Bakgrund Endometrios är ett kroniskt sjukdomstillstånd som kan ge diffusa symtom som exempelvis svår menstruationssmärta, smärta vid samlag, fatigue och nedsatt fertilitet. Att leva med endometrios kan påverka individens fysiska, psykiska, sociala och existentiella välbefinnande i olika grad. För att främja hälsan hos patienter med endometrios och lindra deras lidande har sjuksköterskan en central roll i att erbjuda en trygg och god omvårdnad. En förutsättning för detta är att sjuksköterskan har insikt i patientens perspektiv. Syfte  Syftet var att beskriva patienters upplevelser av vårdrelationer vid endometrios. Metod En icke-systematisk litteraturöversikt som baserades på 17 vetenskapliga artiklar med kvalitativ, kvantitativ och mixad metodansats. Från databaserna PubMed och CINAHL inhämtades artiklar med hjälp av flera olika kombinationer av sökord. En kvalitetsgranskning av inkluderade artiklar har genomförts utifrån Sophiahemmet Högskolas bedömningsunderlag för vetenskaplig klassificering och kvalitet. Resultatet av de vetenskapliga artiklarna analyserades och sammanställdes med en integrerad dataanalys. Resultat Resultatet sammanställdes till två huvudkategorier; betydelsen av att få känna sig delaktig i vårdrelationen samt att få sina behov tillgodosedda. Resultatet belyser att patienter med endometrios upplever brister i sina vårdrelationer och en avsaknad av ett personcentrerat förhållningssätt. Slutsats Denna litteraturöversikt visade värdefulla insikter i hur patienter med endometrios kan gynnas av ett personcentrerat förhållningssätt i vårdrelationen. Sammanställningen identifierade att patienter upplever att hälso- och sjukvårdspersonal har bristande kunskap om endometrios, ger otillräcklig information och i många fall normaliserar deras symtom. Resultatet pekar på behovet av en förbättring inom endometriosvården. Ökad kunskap och förståelse för patientens upplevelse av vårdrelationen kan bidra till ökat välbefinnande. / Background Endometriosis is a chronic medical condition that can cause diffuse symptoms such as severe menstrual pain, pain during intercourse, fatigue and reduced fertility. Living with endometriosis can affect the individual’s physical, psychological, social, and existential wellbeing to varying degrees. To promote the health of patients with endometriosis and alleviate their suffering, the nurse has a central role by offering safe and good care. A prerequisite for this is that the nurse has insight into the patient’s perspective. Aim The aim of this study was to describe patients with endometriosis and their experience of patient-healthcare professional relationships. Method A non-systematic literature review based on 17 scientific articles with qualitative,quantitative and mixed methods. The articles were retrieved from the databases PubMed and CINAHL using various combinations of search terms. A quality review of included articles has been carried out based on Sophiahemmet University's assessment basis for scientific classification and quality. The results of the scientific articles were analyzed and compiled with an integrated data analysis. Results The results were compiled into two main categories; the importance of feeling involved in the patient-healthcare professional relationship and having one's needs met. The result highlight that patients with endometriosis experience shortcomings in their patient-healthcare professional relationships and a lack of a person-centered approach. Conclusions This literature review showed valuable insights into how patients with endometriosis can benefit from a person-centered approach in the patient-healthcare professional relationship.The compilation identified that patients feel that healthcare professionals have a lack of knowledge about endometriosis, provide insufficient information and, in many cases,normalize their symptoms. The result points to the need for an improvement in endometriosis care. Increased knowledge and understanding of the patient’s experience of the patient-healthcare professional relationship can contribute to increased well-being.

This thesis deals with the perceptions of health care in healthcare facilities in South Bohemia as seen by the public. The theoretical part defines health care and health; it also informs about the quality of health care and its evaluation. It deals with health services, healthcare policy and reforms in this sector. It describes the current legislation, part which is international treaties or laws. As an example of a treaty, the thesis mentions Convention on the Protection of Human Rights and the Dignity of the Human Being with regard to the application of biology and medicine, or the Charter of Fundamental Rights and Freedoms. The section about laws mentions particularly Act No. 20/1966 Coll. on Public Health Care. In protecting the rights of patients, the Code of Patients? Rights plays an important role in. An essential part of theory is also the system of healthcare facilities, health services, healthcare professionals and the rights and obligations of various actors in the provision of health care. The objective of the thesis was to map client satisfaction with health care provided in healthcare facilities of South Bohemia. The research part, preceded by a preliminary study, was conducted by means of a quantitative questionnaire survey. The basic research group consisted of persons from the general public living in South Bohemia. In the end, two out of three hypotheses were conformed. They are: (1) health care in South Bohemia was perceived positively by the clients of healthcare facilities and (2) women perceive health care in South Bohemia more critically than men. The third hypothesis, the one that was not confirmed, showed that the clients of healthcare facilities in South Bohemia have not noticed any improvement of health care during the last five years. With regard to the outcome of the third hypothesis, a question can be brought forward as to whether health care is developing in the right direction. Therefore, it would be appropriate to pay more attention to this issue. The results can be published in professional journals and they can serve as inspiration for healthcare professionals. They may also contribute to public awareness of health care and health services in South Bohemia.

This thesis deals with the regulation of advertising of medicinal products aimed at healthcare professionals. The thesis is focused on a deeper analysis of selected provisions, their critical assessment in light of courts' as well as the State Institute for Drug Control's decisions and proposals of possible improvements of the current status. The aim of this thesis is to explore the scope of the current legislation and to evaluate the regulation of the advertising of medicinal products aimed at healthcare professionals from its sufficiency and appropriateness point of view. The aim is also to suggest possible solutions for improving problematic parts. The introduction briefly describes the two fundamental terms, human medicinal products and advertising, along with basic introduction of the price and reimbursement of medicinal products. The introductory section also identifies reasons for the exclusive regulation of this type of advertising. Basic aspects of the regulation are introduces as well. The following section critically evaluates the term healthcare professional in relation to the status of nurses and patients. This is followed by a summary of the basic European Union's regulation that is reflected by those Czech laws regulating advertising of medicinal products aimed at healthcare...

Enligt World Health Organization lever ungefär 55 miljoner människor med en kognitiv sjukdom och varje år insjuknar 10 miljoner. Beteendemässiga och psykiska symtom vid demens förekommer hos nio av tio personer med sjukdomen. Beteendemässiga och psykiska symtom vid demens medför lidande både för personer med sjukdomen och för de som vårdar. Syftet var att beskriva vårdpersonalens upplevelse av att vårda personer med beteendemässiga och psykiska symtom vid demens på akutsjukhus och omsorgsboende. Metoden som tillämpades för att besvara studiens syfte var en litteraturöversikt med systematisk sökstruktur där Polit och Becks niostegsmodell användes genomgående under datainsamling- och analysprocessen. 15 originalartiklar av både kvalitativ och kvantitativ ansats som svarade mot syftet valdes ut, analyserades och sammanställdes i resultatet. Resultatet utmynnade i tre teman: Upplevda utmaningar i omvårdnaden av BPSD, Strategier vid vård av personer med BPSD och Upplevelsen av organisatoriska faktorer som påverkar omvårdnaden vid BPSD och sju subteman: Känslor som väcktes, Miljöfaktorer i omvårdnaden som påverkar BPSD, Att förstå personen bakom sjukdomen, Bemötande och icke-farmakologiska åtgärder, Önskan om mer formell utbildning, Önskan om fler vårdpersonal och mer tid och Upplevelsen av teamet vid BPSD. Slutsatsen var att vårdpersonalen behöver en stödjande organisation som främjar utbildning, tid och effektivt teamarbete för att personer med beteendemässiga och psykiska symtom vid demens ska få adekvat omvårdnad och god livskvalitet. / According to the World Health Organization, approximately 55 million people live with a cognitive disorder, with 10 million new cases emerging every year. Behavioural and psychological symptoms of dementia (BPSD) are present in nine out of ten individuals with the disease. BPSD leads to suffering for both those afflicted and those who care for them. The aim of this study was to elucidate healthcare professionals' experiences of caring for individuals with BPSD in acute hospitals and care homes. The methodology employed to address the study's objective was a systematic literature review using Polit and Beck's nine-step model consistently throughout the data collection and analysis process. Fifteen original articles, encompassing both qualitative and quantitative approaches and aligning with the study's objective, were selected, analysed, and synthesised in the results. The findings culminated in three overarching themes: Perceived challenges in the care of BPSD, Strategies in caring for individuals with BPSD, and Experiences of organisational factors influencing care for BPSD. Additionally, seven subthemes were identified: Emotions evoked, Environmental factors in care affecting BPSD, Understanding the person behind the disease, Approach and non-pharmacological interventions, Desire for more formal training, Need for more healthcare staff and time, and Experience of teamwork in BPSD. The conclusion drawn was that healthcare professionals require a supportive organisation that promotes education, time, and effective teamwork to ensure individuals with BPSD receive adequate care and maintain a good quality of life.

Made available in DSpace on 2016-04-28T20:38:04Z (GMT). No. of bitstreams: 1 Wanda Rogeria Campos de Lima Assis.pdf: 18823938 bytes, checksum: 0c8f9dc56011233df3de402457525e9f (MD5) Previous issue date: 2012-03-12 / This study was conducted in Delfim Moreira (MG) in the area of healthcare, done in an exploratory and descriptive manner, addressed in the form of qualitative research through a vision of social constructionism. The main objective of this study was to analyze the contribution of Program: Re-defining Family Origins of the Healthcare Professional (PRORFOPS) in the theoretical aggregation and the redefinition of professional healthcare practices belonging to the multidisciplinary team from Basic Health Unit (UBS). A total of 15 professionals participated in this project with an emphasis on the intergenerational aspects of family interactions and affective communication. Its specific objectives were: to gain an understanding of families in their interconnected systems, the intergenerational relationships, the affective communication; the process of individualism expanding one s perception of "self" in a relational construct, the potential of the group and their own strengthening; the relevance of themes discussed in the view of these professionals. The following instruments were used: Life Stories, Genograms, Memory Booklets and Questionnaires. The data was analyzed using qualitative tools for Content Analysis, indicating an integration of individual speech within the interconnected systems, and a shift of this same speech towards a relational understanding of self, sensitizing the participants to co-responsibility in familial and social relations / Esse estudo foi realizado em Delfim Moreira (MG), na área de saúde e trata-se de uma pesquisa de campo, de caráter exploratório-descritiva, abordada sob a forma de pesquisa qualitativa dentro de uma visão do Construcionismo Social. O objetivo maior desse estudo foi analisar a contribuição do Programa de Ressignificação da Família de Origem do Profissional de Saúde (PRORFOPS) na complementação teórica e ressignificação da prática de profissionais da saúde pertencentes à equipe multidisciplinar da Unidade Básica de Saúde (UBS). Participaram desse projeto 15 profissionais dando-se ênfase aos aspectos intergeracionais das interações familiares e comunicação afetiva. Seus objetivos específicos foram: a compreensão das famílias atendidas enquanto sistemas interconectados, a Intergeracionalidade, a comunicação afetiva; o processo de individuação ampliando a percepção do si mesmo em construção relacional, as potencialidades do grupo de trabalho e seu fortalecimento; a pertinência dos temas trabalhados, segundo a visão desses profissionais. Utilizou-se dos seguintes instrumentos: Histórias de Vida, Genograma, Livreto de Memórias e Questionários. Os dados obtidos foram analisados com ferramentas qualitativas de Análise de Conteúdo. Essa análise apontou para uma integração do discurso individual com o dos sistemas interligados, e um deslocamento deste mesmo discurso para uma compreensão do eu relacional, sensibilizando o participante para a co-responsabilidade relacional, familiar, social

Submitted by Alison Vanceto (alison-vanceto@hotmail.com) on 2017-01-13T10:35:35Z No. of bitstreams: 1 TeseJCA.pdf: 4804148 bytes, checksum: fc09eaa1031baf137fea35d95ba6dd71 (MD5) / Approved for entry into archive by Marina Freitas (marinapf@ufscar.br) on 2017-01-17T13:08:15Z (GMT) No. of bitstreams: 1 TeseJCA.pdf: 4804148 bytes, checksum: fc09eaa1031baf137fea35d95ba6dd71 (MD5) / Approved for entry into archive by Marina Freitas (marinapf@ufscar.br) on 2017-01-17T13:08:24Z (GMT) No. of bitstreams: 1 TeseJCA.pdf: 4804148 bytes, checksum: fc09eaa1031baf137fea35d95ba6dd71 (MD5) / Made available in DSpace on 2017-01-17T13:08:32Z (GMT). No. of bitstreams: 1 TeseJCA.pdf: 4804148 bytes, checksum: fc09eaa1031baf137fea35d95ba6dd71 (MD5) Previous issue date: 2016-10-19 / Não recebi financiamento / This thesis presents a research behind the creation of a process model for application development and a set of guidelines to instruct and support the work of developers focused on healthcare. The current Brazilian condition reflects that the working environment of healthcare professionals in long term care is conducive to the construction of a new identity and reference for these professionals, who incorporate their personal and social activities to professional activities and build cooperative relations with their peers beyond the professional environment. In this context, where healthcare professionals are re-analyzing their relationship with work and issues that affect the quality of life and the quality of their professional activities, the support of technological resources is a strong partner, especially in sharing and disclosure information and also in management daily tasks. In order to incorporate technology requirements that naturally may be included in the workflow of these professionals without interrupt their routines, software developers have been mobilized to create natural interaction applications that help healthcare professionals and promotes the adoption of applications. Natural interactions are defined here as the way users share information using technological resources and applications instinctively, in a transparent way, without concern the peculiarities of the application or technological appeal. For the development of these applications, which considers users’ profiles who naturally mix professional, personal and social contexts, it is required a process model to guide and assist developers in this task. Thus, as scientific contribution in Computer Science, an application development process model and a set of guidelines to supports the developer’s work to create applications for healthcare professionals have been proposed. The proposed model encourages and provides the integration of different contexts of the healthcare professionals, enabling resource appropriation through the perception of abilities and prior knowledge of these professional, and encourages the addition of some new abilities. / Esta tese apresenta a pesquisa desenvolvida para a criação de um modelo de processo de design de aplicativos e um conjunto de diretivas para orientar e apoiar o trabalho de desenvolvedores de aplicativos para profissionais da área da saúde. O momento atual reflete que o ambiente de trabalho dos profissionais da área da saúde que atuam nos cuidados constantes e durante longos períodos é propício para a construção de uma nova identidade e referência para estes profissionais, que incorporam suas atividades pessoais e sociais às atividades profissionais e constroem relações de cooperação com seus pares além do ambiente profissional. Diante desse contexto, em que profissionais da saúde repensam sua relação com o trabalho e os aspectos que afetam a qualidade de vida e a qualidade das suas atividades profissionais, o apoio dos recursos tecnológicos é um forte aliado, principalmente nos processos de troca, divulgação de informações e gerenciamento de tarefas. Com o intuito de incorporar recursos tecnológicos que naturalmente se insiram no fluxo de trabalho desses profissionais, sem que sejam empecilhos em suas rotinas, mas que os apoiem na realização de suas tarefas, desenvolvedores de software têm se mobilizado na criação de aplicativos com interação natural que auxiliem os profissionais da saúde e favoreçam a adoção de aplicativos desenvolvidos. Interações naturais são definidas aqui como a maneira que o usuário troca informações com aplicativos e recursos tecnológicos de forma instintiva e transparente, sem se inquietar com as peculiaridades do aplicativo ou recurso tecnológico manipulado, por serem formas de interação mais próximas da realidade do usuário. Para o desenvolvimento desses aplicativos, que levam em conta perfis de usuários que naturalmente misturam contextos profissionais, pessoais e sociais, constatou-se a necessidade de um modelo de processo que oriente e auxilie os desenvolvedores nesta tarefa. Assim, como contribuição científica na área de Computação, um modelo de processo de design de aplicativos e as diretivas que orienta e apoia o trabalho de desenvolvedores de aplicativos para profissionais da área da saúde foram propostos. O modelo e as diretivas incentivam e proporcionam a integração dos diferentes contextos dos profissionais da saúde, facilitando a apropriação de recursos tecnológicos através da percepção das habilidades e conhecimentos prévios desses profissionais, e estimulam a adição de novas habilidades.

Cotutelle de thèse / Depuis quelques décennies, il est admis que les nouveau-nés prématurés (moins de 37 semaines de gestation complétées) ressentent la douleur, et semblent y être particulièrement vulnérables. La douleur répétée et non traitée engendre d’importantes répercussions pour les prématurés, telles qu’une hypersensibilité à la douleur et un impact sur le développement cérébral, soit des conséquences jusqu’à sept ans de vie : diminution du volume cérébral, altérations de la microstructure de la matière blanche et modifications de l’activité cérébrale. La douleur chez les prématurés est un phénomène complexe qui est influencé par de nombreux facteurs liés aux caractéristiques spécifiques du prématuré, aux professionnels de la santé et aux parents. Malgré de nombreuses études de diverses disciplines depuis plusieurs décennies, le soulagement de la douleur des prématurés demeure une préoccupation actuelle étant donné le manque d’interventions efficaces, d’où la nécessité de poursuivre les recherches. Afin de guider adéquatement la recherche, l’utilisation d’une théorie permet de définir et de circonscrire les éléments qui seront évalués ainsi que les moyens utilisés pour l’évaluation des variables ciblées, l’interprétation des résultats et leurs retombées. Actuellement, aucune théorie portant sur la douleur procédurale des prématurés n’a été recensée dans les écrits scientifiques. Le but général de cette thèse était de développer, d’évaluer et d’adapter une théorie portant sur la gestion de la douleur procédurale des prématurés afin d’offrir une perspective théorique regroupant différents éléments influençant l’évaluation et le soulagement de la douleur auprès de cette clientèle. Le développement de la théorie Pain Assessment and INterventions in Neonatology (PAIN-Neo) a été réalisée à partir d’une analyse critique des perspectives théoriques existantes en douleur pédiatrique ainsi que par le biais d’une revue exhaustive des écrits visant à recenser les facteurs impliqués dans la gestion de la douleur des prématurés au niveau empirique. De plus, les connaissances et l’expertise de l’étudiante-chercheuse en néonatologie ont permis d’ajouter l’influence des différentes catégories de soins de développement qui visent à promouvoir le développement neurologique du prématuré. Une perspective philosophique réaliste critique sous-tend le développement de la théorie PAIN-Neo, amenant à identifier les différentes configurations Contexte-Mécanismes-Effets pour chaque acteur impliqué dans l’évaluation et le soulagement de la douleur, soit le prématuré, les professionnels de la santé et les parents. L’évaluation de certains liens postulés dans cette théorie a été effectuée par la réalisation d’une revue systématique avec une méta-analyse de données recueillies chez les prématurés (n=1028) et d’une étude transversale quantitative auprès d’infirmières oeuvrant en néonatologie (n=202). Ces études ont permis d’évaluer certains liens établis dans la théorie et de l’adapter à la lumière du volet empirique. La théorie PAIN-Neo qui a été développée dans le cadre de cette thèse propose une vision innovante de la gestion de la douleur procédurale chez le prématuré, pour les chercheurs et les cliniciens en néonatologie, en intégrant le prématuré, les professionnels de la santé et les parents, tout en considérant les différents facteurs individuels et contextuels influençant la douleur pour ces trois acteurs. La théorie PAIN-Neo offre une base théorique afin de guider des recherches impliquant un ou plusieurs de ces acteurs et pour soutenir le développement de guides de pratique clinique reflétant adéquatement la complexité de la gestion de la douleur chez les prématurés. / For several decades, it has been recognized that the preterm infants (less than 37 completed weeks gestation) feel pain and appears to be particularly vulnerable to it. Repeated and untreated pain has important consequences for preterm infants, such as hypersensitivity to pain and impact on brain development, with consequences up to seven years of life: decrease in brain volume, alterations in white matter microstructure and changes in brain activity. Pain in preterm infants is a complex phenomenon that is influenced by many factors related to specific characteristics of the preterm infant, health care professional and parents. Despite numerous studies in various disciplines in the past decades, pain management in preterm infants remains a current concern due to the lack of effective interventions, prompting the need for further research. In order to adequately guide research, a theory is mandatory to define and circumscribe the variables that will be evaluated, the interpretation of results, and their implications. Currently, no theory of procedural pain in preterm infants has been identified in the scientific literature. This thesis aimed to develop, evaluate, and adapt a theory to procedural pain in preterm infants in order to provide a theoretical perspective on elements influencing the assessment and management of pain in this population. The development of the Pain Assessment and INterventions in Neonatology (PAIN-Neo) theory was based on a critical analysis of existing pediatric pain theories, as well as an exhaustive review of the literature to identify the variables involved in pain management of preterm infants at the empirical level. Moreover, the student researcher's knowledge and expertise in neonatology contributed to the theory by adding the interaction of the different categories of developmental care interventions. A critical realist philosophical perspective was chosen for the development of this theory, leading to the identification of the different Context-Mechanism-Outcomes configurations for each actor involved in the assessment and management of pain, i.e., the preterm infant, his or her parents, and the health professionals. The theory was evaluated with a systematic review with a meta-analysis including studies on preterm infants (n=1028) and a quantitative cross-sectional study of neonatal nurses (n=202). These studies validated some of the links established in the theory and provided an opportunity to revise it considering the empirical evaluation. 10 The PAIN-Neo theory developed in this thesis proposes an innovative vision of procedural pain management in the preterm infant for neonatal researchers and clinicians, by integrating the preterm infant, the healthcare professional and the parents, while considering the different individual and contextual factors influencing pain for these three actors. The PAIN-Neo theory can guide research involving one or more of these actors and can support the establishment of comprehensive clinical practice guidelines that reflect the complexity of pain management in preterm infants.

No description available.

D’une juridiction à l’autre, les modèles législatifs encadrant la procréation médicalement assistée (PMA) diffèrent, allant de l’absence de directives nationales à des agences réglementaires supervisant les cliniques de fertilité. De 2010 à 2015, le Québec finançait les services de PMA pour ses résidents sans définir de critères d’accessibilité. Alors que l’adoption de critères d’accessibilité représente un défi éthique complexe, les candidats souhaitant obtenir des services de PMA peuvent être confrontés à un refus par des professionnels sur la base d’une évaluation subjective. Déterminer les critères présentement utilisés par les professionnels en l’absence de directives législatives peut éclaircir les décisions difficiles auxquelles ils font face quotidiennement. Un tel travail peut aussi informer la réflexion éthique quant à l’étude normative de directives dans ce domaine. La présente étude décrit les critères d’accessibilité utilisés par les professionnels travaillant dans des cliniques de fertilité, privées ou publiques, au Québec. Des entrevues semi-dirigées ont été réalisées avec quatre médecins et quatre psychologues. Une recension des écrits a permis de regrouper les critères reportés dans la littérature selon leurs similitudes, puis d’analyser les entrevues selon ces regroupements. De façon générale, les professionnels du Québec utilisent des critères similaires à ceux des professionnels d’autres pays, mais des critères non recensés dans la littérature ont aussi été utilisés par les participants. Les critères utilisés les plus communs étaient la relation conjugale, l’état de santé mentale ainsi que l’âge des candidats. Une découverte importante est que les professionnels n’utilisaient pas un seul critère pour refuser un candidat, mais plutôt une combinaison de facteurs en tenant compte de son contexte de vie. Une autre découverte intéressante est l’utilisation du « rejet temporaire », c’est-à-dire le report des traitements à un meilleur moment pour les candidats selon le professionnel. Les entrevues ont permis de déterminer que les professionnels agissent en tant que gatekeepers et doivent souvent prendre des décisions qui dépassent l’évaluation clinique en se basant sur un jugement personnel. Ce rôle n’est pas facile et les participants ont exprimé des doutes et des remises en question de leurs propres décisions. / From 2010 to 2015, Quebec offered comprehensive public funding for assisted reproductive technologies (ART), allowing access to any female resident ‘of reproductive age’ without specifying eligibility criteria. Other jurisdictions have different models ranging from absence of criteria to regulatory agencies overseeing fertility clinics. While establishing eligibility criteria is an ethically daunting task, candidates wishing to access ART may be confronted with professionals who reject them based on subjective criteria. Exploring what criteria are used in practice, in the absence of regulatory guidance, can shed light on the challenges faced by professionals and their decision-making needs. It can also inform our ethical reflection regarding the normative positions required for establishing guidelines in this sensitive area. This qualitative study describes eligibility criteria used by healthcare professionals working in fertility clinics in Quebec, based on semi-structured interviews conducted with four physicians and four psychologists working in both public and private clinics. An extensive literature review on the topic allowed the separation of criteria into groups under overarching themes, which were then used to analyze the interviews. Findings suggests that overall, professionals in Quebec are using similar criteria to those used by professionals in other countries. They also referred to criteria not found in the literature, which required the creation of new groups for analysis. Among the criteria used by interviewees, the researchers found that the relationship status was the most common, followed by candidates’ mental health and their age. A major finding was that professionals never considered one isolated criterion to reject candidates, but rather based their decision on a combination of factors while considering the context of the candidate’s life. Another important element was the repeated phenomenon of “temporary rejection”, i.e. a professional postponing treatment until a later date describing it as a “better time” for candidates who did not seem ready to undergo treatments. Overall, decisions were made by analyzing the context in which candidates were living and in which the prospective child would be raised. The interviews lead to the conclusion that professionals act as gatekeepers and often need to make normative decisions that go beyond a clinical assessment, based on a personal judgement call. These decisions were not easily taken and participants expressed doubts and decisional conflict.

Thèse de doctorat réalisée avec le soutien financier du Conseil de recherches en sciences humaines (CRSH) du Canada / Problématique : Les milieux de la santé connaissent d’importants changements dans leur fonctionnement avec l’émergence de pratiques basées sur la participation et l’engagement des patients. Appelés à être partenaires, bon nombre d’adultes ne sont toutefois pas en mesure de traiter et d’utiliser l’information en lien avec leur santé en raison d’un faible niveau de littératie. Aussi, les intervenantes et intervenants du milieu cherchent à développer leur compréhension du phénomène et leurs compétences afin de fournir une information accessible à ces personnes et favoriser leur autonomie dans leurs démarches de santé. Or, peu de données empiriques existent quant au développement de ces compétences en milieu du travail. Objectif : Décrire la façon dont des intervenantes et intervenants développent, en cours de pratique, les compétences permettant de soutenir la participation d’une clientèle de faible niveau de littératie à ses soins de santé. Méthodologie : Trente entrevues semi-structurées ont été réalisées auprès d’intervenantes et intervenants inscrits dans une pratique orientée vers l’autonomie et la participation d’une clientèle à risque sur le plan de la littératie : 9 en médecine et pharmacie, 9 en soins infirmiers, 9 dans des champs connexes (nutrition, psychologie, travail social, etc.) et 3 agissant à titre de pairs aidants. En s’appuyant sur Le Boterf (2009, 2010), un modèle de développement de la compétence articulant les trois dimensions suivantes a orienté l’analyse des données : 1) la pratique professionnelle et la performance, soit « ce que je fais/les résultats », 2) la réflexivité, « ce que je pense/vis dans ma pratique » et 3) les ressources, « ce que j'utilise pour apprendre/pour agir. » Le traitement des données, via des cartes conceptuelles, a mené à un modèle de développement professionnel en milieu de travail validé auprès de 5 des personnes interviewées, mais aussi à un modèle de bonnes pratiques au regard de l’agir en matière de pro-littératie. Résultats : Les « bonnes pratiques » identifiées reposent sur quatre piliers, soit 1) mettre en œuvre un partenariat dans et au regard des soins dans une perspective « patient » en lien avec la maladie, la langue et l’écrit; 2) porter attention à des indicateurs de la littératie autres que la scolarité; 3) personnaliser la communication; 4) faciliter l’accès et l’utilisation de l’information, notamment par un soutien pour Internet. Les résultats orientent vers un apprentissage professionnel essentiellement autodirigé s’actualisant par une orchestration de moyens pour apprendre, tant structurés que spontanés, dans l’environnement de travail. Les savoirs « experts » liés à une pratique pro-littératie semblaient détenus par les personnes au sein de l’organisation. Les patients intervenant dans les équipes interprofessionnelles se sont avérés des ressources clés pour développer des savoirs au regard de la communication avec une clientèle qui a un vocabulaire et une façon d’apprendre qui peuvent être différents. Retombées : Le modèle de développement professionnel proposé identifie plusieurs cibles pour soutenir et favoriser le développement des compétences en littératie en milieu de travail. Les groupes d’échange et de travail, notamment ceux intégrant des patients, créent des espaces propices à une coconstruction des savoirs nécessaires à une pratique pro-littératie. / Context : Health care organizations and communities are experiencing significant changes with the emergence of practices based on patients’ participation and engagement. Called to be partners, many adults, however, are not able to process and use information related to their health because of low literacy. Hence, health professionals and community stakeholders are expected to develop their practices and their skills in order to reach them adequately so that they take an active role for their health. However, little empirical data exist regarding the development of these skills in a work-based environment. Objective : Describe how health care practitioners develop their skills to support the participation of patients with low literacy. Methodology : Thirty semi-structured interviews were conducted with male and female workers enrolled in practices oriented towards autonomy and participation of those at risk in terms of literacy : 9 in medicine and pharmacy, 9 in nursing, 9 in related fields (nutrition, psychology, social work ...) and 3 peer support workers. Building on Le Boterf (2009, 2010), a model of competence development articulating the following three dimensions has oriented data analysis : 1) professional practice and performance, that is "what I do / the results"; 2) reflexivity, "what I think and live in my practice"; and 3) resources, "what I use to learn / to act." Data processing, through concept maps, led to a model of workplace’s professional development validated with five of those interviewed and also to a model of good practices. Results : From the data, "good practices" emerged as based on the following four pillars that required to : 1) implement a partnership in health care within a patient’s perspective in terms of his or her disease and spoken/written language; 2) pay attention to indicators of literacy other than education; 3) personalize communication; 4) facilitate access and use of information, including support for Internet. Results show a professional development, mainly self-directed, together with structured and spontaneous learning within the work environment. Knowledge "experts" associated with "good practices" in health literacy seemed held by people within the organization. Patients involved in interprofessional teams appeared to be key resources to develop knowledge in terms of communication with an adult who has his own vocabulary and way of learning. Applications : The proposed professional development model identifies several targets in the workplace to support and promote skills development towards literacy. Exchange and working groups, including those incorporating patients, create spaces conducive to co-construction of necessary knowledge for effective practice in literacy.