Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-09-09T18:17:04Z No. of bitstreams: 1 camilaresendesoaresbrum.pdf: 806451 bytes, checksum: 2ab83192b5775b10a21d4fcf8f00ba0d (MD5) / Approved for entry into archive by Diamantino Mayra (mayra.diamantino@ufjf.edu.br) on 2016-09-13T13:27:02Z (GMT) No. of bitstreams: 1 camilaresendesoaresbrum.pdf: 806451 bytes, checksum: 2ab83192b5775b10a21d4fcf8f00ba0d (MD5) / Made available in DSpace on 2016-09-13T13:27:02Z (GMT). No. of bitstreams: 1 camilaresendesoaresbrum.pdf: 806451 bytes, checksum: 2ab83192b5775b10a21d4fcf8f00ba0d (MD5) Previous issue date: 2011-10-24 / A presente pesquisa teve como objetivo principal investigar as crenças e atitudes dos profissionais da Atenção Primária à Saúde em relação à violência doméstica, antes e após a metodologia de intervenção, verificando possíveis mudanças. Participaram da pesquisa, 65 profissionais que responderam a um questionário auto-aplicável, estruturado, individual e anônimo. O instrumento foi aplicado antes e após uma capacitação conceitual sobre violência doméstica, com o intuito de analisar possíveis mudanças a partir desse tipo de intervenção. Os dados foram analisados através do programa SPSS, teste de significância McNemar. Os resultados indicaram algumas mudanças de crenças significativas a partir da intervenção proposta quanto à forma do profissional da Atenção Primária à Saúde lidar com vítimas de violência doméstica, o papel do profissional da atenção primária em detectar pacientes com problemas relacionados à violência doméstica, quanto ao interesse profissional sobre o padrão, os riscos de saúde relacionados e o aconselhamento para diminuir ou pará-la. Os dados não indicam mudanças em relação à confiança que os profissionais sentem na sua habilidade para lidar com a questão. / This research was focused on investigating the Primary Health Care providers' beliefs and attitudes towards domestic violence issues, before and after the intervention methodology, checking possible changes. The research involved 65 professionals who responded a self-administered, pre-formatted and anonymous questionnaire. In order to examine possible changes that resulted from this type of intervention, the instrument was administered before and after a conceptual training on domestic violence. Data was analyzed using SPSS, McNemar test of significance. The results from the proposed intervention showed some significant changes in the Primary Health Care providers' beliefs as to how to deal with victims of domestic violence, as well as in the role the Primary Health Care provider plays when detecting patients with domestic violencerelated problems, and in the providers' relation to the professional standards, health risks and counseling skills used to diminish or stop it. The data did not indicate changes in the level of confidence that providers have in their ability to deal with the issue.

The present study explored how authenticity is constructed by clinical psychologists and asked what might be the implications of these discourses. The study is concerned with offering a focus on the making of authenticity in discourse as well as providing an understanding of the complexity of authenticity within clinical psychology. The study used a discourse analytic approach known as critical discursive psychology to examine clinical psychologists’ talk of authenticity. Participants included twelve qualified clinical psychologists working in adult mental health services who took part in semi-structured interviews. Following a detailed critical discursive analysis of the texts, four discourses were identified with regard to the construction of authenticity. These discourses were commonly used to construct authenticity in extremely positive terms, however, some participants did draw attention to an ideological dilemma of authenticity versus professionalism. Participants used authenticity to establish their identity and manage their relationships with service users, colleagues and institutions. Drawing upon psychotherapeutic and professional discourses positioned participants as having power and being more authentic than others. Authenticity was problematised in relation to the participants need for professional boundaries. It is suggested that psychologists internalise dominant discourses of authenticity from the profession of clinical psychology, which is itself influenced by wider societal discourses around what it means to be authentic or inauthentic. Extra-discursive factors including institutions and embodiment were found to influence and constrain available discourses. The limitations of this study’s research findings are discussed as well as implications for future research and clinical psychology practice.

This investigation examines how knowledge of a researcher's intent, as well as gender, influences the clinical judgments of mental health professionals in sex role research. Conscious awareness of the study's aim was manipulated by varying experimental instructions to minimize (not salient) or maximize (salient) sex role awareness. Subjects were mental health professionals who rated a protocol of a female or male pseudopatient exhibiting masculine, and lacking feminine, stereotyped behaviors. It was hypothesized that if sex biases affect judgments, more negative ratings should be assigned to a female with cross sex role behavior than to male-appropriate role behavior. Differences should be greater when subjects were unaware of the nature of the study.

Bakgrund: Anorexia nervosa drabbar vanligen unga kvinnor. Sjukdomen grundar sig i en skev kroppsuppfattning vilket leder till bantning för att nå en idealvikt. Personer diagnostiserade med anorexia nervosa kan ha en dålig självbild och bristande självförtroende vilket kan leda till självdestruktivitet och lidande. Sjuksköterskan behöver visa tillit och skapa trygghet i mötet. Professionellt stöd i form av kommunikation och interaktion kan skapa en god vårdrelation. Syfte: Att beskriva hur unga kvinnor diagnostiserade med anorexia nervosa upplever mötet med vårdpersonal. Metod: Datamaterialet består av fem självbiografier som har analyserats med kvalitativ innehållsanalys. Resultat: Ur analysen framkom fyra kategorier; känna sig orättvist behandlad, hamnat i underläge, utsatt för maktmissbruk och tvång samt hopp och förtroende medåtta underkategorier. Konklusion:Mötet med vården upplevs både negativt och positivt. Det är viktigt att vårdpersonal respekterar de unga kvinnornas autonomi och engagerar dem i vården. Att vården präglas av ett etiskt perspektiv och att det avsätts tid till mötet är viktigt. Ett gott bemötande, adekvat kunskap och en icke-dömande attityd från vårdpersonalen är betydelsefullt. / Background: Anorexia nervosa usually affects young women. The disease is based on askewed perception of the body, which leads to dieting to reach an ideal weight. Individualswith anorexia nervosa can have bad self-image and low self-confidence which can result intoself-destructive behavior and suffering. The nurse during the meeting needs to show trustand create safety for the patient. Professional support by communication and interaction canestablished a good care relationship. Aim: To describe how young women diagnosed withanorexia nervosa experience the meeting with health professionals. Method: The datamaterial consists of five autobiographies that have been analyzed with qualitative contentanalysis. Results: The analysis revealed four categories; feel unfairly treated, ending up indisadvantage, exposed to abuse of power and compulsion, hope and confidence. A total ofeight subcategories emerged. Conclusion: The meeting with healthcare is experienced bothnegatively and positively. It is important that healthcare professionals respect the youngwomen’s autonomy and engage them in their healthcare. That the healthcare should becharacterized by an ethical perspective and that time is given in the meeting is important.Good treatment, adequate knowledge and non-judgmental attitudes from healthprofessionals are important.

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This research aimed to understand the social representations of physicians and nurses about excessive investment related to the terminal patient during the health care process in an Adult ICU. The specific aims of such project were to describe how physicians and nurses mean the end of life and the excessive investment regarding the terminal patient, to investigate how such professionals evaluate their academic learning process concerning health care during the dying process, and to identify reactions and feelings of physicians and nurses related to the death of the terminal patient. It consisted of a qualitative, exploratory/descriptive research, founded on Social Representations Theory. Data collection techniques consisted on focused interviews and participant observations. Analysis was based on content analysis. The ethical principles were respected, so that the participants rights were preserved, and an Informed Consent Document was signed as a condition to participate in the research. Among the results, it was possible to observe that physicians and nurses build their social representations about dysthanasia in the ICU under the influence of several factors, having as a starting point the absence of teaching and preparation to deal with death in the hospital context during undergraduate studies and medical residency, as well as the complexity of the daily contact with death and the dying process, together with feelings and defense mechanisms, spirituality and religiosity. Moreover, there are assertions that dysthanasia really happens, the firm pleads of the family of the terminal patient admitted in an ICU, the great complexity of decision making, that begins before admission of the patient in the ICU, decisions whether to invest on the patient or not, and the criteria used to decide when to stop investing, the role of the health professionals team on decision making, the enormous preoccupations concerning ethical and legal repercussions related to the decisions made as concerns the Code of Professional Ethics and the Brazilian Law, besides absences and euphemisms employed when registering the diagnosis, prognosis and care offered to the terminal patient, and last, the expectation of a dignified death as concerns the professional himself and the family, wishing to die at home, together with the family, having accepted the end of life. This study concludes that there are urgent needs of improvement regarding multiple aspects related to death: its approach during undergraduate studies and residency; adequate communication among professionals during decision making process and during the professional activities in the ICU, the ponderation between the wishes of the family and the real possibilities of survival of the patient. It is important to consider the situation of the patient and think that, concerning a hypothetical end of life, everything the professional dispenses to the patient in an ICU is solely what he would not desire as a dignified death, for himself or his family members. / Esta pesquisa objetivou compreender as representações sociais de médicos e enfermeiros acerca do investimento excessivo no paciente terminal durante o processo de cuidar em uma UTI Adulto. Os objetivos específicos visaram descrever como médicos e enfermeiros significam terminalidade de vida e o investimento excessivo no paciente terminal; investigar como estes profissionais avaliam a sua formação acadêmica face ao cuidado no processo de morrer; e identificar reações e sentimentos de médicos e enfermeiros frente à morte do paciente. Constou de uma pesquisa qualitativa, exploratório-descritiva, fundamentada na Teoria das Representações Sociais. As técnicas de coletas de dados foram a entrevista focalizada e a observação participante. O processo de análise foi embasado na análise de conteúdo. Os princípios éticos foram respeitados, de forma a proteger todos os direitos dos participantes, com formalização da participação por meio de Termo de Consentimento Livre e Esclarecido. Dentre os resultados, observou-se que os médicos e enfermeiros constroem as suas representações sociais sobre a distanásia em UTI sob influência de múltiplos fatores, partindo da ausência do ensino e preparação para lidar com a morte no cotidiano hospitalar durante a graduação e a residência médica; a complexidade da convivência cotidiana com a morte e o processo de morrer, juntamente com os sentimentos e mecanismos de defesa; a espiritualidade e a religiosidade; as afirmações de que a distanásia realmente acontece; os pedidos obstinados da família do paciente terminal internado na UTI; as grandes complexidades das tomadas de decisão, que se iniciam desde antes da admissão do paciente na UTI, passando pelas dúvidas em relação ao investimento, ou não, no mesmo e nos critérios utilizados para se saber até onde investir; o papel da equipe nas tomadas de decisão; o enorme receio das repercussões éticas e legais em relação às decisões tomadas, no que se refere aos códigos de ética profissional e o Código Penal brasileiro, além das ausências e eufemismos empregados nos registros de diagnóstico, prognóstico e cuidado ofertado ao enfermo terminal; e, por fim, os anseios de boa morte para o próprio profissional e seus familiares, com desejos de falecer em casa, junto com a família, como forma de aceitação da sua finitude. Concluiu-se, neste estudo, que existem necessidades de aperfeiçoamento no que tange a múltiplos aspectos referentes à morte: sua abordagem, na graduação e residência; comunicação adequada entre os profissionais durante os processos decisórios e durante o trabalho na UTI; a ponderação entre os desejos da família e as reais possibilidades de sobrevivência do doente. É importante se colocar no lugar do doente e considerar que, em uma hipotética terminalidade de vida, tudo o que o profissional dispensa ao paciente dentro de uma UTI é tão somente aquilo que não desejaria, como morte digna, para si ou familiares.

Bakgrund: Antalet personer som drabbas av demenssjukdom förväntas öka i takt med att populationens livslängd blir allt längre. Demenssjukdomar skapar förändringar i hjärnan som gör att patienterna har svårigheter att samtala, tolka sin verklighet och minnessvårigheter. Vårdpersonalen förväntas ge en god och säker omvårdnad till varje enskild patient. Delaktighet anses vara en grundförutsättning för den personcentrerade vården, där vårdpersonalen har en viktig uppgift i att göra patienterna delaktiga genom att ge vård som är tillrättalagd efter patientens specifika behov. Syfte: Syftet var att beskriva vårdpersonals upplevelser av att vårda patienter med demenssjukdomar. Metod: En litteraturöversikt med kvalitativ ansats baserad på tolv vetenskapliga artiklar. Resultat: Ur analysen framkom fyra teman och fjorton underteman. Huvudtemana var: Kommunikation – en utmaning för vårdpersonal, Andliga och existentiella frågor – en utmaning för vårdpersonal, Kunskap och erfarenhet bygger bra vårdpersonal, och Den känslomässiga vårdpersonalen. Konklusion: Kommunikationsproblem, tidsbrist och brist på utbildning leder till att vårdpersonalen känner en känsla av otillräcklighet i samband med vården av patienter med demenssjukdom. Vårdpersonalens välbefinnande förbättras genom att de känner stöd från kollegor, chefer och ett öppet arbetsklimat. / Background: The number of people afflicted with dementia is expected to increase due to the longer life expectancy of the population. Dementias create changes in the brain causing the patients to have difficulties speaking, interpreting their reality and remembering. Health professionals are expected to provide each patient with good and safe care. Involvement is considered a prerequisite for the person-centred care, where the nurses have an important task in making the patients involved by providing care personalised after the patients’ specific needs. Aim: The aim was to describe health professionals’ experiences of caring for patients with dementia. Method: A literature review with a qualitative approach based on twelve scientific articles. Results: From the analysis four main themes and fourteen subthemes emerged. The main themes were: Communication – A Challenge for Health Professionals, Spiritual and Existential Questions – A Challenge for Health Professionals, Knowledge and Experience Makes Good Health Professionals, Anxiety of Prioritising and The Emotional Health Professionals. Conclusion: Communication problems, lack of time and lack of education leads to nurses having a feeling of insufficiency regarding their care of patients with dementia. The nurses’ well-being is improved by them feeling supported by colleagues, bosses and an open working climate.

A ferramenta do trabalho em equipe é proposta para organizar o trabalho em saúde e enfermagem como maneira de se responder às mudanças do modelo de atenção à saúde e do paradigma da atenção à saúde mental. Reconhecendo sua importância no contexto atual, realizou-se uma revisão sistemática da literatura acerca do trabalho em equipe na saúde e na enfermagem, com o objetivo de identificar a produção e analisá-la criticamente, segundo a quantidade, cronologia, procedência de nacionalidade, instituição de origem e o tipo de pesquisa; referencial teórico-metodológico adotado; resultados e suas contribuições como base de conhecimento para a assistência e a gerência dos serviços de saúde. O referencial teórico utilizado foi o processo de trabalho, de Mendes-Gonçalves e Mehry, e o trabalho em equipe, de Peduzzi. Metodologicamente, o estudo seguiu o caminho da revisão sistemática, com a busca ativa de publicações em bancos de dados on line, através de descritores e palavras-chave relacionados ao trabalho em equipe. Embora a primeira busca tenha retornado uma grande quantidade de publicações (1837 artigos), após os diversos procedimentos para seleção da literatura pertinente, foram selecionadas 70 publicações. Os resultados mostram a dificuldade em pesquisar o tema nos bancos de dados, principalmente dada a ausência de definição dos termos trabalho em equipe e interdisciplinaridade; assim como a falta de rigor metodológico e conceitual das publicações. O trabalho em equipe é concebido como um processo grupal e interdisciplinar, no qual se observa sinergia positiva, coordenação, cooperação e responsabilidade coletiva, compartilhamento de objetivos comuns e interação entre os membros, possível através da comunicação. Os elementos identificados para caracterizar o trabalho em equipe, além daqueles (já) citados na concepção, incluem a autonomia profissional, a flexibilização da divisão do trabalho e a integralidade da atenção à saúde. A conclusão do estudo destaca a necessidade de aprofundamento de pesquisas teórico-empíricas sobre o tema para fundamentar sua abordagem teórica, e fornecer subsídios para a formulação de propostas que permitam melhorar a utilização prática do trabalho em equipe, assim como sua avaliação sistemática / The tool of work as a team is proposed to organize the work in health and nursing as a way to answer to the changes of the model of primary health care and the paradigm of attention to mental health. Recognizing its importance in the current context, took place a systematic review of literature about the work as a team in health and nursing, with the objective of identifying the production and look at it critically, according to the quantity, chronology, nationality, institution of origin and the type of search; reference theoretical and methodological adopted; results and their contributions as a basis of knowledge for the care and management of health services. The theoretical reference used was the work process based in Mendez-Gonçalvez and Mehry, and work in teams, based in Peduzzi. Methodologically, the study followed the path of systematic review, with the active search for publications in databases online through descriptors and keywords related to teamwork. Although the first search has returned a large number of publications (1837 articles), after the various procedures for selecting the relevant literature, were selected 70 publications. The results include the difficulty in researching the topic in databases, particularly given the lack of definition of terms and interdisciplinary work in teams, as well as the lack of methodological rigor and conceptual of the articles. The work in teams was designed as a group and interdisciplinary process, which says positive synergy, coordination, cooperation and collective responsibility, sharing common objectives and interaction between members, possible through communication. The elements identified to characterize the work as a team, beyond those cited in the design, include a professional autonomy, the division of labour flexibility and comprehensiveness of health care. The conclusion of the study highlights the need for deepening of theoretical and empirical research on the issue to justify its theoretical approach, and provide subsidies for the formulation of proposals to improve the practical use of the work as a team, as well as its systematic assessment

Bakgrund: Hälso- och sjukvårdspersonal har ett yrke med hög arbetsbelastning som riskerar att leda till arbetsrelaterad stress som i sin tur kan leda till att patientvården påverkas. Det resulterar även i hög sjukfrånvaro, extra ekonomiska utgifter och hög personalomsättning. Följden av detta blir att samhället och organisationen förlorar både kompetens och ekonomiska medel. De senaste åren har användandet av mindfulness uppmärksammats inom den svenska hälso- och sjukvården. Den hittills genomförda forskningen tyder på att mindfulness kan ha gynnsamma effekter så som stressminskning, avslappning och förbättring av livskvalitén. Syfte: Syftet med litteraturöversikten var att sammanställa aktuell forskning om mindfulness som intervention vid arbetsrelaterad stress hos hälso- och sjukvårdspersonal. Metod: Studien genomfördes som en litteraturöversikt där 15 vetenskapliga artiklar med kvantitativ, kvalitativ samt mixad ansats inkluderades. Sökningarna gjordes via databaserna PubMed, CINAHL och PsycINFO. Resultat: I resultatet framkom det två kategorier: Mindfulness-baserade interventioner som kan användas för att hantera arbetsrelaterad stress samt mindfulness påverkan vid arbetsrelaterad stress. Resultatet visade att mindfulnessträning har en reducerande påverkan på stress, utmattning, depression och ångest samt en ökning av medkänsla och medveten närvaro. Slutsats: Mindfulness har en mängd olika variationer av interventioner som kan vara fördelaktiga för att minska hälso- och sjukvårdspersonalens stress. Mindfulness som intervention har potential att effektivt minska arbetsrelaterad stress bland hälso- och sjukvårdpersonal. Litteraturöversiktens resultat är relevant för att minska stressnivå hos hälsooch sjukvårdspersonal vilket medför minskade vårdkostnader samt öka förutsättningar för att ge god och säker vård till patienten. / Background: Health care professionals have a profession with a high workload that risks leading to work-related stress, which in turn can lead to patient care being affected. It also results in high sick leave, extra financial expenses and high staff turnover. The consequence of this is that society and the organization lose both competence and financial resources. In recent years, the use of mindfulness has gained attention in Swedish health care. The research conducted so far suggests that mindfulness can have beneficial effects such as stress reduction, relaxation, and improving the quality of life. Aim: The purpose of the literature review was to compile current research on mindfulness as an intervention to manage work-related stress among health care professionals. Method: The study was conducted as a literature review which included 15 scientific articles with a quantitative, qualitative and mixed-method. The searches were made through the databases PubMed, CINAHL and PsycINFO. R esults: In the result, two categories emerged: Mindfulness-based interventions that can be used to deal with work-related stress and mindfulness impact on work-related stress. The results showed that mindfulness training has a reducing effect on stress, burnout, depression and anxiety, as well as an increase in compassion and conscious presence. Conclusion: Mindfulness has a variety of interventions that can be beneficial in reducing the stress of health care professionals. Mindfulness as an intervention has the potential to reduce work-related stress among healthcare professionals effectively. The results of the literature review are relevant to reducing the stress level of health care professionals, which results in reduced healthcare costs and increased conditions for providing good and safe care to the patient.

MPM / Oliver Tambo Institute of Governance and Policy Studies

MPH / Department of Public Health / HIV/AIDS is an overwhelming global pandemic that affects the country’s health-care system. In order to reduce HIV/AIDS morbidity and mortality, the World Health Organization has called on countries to provide earlier access to antiretroviral therapy. In order to comply with the World Health Organization’s call, South Africa has developed the National Consolidated Guidelines, which were aimed at increasing access to ART as well as reducing new infections through viral suppression. Although the new guidelines have been implemented, they have not been fully implemented, especially in rural-based Primary Health Care facilities. The researcher observed that women who were pregnant were not tested every three months, as prescribed by the HIV/AIDS guidelines. The aim of this study was to investigate Challenges faced by health professionals regarding the implementation of HIV/AIDS guidelines at PHC facilities of Vhembe District, South Africa. This study adopted a qualitative, explorative, descriptive and contextual approach targeting nurses working at rural-based primary health care facilities at Vhembe District. Face-to face in-depth, Semistructured interviews were conducted, audiotaped and transcribed verbatim. The study used non-probability quota sampling method to identify participants until data saturation was reached with 12 participants. The results revealed that nurses faced some challenges when implementing HIV/AIDS guidelines, including shortages of resources, poor technical support, poor infrastructure, work overload, patients starting ART while there are not ready, shortage of ART, late booking of antenatal care, and mothers’ denial of HIV positive status, HIV positive babies, and poor RPC after birth. Ethical considerations were observed throughout the study. The data collected was analyzed using interpretative phenomenological analysis and all measures to ensure trustworthiness of the study findings were ensured. Some recommendations were made based on the findings of the study / NRF