt forskning i västvärlden råder negativa uppfattningar om människor med obesitas vilket kan leda till diskriminering och stigmatisering. I vården behöver patienter med obesitas ofta mer omvårdnad än normalviktiga samt utrustning som är anpassad för deras storlek. Syfte: Att beskriva vilka erfarenheter sjukvårdspersonal har av att vårda patienter med obesitas. Metod: En litteraturstudie av 11 studier med kvalitativ och kvantitativ ansats. Resultat: Fyra teman framkom i resultatet. Ansvar, Kunskap om obesitasbehandling, Attityder och Omvårdnad. Samtlig sjukvårdspersonal är överens om att obesitas ska behandlas och att de har ett ansvar att hjälpa patienterna. Mer kunskap gav sjukvårdspersonalen mer självförtroende att ge viktminskningsråd. De blir frustrerade och mindre optimistiska att hjälpa till när patienterna misslyckas med att gå ner i vikt. Familjen ansågs som ett viktigt stöd för att patienter ska lyckas med sin viktminskning. Slutsats: Sjukvårdspersonal värderade kunskap om att behandla obesitas högt och mer kunskap ledde till färre negativa attityder mot patienter med obesitas. Klinisk betydelse: Att beskriva hur sjukvårdspersonal ser på patienter med obesitas och vilka erfarenheter de har av vården med dem, kan medvetandegöra attityder, vilket kan leda till ett bättre bemötande. Färre negativa attityder kan ge en bättre atmosfär i vården. / Background: Obesity has increased by nearly 50 percent since 1980 and today there is an estimated 500 million adults living with obesity. According to research in the western society, people hold negative perceptions about obesity which can lead to discrimination and stigmatization. In health care, patients with obesity often need more care than normal-weight patients and special health care equipment is needed to equip larger sizes. Aim: The aim of this study was to describe health care professionals’ experiences of caring patients with obesity. Method: A literature review of 11 studies of qualitative and quantitative approach. Results: Four themes emerged from the results. Responsibility, Knowledge in treatment of obesity, Attitudes and Nursing. All health care professional agreed that obesity should be treated and that they have a responsibility to help the patients. More knowledge gave health care professionals better confidence when giving advice in reducing weight. Frustration also was experienced by health care professionals when patients failed to lose weight. The family was seen as an important support for patients to succeed with their weight loss. Conclusion: Health care professional highly valued knowledge about treating obesity. Increased knowledge leads to less negative attitudes towards patients with obesity. Clinical significance: To describe health care professionals’ attitudes towards patients with obesity and their experiences of care, may lead to higher awareness of their own attitudes, which can result in better treatment. Less negative attitudes might provide a better atmosphere in care.

The Nordic countries share common interests to digitize services in the health care sector from which their eHealth strategies are a proof of. Sweden has specifically put effort on the global scheme by setting a goal of being the best in eHealth by 2025. As one of the main goals of the strategies is increasing patient empowerment, perspective of the health care professionals in this digital shift has yet remained less noticed and the concrete effects on them is still scarcely studied. This study focuses on providing the aspect of the health care professionals and how they have perceived and experienced the digital tools and eHealth services affecting their work and what attitudes they themselves have as users.                                This study utilized the mixed method approach and was done in collaboration with the Digga Halland project which aims towards enhancing health care workers’ digital competences and conditions to utilize eHealth. Previously collected baseline survey data from health care professionals in different municipalities in the Halland region was analysed and five health care professionals were recruited for in-depth, phenomenological interviews.             The results of this research indicate that the use of digital tools and services is common among health care professionals at work and outside work and the workers consider their digital competence rather good. However, the interview respondents presented varying attitudes towards digital services and eHealth depending on whether the services were evaluated from a professional role or outside work role when the professionals used the services themselves. Also, the current professional position guided whether the digital shift and eHealth were experienced more positively or negatively.

O suicídio é um fenômeno complexo, considerado problema de saúde pública devido às altas taxas de tentativas e consequentes óbitos. O contato inicial com o paciente que tentou o suicídio, na maioria das vezes, ocorre no pronto-socorro do hospital geral, sendo, fundamental analisar o relacionamento entre os membros da equipe de saúde e o paciente com comportamento suicida para entender como o cuidado está sendo oferecido. Este estudo teve como objetivo compreender como profissionais de saúde, que atuam no pronto-socorro, vivenciam a assistência prestada ao paciente que tentou suicídio. A pesquisa teve caráter qualitativo e a coleta de dados foi realizada por meio de entrevistas abertas. O material obtido a partir dos depoimentos foi avaliado por meio da técnica da análise temática. As respostas dadas pelos colaboradores foram agrupadas em temas comuns: conceituação do suicídio; importância do atendimento multiprofissional; diferenças entre o SUS e o sistema privado; as distintas posturas dos profissionais de saúde; relação família-paciente; medicamentos como forma de cuidado e tentativa de suicídio; sofrimento psíquico entre os profissionais. A presente investigação apontou que a assistência ao paciente que tentou o suicídio no pronto-socorro é inadequada, marcada pela falta de preparo e fragmentação do cuidado. Evita-se o contato com o sofrimento intenso relacionado com o ato suicida e o cuidado a esse paciente é redirecionado aos profissionais da saúde mental. Os fatores que influenciam na assistência precisam ser reconhecidos e reformulados para que haja melhoria na qualidade dos atendimentos possibilitando um cuidado integral à pessoa com ideação e tentativa de suicídio / Suicide is a complex phenomenon, considered a public health problem given high resultant mortality rates. In the majority of cases, initial contact with patients who attempted suicide occurs in the emergency room of a general hospital. As a result, analyzing the relationship between members of the healthcare team and the patient with suicidal behavior is paramount to understanding how care is being provided. The objective of this study was to understand health care professionals experiences in treating attempted suicide patients while working in the E.R. The study was qualitative in nature and data were collected via open interviews. The data obtained from the depositions were analyzed using thematic analysis. The responses given by the interviewees were grouped into topics: the concept of suicide; the importance of multidisciplinary care; differences between the public and private health systems; the different postures of health care professionals; the patient-family relationship; medication as both a form of treatment and a manner for attempted suicide; and psychic suffering among health care professionals. The present study found that care for patients provided in the E.R. after attempting suicide is inadequate, defined by a lack of preparation on part of the health care professionals and fragmented care. Health care professionals avoid contact with the intense suffering related with the act of suicide and these patients are redirected to mental health professionals. The diverse factors that influence care should be recognized and reconsidered so that the quality of care is improved, which would provide for holistic care of the patient with suicidal thoughts or attempted suicide

Bakgrund: Barns övervikt ökar i Sverige, vilket är en trend som behöver brytas. Vårdpersonal upplever att det är svårt att samtala om ämnet med föräldrar. Syfte: Undersöka och öka förståelsen för föräldrarnas perspektiv av samtalen med vårdpersonal gällande barns övervik samt identifiera barriärer inom kommunikationen. Metod: Arbetet är en allmän litteraturöversikt som visar på det sammanfattade kunskapsläge som råder. Resultat: Fyra kategorier samt 11 subkategorier har framkommit i resultatet. Föräldrar anser att bemötandet och relationen med vårdpersonal är viktig. Vissa ordval bör undvikas och föräldrarna bör mötas med respekt och inte skuldbeläggas. Familjecentrerad vård föredras. Föräldrar kan ha ett annat synsätt på vad som är mest motiverande för att genomföra en livsstilsförändring. Ett område som delade gruppen föräldrar är huruvida barnet ska närvara vid övervikssamtal. Rädsla att barnet ska ta skada uppgavs vara orsaken. Rådgivningen som ges kritiseras generellt. Föräldrars oro för barnets övervikt behöver tas på större allvar. Barriärer som okunskap, tidsbrist, övervikt och omedvetenhet hos föräldrar samt kulturella skillnader har också identifierats. Slutsats: Arbetet visar på att övervikt ska behandlas som vilket annat sjukdomstillstånd som helst. Familjecentrerad vård föredras där hela familjen involveras. Familjen ska mötas med respekt och inte skuldbeläggas. Kunskapsnivån och motivation till förändring kan förbättras av vårdpersonal. Negligera inte oro för övervikt. Barriärer inom området kräver eftertanke från vårdpersonalens sida. / Background: Overweight among children in Sweden increases, this trend needs to change. Health care professionals find it difficult to talk about the subject with parents. Aim: Increase the understanding of parents’ perspective on conversations with health care professionals regarding their child’s overweight and identify barriers in communication. Methods: General literature review. Result: Four categories and 11 subcategories have emerged. Parents consider the relationship with health care professionals to be important. Certain choices of words should be avoided and parents should be treated with respect and not guilt. Family-centered care is preferred. Parents may have another approach to what’s most motivating to make a change in their lifestyle. One area that divides the group of parents’ is whether or not the child should be present during the meeting about overweight. The cause of this is fear that the child should be harmed. Counseling given today is generally criticized. Parents concearns about the childs overweight should be taken seriously. Barriers such as ignorance, lack of time, overweight in parents, unawareness of parents and cultural differences have been identified. Conclusion: Overweight should be treated as any other health condition. Family-centered care is preffered where the whole family is involved. The family should be treated with respect and not be subject to guilt. Knowledge and motivation for change can be improved by health care professionals. Do not neglect concerns about overweight. Barriers in this area require consideration from the health care professionals.

This study was designed to identify the spiritual needs of multicultural Australians with a health problem, in order to understand the educational implications for health care professionals. The rationale for the research was supported by the Australian Council for Health Service (1997) requirement that health care professionals meet the spiritual needs of their patients and clients'. At the commencement of this study, no research had been published on what these spiritual needs might be. To discover what health care professionals needed to be taught in order to meet the spiritual needs of their patients, I required a suitable group of patients. Then, after identify their spiritual needs, I wanted to explore ways in which these needs could be met. For this to occur, I also needed to identify factors that would fulfill patients' spiritual needs or prevent them from being met. This research proceeded in two stages. The first involved collecting data from all spiritual groups in Western Australia. The second involved the recruitment and interviewing a small number of ex-patients to gain their perspective of health care related spirituality and needs. To gain data about the various spiritual groups in Western Australia, I wrote to all organisations and associations, asking for information and reference material. This data was analysed using HyperResearch (1995), and themes common to all spiritual groups were developed. The inter-relationship between these themes provided the framework for an emergent model of spirituality. / For the second part of the research which involved a case study of health care patients, a qualitative methodology was used. This approach enabled me to explore the phenomenon of spirituality from the perspective of eight participants, which involved identifying their spiritual needs, the care they desired, and the rite of passage they underwent when receiving health care. The qualitative methodology enabled me to explore the subject from a sensitive holistic perspective, and to protect the integrity of the participants. I wanted to know what patients understood about their spirituality and how spiritual care could be implemented not only in clinical practice but also into health care education programs. The participants' detailed subjective experience was especially important, because I wanted to know how they identified their spiritual needs, how they had requested their needs be met by health care professionals, and the extent to which health care professionals had reacted to those cues. I formulated an 'interpretive phenomenology research' design based on the philosophical writings of Heidegger and Bakhtin. Heidegger argued that people gain knowledge of a subject from their own subjective experience, and of the person being in their world (simultaneous past, present and future thoughts). Bakhtin stated that to bring about social change, the researcher needed to understand the social context of the people's language including their culture, politics, government-provided amenities (such as education and health care), employment and social interaction, both within and outside their communities in which they live. The eight participants were interviewed a number of times in order to explore the phenomenon of spirituality beyond the notions already published in the literature (i.e. from multicultural Australian's perspective). / They told of hospital or health care experiences that included: health care for childbirth, mental and psychiatric illnesses (depression, manic-depression, and anxiety), immunology (lymphoma), stroke, detoxification of alcohol, arthritis, coronary occlusion, hypertension, and peritonitis; surgical procedured/s such as repair of hernia, bowel obstruction, eye surgery, orchiopexy (removal of testes from inguinal canal into the scrotal sac), caesarian birth, appendectomy, and oophorectomy (removal of ovaries); treatments such as radiotherapy, chemotherapy, and physiotherapy; and hospital experiences in both large and small public and private acute hospitals, private and public mental health/psychiatric hospitals, intensive care and coronary care units. These situations demonstrate the diversity of contexts which people want their spiritual needs met. The study revealed that it is not only dying patients who have spiritual need; spiritual needs exist in widespread ordinary conditions and across a wide range of health care services. The eight participants - Ann, Athika, Garry, Red, Rosie, Scarlet, Sophie, and Tom (pseudonyms) - were drawn from many of the multicultural groups resident in Western Australia including Aboriginal, Chinese, English, European, Indian, and Irish peoples. Their spiritualities encompassed Judeo-Christian, Buddhist, Hindu, Pagan Romany, Society of Friends (Quaker), Humanist, Socialist, and Communist values and beliefs. The results of the research give insight into the eight participants' perspectives on being a person, their understanding of spirituality, perceived spiritual needs, their desired levels of spiritual care, and the rite of passage they experienced when undergoing health care treatment in hospital. / The participants' spiritual needs comprised of four categories: 'mutual trust', 'hope', 'peace' and 'love'. The levels of spiritual care spoke of desiring were: 'acknowledgement', 'empathy', and 'valuing'. Recommendations are given for health care professionals to provide spiritual care for the eight participants, and implications are considered for the spiritual education of future health care professionals in order to sensitise them to the wide range of healthcare related spiritual needs they might encounter in local multicultural communities. It is recognised that the scope of the implications is contingent on further research establishing the incidence of health-care related spiritual needs among the broader population of multi-cultural Western Australians. The richness and depth of the data and the very sensitive nature of the material that came from the eight people who shared their experiences with me has rendered this thesis an important document. The nature of the various incidents and situations they shared with me, I believe, demonstrated their preparedness to tell their story so that health care can be improved. On many occasions, I felt honoured that they had sufficient trust in me to enable them to report such deep and personal suffering. For example, Rosie told me of her mental torment and of not knowing if she was alive or dead; of how she burnt her legs to try to feel pain in order to see if she was alive. It was stories such as this that gave me the passion to write this thesis well in order to do justice to all people who want spirituality included in health care treatment.

Diss. Göteborg : Univ. , 2007. / S. 184-202: Bibliografi.

CoordenaÃÃo de AperfeÃoamento de Pessoal de NÃvel Superior / Decorrente de um processo sÃcio-histÃrico, a morte tornou-se um tabu para a sociedade atual. Hà um fechamento do tema, afastando-o das discussÃes cotidianas e isolando sua vivÃncia. Tal fato ocasiona um cuidado em saÃde pouco humanizado aos pacientes em fim de vida ou sem possibilidade de cura, demarcando a supremacia da tÃcnica nas relaÃÃes de cuidado e um esquecimento do lugar do outro nesses processos. Nesse contexto, o objetivo geral desta pesquisa à compreender quais os princÃpios Ãticos que sustentam as relaÃÃes de cuidado dos profissionais de saÃde junto a crianÃas e adolescentes em vulnerabilidade extrema vivenciando a experiÃncia de morte iminente, e analisÃ-lo à luz da perspectiva da alteridade radical em Emmanuel LÃvinas; e os objetivos especÃficos sÃo conhecer, a partir da visÃo dos profissionais de saÃde, a relaÃÃo estabelecida entre eles e os pacientes; discutir as formas de cuidado destinadas a esses pacientes e identificar as possibilidades de atuaÃÃo nesse contexto. Esta pesquisa à de natureza qualitativa, fundamentada na proposta da desconstruÃÃo, em Jacques Derrida, e utilizou a pesquisa em cotidiano e a entrevista semiestruturada com equipes de saÃde de um hospital pÃblico pediÃtrico no Estado do Cearà para obtenÃÃo do seu corpus. De acordo com os resultados encontrados, os opostos âVivificaÃÃo da Morte e MortificaÃÃo da Vidaâ foram postos em diÃlogo. Tal relaÃÃo refere-se Ãs aÃÃes dos profissionais que produziam vida mesmo em situaÃÃes de terminalidade atravÃs da realizaÃÃo dos sonhos, organizaÃÃo de festas de aniversÃrios, respeito pelo desejo dos pacientes, possibilidade de fechamentos e despedidas antes da morte, alÃm do foco na qualidade de vida e no respeito à autonomia. No entanto, outras aÃÃes produziram processos de mortificaÃÃo da vida, quando a vontade do paciente nÃo era respeitada, a equipe impunha decisÃes de forma arbitrÃria e nÃo dialogada e era dispendido um cuidado exclusivamente tÃcnico e sem vinculaÃÃo afetiva. Acredita-se que a relaÃÃo com o outro que se dà pela via da vulnerabilidade, exposiÃÃo, sensibilidade e passividade mostra-nos possibilidades de caminhos no campo do cuidado que permitem ao eu deslocar-se do seu lugar de soberania para dar lugar ao outro. Apontando-nos, portanto, horizontes de atuaÃÃo que nÃo sejam indiferentes ao sofrimento, que se responsabilizem pelos processos dos sujeitos e tomem providÃncias para nÃo deixar o outro sà em sua dor e na sua morte, respondendo ao outro: EIS-ME AQUI. Como desdobramento da pesquisa, destarte, almeja-se constituir espaÃos para pensar a relaÃÃo entre Ãtica e cuidado e fomentar o desenvolvimento de relaÃÃes de cuidado pautadas na dimensÃo Ãtica do fazer em saÃde, beneficiando pacientes e profissionais.

O suicídio é um fenômeno complexo, considerado problema de saúde pública devido às altas taxas de tentativas e consequentes óbitos. O contato inicial com o paciente que tentou o suicídio, na maioria das vezes, ocorre no pronto-socorro do hospital geral, sendo, fundamental analisar o relacionamento entre os membros da equipe de saúde e o paciente com comportamento suicida para entender como o cuidado está sendo oferecido. Este estudo teve como objetivo compreender como profissionais de saúde, que atuam no pronto-socorro, vivenciam a assistência prestada ao paciente que tentou suicídio. A pesquisa teve caráter qualitativo e a coleta de dados foi realizada por meio de entrevistas abertas. O material obtido a partir dos depoimentos foi avaliado por meio da técnica da análise temática. As respostas dadas pelos colaboradores foram agrupadas em temas comuns: conceituação do suicídio; importância do atendimento multiprofissional; diferenças entre o SUS e o sistema privado; as distintas posturas dos profissionais de saúde; relação família-paciente; medicamentos como forma de cuidado e tentativa de suicídio; sofrimento psíquico entre os profissionais. A presente investigação apontou que a assistência ao paciente que tentou o suicídio no pronto-socorro é inadequada, marcada pela falta de preparo e fragmentação do cuidado. Evita-se o contato com o sofrimento intenso relacionado com o ato suicida e o cuidado a esse paciente é redirecionado aos profissionais da saúde mental. Os fatores que influenciam na assistência precisam ser reconhecidos e reformulados para que haja melhoria na qualidade dos atendimentos possibilitando um cuidado integral à pessoa com ideação e tentativa de suicídio / Suicide is a complex phenomenon, considered a public health problem given high resultant mortality rates. In the majority of cases, initial contact with patients who attempted suicide occurs in the emergency room of a general hospital. As a result, analyzing the relationship between members of the healthcare team and the patient with suicidal behavior is paramount to understanding how care is being provided. The objective of this study was to understand health care professionals experiences in treating attempted suicide patients while working in the E.R. The study was qualitative in nature and data were collected via open interviews. The data obtained from the depositions were analyzed using thematic analysis. The responses given by the interviewees were grouped into topics: the concept of suicide; the importance of multidisciplinary care; differences between the public and private health systems; the different postures of health care professionals; the patient-family relationship; medication as both a form of treatment and a manner for attempted suicide; and psychic suffering among health care professionals. The present study found that care for patients provided in the E.R. after attempting suicide is inadequate, defined by a lack of preparation on part of the health care professionals and fragmented care. Health care professionals avoid contact with the intense suffering related with the act of suicide and these patients are redirected to mental health professionals. The diverse factors that influence care should be recognized and reconsidered so that the quality of care is improved, which would provide for holistic care of the patient with suicidal thoughts or attempted suicide

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Criminal law aspects of the first aid (summary) Ondrej Horak The purpose of this thesis is to clarify and to analyze the criminal law aspects of the first aid in relation to the healthcare professionals. A duty to provide first aid is stricter for the healthcare professionals and unlike laymen they cannot withdraw from this obligation even in life or health threatening situations. At the same time, they face the highest rate of accusations of having committed the crime of breach of the duty to provide the first aid. This work aims to support a discussion on this crime and to contribute to raise the legal awareness within the healthcare professionals. Last, but not least, the goal of this thesis is to point out particular complicated questions related to this topic and to outline possible solutions to improve the legal regulation. The thesis is composed of five chapters. Chapter One provides a summary of the general legal framework of the first aid including both national and international rules. A part of the summary is also concerned with delegated regulation and outlook for the impact of the medical reform. Chapter Two defines three fundamental terms which can be found very often in relation to this topic and which are the key terms to understand this issues. These are the terms: "necessary aid, the...