This paper provides an analysis of Bradshaw and Colleagues' model of military healthcare professionals' moral distress experiences. Using novel interview data collected from Canadian Forces healthcare professionals, the steps of the model are validated or potential refinements are suggested. / Military healthcare professionals (HCPs) may experience moral distress during international deployment. Moral distress is experienced when a HCP faces a moral dilemma, e.g., knows the morally correct course of action but is blocked from taking it, or where all available courses of action require something of moral significance be given up. While the literature indicates that moral distress often negatively impacts the mental health of the individual and the effectiveness of the organization, limited research has examined moral distress amongst military HCP. Many similar stressors and psychological health problems are present for both civilian and military HCP; however, the unique context of deployment necessitates further examination. This thesis explores the military HCP experience with moral distress by using Bradshaw and colleague’s model of progression from the encounter with a moral dilemma to the impact on individuals and organizations. Through the analysis of novel interviews collected by the Ethics in Military Medicine Research Group (EMMRG), Bradshaw and colleague’s model of military moral distress is compared to participant’s experiences and qualitatively analysed, with the results outlining where the model is supported and where refinement is recommended. These challenges were then supported by a literature review from the disciplines of virtue and feminist ethics, moral psychology, bioethics, and civilian HCP moral distress research. Two novel and significant revisions to the model are suggested: representing and integrating the cumulative experience of moral distress, and re-conceptualizing the resolution process based on the consideration of contextual controllability on moral responsibility. / Thesis / Master of Science (MS) / This thesis examines the experience of moral distress in military healthcare professionals (HCPs) while working abroad, where a HCP faces a moral dilemma, e.g., knows the morally correct course of action but is blocked from taking it or it requires something of moral significance be given up. This thesis analyses the most recent model of military HCP moral distress (Bradshaw, et al., 2010) by comparing it to the experiences described by participants in the Ethics in Military Medicine Research Group (EMMRG) study. The results outline support for the model as well as novel suggestions for revision, which are supported by literature from a variety of disciplines. Two adjustments to Bradshaw and colleague’s model are suggested: clearer representation of the cumulative nature of moral distress as well as a reconceptualization of the resolution process to consider the influence of the immediate and extended environment on moral responsibility.

Cancer is a potentially life-threatening disease, which affects millions of people worldwide. It is multifaceted in nature and can lead to impairment in a person‟s physical, social and emotional functioning (Beatty, Oxlad, Koczwara, & Wade, 2008). Multidimensional treatment, with highly specialised professionals, equipment and services is thus needed for the effective treatment thereof (Mathews, West, & Buehler, 2009). Patients treated within the private and public healthcare sectors of South Africa have vastly differing treatment experiences. Only about 20% of the South African population has access to and can afford treatment within the private healthcare sector (Somdyala, Bradshaw, Gelderblom, & Parkin, 2010). While private sector patients have access to information, social workers and support groups, those in the public sector face life-threatening waiting times and a lack of empathy by public sector staff, weighed down by patient numbers and a lack of resources (Pillay 2002; Bateman, 2011). A study previously conducted by the researchers highlighted cancer patients‟ perceptions and experiences of treatment as being one of the most prominent themes influencing patients‟ overall cancer experience (Venter, Venter, Botha, & Strydom, 2008). This, coupled with the fact that the majority of research studies previously conducted in South Africa generally focused on the biomedical aspects of cancer (Albrecht, 2009), make exploring patients and healthcare professionals‟ perceptions and experiences of cancer treatment in a South African context potentially valuable. The thesis consists of three sub-studies reported in three manuscripts. The aim of the first article was to provide a narrative literature review exploring cancer survivorship and management in the South African context by scrutinising research previously conducted on cancer treatment. The aim of the second and the third article was to explore patients and healthcare professionals‟ perceptions and experiences of cancer treatment in the private and public healthcare sectors in the Eastern Cape, South Africa. A 100 participants were purposively sampled from a government-funded hospital (n = 30 patients; n = 22 healthcare professionals) and a private treatment facility (n = 30 patients; 18 healthcare professionals). Data was collected by making use of both qualitative (self-report questionnaire consisting of open-ended questions; interviews) and quantitative (Needs Evaluation Questionnaire) measures. A qualitative content and statistical analysis was conducted. Findings indicate that despite the expressed need for treatment to move towards a more biopsychosocial approach, the majority of the healthcare professionals in the current study are still primarily following a biomedical approach. Findings also indicate that the majority of the difficulties and frustrations experienced could be seen as being contextual problems and were not necessarily related to cancer treatment per se. Poor availability of resources and the South African population‟s diverse characteristics were responsible for the majority of the difficulties reported. Differing cultural beliefs, language barriers, illiteracy and unemployment were al seen as negatively influencing the treatment process. This is consistent with Serin et al. (2004), who reported that there is a significant relationship between the systemic nature of medical issues and the social, material and psychological difficulties cancer patients‟ experience. The systemic nature of healthcare needs highlighted in the current study emphasises the necessity for cancer treatment in South Africa to employ a more biopsychosocial approach. True collaboration between healthcare professionals working towards a common goal should thus be considered as being the ideal. Considering the socioeconomic divide and resource discrepancy between the private and public healthcare sectors in South Africa, credence must be given to the allocation of resources in the public sector. If this incongruity is to be addressed, there would have to be cooperation at government level. Assistance with regard to the allocation of funds, as well as the meticulous monitoring of the distribution thereof, is needed. Funding should be used to increase human and technical resources, as well as for staff development. Equitable care for all cancer patients, regardless of their socioeconomic status, is the ideal. The following recommendations on how to improve overall cancer care, in both sectors, can also be made: existing treatment sites need to be updated and additional sites developed; continuous research needs to be conducted; funds need to be allocated towards the development of effective transport and translation services; cultural diversity should be taken into account when developing awareness campaigns and treatment plans; healthcare professionals need to adopt a holistic approach during which attention is given to communication, establishing rapport and patient participation; and lastly healthcare professionals should also be encouraged to pay attention to their own healthcare needs as well. / PhD (Psychology), North-West University, Potchefstroom Campus, 2014

Cancer is a potentially life-threatening disease, which affects millions of people worldwide. It is multifaceted in nature and can lead to impairment in a person‟s physical, social and emotional functioning (Beatty, Oxlad, Koczwara, & Wade, 2008). Multidimensional treatment, with highly specialised professionals, equipment and services is thus needed for the effective treatment thereof (Mathews, West, & Buehler, 2009). Patients treated within the private and public healthcare sectors of South Africa have vastly differing treatment experiences. Only about 20% of the South African population has access to and can afford treatment within the private healthcare sector (Somdyala, Bradshaw, Gelderblom, & Parkin, 2010). While private sector patients have access to information, social workers and support groups, those in the public sector face life-threatening waiting times and a lack of empathy by public sector staff, weighed down by patient numbers and a lack of resources (Pillay 2002; Bateman, 2011). A study previously conducted by the researchers highlighted cancer patients‟ perceptions and experiences of treatment as being one of the most prominent themes influencing patients‟ overall cancer experience (Venter, Venter, Botha, & Strydom, 2008). This, coupled with the fact that the majority of research studies previously conducted in South Africa generally focused on the biomedical aspects of cancer (Albrecht, 2009), make exploring patients and healthcare professionals‟ perceptions and experiences of cancer treatment in a South African context potentially valuable. The thesis consists of three sub-studies reported in three manuscripts. The aim of the first article was to provide a narrative literature review exploring cancer survivorship and management in the South African context by scrutinising research previously conducted on cancer treatment. The aim of the second and the third article was to explore patients and healthcare professionals‟ perceptions and experiences of cancer treatment in the private and public healthcare sectors in the Eastern Cape, South Africa. A 100 participants were purposively sampled from a government-funded hospital (n = 30 patients; n = 22 healthcare professionals) and a private treatment facility (n = 30 patients; 18 healthcare professionals). Data was collected by making use of both qualitative (self-report questionnaire consisting of open-ended questions; interviews) and quantitative (Needs Evaluation Questionnaire) measures. A qualitative content and statistical analysis was conducted. Findings indicate that despite the expressed need for treatment to move towards a more biopsychosocial approach, the majority of the healthcare professionals in the current study are still primarily following a biomedical approach. Findings also indicate that the majority of the difficulties and frustrations experienced could be seen as being contextual problems and were not necessarily related to cancer treatment per se. Poor availability of resources and the South African population‟s diverse characteristics were responsible for the majority of the difficulties reported. Differing cultural beliefs, language barriers, illiteracy and unemployment were al seen as negatively influencing the treatment process. This is consistent with Serin et al. (2004), who reported that there is a significant relationship between the systemic nature of medical issues and the social, material and psychological difficulties cancer patients‟ experience. The systemic nature of healthcare needs highlighted in the current study emphasises the necessity for cancer treatment in South Africa to employ a more biopsychosocial approach. True collaboration between healthcare professionals working towards a common goal should thus be considered as being the ideal. Considering the socioeconomic divide and resource discrepancy between the private and public healthcare sectors in South Africa, credence must be given to the allocation of resources in the public sector. If this incongruity is to be addressed, there would have to be cooperation at government level. Assistance with regard to the allocation of funds, as well as the meticulous monitoring of the distribution thereof, is needed. Funding should be used to increase human and technical resources, as well as for staff development. Equitable care for all cancer patients, regardless of their socioeconomic status, is the ideal. The following recommendations on how to improve overall cancer care, in both sectors, can also be made: existing treatment sites need to be updated and additional sites developed; continuous research needs to be conducted; funds need to be allocated towards the development of effective transport and translation services; cultural diversity should be taken into account when developing awareness campaigns and treatment plans; healthcare professionals need to adopt a holistic approach during which attention is given to communication, establishing rapport and patient participation; and lastly healthcare professionals should also be encouraged to pay attention to their own healthcare needs as well. / PhD (Psychology), North-West University, Potchefstroom Campus, 2014

Bakgrund: Studier visar att en av tre kvinnor världen över har blivit utsatta för våld i en nära relation. Våld i nära relationer finns i alla samhällsklasser och är ett världshälsoproblem. Vårdpersonal kommer ofta i kontakt med kvinnor som blivit utsatta för våld av en manlig partner. Många kvinnor mister livet varje år på grund av konsekvenserna från våldet. Syfte: Att beskriva vårdpersonalens erfarenheter av att vårda kvinnor som blivit utsatta för våld i en nära relation. Metod: Designen är en litteraturöversikt. Datainsamling har skett i databaserna Cinahl och PubMed. Resultat: Resultatet är baserat på 15 vetenskapliga artiklar och visade tre huvudområden: identifiering av kvinnor som lever med våld i en nära relation, hinder för att kunna identifiera de utsatta kvinnorna och vårdpersonalens möte med kvinnor som lever med våld i en nära relation. Vårdpersonalen upplevde svårigheter att identifiera kvinnor som blivit utsatta för våld i nära relationer. Hinder för att utföra screening var framförallt brist på kunskap och utbildning hos vårdpersonalen. Vårdpersonalen upplevde det svårt att möta våldsutsatta kvinnor, på grund av att det fanns svårigheter att distansera sig från de utsatta kvinnorna. Slutsats: Utifrån denna studie kan slutsatsen dras att riktlinjer, kunskap och träning behövs samt rutiner för att kunna utföra screening, för att vårdpersonalen ska kunna identifiera och ge kvinnor som lever med våld i nära en relation en god vård. / Background: Studies show that one of three women worldwide are exposed to intimate partner violence. Intimate partner violence exists in all social classes and is a global health problem. Healthcare professionals often come in contact with women who have experienced intimate partner violence. Many women lose their lives each year as a result from the violence. Purpose: To describe the healthcare professionals experience of taking care of women who have experienced intimate partner violence. Method: The method is a literature review. Data collection has taken place in databases Cinahl and PubMed. Results: The results is based on 15 scientific articles and three main areas emerged in the outcome: identification of women who lives with intimate partner violence, barriers to identifying the vulnerable women and healthcare professionals meeting with women who have experienced intimate partner violence. Healthcare professionals experience difficulties in identifying women who were exposed to intimate partner violence. Barrier to performing screening were primarily lack of knowledge and training in healthcare professionals. The healthcare professionals experienced it difficult to meet women who lived with intimate partner violence, due to the difficulty of distancing themselves from vulnerable women. Conclusions: From this study, the clue can be drown that guidelines, knowledge and training are needed, and also routines for screening, in order to identify women who are living with intimate partner violence.

Bakgrund: Psykisk ohälsa är ett växande samhällsproblem. Attityder av negativt slag presenteras som en grund för stigmatisering som preciserades redan av de gamla grekerna. Integrationen av stigma är ett problem för samhället då det påverkar och influerar våra tankar och handlingar. Vidare kan det bidra till hur vårdrelationen kommer att se ut vilket i sin tur kan bli positivt eller negativt. Hur sjuksköterskan uttrycker sina attityder mot patienter spelar således en viktig roll. Detta för att kunna ge alla patienter den personcentrerade och goda vård de har laglig rätt till få. Syfte: Att beskriva hur hälso- och sjukvårdspersonal uttrycker deras attityder gentemot patienter med psykisk störning. Metod: En litteraturöversikt med datainsamling från databaserna CINAHL Complete, Medline och PsycINFO. Resultat: Både positiva och negativa attityder återfanns i resultatet. Även stigmatisering av personer med psykisk ohälsa förekom. Patienter med psykiska störningar blev även misstrodda för sina fysiska symtom då de sökte somatisk vård. Attityder visade sig skilja sig beroende på erfarenhet, utbildning och var de arbetar. Det framkom en kunskapsbrist och ett kunskapsbehov. Vidare efterfrågas utbildning och mer träning i möten med personer med psykisk störning av hälso-och sjukvårdspersonal. Diskussion: Resultatet diskuteras utifrån bakgrunden samt Joyce Travelbees teori om den mellanmänskliga relationen. I resultatet framkom att både positiva och negativa attityder uttrycks gentemot patienter med psykisk störning. Även stigmatisering förekom i form av uttryckta attityder och som strukturellt problem. Hälso-och sjukvårdspersonal lyfter deras kunskap om psykisk ohälsa som bristfällig och en önskan om att öka kunskapen. / Background: Mental illness is a growing problem in the society. Attitudes of negative character are presented as the ground for stigmatizing and since the old Greeks we have been forming the meaning of the word stigma. Stigma has become wider and more integrated in the society. The integration of stigma is a growing problem due to its impact and influence in the way we humans think and act. In addition this can be a contribution to how the healthcare relationship turns out, it may be positive or negative. However the expressed attitudes against patients play an important role in the hope of providing good care. Aim: The aim of this study is to describe how healthcare professionals express their attitudes towards patients with mental disorder. Method: The method used by the authors is a structured review of the literature using databases such as CINAHL Complete, Medline and PsycINFO. Results: The result showed that healthcare workers express both positive and negative attitudes, even stigmatization occurs. Patients with mental disorder were also misbelieved for their physical symptoms. Healthcare professionals mixed attitudes varied depending on work experience, education and place of work. The need for more education was expressed by a big number   of participants. Discussion: The result has been discussed based on the background and Joyce Travelbee’s theory, Human-to-Human Relationship. The result revealed both positive and negative attitudes towards people with mental illness. Also stigmatization was highlighted in the form of expressed attitudes and structural problem. Healthcare professionals also underline their knowledge of mental illness as being inadequate and a wish for increased knowledge was expressed.

Titel: Att vara anhörig i den palliativa vården   Bakgrund: En obotlig sjukdom drabbar även anhöriga till den sjuke. I den palliativa vården möter den anhörige vårdpersonal inom olika yrkesgrupper som har till uppgift att stötta och hjälpa. Tidigare forskning visar dock att anhöriga inte alltid får det stöd de önskar eller har behov utav. Syfte: Att belysa anhörigas erfarenheter av mötet med vårdpersonal i den palliativa vården. Metod: Studien hade en kvalitativ ansats med data från femton individuella intervjuer som analyserades med latent innehållsanalys enligt Graneheim och Lundman. Resultat: Studien resulterade i fem kategorier: En god relation, Stöd från vårdpersonal, Möjlighet till delaktighet, Kunskap respektive Organisatoriska aspekter. Dessa utmynnade i ett övergripande huvudtemat: Förutsättningar för ett gott möte mellan anhörig och vårdpersonal. Resultatet visade att anhörigas erfarenheter av mötet var i många fall positivt där kunnig vårdpersonal var engagerad och visade respekt för den anhörige. En god kommunikation var en förutsättning och bidrog till en känsla av trygghet. Dock kunde olika faktorer så som stress, okunskap och brister i organisation leda till negativa upplevelser för den anhörige. Slutsats: Studiens resultat visar att för att ett gott möte ska kunna skapas är det betydelsefullt att förutsättningarna finns och det är flera faktorer som inverkar. Grundläggande är respekt, både i kommunikation och handling men även utifrån organisatoriska faktorer så som exempelvis vårdmiljö. Men för ett gott möte är det även viktigt att den anhörige känner trygghet, möts av god kunskap och ges möjlighet till att vara delaktig i vården. / Title: Being a relative of palliative care   Background: An incurable disease also affects relatives. In the palliative care, the relatives meet healthcare staff from different occupational groups whose task is to support and help. However, previous research shows that relatives do not always receive the support they want or need.                                                       Aim: To illuminate relatives' experiences of encounter with healthcare professionals in palliative care.   Method: The study had a qualitative approach with data from fifteen individual interviews that were analyzed with latent content analysis according to Graneheim and Lundman.   Result: The study resulted in five categories: A good relationship, Support from healthcare professionals, Opportunity for participation, Knowledge and Organizational aspects. These resulted in an overall main theme: Prerequisites for a good meeting between relatives and healthcare professionals. The result showed that the relatives’ experiences of the meeting with the healthcare personnel were in many cases positive. Knowledgeable personnel were dedicated and showed respect. Good communication was a prerequisite and contributed to a sense of safety. However, various factors such as stress, ignorance and organizational deficiencies could lead to negative experiences for the relative.   Conclusion: The result shows that there are several factors that are important in order to create a good encounter. Fundamental is respect, both verbally and in actions, but also on the basis of organizational factors such as care environment. In order to create the conditions for a good encounter, it is important that the relatives feels safe, meet staff with good knowledge and are given the opportunity to participate in the care.

Introdução: O trabalho em saúde é reconhecido como uma prática coletiva que tem como finalidade a promoção da saúde das pessoas, sua família e comunidade, bem como a relação entre os profissionais nos serviços de saúde e sociedade, a qual é permeada por ações técnicas e interpessoais. Este estudo tem a intenção de contribuir para que se amplie o corpo de conhecimento acerca do processo de cuidar e da saúde, na esfera do trabalho, segundo a ótica da equipe Estratégia Saúde da Família, considerando seus referenciais biopsicossociais. Objetivo: Compreender como o profissional de saúde da equipe Estratégia Saúde da Família entende seu processo de trabalho, no município de Porto Nacional – TO. Metodologia: Tratou-se de uma pesquisa qualitativa do tipo exploratório-descritiva, onde utilizou-se o método de análise de conteúdo para a análise dos dados. Os dados foram coletados seguindo um roteiro de entrevista semiestruturado. Resultados e Discussão: Os profissionais compreendem o trabalho que realizam como de suma importância para a comunidade e apresentam satisfação em realizar o trabalho em saúde. Relatam que as maiores dificuldades para a realização do trabalho estão relacionadas à ausência de material físico e humano de investimentos no processo de educação permanente em saúde, mas, buscam produzir seu trabalho enfrentando as dificuldades, visando não deixar o usuário sem atendimento. Conclusão: Compreendeu-se que os profissionais de saúde desta pesquisa sentem-se comprometidos com o seu trabalho. Percebem a importância do seu fazer, para o processo de educação e promoção da saúde dos usuários, e reconhecem que as atividades desenvolvidas, possibilitam a melhora da situação em saúde da comunidade. Considerações Finais: Acredita-se que a compreensão sobre o processo de trabalho visa articular a discussão acerca do trabalho em saúde, visto como uma atividade complexa e que requer avaliações que possibilitem ampliar a melhora da qualidade de serviço prestada aos usuários do Serviço Único de Saúde. / Introduction: Health work is recognized as a collective practice aimed at promoting the health of people, their families and communities, as well as the relationship between professionals in health services and society, which is permeated by technical and interpersonal skills. This study intends to contribute to expand the body of knowledge about the process of caring and health, in the sphere of work, according to the perspective of the Family Health Strategy team, considering their biopsychosocial frameworks. Objective: Understanding how the health professional of the Family Health Strategy team understands their work process in the municipality of Porto Nacional – TO. Methodology: This was a qualitative research of the exploratory-descriptive type, where the content analysis method was used to analyze the data. Data were collected following a semi-structured interview script. Results and Discussion: Professionals understand the work they perform as of paramount importance to the community and present satisfaction in performing health work. They report that the greatest difficulties for the accomplishment of the work are related to the absence of physical and human material of investments in the process of permanent education in health, but, they seek to produce their work facing the difficulties, aiming not to leave the user without care. Conclusion: It was understood that the health professionals of this research feel committed to their work. They perceive the importance of their doing, to the process of education and health promotion of the users, and recognize that the activities developed, enable the improvement of the health situation of the community. Final Considerations: It is believed that the understanding about the work process aims to articulate the discussion about health work, as a complex activity and that requires evaluations that enable to improve the quality of service provided to the users of the Single Health Service.

Made available in DSpace on 2016-04-04T18:27:49Z (GMT). No. of bitstreams: 1 Katia Perez Ramos.pdf: 749029 bytes, checksum: 4936cc8552dcf26b27520a4fd7750c4a (MD5) Previous issue date: 2004-11-23 / This research has as a general purpose of developing and validation na auxiliary scale of body dysmorphic disorder (BDD) for healthcare professionals. Three samples of participants took part on it: Group 1: which comprises fifteen esthetic plastic surgery patients diagnosed as having BDD; Group 2: which includes fifteen esthetic plastic surgery patients diagnosed as not having BDD; Group 3: five professionals of psychiatry and psychology which stood as judges to evaluate the items of the scale. Initially, the items of the scale were generated from the study of 4 BDD evaluation questionaries which existed already, comtemplating the diagnostic criteria of the DSM-IV (1994) and of scientific assays on the BDD field. Fifty items were, then, built (1st version) which were evaluated by the authoress regarding relevance, objectivity, clearness and precision. From this analysis ten items were discarded, resulting in a 40-item scale (2st version). The relevance of the items to the construct by means of the theoretical analysis of judges. As a result from this analysis five more items were discarded for not obtaining an agreement of at least 80% among the judges (3sd version). The third version of the scale was applied on both groups (G1 and G2). The results from this aplication were submitted to the BDD construct study by means of factorial analysis. The discriminating validity was accomplised by the application of the 3sd scale version of the clinical population (G1) and of sample the non clinical population (G2). The estimate of the U Mann-Whitney Test showed that the scale is sensitive to distinguish the individuals diagnosed as having BDD from those diagnosed as not having the disorder. Besides, the instrument was applied once more twenty days later on both groups (G1 and G2), to submit the scale to the test-retest precision. Through the application of the Pearson Test one verified an expressive correlation between the first and the second application for group 1 as well as for group 2. As a result from these quantitative analyses no item was discarded for they showed to be relevant for the BDD measurement. It was, then, proposed a pilot version of the BDD diagnosis auxiliary instrument to be used by healthcare professionals. The current instrument consists of thirty five items measured by the four-point Likert scale. / A presente pesquisa teve por objetivo geral desenvolver e validar uma escala auxiliar de diagn?stico do Transtorno Dism?rfico Corporal (TDC) para profissionais da ?rea da sa?de. Para tanto contou com tr?s amostras de participantes: Grupo I: que englobou 15 pacientes de cirurgia pl?stica est?tica diagnosticados com TDC; Grupo 2: que incluiu 15 pacientes de cirurgia pl?stica est?tica sem o diagn?stico de TDC e; Grupo 3: 5 profissionais da ?rea de Psiquiatria e Psicologia que serviram como ju?zes para avaliar os itens da escala. Inicialmente os itens da escala foram gerados por meio do estudo de quatro question?rios de avalia??o do TDC j? existentes, contemplando os crit?rios diagn?sticos do DSM-IV (1994) e de trabalhos cient?ficos na ?rea do TDC. Construiu-se, ent?o, 50 itens (P Vers?o) os quais foram avaliados pela autora em rela??o a pertin?ncia, objetividade, clareza e precis?o. A partir desta an?lise foram descartados dez itens, o que resultou em uma escala de 40 itens (2a Vers?o). Analisou-se a pertin?ncia dos itens ao construto, por meio da an?lise te?rica de ju?zes. Como resultado desta an?lise mais cinco itens foram descartados por n?o obterem uma concord?ncia de no m?nimo 80% entre os ju?zes (3a Vers?o). A terceira vers?o da escala foi aplicada nos dois grupos (G1 e G2). Os resultados dessa aplica??o foram submetidos ao estudo do construto do TOC por meio da an?lise fatorial. A validade discriminativa foi realizada por meio da aplica??o da primeira vers?o da escala em uma amostra da popula??o cl?nica (G I) e uma amostra da popula??o n?o cl?nica (G2). O c?lculo da prova U de Mann-Whitney mostrou que a escala ? sens?vel para discriminar os indiv?duos diagnosticados com TDC dos indiv?duos sem o diagn?stico do transtorno. Al?m disso, o instrumento foi reaplicado ap?s 20 dias nos dois grupos (G1 e G2), para submeter a escala ? precis?o de teste-reteste. Atrav?s da aplica??o da correla??o de Pearson verificou-se uma alta correla??o entre a primeira e a segunda aplica??o tanto do Grupo 1 como do Grupo 2. Como resultado dessas an?lises quantitativas n?o foi descartado nenhum item pois os 35 mostraram ser significativos para a mensura??o do TDC. Foi proposta ent?o, uma vers?o piloto do instrumento auxiliar de diagn?stico do TDC para a utiliza??o por profissionais da ?rea da sa?de. O instrumento ficou composto por 35 itens medidos por escalas Likert de quatro pontos.

Att drabbas av stroke kan medföra fysiska, psykiska, kognitiva och emotionella svårigheter och funktionsnedsättningar. Att rehabilitera bristande funktioner är början på en omfattande process som kräver stöd och motivation från människor i omgivningen.   Syfte: Utifrån vårdpersonals perspektiv undersöks och beskrivs faktorer som motiverar och har positiv inverkan på rehabilitering. 16 personer som samtliga arbetar med rehabilitering av strokepatienter deltog.  Metod: Med en enkät kartläggs personalens uppfattning och åsikter kring rehabiliteringsplanens betydelse och faktorers påverkan på motivationen. Frågorna är indelade i 5 teman: Rehabiliteringsplan, mål, framgångsfaktorer, motivation och motiverande faktorer. I studien undersöks om det finns signifikant skillnad mellan motivation och rehabilitering i relation till de viktigaste målen som bedöms vara hygien, gå och äta. Resultat: Rehabiliteringsplanen anses vara ett viktigt verktyg för att kartlägga behov men också för att motivera patienten. Hygien, äta och gå anses vara de vanligaste målen. Glad och positiv personal bedöms ha stor inverkan på motivationen. Även familjen anses ha stor inverkan på rehabilitering medan det egna intresset är av mindre betydelse. Enligt studien finns inget signifikant samband mellan motivation och rehabilitering inom målen hygien, gå och äta.  Slutsats: En rehabiliteringsplan grundad på patientens behov ökar den inre motivationen och därmed också möjligheten att se sin aktiva roll och vara mottaglig för yttre motivation. / Stroke can cause physical, mental, cognitive and emotional difficulties and disabilities. Rehabilitating inadequate functions is the beginning of an extensive process that requires support and motivation from people around the world. Aim: From the perspective of healthcare professionals, factors that motivate and positively affect rehabilitation are investigated and described. 16 people who all work with rehabilitation of stroke patients participated. Method: With a survey, the staff's perception and views of the importance of the rehabilitation plan and factors influence the motivation. The questions are divided into 5 themes: Rehabilitation plan, goals, success factors, motivation and motivational factors. The study examines whether there is a significant difference between motivation and rehabilitation in relation to the most important goals that are thought to be hygiene, go and eat. Result: The rehabilitation plan is considered an important tool for mapping needs but also motivating the patient. Hygiene, eating and walking are stated as the most common goals. Happy and positive staff are expected to have a major impact on motivation. The family is also considered to have a major impact on rehabilitation while its own interest is less important. According to the study, there is no significant correlation between motivation and rehabilitation within the goals of hygiene, walking and eating. Conclusion: A rehabilitation plan based on patient needs increases internal motivation and thus also the ability to see its active role and be receptive to external motivation.

Introdução: Os erros de medicação em hospitais têm origem multidisciplinar e multifatorial, podendo ocorrer em qualquer uma das etapas do processo de utilização dos medicamentos. A constatação de que os erros podem ocorrer implica no reconhecimento de que medidas devem ser tomadas. Os erros de medicação não devem ser banalizados, nem magnificados, devem ser adequadamente abordados em todas as suas repercussões pessoais, profissionais e institucionais. O Modelo de Bioética Complexa é um referencial adequado para abordar a temática dos erros de medicação, por refletir sobre situações de complexidade crescente, incluindo os múltiplos aspectos envolvidos. Objetivos: Avaliar o sistema de notificação de erros de medicação do HCPA segundo o referencial da Bioética Complexa. Analisar a percepção de colaboradores das áreas de Enfermagem, Farmácia e Medicina sobre a notificação e o monitoramento dos erros de medicação na Instituição. Identificar as barreiras para a notificação dos erros de medicação. Identificar os facilitadores para a notificação dos erros de medicação. Identificar os motivos para realizar a notificação de erros de medicação. Método: Trata-se de um estudo descritivo e exploratório. Foi realizada uma pesquisa online através da ferramenta Formulários Google®. O questionário, composto por 9 perguntas, foi elaborado tendo como referência perguntas de estudo prévio sobre o tema. O questionário era anônimo, não sendo possível identificar os participantes. Por e-mail institucional do HCPA, foi enviado convite com o endereço eletrônico para acessar o instrumento de coleta de dados. Não foram incluídos colaboradores vinculados ao Programa de Gestão da Qualidade e da Informação em Saúde (QUALIS) e à Gerência de Risco (GR), bem como coordenadores e assessores do HCPA. O envio dos e-mails foi realizado em um período de 60 dias. Foram realizados 2 a 4 envios, em diferentes dias da semana. Foi obtida uma amostra aleatória de 411 participantes, de um total de 3872 colaboradores (profissionais de nível superior das áreas de Medicina, Enfermagem e Farmácia, contratados ou residentes, e técnicos de Enfermagem e de Farmácia). O conteúdo das respostas às perguntas abertas do questionário foi submetido à técnica de análise de conteúdo de Bardin. Os dados foram armazenados e avaliados no software de análise qualitativo QSR NVivo® versão 10. Resultados: Foram identificadas três categorias principais de barreiras: Barreiras Individuais, Barreiras Organizacionais e Barreiras Culturais. Na categoria Barreiras Individuais, emergiram seis subcategorias: medo, desconhecimento, responsabilidade, falta de comprometimento, esquecimento e vergonha. Na categoria Barreiras Organizacionais, emergiram quatro subcategorias: demanda de trabalho, dificuldades com o sistema de notificação, falta de feedback e infraestrutura. Na categoria Barreiras Culturais, emergiram três subcategorias: cultura de segurança não priorizada, cultura de banalização dos erros e cultura de infalibilidade. O medo foi a barreira individual mais referida pelos participantes. A demanda de trabalho foi percebida como uma das principais barreiras organizacionais pelos colaboradores e foi relacionada à falta de tempo. A partir da análise das respostas dos participantes, emergiram 12 categorias de facilitadores para a notificação dos erros de medicação: Divulgação e informação, Condução adequada da análise, Sistema de notificação, Resposta não punitiva, Feedback, Clareza, Cultura, Treinamento, Anonimato, Trabalho em equipe, Demanda de trabalho e Comprometimento. Doze categorias foram identificadas como motivos para notificar os erros de medicação. As categorias foram agrupadas quanto à sua relação com os profissionais, com os processos e com os pacientes. Motivos relacionados ao profissional: a Educação, a Proteção do Profissional envolvido em um erro de medicação e a Responsabilidade. Motivos relacionados aos processos envolvidos: Prevenir novos erros, Revisão dos processos, Análise dos erros, Barreiras de segurança, Protocolo Institucional e Cultura de segurança. Motivos relacionados aos pacientes: Segurança do Paciente, Qualidade da assistência e Riscos. Considerações finais: Verifica-se o engajamento dos profissionais participantes que deram inúmeras contribuições para o entendimento e aprimoramento do processo de notificação de erros de medicação, com uma ênfase na segurança do paciente. / Background: Medication errors in hospitals have multidisciplinary and multifactorial origin and can occur at any stage of the process of use of medicines. The finding that errors may occur involves the recognition that measures should be taken. Medication errors should not be trivialized or magnified, they should be adequately addressed in all their personal, professional and institutional repercussions. The Complex Bioethics model is an appropriate framework to address the issue of medication errors, by reflecting on the increasing complexity of situations, including the many aspects involved. Objective: To evaluate the medication error reporting system of the HCPA under the framework of Complex Bioethics. To analyze the perception of employees in the areas of Nursing, Pharmacy and Medicine on the reporting and monitoring of medication errors in the institution. Identify barriers to the reporting of medication errors. Identify facilitators for reporting of medication errors. Identify the reasons to perform medication error reporting. Method: This is a descriptive and exploratory study. It was done a search online through Google Forms tool. The questionnaire consists of 9 questions, it has been established as a previous study questions reference on the subject. The questionnaire was anonymous, it is not possible to identify participants. Email invitation has been sent to the email address of the participants to access the questionnaire. The sending of e-mails was conducted in a period of 60 days. A random sample of 411 participants was obtained, a total of 3872 employees. The content of the answers to open questions of the questionnaire was submitted to Bardin content analysis technique. The data were stored and evaluated by qualitative analysis software QSR NVivo version 10. Results: We identified three main categories: individual barriers, organizational barriers and cultural barriers. In the category individual barriers emerged six sub-categories: fear, ignorance, responsibility, lack of commitment, forgetfulness and shame. In the category organizational barriers, four subcategories emerged: workload, difficulties with the reporting system, lack of feedback and infrastructure. In the category cultural barriers revealed three subcategories: not prioritized safety culture, banalization of errors and infallibility culture. Fear was the individual barrier most reported by the participants. The workload was perceived as a major organizational barrier by employees and was related to lack of time. From the analysis of the responses of the participants emerged 12 categories of facilitators for the reporting of medication errors: shared information, proper conduct of the analysis, reporting system, non- punitive response, feedback, clarity, culture, training, anonymity, teamwork, workload and commitment. Twelve categories were identified as reasons for reporting medication errors. The categories were grouped as to its relationship with the professionals, with the procedures and with patients. Reasons related to Professional: education, professional protection and responsibility. Reasons related to the processes involved: To prevent new errors, review of processes, analysis of errors, safety barriers, institutional protocol and safety culture. Reasons related to patients: patient safety, quality of care and risks. Conclusion: There is the engagement of the professionals who gave numerous contributions to the understanding and improvement of medication errors notification process, with an emphasis on patient safety.