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Diss. (sammanfattning) Göteborg : Göteborgs universitet, 2007. / Härtill 5 uppsatser.

Thesis (Ph. D.)--University of Washington, 1992. / Vita. Includes bibliographical references (leaves [157]-166).

Bakgrund Sjukvårdspersonal får dagligen handskas med etiska överväganden och beslut. Ställningstagandet om när livsuppehållande behandling ska fortsätta eller avslutas är ett komplext beslut som kräver flera överväganden. Läkaren har det fulla ansvaret vid ställningstagandet om att avsluta livsuppehållande behandling. Sjuksköterskan besitter ofta viktig kunskap och kännedom om patientens behov, vilket kan bidra till beslutsprocessen med betydelsefull information. Syfte Syftet med litteraturstudien var att belysa sjuksköterskans upplevelse av delaktighet och kommunikation gällande det etiska ställningstagandet om att avsluta eller avstå från patientens livsuppehållande behandling. Metod Beskrivande litteraturöversikt av tio kvalitativa vetenskapliga artiklar. Resultat Analysen resulterade i två teman; delaktighet och kunskapsbrist. Resultatet visade att sjuksköterskor ansåg sitt deltagande i ställningstagandet om att bibehålla eller avsluta livsuppehållande behandling som bristande. Sjuksköterskan upplevde att samarbetet med läkaren i beslutsprocessen inte fungerade och kände ofta en frustration över att inte bli tillräckligt lyssnad på. Ytterligare hinder för sjuksköterskans delaktighet i beslutsprocessen framkom av sjuksköterskors kunskapsbrist gällande lagar, riktlinjer och etik samt bristande arbetserfarenhet och självförtroende.  Slutsats Sjuksköterskans delaktighet i vårdteamet kring ställningstagandet om att bibehålla eller avsluta livsuppehållande behandling är bristfälligt. Ytterligare belyser studien sjuksköterskans behov av ökad kunskap inom lagar, riktlinjer och etik. / Background Healthcare professionals deal with ethical considerations and standpoints on a daily basis. Decision-making about when life-sustaining treatment should be continued or terminated is a complex position that requires several considerations. The doctor has the full responsibility regarding the standpoint to discontinue life sustaining treatment. The nurse often possesses important knowledge and understandings of the patient´s needs, which can provide important information in the decision making. Aim The aim of the study was to illustrate nurse´s experience of participation and communication regarding the ethical decision-making to terminate or refrain from patients life-sustaining treatment. Method Descriptive litterature review of ten qualitative research articles. Results The study resulted in two themes; participation and lack of knowledge. The results show that nurses considered their participation in the stance of maintaining or sustaining treatment as inadequate. The nurses felt that the cooperation with the physician in the decision-making did not work and felt a frustration related to not being listened to. Additional barriers to nurse’s participation in the decision-making appeared by nurse’s lack of knowledge regarding laws, guidelines and nursing ethics, as well as lack of work experience and confidence. Conclusion The nurse’s participation in the caring team about the stance of maintaining or sustaining life support care is inadequate. The study also highlight the nurses need for increased knowledge of laws, guidelines and ethics. / <p>Röda Korsets sjuksköterskeförening stipendium 2017</p>

Orientador: Márcio Ajudarte Lopes / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Odontologia de Piracicaba / Made available in DSpace on 2018-08-22T04:09:12Z (GMT). No. of bitstreams: 1 Sabino-Bezerra_JoseRibamar_D.pdf: 1590121 bytes, checksum: ed46f540b0ed282c5f418bd7ff03ad86 (MD5) Previous issue date: 2013 / Resumo: O câncer de cabeça e pescoço representa o sexto tipo mais comum em todo mundo e é uma preocupação crescente das agências de saúde pública. O tratamento é baseado em cirurgia, radioterapia e quimioterapia, isoladas ou em conjunto e, são responsáveis por importantes sequelas que afetam negativamente as atividades diárias dos pacientes, contribuindo para uma diminuição na qualidade de vida. Entretanto, as informações prévias ao tratamento e a compreensão destas complicações pelos pacientes são insuficientes para prepará-los para o tratamento. Na literatura médica a utilização de vídeos educativos é documentada como uma ferramenta importante na transmissão de informações prévias a tratamentos complexos, demonstrando resultados promissores na melhoria da compreensão dos pacientes. No entanto, a utilização de vídeos educacionais esclarecendo as complicações do tratamento direcionadas aos pacientes com câncer de cabeça e pescoço é escassa, não havendo nenhum artigo que se dedique exclusivamente a estes pacientes. Portanto, o objetivo deste estudo foi avaliar o efeito de um vídeo educativo sobre a melhoria da compreensão dos pacientes com câncer de cabeça e pescoço submetidos à radioterapia sobre as complicações do tratamento. Para isto, a equipe de oncologia multidisciplinar, composta por membros do Centro de Oncologia do Hospital dos Fornecedores de Cana (CEON-HFC) e da Faculdade de Odontologia de Piracicaba (FOP-UNICAMP), produziu um vídeo de 6 minutos sobre os efeitos colaterais da radioterapia na região de cabeça e pescoço. Um estudo clínico controlado foi realizado com dois grupos: o grupo controle (n = 19), que recebeu informação verbal, e o grupo de vídeo (n = 19), que recebeu informação verbal e assistiu ao vídeo. Para medir o nível de compreensão, bem como levantar dados socioeconômicos, dois questionários foram dados a ambos os grupos, um antes do início da radioterapia e outro após o término da radioterapia. Trinta e oito pacientes foram incluídos no estudo. Trinta e um pacientes (81,58%) tinham um nível de escolaridade inferior ao ensino médio. Todos os pacientes do grupo de vídeo responderam corretamente por que eles foram submetidos à radioterapia. Por outro lado, três pacientes (15,79%) do grupo do controle não conhecia o motivo para o tratamento. Apenas um paciente (5,26%) do grupo de vídeo tinha dúvidas sobre o tratamento, em comparação a sete do grupo de controle (36,84%). Como conclusão, o estudo demonstra que a utilização de vídeo educativo pode melhorar a compreensão do paciente com câncer de cabeça e pescoço sobre o tratamento com radioterapia e seus efeitos colaterais, independente de seu nível de escolaridade / Abstract: The head and neck cancer is the sixth most common type worldwide and is an increasing concern for public health agencies around the world. The treatment is based on surgery, radiotherapy and chemotherapy, alone or combined, and are responsible for important consequences that negatively affect patients' daily activities, contributing to a decrease in quality of life. However, the information prior to treatment and understanding of these complications by patients are insufficient to prepare them for treatment. In the medical literature the use of educational videos is well documented as an important tool in transmitting complex information prior to treatment, demonstrating promising results in improving understanding of the patients. However, the use of educational videos explaining the complications of treatment directed to patients with head and neck cancer is scarce, and there is no article devoted exclusively to these patients. Therefore, the aim of this study was to evaluate the effect of an educational video on improving the understanding of patients with head and neck cancer undergoing radiotherapy on complications of treatment. For this, the multidisciplinary oncology team, composed of members of the Oncology Center of the Hospital of Sugarcane Suppliers (CEON-HFC) and Piracicaba Dental School (FOP-UNICAMP), produced a 6 minute video about the side effects of radiotherapy in the head and neck. A controlled clinical study was conducted with two groups: a control group (n = 19) who received verbal information and the video group (n = 19) who received verbal and watched the video. To measure the level of understanding and raise socioeconomic data, two questionnaires were given to both groups, one before the start of radiotherapy and another after the end of radiotherapy. Thirty-eight patients were included in the study. Thirty-one patients (81.58%) had an education level less than high school. All patients in the video group answered correctly why they underwent radiotherapy. Furthermore, three patients (15.79%) in the control group did not know the reason for the treatment. Only one patient (5.26%) in video group had doubts about the treatment, compared to seven in the control group (36.84%). In conclusion, this study demonstrates that the use of educational video can improve understanding of the patient with head and neck cancer on treatment with radiotherapy and its side effects, regardless of their level of education / Doutorado / Patologia / Doutor em Estomatopatologia

Introduktion: Demenssjukdomar beskrivs som en folksjukdom där en person så ofta som var tredje sekund insjuknar i världen, och i Sverige beräknas samhällskostnaden till närmare 62,9 miljarder kronor årligen. I enlighet med patientlagen skall all vård bedrivas i samråd med patienten, vilket kan försvåras när personen har en kognitiv funktionsnedsättning. Syfte: Syftet var att beskriva delaktighet för personer med kognitiv funktionsnedsättning och deras anhöriga vid beslut om livsuppehållande åtgärder.  Metod: Litteraturöversikt med beskrivande design baserad på tio kvalitativa originalartiklar från PubMed och CINAHL som kvalitetgranskats. Resultatanalysen av artiklarna utgick från Fribergs modell för innehållsanalys. Resultat: Det framkom att personer med kognitiv funktionsnedsättning har olika uppfattningar om hur aktivt delaktiga de vill vara i beslut om livsuppehållande åtgärder. Det fanns de som ansåg att besluten skulle avgöras av vårdgivare och inte av dem själva, men det fanns även de som ville vara mera aktiva i beslut om livsuppehållande åtgärder. De som ville vara mera aktiva i besluten hade gemensamt att de ville underlätta för familj och anhöriga då de var medvetna om att sjukdomen en dag skulle göra dem oförmögna att förmedla sina önskningar.  Slutsats: Personer med kognitiv funktionsnedsättning har olika uppfattningar hur delaktiga de vill vara rörande beslut om livsuppehållande åtgärder. Resultatet pekar på att ett personcentrerat förhållningssätt hos vårdpersonal underlättar för personer med kognitiv funktionsnedsättning att förmedla sin önskan om delaktighet vid beslut om livsuppehållande åtgärder. Anhöriga till personer med kognitiv funktionsnedsättning upplevde ett behov av utbildning för vårdpersonal i samtalsteknik riktade till patientgruppen samt i sjukdomar som ger kognitiv funktionsnedsättning. / Introduction: Dementia diseases are described as a public disease where a person falls ill as often as every three seconds in the world, and in Sweden the estimated social cost is almost 62.9 billion SEK yearly. In accordance with the Patient Act, all care must be provided in consultation with the patient, which can be difficult when the person has a cognitive impairment. Aim: The aim was to describe the participation of people with cognitive disabilities and their relatives when deciding on life support measures.  Method: Literature review with a descriptive design based on ten qualitative original articles collected from PubMed and CINAHL that were quality reviewed. The analysis of the articles was based on Friberg's model for content analysis. Results: It emerged that people with cognitive disabilities have different views on how actively they want to be involved in decisions about life-sustaining measures. There were those who believed that decisions should be made by caregivers and not by themselves, but there were also those who wanted to be more active in decisions about life-sustaining measures. Those who wanted to be more active in the decisions had in common that they wanted to make it easier for family and relatives as they were aware that the disease would one day make them unable to convey their wishes. Conclusion: Persons with cognitive disabilities have different views on how involved they want to be in decisions about life-sustaining measures. The result indicates that a person-centered approach among healthcare professionals makes it easier for persons with cognitive disabilities to convey their desire for participation in decisions about life-sustaining measures. Relatives of persons with cognitive impairment experienced a need for training for care staff in conversational techniques aimed at the patient group as well as various diseases that cause cognitive impairment.

O objetivo deste estudo foi desenvolver o conceito de morte digna da criança na Unidade de Terapia Intensiva pediátrica. O Modelo Híbrido de Desenvolvimento de Conceitos foi aplicado em suas três fases: Teórica, de Campo e Analítica Final. Na Fase Teórica, foram analisados 49 artigos nas áreas Médica e de Enfermagem que estudaram e focalizaram a morte digna da criança. A Fase de Campo foi conduzida através de entrevistas semi-estruturadas com nove enfermeiras e sete médicos que atuavam em UTI pediátrica. Os dados da Fase de Campo foram analisados utilizando-se os resultados da Fase Teórica como eixo teórico e a Análise de Conteúdo como referencial metodológico. Na Fase Analítica Final, os resultados da Fase Teórica e de Campo foram comparados, analisados e integrados. Os dados evidenciam que a MORTE DIGNA na UTI pediátrica é ter um tratamento clínico de excelência no final de vida, com honra aos benefícios da evolução natural da doença, respeito aos aspectos socioculturais, conforto físico e bem-estar. A morte digna ocorre em um contexto de veracidade e parceria entre a equipe e a família, no qual é possível expressar expectativas e receios. O resultado da morte digna é o alívio do sofrimento tanto da criança quanto da família. Os dados da Fase Teórica apontam os antecedentes, atributos e conseqüências da morte digna como situações protocolares, porém, na Fase de Campo foi possível identificar o componente experiencial que está por trás das condutas dos profissionais diante da criança em final de vida. Assim, pôde-se compreender como se dá a manifestação do conceito na prática clínica, possibilitando a ampliação dos dados identificados na Fase Teórica. Clarificar o conceito de morte digna na UTI pediátrica permite fortalecer teorias sobre os cuidados no final de vida à criança e à família, bem como possibilita aos profissionais que atuam na prática clínica refletirem sobre as motivações que pautam atitudes e decisões diante da criança fora de possibilidade de cura / The purpose of this research was to develop the concept of dignified death for children in the Pediatric Intensive Care Unit. The Hybrid Model of Concept Development was applied in its three phases: Theoretical, Fieldwork and Final Analytical. In the Theoretical Phase 49 papers in the Medical and Nursing fields were analyzed, which studied and focused on the dignified death for children. The Fieldwork was conducted through semi-structured interviews with nine doctors and seven registered nurses who worked in pediatric ICUs. The data from the Fieldwork Phase was analyzed having the results of Theoretical Phase as the theoretical axis and the Content Analysis as the methodology. In the Final Analytical Phase, the results from the Theoretical and Fieldwork Phases and were compared, analyzed and integrated. The data show that the DIGNIFIED DEATH for children in the pediatric ICU means having a clinical treatment of excellence at the end-of-life, honoring the benefits of the natural evolution of the disease, respecting the socio-cultural aspects, physical comfort and welfare. A dignified death occurs in a context of veracity and partnership between the team and the family, in which it is possible to express hopes and fears. The result of the dignified death is the relief of suffering from both the child and the family. Data from the Theoretical Phase suggests that the antecedents, attributes and consequences of dignified death as being protocol situations, however, in the Fieldwork it was possible to identify the component of the experience behind the conduct of the professionals when dealing with children at end-of-life. Thus, it was possible to understand how the manifestation of the concept occurs in clinical practice, allowing the expansion of the data identified in the Theoretical Phase. Clarifying the concept of dignified death in the pediatric ICU can strengthen theories about end-of-life care to children and families and makes it possible to professionals who work in clinical practice to reflect on the motivations that guide their attitudes and decisions when dealing with a child in life-sustaining condition

Thesis (Ph.D. in Nursing) -- University of Colorado at Denver and Health Sciences Center, 2005. / Typescript. Includes bibliographical references (leaves 139-146). Free to UCDHSC affiliates. Online version available via ProQuest Digital Dissertations;

O objetivo deste estudo foi desenvolver o conceito de morte digna da criança na Unidade de Terapia Intensiva pediátrica. O Modelo Híbrido de Desenvolvimento de Conceitos foi aplicado em suas três fases: Teórica, de Campo e Analítica Final. Na Fase Teórica, foram analisados 49 artigos nas áreas Médica e de Enfermagem que estudaram e focalizaram a morte digna da criança. A Fase de Campo foi conduzida através de entrevistas semi-estruturadas com nove enfermeiras e sete médicos que atuavam em UTI pediátrica. Os dados da Fase de Campo foram analisados utilizando-se os resultados da Fase Teórica como eixo teórico e a Análise de Conteúdo como referencial metodológico. Na Fase Analítica Final, os resultados da Fase Teórica e de Campo foram comparados, analisados e integrados. Os dados evidenciam que a MORTE DIGNA na UTI pediátrica é ter um tratamento clínico de excelência no final de vida, com honra aos benefícios da evolução natural da doença, respeito aos aspectos socioculturais, conforto físico e bem-estar. A morte digna ocorre em um contexto de veracidade e parceria entre a equipe e a família, no qual é possível expressar expectativas e receios. O resultado da morte digna é o alívio do sofrimento tanto da criança quanto da família. Os dados da Fase Teórica apontam os antecedentes, atributos e conseqüências da morte digna como situações protocolares, porém, na Fase de Campo foi possível identificar o componente experiencial que está por trás das condutas dos profissionais diante da criança em final de vida. Assim, pôde-se compreender como se dá a manifestação do conceito na prática clínica, possibilitando a ampliação dos dados identificados na Fase Teórica. Clarificar o conceito de morte digna na UTI pediátrica permite fortalecer teorias sobre os cuidados no final de vida à criança e à família, bem como possibilita aos profissionais que atuam na prática clínica refletirem sobre as motivações que pautam atitudes e decisões diante da criança fora de possibilidade de cura / The purpose of this research was to develop the concept of dignified death for children in the Pediatric Intensive Care Unit. The Hybrid Model of Concept Development was applied in its three phases: Theoretical, Fieldwork and Final Analytical. In the Theoretical Phase 49 papers in the Medical and Nursing fields were analyzed, which studied and focused on the dignified death for children. The Fieldwork was conducted through semi-structured interviews with nine doctors and seven registered nurses who worked in pediatric ICUs. The data from the Fieldwork Phase was analyzed having the results of Theoretical Phase as the theoretical axis and the Content Analysis as the methodology. In the Final Analytical Phase, the results from the Theoretical and Fieldwork Phases and were compared, analyzed and integrated. The data show that the DIGNIFIED DEATH for children in the pediatric ICU means having a clinical treatment of excellence at the end-of-life, honoring the benefits of the natural evolution of the disease, respecting the socio-cultural aspects, physical comfort and welfare. A dignified death occurs in a context of veracity and partnership between the team and the family, in which it is possible to express hopes and fears. The result of the dignified death is the relief of suffering from both the child and the family. Data from the Theoretical Phase suggests that the antecedents, attributes and consequences of dignified death as being protocol situations, however, in the Fieldwork it was possible to identify the component of the experience behind the conduct of the professionals when dealing with children at end-of-life. Thus, it was possible to understand how the manifestation of the concept occurs in clinical practice, allowing the expansion of the data identified in the Theoretical Phase. Clarifying the concept of dignified death in the pediatric ICU can strengthen theories about end-of-life care to children and families and makes it possible to professionals who work in clinical practice to reflect on the motivations that guide their attitudes and decisions when dealing with a child in life-sustaining condition

Bakgrund: Amyotrofisk lateral skleros (ALS) är en ovanlig sjukdom vars sjukdomsförlopp kan gå mycket fort. Det är vanligt att patienter med ALS får livsuppehållande behandlingar för att förlänga livet och för att förbättra livskvaliteten. Olika typer av behandling används för denna patientgrupp. De som beskrivs är ventilationsbehandling och nutritionsbehandling med gastrostomi. Självbestämmande, hälsa och livskvalitet är komponenter av värde för att förstå patienters perspektiv. Syfte: Syftet var att beskriva hur det är att leva med livsförlängande behandling vid sjukdomen ALS. Metod: En litteraturöversikt utfördes med vetenskapliga artiklar inom kunskapsområdet för att belysa det aktuella kunskapsläget. Fribergs metodbeskrivning och analysmetod användes. Tolv vetenskapliga artiklar användes från flertal länder i resultatet. Resultat: Resultatet presenteras i huvudteman med tillhörande subteman. Tema ett: Att ta beslut till behandling innefattar Patientens roll i beslutsfattande och Sjukvårdens betydelse vid beslutsfattande. Tema två: Att acceptera behandling är en process. Tema tre: Att vara i nuet och leva vidare med behandling innefattar Att vara i nuet och Att leva vidare. Diskussion: Den teoretiska utgångspunkten som användes var Virginia Hendersons behovsteori i grundläggande sjukvård. Uppsatsen visar vad patienter uttrycker som betydelsefullt när de står inför beslut kring livsförlängande behandling. Att ha självbestämmande, att ha kontroll och att sjukvården ska vara förtroendeingivande är betydelsefullt. Acceptansprocessen, stöd och möjligheter till att leva vidare har betydelse för meningsfullheten hos patienter. / Background: Amyotrophic lateral sclerosis (ALS) is an unusual disease where the disease progress can be very fast. It is common for patients with ALS to receive life-sustaining treatments to prolong their lives and improve their quality of life. Different types of treatment are used for this group of patients, those described are ventilation and nutritional treatment with gastrostomy. Self-determination, health and quality of life are components of value to understand the patient's perspective. Aim: The aim was to describe how it is to live with life-prolonging treatment with the disease ALS. Method: A literature review was conducted with scientific articles to highlight the current state of knowledge in the field. Friberg's methodology and method of analysis were used. Twelve scientific articles were used from several countries in the result. Results: The results are presented in main themes with associated subthemes. Theme one: Decision making for treatment includes the role of the patient in decision making and the meaning of health care in decision making. Theme two: Accepting treatment is a process. Theme Three: Being in the present and continuing on with treatment includes being in the present and living on. Discussion: The theoretical basis used was Virginia Henderson and her theory of needs in the basic healthcare. This essay shows what patients express as important when they are faced with decisions about life-prolonged treatment. Having self-determination, having control and that the care must be trustworthy are important. The acceptance process, support and the opportunity to live on are important for the meaningfulness of patients.