Os profissionais cuidam dos doentes de acordo com seus conceitos e crenças. Buscou-se analisar as crenças sobre dor crônica não oncológica dos profissionais de saúde que atendem doentes com dor crônica em Centros de Dor da cidade de São Paulo, por meio do Inventário de Atitudes frente à Dor-profissionais. Nove (81,8%) dos onze Centros de Dor identificados concordaram em participar. Os profissionais preencheram ficha de caracterização pessoal, profissional e o Inventário de Atitudes frente à Dor-profissionais, adaptado do Inventário de Atitudes frente à dor-versão breve (IAD-breve), utilizado para doentes. Foram entrevistados 75 profissionais (59,5%). A média de idade foi 42,8 anos (DP=10,5), a distribuição foi semelhante entre os sexos e o tempo médio de graduação foi 16 anos (DP=9,9). A maioria dos profissionais eram médicos 58,7%, seguidos pelos fisioterapeutas (42,7%) e dentistas (10,7%). A maioria (42,7%) possuía especialização e 26,7%, mestrado ou doutorado. Sessenta por cento dos profissionais auto-avaliaram sua experiência com doentes com dor crônica como mediana e 44,0% relataram atender mais que 20 doentes ao mês. O IAD-versão profissional foi validado com 20 itens, a análise fatorial confirmou 6 domínios (emoção, controle, incapacidade, solicitude, cura médica e dano físico) e a confiabilidade dos domínios, avaliada por meio do alfa de Cronbach, variou entre 0,567 a 0,807, valores considerados moderados e bons. Os profissionais mostraram crenças “fortemente desejáveis" nos domínios controle (3,1) e emoção (3,7) e “moderadamente desejáveis" nos domínios dano físico (1,2) e incapacidade (1,5); crença “fortemente não desejável" foi encontrada no domínio cura médica (3,4) e “moderadamente não desejável" no domínio solicitude (2,5). Visando identificar se diferenças nas crenças poderiam estar relacionadas às características demográficas e profissionais, foram compostos 3 clusters: médicos/ pós-graduados; não médicos/especializados/ pouco experiente e graduados/dor crônica oncológica. A comparação entre os clusters não mostrou diferenças estatisticamente significantes. A inexistência de diferenças indicou que variáveis como profissão, sexo, idade, nível de escolaridade e de experiência não influiu nas crenças dos profissionais frente à dor crônica. As crenças “indesejáveis" manifestadas pelos profissionais de que solicitude é desejável e que se pode esperar cura para dor crônica não oncológica indicam a necessidade de incorporação de novos conceitos na prática clínica. Crenças não adequadas podem levar a equívocos na condução no tratamento como reforçar expectativas irrealistas, aumentar a incapacidade e a dependência. / Health professionals assist patients according to their concepts and beliefs. This study analyzed the beliefs of health professionals who assist patients with nonmalignant chronic pain, in different Pain Clinics in Sao Paulo – Brazil, using the Pain Attitude Inventory - Professionals. Nine (9) out of 11 Pain Clinics, (81.8%) identified in Sao Paulo, agreed to participate. The professionals completed a Personal and Professional Characterization Profile and the Pain Attitude Inventory – Professionals, adapted from the Survey of Pain Attitudes–Brief (SOPA-B). Seventy five (75) professionals were interviewed (59.5%). The mean age was 42.8 years (SD=10.5), the distribution regarding gender was similar, and they had a mean of 16 years (SD= 9.9) since graduation; the majority were physicians (58.7%), followed by physical therapists (42.7%) and dentists (10.7%); many of the respondents had completed specialization courses (42.7%), and 26.7% had a master or doctorate degree; 60% of the professionals self-assessed their experience with patients with nonmalignant chronic pain as moderate and 44.0% stated that they assist over 20 patients per month. The Pain Attitude Inventory – Professionals was validated with 20 items, the factorial analysis confirmed 6 domains (emotion, control, disability, solicitude, cure and harm), and the reliability of the domains, assessed by Chronbach’s alfa, ranged from 0.567 and 0.807, values which are considered moderate to good. The professionals showed beliefs that were “strongly desirable" in the control (3.1), and emotion (3.7) domains, and “moderately desirable" beliefs in the harm (1.2), and disability (1.5) domains; and “strongly undesirable" beliefs in the cure domain (3.4) and finally “moderately undesirable" beliefs in the solicitude domain (2.5). In order to identify if differences in beliefs could be related to demographic and professional characteristics, three (3) clusters were formed: physicians/post-graduation; non-physicians/specialization courses/ little experience; and graduates/ oncology pain. The comparison between these clusters did not show any statistically significant differences. This inexistence of differences indicated that variables such as profession, gender, age, educational level and years of professional experience did not influence the beliefs of health professionals concerning chronic pain. The “undesirable" beliefs expressed by the health professionals, that “solicitude" is desirable and that a cure for nonmalignant chronic pain is highly possible, indicate that there is a need for the incorporation of new concepts in clinical practice. Inadequate beliefs can mislead the conduction of treatment as well as reinforce unrealistic expectations, and cause increases in incapacity and dependence.

Os profissionais cuidam dos doentes de acordo com seus conceitos e crenças. Buscou-se analisar as crenças sobre dor crônica não oncológica dos profissionais de saúde que atendem doentes com dor crônica em Centros de Dor da cidade de São Paulo, por meio do Inventário de Atitudes frente à Dor-profissionais. Nove (81,8%) dos onze Centros de Dor identificados concordaram em participar. Os profissionais preencheram ficha de caracterização pessoal, profissional e o Inventário de Atitudes frente à Dor-profissionais, adaptado do Inventário de Atitudes frente à dor-versão breve (IAD-breve), utilizado para doentes. Foram entrevistados 75 profissionais (59,5%). A média de idade foi 42,8 anos (DP=10,5), a distribuição foi semelhante entre os sexos e o tempo médio de graduação foi 16 anos (DP=9,9). A maioria dos profissionais eram médicos 58,7%, seguidos pelos fisioterapeutas (42,7%) e dentistas (10,7%). A maioria (42,7%) possuía especialização e 26,7%, mestrado ou doutorado. Sessenta por cento dos profissionais auto-avaliaram sua experiência com doentes com dor crônica como mediana e 44,0% relataram atender mais que 20 doentes ao mês. O IAD-versão profissional foi validado com 20 itens, a análise fatorial confirmou 6 domínios (emoção, controle, incapacidade, solicitude, cura médica e dano físico) e a confiabilidade dos domínios, avaliada por meio do alfa de Cronbach, variou entre 0,567 a 0,807, valores considerados moderados e bons. Os profissionais mostraram crenças “fortemente desejáveis” nos domínios controle (3,1) e emoção (3,7) e “moderadamente desejáveis” nos domínios dano físico (1,2) e incapacidade (1,5); crença “fortemente não desejável” foi encontrada no domínio cura médica (3,4) e “moderadamente não desejável” no domínio solicitude (2,5). Visando identificar se diferenças nas crenças poderiam estar relacionadas às características demográficas e profissionais, foram compostos 3 clusters: médicos/ pós-graduados; não médicos/especializados/ pouco experiente e graduados/dor crônica oncológica. A comparação entre os clusters não mostrou diferenças estatisticamente significantes. A inexistência de diferenças indicou que variáveis como profissão, sexo, idade, nível de escolaridade e de experiência não influiu nas crenças dos profissionais frente à dor crônica. As crenças “indesejáveis” manifestadas pelos profissionais de que solicitude é desejável e que se pode esperar cura para dor crônica não oncológica indicam a necessidade de incorporação de novos conceitos na prática clínica. Crenças não adequadas podem levar a equívocos na condução no tratamento como reforçar expectativas irrealistas, aumentar a incapacidade e a dependência. / Health professionals assist patients according to their concepts and beliefs. This study analyzed the beliefs of health professionals who assist patients with nonmalignant chronic pain, in different Pain Clinics in Sao Paulo – Brazil, using the Pain Attitude Inventory - Professionals. Nine (9) out of 11 Pain Clinics, (81.8%) identified in Sao Paulo, agreed to participate. The professionals completed a Personal and Professional Characterization Profile and the Pain Attitude Inventory – Professionals, adapted from the Survey of Pain Attitudes–Brief (SOPA-B). Seventy five (75) professionals were interviewed (59.5%). The mean age was 42.8 years (SD=10.5), the distribution regarding gender was similar, and they had a mean of 16 years (SD= 9.9) since graduation; the majority were physicians (58.7%), followed by physical therapists (42.7%) and dentists (10.7%); many of the respondents had completed specialization courses (42.7%), and 26.7% had a master or doctorate degree; 60% of the professionals self-assessed their experience with patients with nonmalignant chronic pain as moderate and 44.0% stated that they assist over 20 patients per month. The Pain Attitude Inventory – Professionals was validated with 20 items, the factorial analysis confirmed 6 domains (emotion, control, disability, solicitude, cure and harm), and the reliability of the domains, assessed by Chronbach’s alfa, ranged from 0.567 and 0.807, values which are considered moderate to good. The professionals showed beliefs that were “strongly desirable” in the control (3.1), and emotion (3.7) domains, and “moderately desirable” beliefs in the harm (1.2), and disability (1.5) domains; and “strongly undesirable” beliefs in the cure domain (3.4) and finally “moderately undesirable” beliefs in the solicitude domain (2.5). In order to identify if differences in beliefs could be related to demographic and professional characteristics, three (3) clusters were formed: physicians/post-graduation; non-physicians/specialization courses/ little experience; and graduates/ oncology pain. The comparison between these clusters did not show any statistically significant differences. This inexistence of differences indicated that variables such as profession, gender, age, educational level and years of professional experience did not influence the beliefs of health professionals concerning chronic pain. The “undesirable” beliefs expressed by the health professionals, that “solicitude” is desirable and that a cure for nonmalignant chronic pain is highly possible, indicate that there is a need for the incorporation of new concepts in clinical practice. Inadequate beliefs can mislead the conduction of treatment as well as reinforce unrealistic expectations, and cause increases in incapacity and dependence.

Whilst differing perspectives can be an asset, they have also been found to lead to conflict and misunderstanding in multidisciplinary practice. Evidence suggests that different mental health disciplines hold differing attitudes towards mental disorder, reflecting differing implicit models held. To contribute to our understanding of this problem the present study investigates psychologists’ concepts of mental disorder, building on a pilot study conducted by Harland et al. with psychiatrists (2009). The Maudsley Attitude Questionnaire was used in an online survey of trainee clinical psychologists (N = 288). Principal components analysis was used to investigate implicit models. It was hypothesised that psychologists’ understandings of mental disorder would differ from psychiatrists'. The findings showed that psychologists endorsed different models for different diagnostic categories of mental disorder. Psychologists favoured the social realist model overall. Principal components reflecting a biological-psychosocial continuum, and scales of cognitive/behavioural and psychodynamic/spiritual model endorsement were revealed. The study concluded that, when compared to the findings of Harland et al. (2009), psychologists appear to make more use of psychosocial and less use of biological factors in their understanding of mental disorder than do psychiatrists. There appear to be fundamental differences in psychologists' and psychiatrists’ implicit models of mental disorder. A greater emphasis on multidisciplinary training initiatives is recommended.

Bakgrund: Ett barn dagligen drabbas av cancersjukdom i Sverige. Föräldrarna har en viktig del i vården som följer. Cancern leder till stora livsförändringar hos familjen och framkallar många olika känslor. Vården ska anpassas efter hela familjens behov och familjen ska göras delaktiga i vården. Syfte: Syftet var att undersöka föräldrars upplevelse att ha ett barn som lider av cancer, samt hur de upplever att sjuksköterskan kan underlätta deras nya livssituation. Metod: En litteraturöversikt där 11 vetenskapliga artiklar ligger till grund. Resultat: Alla reagerade olika och det fanns många olika känslor som föräldrarna upplevde. Många föräldrar upplevde ett förändrat föräldraskap, då de kände sig osäkra på sin föräldraroll. Ett cancerbesked gjorde det svårt att planera framtiden och vardagen förändrades, då fokus låg på det sjuka barnets vård. Cancer gjorde att föräldrarna fick nya perspektiv och inte längre tog livet för givet. Information var något föräldrarna upplevde som viktigt. De ville ha all information och att den förmedlades på ett bra sätt och med känsla. Sjuksköterskan är ofta nära föräldrarna därmed utgör de ett stort stöd. Föräldrarna upplevde att sjuksköterskan hade ett stort ansvar att prata med och stötta dem i deras välmående under barnets sjukdom. Slutsats: Många känslor är inblandade när ens barn lider av cancer, det är svårt att förutse hur föräldrarna kommer reagera eftersom alla har unika upplevelser. Sjuksköterskan kan underlätta situationen genom god kommunikation och adekvat information. Det är viktigt att sjuksköterskan skapar ett band till familjen, för att stötta dem genom en svår tid. / Background: In Sweden one child is daily diagnosed with cancer. Parents have an important role in the care. A cancer diagnose is life changing for everybody and induces a lot of different feelings. The health care should be adapted to the whole family ́s need and the family should be involved in the health care. Aim: The aim of this study was to examine parents experience to have a child diagnosed with cancer and how they believe the nurse can facilitate in their new life situation. Method: A review based on 11 scientific articles. Result: All parents responded different and expressed different feelings. Many parents experienced a changed parenthood. The cancer diagnose made it difficult to plan for the future. Their everyday life changed, since focus was on the ill child. The diagnose gave new perspectives and they no longer took life for granted. The parents believed that information was important. They wanted as much information as possible and that the nurse delivered it in a good way. The nurse is often the one the parents connects to, which makes them a big support. The parents believed that the nurse had a responsibility to talk to and support the parent’s witch contributed to their wellbeing.Conclusion: A lot of feelings are involved when the child is diagnosed with cancer, it is hard to predict how the parents will react because everybody are unique. The nurse can support parents in the situation through good communication and adequate information. It is important that the nurse have a close interaction with the family, in order to support them.

Clinical leadership and compassionate care in the NHS have become priorities in influential papers and policies. There is a paucity of research to underpin conceptualisations of compassionate leadership and of leadership development in clinicians in the NHS, particularly clinical psychologists who may be able to lead in healthcare environments in unique ways due to the values and competencies of their profession. This present study sought to use a grounded theory approach to build a preliminary model of the transformational process of how clinical psychologists may evolve into compassionate leaders. Twelve clinical psychologists from varied specialities and with different years of experience took part in semi-structured qualitative interviews. Their data were analysed using a grounded theory methodology involving open, selective and theoretical coding. The findings indicate that psychologists may develop as leaders through their personalities and sense of mission, through reaching out to and being accepted by colleagues and through leading by doing. Participants who became compassionate in leadership seemed to be enabled by reflection, supervision and being treated with compassion. These findings are discussed with regard to extant theory and literature. Clinical and theoretical implications and a methodological critique are discussed.

This study investigated the prevalence of voluntary self-practice of Cognitive Behaviour Therapy (CBT) by accredited CBT practitioners, and explored the ability of the Theory of Planned Behaviour (TPB) to predict intentions to engage in CBT self-practice. A TPB questionnaire was constructed by implementing the protocol devised by Francis et al. (2004), with content specific items generated from an elicitation exercise to obtain salient beliefs regarding CBT self-practice. A sample of 177 accredited CBT practitioners completed an online survey which included demographic items and the TPB questionnaire. It was found that 46.4% of participants intended to self-practice CBT more than once a week over the following month. While the TPB predicted intentions to self-practice CBT (R2 = .445, p < .001), structural equation modeling revealed that the theory of reasoned action (R2 = .473, p < .001) was the best model fit of the observed data (RMSEA = .00, CFI = 1.00). It was concluded that a substantial proportion of CBT practitioners intended to regularly engage in CBT self-practice, with intentions predicted by subjective normative beliefs and attitudes towards the behaviour. Implications are discussed, with calls for the study to be replicated. Potential future research is considered, with suggestions to explore the role of CBT self-practice to promote therapist wellbeing.

Bakgrund: Kvinnlig könsstympning är ett ingrepp som länge utförts i stora delar av världen. 196 medlemsländer har anslutit sig till Förenta Nationens (FN) konvention om barns rättigheter för att gemensamt arbeta för att avskaffa denna typ av skadliga sedvänja. Genom kontinuerliga datainsamlingar om kvinnlig könsstympning förutspås en signifikant ökning i takt med att världens befolkning ökar. Hälso- och sjukvårdspersonal känner till ingreppet men få kan identifiera dess olika typer. Syfte: Syftet med studien var att beskriva vad hälso- och sjukvårdspersonal har för erfarenheter av att vårda patienter som genomgått kvinnlig könsstympning. Metod: Metoden är en litteraturöversikt baserad på sju kvalitativa artiklar, tre kvantitativa artiklar samt en artikel med mixad metod vilka var inhämtade från tre olika databaser; Cinahl Complete, PubMed och Academic Search Complete. Resultat: Resultatet presenteras under två kategorier: Bristande kunskap samt Det komplexa vårdandet. Hälso- och sjukvårdspersonal uttryckte att de hade bristande kunskaper och erfarenheter med att vårda och möta kvinnor som genomgått kvinnlig könsstympning. Många ansåg att de upplevde omtumlande känslor vid möten med kvinnor som genomgått kvinnlig könsstympning och deras familjer. Att se det kvinnliga könsorganets förändrade anatomi med mycket ärrbildning var svårhanterbart för många hälso- och sjukvårdare. Diskussion: Resultatet diskuterades utifrån Leiningers transkulturella omvårdnadsteori samt konsensusbegreppet människan. Den transkulturella medvetenheten och förmågan att bortse från det egna etnocentriska synsättet ligger till grund för det professionella vårdandet. / Background: Female genital mutilation is a procedure that has long been carried out in many parts of the world. 196 member countries have joined United Nation's (UN) Convention on the rights of children, to work together to eliminate this kind of malicious practice. Through continuous data collection of female genital mutilation, it predicts a significant rise as the world population increases. Health professionals are familiar with the procedure, but few can identify its different types. Aim: The aim was to describe health professionals’ experiences of caring for patients who have undergone female genital mutilation. Method: The method consists of a literature review based on seven qualitative articles, three quantitative articles and one with mixed method retrieved from three different databases; Cinahl Complete, PubMed and Academic Search Complete. Results: The results are presented under two categories: Lack of knowledge and The complexity of caring. Health professionals expressed a lack of knowledge and experience to nurture and meet women who have undergone female genital mutilation. Many felt that they experienced tumultuous feelings at meetings with women who have undergone female genital mutilation and their families. Seeing the female genitalia altered anatomy with very severe scarring was unmanageable for many health professionals. Discussion: The results were discussed on the basis of Leininger's transcultural nursing theory and the concept of consensus human. The transcultural awareness and the ability of health professionals' to ignore their own ethnocentric approach is the basis for the professional caring.

Bröstmjölk är en komplett näringskälla för det nyfödda barnet. Förutom att tillföra barnet alla näringsämnen hen behöver så ger bröstmjölken energi, bygger upp kroppen samt skyddar det nyfödda barnet mot sjukdomar. Amning är ett samspel mellan mamma och barn som påverkas av många faktorer. För en tvillingmamma är initiering av amning en större utmaning än för en mamma som fött ett barn, då omvårdnaden kring barnen blir dubbel. Syftet med studien var att beskriva tvillingmammors erfarenhet av amningsstöd, dels från vårdpersonal, dels från sociala medier, för att initiera och upprätthålla en fungerande amning. Studien är en intervjustudie med kvalitativ metod. Datamaterial samlades in genom intervjuer av sex utvalda tvillingmammor. Mammorna söktes och valdes ut via en Facebookgrupp. I resultatet framkom två kategorier: Mammans initiativ och Vårdpersonalens engagemang. Resultatet tyder på att de intervjuade mammornas erfarenhet är att vårdpersonal idag saknar den specifika kunskapen om/och förståelse för hur mycket arbete det innebär för en tvillingmamma att få amningen att fungera. Många mammor söker idag den information de inte erhållit via vårdpersonal på annat sätt, oftast via sociala medier. Utifrån den här studien kan vårdpersonal få en ökad förståelse för tvillingmammors behov av extra amningsstöd och information. / Breast milk is a complete food source for the newborn. In addition to supplying the baby all the nutrients it needs breast milk also provides energy, builds up the body and protects the newborn against disease. Breastfeeding is an interaction between mother and child that is affected by many factors. For a twin mother is initiation of breastfeeding more of a challenge than for a mother who gave birth to a child, then care about the children becomes twice.The purpose of this study was to describe the mother of twin´s experience of breastfeeding support, both from health professionals as well as from social media, to initiate and maintain a functional breastfeeding. The study is an interview study of qualitative method. Data material was collected through interviews with six selected twin mothers. The informants were sought and selected through a Facebook group. The results revealed two categories: The mother's initiative and The involvement of health professionals. The result indicates that the interviewed mothers experience is that health professionals today lack the specific knowledge and understanding of how much work it means for a twin mother to get a functional breastfeeding. Many mothers today are using other sources in seeking the information they did not receive by health professionals, mostly through social media. Based on this study, health professionals might gain a greater understanding of the need twin mothers have for more support and information regarding breast feeding twins.

Bakgrund: Övervikt och fetma orsakar idag fler dödsfall än undervikt. Det är ett folkhälsoproblem som ökar över hela världen. Övervikt och fetma leder till såväl fysiska som psykiska problem och besvär för den drabbade. Forskning har visat att patienter med övervikt eller fetma upplever mest stigmatisering i vuxen ålder. Syfte: Syftet med denna litteraturöversikt är att belysa bemötandet av patienter med övervikts- och fetmaproblematik ur patientens och vårdpersonalens perspektiv. Metoder: En litteraturöversikt. Resultat: Det framkom att patienter med högre BMI upplevde negativt bemötande från vårdpersonal, att de inte blev hörda. Patienterna sökte inte gärna vård. Det framkommer att vårdpersonalen hade en negativ attityd till patienter med övervikt eller fetma och ville helst inte vårda dessa. Slutsats: Patienter med övervikt eller fetma är en utsatt patientgrupp i såväl samhälle som inom vården. Patienterna upplever att de inte blir hörda och inte blir tagna på allvar. Vårdpersonal är enig om att vården måste hjälpa dessa patienter, trots det uppger en stor del av vårdpersonal att de inte vill vårda patienter med övervikt eller fetma relaterat till tidsbrist. / Background: Overweight and obesity cause today more deaths than underweight. There is a public health disorder that is increasing worldwide . Overweight and obesity leads to both physical and mental problems and inconvenience for the patient. Aim: The purpose of this study is to highlight the treatment of obese and overweight patients from the patient and the health-care personnel’s’ perspective. Methods: A literature review. Findings: It emerged that patients with a higher BMI experienced negative attitude from medical professionals , that they felt not being listened to and excluded. Patients dreaded to seek care. It appears that healthcare staff had a negative attitude and are not willing to care for overweight or obese patients. Conclusions: Overweight and obese patients are a vulnerable group of patients in both society and in healthcare. Patients feel they are not heard, they will be excluded and not taken seriously. Caregivers agrees that they must help these patients, despite the state a large part of health care workers that they would rather not care for obese patients.

This qualitative research study addressed the gap in the literature and lack of clinical guidelines and frameworks for health professionals as they assess and manage risk when balancing the safety and autonomy of community-dwelling older adults. Twelve health professionals were asked in individual interviews how they perceive, identify, assess and treat risk and how they negotiate the safety and autonomy of their clients. Informed by grounded theory methodology, the findings revealed what kinds of decisions health professionals made and how they made them within this clinical context. These findings from the perspective of the health professional contributed to the development of a definition of living at risk, a safety continuum and a conceptual/practice framework to help health professionals, including occupational therapists, make sound clinical decisions as they balance the autonomy and safety of their community-dwelling older adult clients.