En vårdrelations uppbyggnad är en komplex process där hinder och möjligheter finns. Vårdrelationen är central i den personcentrerade vården och kan vara både vårdande och icke-vårdande. Syftet med litteraturstudien var att beskriva vårdrelationens hinder och möjligheter ur patienters perspektiv. Litteraturstudiens resultat baseras på tio vetenskapliga artiklar som har bearbetats med ett deduktivt förhållningssätt utifrån Halldórsdóttirs omvårdnadsteori. Hinder som framkom i resultatet var att vårdare ofta var för upptagna för sina patienter eller visade ovilja till sitt arbete. Det gjorde att patienterna drog sig tillbaka och kände sig ensamma. Resultatet visade att patienterna beskriver respekt och bekräftelse som två möjligheter i uppbyggnaden av en vårdrelation. Detta resulterade i att patienterna kunde tala fritt om sina behov för vårdarna. Både hinder och möjligheter kan överensstämma med Halldórsdóttirs omvårdnadsteori, där väggen står för hinder och bron står för möjligheter. Genom denna litteraturstudie framkom att det finns begränsad forskning kring ämnet därför skulle det vara av intresse att forskningen i framtiden fortsätter undersöka vårdrelationen ur patienters perspektiv. / A nurse-patient relations contexture is a complex process in which there are both barriers and facilitators. The nurse-patient relations is central to the person centered care and can be both caring and uncaring. The aim of this study was to describe the nurse-patient relations barriers and facilitators from the patients' perspective. The literature study results are based on ten scientific articles and are analyzed with a deductive approach by Halldórsdóttirs nursing theory. Barriers that emerged in the result is that nurses were often too busy for their patients or showed reluctance to work. This meant that patients withdrew and felt lonely. The result showed that patients described respect and comfirmation as two facilitators in the contexture of a nurse-patient relations. This resulted in that patients were able to speak freely about their needs for caregivers. Both barriers and facilitators could apply with Halldórsdóttirs nursing theory where the wall represent barriers and the bridge represent facilitators. Through this study it revealed that there is limited research on the topic so it would be of interest that research will continue examining the nurse-patient relations from the patients' perspective.

The aims of this thesis are to investigate the factors influencing treatment fidelity of health behaviour change (HBC) interventions. The thesis will focus on HBC interventions delivered by practice nurses (PNs) and health care assistants (HCAs) to patients within general practice, although the findings will be explored within the context of the wider treatment fidelity literature. The thesis comprises five studies, focussed on exploring, enhancing and assessing fidelity of delivery and receipt of HBC interventions. Through developing an enhanced understanding of these areas of treatment fidelity, the thesis will also make recommendations for strategies to enhance and assess fidelity of delivery and receipt of future HBC interventions. Study one is a meta-synthesis of qualitative studies that explored the views and experiences of nurses who had delivered HBC interventions with a focus on how this can inform future delivery of HBC interventions. Study two is an Interpretative Phenomenological Analysis of PNs’/HCAs’ experiences of helping patients to change their health behaviours within the context of their routine care, and before and after delivery of an intervention to facilitate increased walking. Study three reports a quantitative assessment of delivery of intervention techniques to facilitate increased walking, as specified in an intervention protocol, by PNs/HCAs. Study four explores PNs’/HCAs’ views and experiences of the factors that influenced their delivery of the walking intervention. Study five investigates treatment receipt, by exploring patients’ understanding of, and experiences of receiving the walking intervention. The key findings from this research are that delivery and receipt of HBC interventions within general practice are influenced by a range of factors that include the providers’ confidence and skills, the patients’ expectations and/or engagement with the intervention and the general practice within which the intervention is delivered. A number of these factors are difficult to influence and so research teams need to develop a range of strategies to enhance delivery and receipt of HBC interventions. These may include appropriate preparation for providers to deliver the intervention, the provision of a simple intervention resource to support delivery of the intervention and the development of strategies to enhance patients’ understanding of intervention techniques.

Bakgrund: Akutmottagningar är överrepresenterade när det gäller förekomsten av våld inom vården. Våldet påverkar sjuksköterskans förmåga att ge god vård negativt och riskerar både patientsäkerheten och arbetsmiljön på akutmottagningen. Syfte: Att undersöka vilka riskfaktorer som kan öka risken för att en patient uppvisar ett våldsamt beteende på akutmottagningen samt hur personalen bemöter dessa patienter. Metod: Arbetet är designat som en integrativ litteraturstudie där 12 artiklar inkluderades. Resultat: Ett flertal faktorer identifierades som betydelsefulla för risken att en patient uppvisar ett våldsamt beteende på akutmottagningen. Utifrån dem identifierades fyra faktorer som särskilt viktiga; väntetider under “strukturella faktorer”, alkohol eller drogpåverkade patienter under “substansrelaterade faktorer” samt patienter med psykiatrisk sjukdom under “medicinska faktorer”. Deltagarna i de olika studierna identifierade ofta samma faktorer, även om de lade olika mycket tyngd vid olika faktorer. Hur akutvårdspersonalen hanterade kontakten med de patienter som uppvisade ett våldsamt beteende var olika bland annat beroende på erfarenhet. Bättre kommunikation, information och ett empatiskt bemötande kunde minska risken för våldsamt beteende och avvärja ett våldsamt beteende. Slutsats: Förekomsten av våld på akutmottagningen kan sällan förklaras av en enskild faktor, utan oftast spelar många separata faktorer in. De riskfaktorerna som identifierats som enskilt största för risken för våld på akutmottagning är väntetider, alkohol och/eller drogpåverkade patienter samt patienter med psykiatrisk sjukdom. God kommunikation, information och empati kan minska risk för våld eller kan minska eller förebygga att våld uppstår. / Background: Emergency departments are over-represented in the incidence of violence in health care. Violence affects nurses' ability to provide good care in a negative way and increases the risks to both patient safety and workplace environment. Purpose: To investigate the risk factors that can increase the risk of a patient exhibiting violent behavior in the emergency department and how the staff treats these patients. Method: The thesis is designed as an integrative literature review in which 12 articles were included. Results: Several factors were identified as important to the risk of patients exhibiting violent behavior when visiting the emergency department. Four factors amongst them were identified as especially important: waiting times under “structural factors”, patients under the influence of alcohol or narcotics under “factors related to substances”, as well as patients with psychiatric disorders under “medicinal factors”. The participants in the different studies often identified the same factors, even though they had differing opinions on the importance of the factors. The emergency department staff handled the contact with patients exhibiting violent behavior differently based on several factors such as experience. Better communication, information and an empathic treatment of could lessen the risk of violent behavior and help stave off violent behavior. Conclusion: The most common risk factors for violence in the emergency department are waiting times, alcohol and / or drug affected patients and patients with psychiatric illness. Good communication, information and empathy can reduce the risk of violence or averting violence.

O nascimento de um bebê malformado, especialmente, quando a aparência é defigurada, provoca um impacto nos profissionais que prestam atendimento ao recémnascido, imediatamente, após o nascimento, repercutindo na qualidade da assistência prestada. Este estudo foi motivado pela inquietação da pesquisadora procurar compreender as ações e reações dos enfermeiros quando assistem o nascimento de recém-nascidos com malformação desfigurante no contexto da sala de parto. O estudo teve como objetivo: compreender a experiência dos enfermeiros que assistem o nascimento de um recém-nascido com malformação desfigurante. Optou-se por realizar uma pesquisa com abordagem qualitativa, estudo de caso coletivo, e os dados foram analisados à luz do referencial teórico do Interacionismo Simbólico. A coleta de dados ocorreu por meio de entrevista semi-estruturada com enfermeiros que atuam no centro obstétrico de um Hospital Municipal, situado na zona sul da cidade de São Paulo. As entrevistas foram gravadas em fita cassete, posteriormente, transcritas em sua íntegra e analisadas. A análise dos dados permitiu identificar categorias conceituais que compuseram os dois temas: Compartilhando com a equipe médica a assistência ao recém-nascido e Assumindo a responsabilidade da assistência ao binômio mãe-recém-nascido. Os resultados do estudo salientaram a dificuldade enfrentada pelo enfermeiro na assistência do nascimento de um bebê malformado em decorrência do despreparo na formação profissional, relacionada ao processo de comunicação enfermeiro-paciente e dificuldade de lidar com as próprias emoções / The birth of a malformed child, specially when the malformation affects the baby appearance, provokes impact on caregivers who attend the baby immediately after childbirth and on quality of attendance. This study was motivated by the necessity of understanding the performance of nurses when they attend babies with visible congenital malformation. The aim of this study was to understand the nurse`s experience for attending babies with visible congenital disfigurement in the context of delivery room. The qualitative methodological approach used in this study was the Collective Case Study and to analyse data it was used the Symbolic Interactionism theoretical framework. The sample was composed by ten nurses that work at the birth center of a public hospital located in the south district of São Paulo city. Data was obtained by interview that was recorded, transcripted and analysed. From data analysis categories emerged that composed two themes: Sharing the newborn care with medical staff and Assuming the responsibility of the mother-infant care. The results point out the difficulties faced by the nurses when they need to take care of the babies who have visible congenital disfigurement due to their unprepared formation related to the nurse-patient relationship and the difficulties to deal with their emotions

Bakgrund: Alla patienter är oroliga inför anestesi då de förlorar kontrollen över sin kropp. De önskar ha en bra kontakt med anestesisjuksköterskan för att kunna förmedla sina behov. Informationsbehovet är dock olika för alla patienter, vissa vill veta allt medan andra vill få sparsamt med information. Syfte: Syftet är att beskriva anestesisjuksköterskors erfarenheter av att möta patienter inför och under anestesi. Metod: Kvalitativ systematisk litteraturstudie av bearbetat material. Resultat: Anestesisjuksköterskorna ansåg att det var viktigt att se patientens behov för att kunna skapa trygghet, likväl som att ha en bra kommunikation. Tidsbrist var dock vanligt förekommande vilket skapade hinder i mötet med patienten. Slutsats: Anestesisjuksköterskorna vill utföra ett bra arbete, men då patienterna och verksamheten ofta ställer motstridiga krav krävs en ständig avvägning för att avgöra vad som är bäst här och nu. / Background: All the patients are apprehensive prior to anesthesia, due to the fact that they lose control of their bodies. The patients desire good contact with the nurse anesthetist, in order to convey their needs. The need for information vairy for all the patients. Some require detailed information, while others only sparingly need information. Aim: The aim of the study is to describe nurse anesthetists experience in meeting the patients prior and during anesthesia. Method: A systematic qualitative literature study of published materials was conducted. Results: The nurse anesthetists believe that it is important to see the patients needs, in order to be able to build a sense of security, in addition to good communication. The common obstacle is shortage of time, which affects contact with the patient. Conclusion: The nurse anesthetists feel a need to perform good work. But the patienten och the administration often make conflicting demands, which means that a constant consideration is needed to decide what’s best here and now.

Bakgrund: Forskningen idag visar att psykisk ohälsa ökar globalt. I samhället kan vi se en stigmatiserande och diskriminerande attityd gentemot personer med psykisk ohälsa. Det framgår att denna patientgrupp har ett större behov av vård men att de känner sig orättvist bemötta och behandlade inom hälso- och sjukvården. Syfte: Litteraturöversikten ämnar beskriva attityder hos sjuksköterskor inom somatisk vård gentemot personer med psykisk ohälsa. Metod: Litteraturöversikten har en integrativ metod vilket innebär att både kvalitativa (9) och kvantitativa artiklar (2) har använts för resultatet. Artiklarna är tagna från databaserna MEDLINE, CINAHL och PsycINFO. Alla artiklar har genomsökts för att svara på litteraturstudiens syfte och har kvalitetsgranskats enligt riktlinjer för Hälsohögskolan i Jönköping. Resultat: Efter analys framkom tre teman: Att ha en dömande attityd mot patienten, Undvikande attityder och Empatiska attityder. Slutsats: Diskriminerande och positiva attityder kan hittas hos sjuksköterskor. Däremellan fanns sjuksköterskor som bortprioriterar att vårda patienter med psykisk ohälsa relaterat till yttre och inre omständigheter såsom ansvarsuppfattning, vårdkultur, brist på tillgångar, maktlöshet, hopplöshet. Utbildning och erfarenhet kan enligt litteraturöversiktens resultat ge positiva attityder hos sjuksköterskan under rätt förutsättningar men samhällets syn på personer med psykisk ohälsa verkar vara en stark faktor som påverkar sjuksköterskors attityd. Sjuksköterskans attityd mot personer med psykisk ohälsa korrelerade med samhället hen levde i. / Background: Today's research shows that mental illness is increasing globally. In society, we can see a stigmatizing and discriminatory attitude towards people with mental illness. It appears that this patient group has a greater need for care, but that they feel unfairly treated and cared for in the health and medical care. Aim: The literature review aims to describe attitudes of nurses in somatic care towards people with mental illness. Method: This literature review has an integrative method which means that the result is based on both qualitative (9) and quantitative articles (2) from databases MEDLINE, CINAHL and PsycINFO. All articles have been read thoroughly to correlate to the studys’ aim and their quality has been assessed with guidelines from the School of Health and Welfare in Jönköping. Result: Three main themes emerged: Having a judgmental attitude towards the patient, avoiding attitudes and empathetic attitudes. Conclusion: Discriminatory and positive attitudes can be found in nurses. In between, there are nurses who prioritize caring for patients with mental illness related to external and internal circumstances such as perception of responsibility, care culture, lack of assets, powerlessness and hopelessness. Education and experience can, according to the results of the literature review, give positive attitudes to the nurse under the right conditions, but society's view of persons with mental illness seems to be a strong factor that influences nurses' attitude. The nurse's attitude towards people with mental illness correlated with society lived in.

Background: In the post-operative phase, the patient's ability to communicate is impaired. The postoperative patient is therefore in great need of that the information given is being individually adapted. Objectives: The aim of this study was to investigate communicative barriers and facilitating factors between the nurse and the patient in postoperative care and to describe areas of improvement. Methods: Literature study consisting of 12 qualitative scientific original articles focusing on communication between the nurse and the patient in postoperative care and the patient's communicative needs and the nurse's approach to this. Findings: The literature study showed that barriers like stressful working conditions led to short or no communication between the nurse and the patient, and that the postoperative care time thereby was prolonged. Different language, dialects, gender, cultural beliefs and socio-economic backgrounds meant that the information from the nurses was not perceived - or interpreted correctly - and that the time spent developing the message increased the workload. Patients who took an interest in their treatment and asked questions, acted as a positive facilitator. In by doing this, the patients increased the likelihood of being helped and communicated with by the nurses. Conclusion: The result of the literature study shows that an established clear communicative interaction between the nurse and the patient, with individualized care, could be perceived by the patient as just as important and desirable as a quick recovery from illness. / Bakgrund: I det postoperativa skedet är patientens förmåga att kommunicera nedsatt. Den postoperativa patienten är därför i stort behov av att informationen som ges är individanpassad. Syfte: Syftet var att undersöka kommunikativa barriärer och underlättande faktorer mellan sjuksköterskan och patienten i postoperativ vård samt beskriva förbättringsområden. Metod: Litteraturstudie bestående av 12 stycken kvalitativa vetenskapliga originalartiklar med fokus på kommunikation mellan sjuksköterskan och patienten i postoperativ vård samt patientens kommunikativa behov och sjuksköterskans förhållningssätt till detta. Resultat: Litteraturstudien visade på att barriärer likt stressiga arbetsförhållanden ledde till kort eller ingen kommunikation mellan sjuksköterskan och patienten samt att den postoperativa vårdtiden därigenom blev förlängd. Olika modersmål, dialekt, kön, kulturell övertygelse och socioekonomisk bakgrund gjorde att informationen från sjuksköterskorna ej uppfattades- eller tolkades korrekt samt att tiden lagd på att få fram budskapet ökade arbetsbördan. Vad som agerade underlättande var patienter som själva var framåt och frågade om sin behandling. Detta resulterade i att dessa patienter fick hjälp samt ökade sannolikheten för kommunikation med sjuksköterskorna. Slutsats: Resultatet av litteraturstudien visade att ett etablerat tydligt kommunikativt samspel mellan sjuksköterskan och patienten, med individanpassad vård, kunde av patienten upplevas som lika viktigt och önskvärt som ett snabbt tillfrisknande från sjukdom.

Chang Anne Marie. / "April 1999." / Thesis (Ph.D.)--Chinese University of Hong Kong, 1999. / Includes bibliographical references (p. 245-280). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web. / Abstracts in English and Chinese.

CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / Objetivou-se validar um modelo de comunicaÃÃo nÃo-verbal para o atendimento de enfermagem à clientela cega, segundo o referencial teÃrico de E.T. Hall (1986). Trata-se de um estudo metodolÃgico, desenvolvido no LabCom_SaÃde do Departamento de Enfermagem da UFC, no perÃodo de outubro de 2007 a junho de 2008. Foram selecionados 15 cegos e 15 enfermeiros para comporem cada grupo, treinado e nÃo-treinado e ambos tiveram as mesmas caracterÃsticas. Os cegos foram contatados por meio da AssociaÃÃo dos Cegos do Estado do Cearà e os enfermeiros a partir dos Centros AcadÃmicos. A fase de coleta de dados do grupo nÃo-treinado deu-se durante o mÃs de abril de 2008, por meio de consultas. Estas ocorreram dentro do LabCom_SaÃde e os dados foram coletados por meio de filmagens. O primeiro passo para a construÃÃo do modelo foram os estudos realizados acerca da teoria de Hall (1986). Subdividiu-se a consulta de enfermagem em quatro etapas denominadas etapas do cuidado. Em cada etapa de cuidado sÃo orientadas as aÃÃes do enfermeiro, descreve-se a aÃÃo e como deve ser desenvolvida tal aÃÃo. A etapa do cuidado 1 refere-se à organizaÃÃo do ambiente para desenvolver a Consulta de Enfermagem. Na etapa do cuidado 2 o enfermeiro deve receber o paciente na entrada do consultÃrio para introduzi-lo no ambiente onde serà realizada a consulta e deve cumprimentÃ-lo e informar a localizaÃÃo dos mÃveis e objetos. Jà a etapa do cuidado 3 aborda o desenvolvimento da CEnf propriamente dita. A etapa do cuidado 4 constitui-se a Ãltima etapa do modelo de comunicaÃÃo nÃo-verbal e enfoca a finalizaÃÃo da consulta e o encerramento da comunicaÃÃo com o paciente. ApÃs ser construÃdo, o referido modelo foi submetido à validaÃÃo aparente e de conteÃdo. Foi analisado por trÃs especialistas em comunicaÃÃo nÃo-verbal, por ser um nÃmero jà adotado em pesquisas anteriores. As sugestÃes incluÃdas no modelo se referiram à abrangÃncia, forma de apresentaÃÃo e representatividade do conteÃdo. Em seguida, iniciou-se a segunda etapa de validaÃÃo, por meio da qual o modelo foi submetido à testagem. Os enfermeiros e concludentes foram treinados de acordo tanto com as tÃcnicas de comunicaÃÃo pertinentes à utilizaÃÃo da comunicaÃÃo nÃo-verbal quanto em relaÃÃo à utilizaÃÃo do modelo com cegos. Quanto à coleta dos dados, foi realizada mediante o uso de trÃs cÃmeras filmadoras que registraram toda a consulta de enfermagem entre a enfermeira, o cego e o acompanhante, quando este estivesse presente. Para a anÃlise dos dados das filmagens foram escolhidos outros trÃs juÃzes, enfermeiros e estudantes do Programa de PÃs-GraduaÃÃo em Enfermagem, do nÃvel mestrado e doutorado, da UFC. Eles foram treinados em relaÃÃo à utilizaÃÃo do instrumento de anÃlise da comunicaÃÃo nÃo-verbal do enfermeiro-cego (CONVENCE) e do instrumento de validaÃÃo do modelo. Pelo fato deste estudo ser duplo cego, os juÃzes nÃo eram informados acerca de qual grupo, controle ou experimental, eram realizadas as anÃlises. Os dados coletados foram inseridos em planilha eletrÃnica com a utilizaÃÃo do programa SPSS, versÃo 14.0, e analisados em freqÃÃncia absoluta por meio de tabelas univariadas. Para se analisar a associaÃÃo entre as variÃveis e os enfermeiros nos grupos controle e experimental, foram empregados os testes qui-quadrado (&#967;2) e o mÃximo de verossimilhanÃa. Cumpriram-se as normas que regulamentam pesquisas em seres humanos, conforme a ResoluÃÃo 196/96 do MinistÃrio da SaÃde. Ao se comparar as aÃÃes da etapa do cuidado 1 entre o grupo treinado e nÃo-treinado, observa-se que o grupo treinado obteve resultado excelente (p<0,0001) em quatro dos cinco itens avaliados. Somente o item âtemperaturaâ apresentou proporÃÃo aproximadamente igual na escala. Na Tabela 3, ao se comparar as aÃÃes da etapa do cuidado 2 entre os grupos, observa-se que o treinado obteve resultado excelente (p<0,05) em todos os itens avaliados. Portanto, houve associaÃÃo estatisticamente significante em todas as aÃÃes. Em relaÃÃo aos resultados obtidos pela Tabela 4, observam-se resultados excelentes (p<0,05) em oito dos nove itens avaliados do grupo treinado em relaÃÃo ao grupo nÃo-treinado na etapa do cuidado 3. Apenas o item referente a âseguir o roteiro da CEnfâ ficou prÃximo ao valor do teste, ressaltando que esta aÃÃo obteve forte indicador de associaÃÃo. Os dados da Tabela 5 mostraram tambÃm resultados excelentes (p<0,05) do grupo treinado em relaÃÃo ao grupo nÃo-treinado nas trÃs das quatro aÃÃes desenvolvidas na etapa do cuidado 4. Conforme se percebe na Tabela 6, todos os itens contribuem para a confiabilidade interna do Modelo de ComunicaÃÃo NÃo-Verbal Enfermeiro-Cego. Conclui-se com este trabalho a necessidade de implementaÃÃo prÃtica tanto por parte dos enfermeiros como dos estudantes de enfermagem deste Modelo de ComunicaÃÃo NÃo-Verbal com o paciente cego para tornar o cuidado efetivo e afetivo, especialmente com aqueles que necessitam compreender e serem compreendidos em sua vida cotidiana. Confirma-se a hipÃtese de que o Modelo de ComunicaÃÃo NÃo-Verbal Enfermeiro-Cego à eficaz na consulta de enfermagem a pacientes cegos. / The goal was to validate a non-verbal communication model for nursing care delivery to blind clients, based on the reference framework by E.T. Hall (1986). This methodological research was developed at the LabCom_SaÃde research lab of the Nursing Department at Cearà Federal University between October 2007 and June 2008. Fifteen blind people and 15 nurses were selected for each group, i.e. trained and non-trained, both with the same characteristics. The blind were contacted through the Cearà State Association of the Blind (ACEC) and the nurses through the Academic Centers (CAs). In the non-trained group, data were collected in April 2008 through consultations. These took place inside the LabCom_SaÃde and data were collected through movie recordings. The studies carried out about Hallâs theory (1986) represented the first step to construct the model. The nursing consultation was subdivided in four phases, which were called care phases. In each phase, orientations are given for the nurseâs actions and the action is described, as well as how this action should take place. Care phase 1 refers to the organization of the environment to develop the Nursing Consultation (CEnf). In care phase 2, the nurse should receive the patient at the entry of the consultation room to introduce him/her into the environment where the consultation will take place, greet the patient and inform where furniture and objects are located. Care phase 3 addresses the development of the CEnf itself. Care phase 4 constitutes the final phase of the non-verbal communication model and focuses on how to end the consultation and close off communication with the patient. After its construction, the Model was submitted to face and content validation. It was analyzed by three specialists in non-verbal communication specialists, a number already adopted in earlier studies. The suggestions included in the model referred to range, presentation form and content representativeness. Next, the second validation phase started, through which the model was tested. The nurses and blind people were trained in terms of the communication techniques that are important in the use of non-verbal communication as well as the use of the Model with blind people. Data were collected with the help of three film cameras that recorded the entire nursing consultation among the nurse, the blind and the companion, if present. To analyze the movie data, three other judges were chosen, who were nurses and students from the Graduate Nursing Program at Cearà Federal University, masterâs and doctoral level. They were trained on how to use to nurse-blind non-verbal communication analysis instrument (CONVENCE) and the model validation instrument. As this was a double-blind study, the judges were not informed about which group â control or experimental - they were analyzing. The collected data were inserted in an electronic worksheet, using SPSS software, version 14.0, and analyzed as absolute frequencies through univariate table. To analyze the association between the variables and the nurses in the control and experimental groups, the chi-square (&#967;2) test and the maximum likelihood estimation were used. Guidelines for research involving human beings were complied with, in accordance with Resolution 196/96 by the Brazilian Ministry of Health. The comparison between care phase 1 actions in the trained and non-trained group showed that the trained group obtained excellent results (p<0.0001) on four of the five items under analysis. The only exception was the âtemperatureâ item, with an approximately equal proportion on the scale. Table 3 shows that, when comparing care phase 2 actions between the groups, the trained group obtained an excellent result (p<0.05) on all items under evaluation. Hence, statistically significant associations were found for all actions. As to the results obtained in Table 4, excellent results are observed (p<0.05) on eight of the nine items assessed for the trained group in comparison with the non-trained group in care phase 3. Only the item related to âfollowing the CEnf scriptâ remained close to the test value, highlighting that this action obtained a strong association score. Data in Table 5 also showed excellent results (p<0.05) for the trained group in comparison with the non-trained group for three of the four actions developed in care phase 4. As observed in Table 6, all items contributed to the internal reliability of the Nurse-Blind Non-Verbal Communication Model. Through this research, it is concluded that nurses and even nursing students need to implement this Non-Verbal Communication Model with a view to effective and affective care, especially for patients who need to understand and be understood in their daily life. The hypothesis is confirmed that the Nurse-Blind Non-Verbal Communication Model is effective in nursing consultations with blind patients.

This phenomenological study describes the lived experience of pain inflicted in the context of medically prescribed treatment, explores the meanings of such pain for patients who endured it and for nurses whose actions contributed to its generation, and presents a thematic description of the phenomenon of clinically inflicted pain. The study is informed by phenomenology, both in terms of its premises and orientation, and its research design and method. The participants in the study were 14 adult patients, admitted to hospital following burn injuries, or receiving intravenous chemotherapy upon diagnosis of cancer, and 20 nurses involved in their care. Data collection took place over a period of five months and included participant observation and compilation of field notes, and a total of 89 tape-recorded interviews (48 with patients and 41 with nurses). Through the process of hermeneutic interpretation a number of themes were identified and used to describe the phenomenon of clinically inflicted pain and the structure of the lived experience of the patients and nurses concerned. The phenomenon of clinically inflicted pain is described in terms of four related themes: 1) the hurt and painfulness of inflicted pain; 2) handing one's body over to others; 3) the expectation and experience of being wounded, and 4) restraining the body and the voice. These themes point to the embodied nature of pain experience and the extent to which the person is involved not only in the enduring of pain but also in its generation. The broader lifeworld of clinically inflicted pain involves patients in the experience of constituting such pain, often as punishment and almost always as something unavoidable, and in turn being constituted by their experiences in terms of losing and seeking to regain a sense of embodied self and of personal situation, and by changed experiences of lived space and lived time. Nurses who themselves helped to generate pain, frequently overlooked the patient's lived exerience and thus the essential nature of inflicted pain as painful, wounding, and demanding cooperation and composure from the patient. Instead, the pain frequently became invisible to nurses involved in its infliction, or when it could not be overlooked or ignored, it was perceived as inevitable, non-harmful, and even as beneficial to patients' recovery. The strategic responses that nurses adopted to pain infliction included detachment from the perceived impact and consequences of their own actions and objectification of the person in pain as a body-object on whom certain tasks had to be performed. An alternative to the strategy of detachment and objectification was involvement in a therapeutic partnership between the nurse and the patient, where shared control over pain infliction and relief helped to sustain trust in the relationship and preserve personal integrity of the patient and the nurse. The study points to dangers for both patients and nurses when clinically inflicted pain is ignored, overlooked, or treated with detachment. It also points a way toward nursing practice that is guided by thoughtfulness and sensitivity to patients' lived experience, and awareness of freedom and responsibility inherent in nursing actions, including those involved in inflicting and relieving pain. The study raises questions about nurses' knowledge, attitudes, and actions in relation to clinically inflicted pain, and highlights the need for nursing education and practice to consider the contribution of a phenomenological perspective to the understanding of human experience of pain, and the nursing role in its generation, prevention, and relief.