Made available in DSpace on 2017-06-01T18:08:54Z (GMT). No. of bitstreams: 1 margarida_maria_florencio_dantas.pdf: 490570 bytes, checksum: b1f4c5661387baa4bc4812793bd76819 (MD5) Previous issue date: 2015-01-28 / The present work brings a reflection about the deal with the imminence of death before an illness, in the perspective of the people who chose the form of palliation treatment. To that end, the objective of this research is to understand how a subject seriously ill, without possibility of cure, palliation, experiencía as a possibility to experience their illness. Thus, the study focuses on the meanings assigned to palliation, the process of choosing this treatment and the impact of this choice. Five subjects who were interviewed opted for palliation for treatment before a diagnosis of impossibility of curing their illnesses. For the production of research data, the researcher's observations were recorded in a field journal and listening to the sick subjects, through a semidirected interview recorded and transcribed verbatim. The analysis of the narratives and this journal came from a descriptive analysis of inspiration s Foucault. With respect to the results, it is possible to say that every guy who chose the alleviation, made before the established clinical picture. Thus, they occupied with you, look at you, for your needs, expectations, making alleviation a lifestyle. These patients considered the conscience of his finitude, amid the management of death by the health team, and constituted as subject of their actions, considering its priorities: family, work, leisure and quality of life. What made them deal safely and securely with the impacts of this choice, the negation of the relatives towards her, for example. Given this, it is concluded that despite a health team management in favor of palliation, seeing her as the good death, it is possible the subject ill make this choice from its own mode of subjects to subjetive before falling ill, which makes this choice have a singular meaning, particularly, to the guy who considers. / O presente trabalho traz uma reflexão a respeito do lidar com a iminência da morte diante de um adoecimento, na perspectiva das pessoas que escolheram a paliação como forma de tratamento. Para tanto, o objetivo desta pesquisa é a compreensão de como um sujeito gravemente doente, sem possibilidade de cura, experiencía a paliação, como possibilidade de vivenciar sua enfermidade. Assim, o estudo focaliza os sentidos atribuídos à paliação, o processo de escolha deste tratamento e os impactos desta escolha. Foram entrevistados cinco sujeitos que optaram pela paliação como modo de tratamento diante de um diagnóstico de impossibilidade de cura de suas doenças. Para a produção dos dados da pesquisa, foram utilizadas as observações da pesquisadora registradas em um Diário de Campo e a escuta dos sujeitos doentes, através de uma entrevista semidirigida gravada e transcrita literalmente. A análise das narrativas e deste diário se deu a partir de uma análise descritiva de inspiração foucaultiana. Com relação aos resultados, é possível dizer que cada sujeito que escolheu a paliação, o fez diante do quadro clínico estabelecido. Assim, eles se ocuparam consigo, olharam para si, para suas necessidades, expectativas, fazendo da paliação um estilo de vida. Estes pacientes consideraram a consciência de sua finitude, em meio ao gerenciamento da morte pela equipe de saúde, e se constituíram como sujeito de seus atos, considerando suas prioridades: a família, o trabalho, o lazer e a qualidade de vida. O que os fez lidar com segurança e firmeza com os impactos desta escolha, a negação dos familiares com relação a ela, por exemplo. Diante disso, conclui-se que apesar de um gerenciamento da equipe de saúde em favor da paliação, vendo-a como a boa morte, é possível o sujeito doente realizar esta escolha a partir do seu modo próprio de subjetivar-se diante do adoecer, o que faz esta escolha ter um significado singular, particular, para o sujeito que a considera.

This project addressed the continuing education needs of nursing staff and other health care professionals for delivering competent and compassionate palliative or end of life care. The scope of the project included, writing a grant application, training and certification by the end of life Nursing Education Consortium and implementing an education program for staff at the Loma Linda Veterans Affairs medical center.

Introduction: Rustenburg is a fast growing city in the world. This growth influences establishment of new faith based churches which is, in many respects at the expense of mission churches. The HIV/AIDS pandemic and diseases related to stresses results in movement of Christians from one church to the other. Christians are vulnerable when facing life stressors which results into changing allegiance to a particular church. This is a qualitative descriptive/ exploratory study Method: The researcher purposely selected respondents from the black Christian community of Rustenburg. These are those Christians who have moved from one church to join another .From these interviews the themes that emanate are discussed. Leaders of prominent churches were also interviewed . Findings: The qualities of church leaders have an influence on the movement of its members. The media, especially the local radio station has been widely used to attract new members. The availability of a pastor in times of need plays a vital role. Power struggles seem to disappoint some loyal Christians who may reluctantly leave the church. Financial benefits also play an important role in attracting membership. The faith based churches have grown both in numbers and in membership. Women with their healing power are active especially in the Zion churches. The help seeking behaviour of Christians also influences their affiliation to a particular church such as seeking / Christian Spirituality, Church History and Missiology / M. Th. (Missiology)

No description available.

Title: Exploring the lived experiences of nurses caring for the terminally ill patients with AIDS in selected wards in a level one district hospital. Aim: The purpose of this study was to explore and describe the experiences of nurses caring for dying patients with AIDS in the context of palliative care. Methodology: The study explored the meaning of caring and terminal illness and the lived experiences of nurses in the context of AIDS in palliative care. A constructivist paradigm underpinned this study. A qualitative research approach was used and Giorgi’s five steps of analysis were aligned to the Husserlian phenomenology method to make sense of the data. Individual in-depth interviews were conducted with ten of the operational nurses who were caring for patients suffering from AIDS in the palliative care wards of a level one state-aided district hospital. These included professional nurses, enrolled nurses and enrolled nursing assistants. The interviews were audio-taped. Findings: The findings of the study were presented and discussed according to the two categories that emerged during the data analysis, namely, conceptualization of the core concepts of caring and terminal illness and the experiences of caring in the context of palliative care. Each of these categories had themes and sub-themes that were presented and discussed. The conceptualization of the core terms influenced the nurses’ actions, behaviors and opinions as they described their experiences of taking care of terminally ill patients who suffered from AIDS. The nurses’ lived experiences were conceptualized into three main themes: the social networking that enabled the nurses to collaborate with colleagues in the interdisciplinary teams and share knowledge, skills and support within the palliative care team to optimize patient outcomes; factors hindering the nurses abilities to provide quality care to their patients and the internal and external mechanisms that enabled the nurses to provide care within palliative care contexts despite the encountered challenges. Conclusion: Nurses are exposed to increasing work-load in the context of HIV/AIDS, particularly in the care of terminally ill patients suffering from AIDS as they deal with complex emotional aspects of the diseases. Routine exposure to suffering and death accustom the nurses to dealing with death, resulting in situations where they display lack of care and respect for the terminal patients. Therefore, the antecedents that alter the nurses’ level of caring augmented by the emotionally taxing contexts are an agenda that needs to be addressed in order to achieve emotional work through improved nurse-patient relationships. / Thesis (M.N.)-University of KwaZulu-Natal, Durban, 2012.

Introduction: Rustenburg is a fast growing city in the world. This growth influences establishment of new faith based churches which is, in many respects at the expense of mission churches. The HIV/AIDS pandemic and diseases related to stresses results in movement of Christians from one church to the other. Christians are vulnerable when facing life stressors which results into changing allegiance to a particular church. This is a qualitative descriptive/ exploratory study Method: The researcher purposely selected respondents from the black Christian community of Rustenburg. These are those Christians who have moved from one church to join another .From these interviews the themes that emanate are discussed. Leaders of prominent churches were also interviewed . Findings: The qualities of church leaders have an influence on the movement of its members. The media, especially the local radio station has been widely used to attract new members. The availability of a pastor in times of need plays a vital role. Power struggles seem to disappoint some loyal Christians who may reluctantly leave the church. Financial benefits also play an important role in attracting membership. The faith based churches have grown both in numbers and in membership. Women with their healing power are active especially in the Zion churches. The help seeking behaviour of Christians also influences their affiliation to a particular church such as seeking / Christian Spirituality, Church History and Missiology / M. Th. (Missiology)

Com o avanço dos recursos científico-tecnológicos da medicina, a expectativa de vida vem crescendo de forma substancial nas últimas décadas. Doenças, que no passado eram letais, são hoje passíveis de tratamento. Enfermidades que não apresentavam perspectiva de cura tiveram seu curso e evolução alterados assegurando um aumento na sobrevida dos pacientes. A busca pelo prolongamento e manutenção da vida ao longo dos tempos, foi se configurando como esforços de distanciamento e negação da morte, por vezes, através de tratamentos obstinados e fúteis. A ampliação da quantidade de vida passou a ocupar lugar privilegiado na assistência. Diante do aumento de pacientes gravemente enfermos ou fora de possibilidade terapêutica, os embates da comunidade científica acerca da qualidade de vida se voltam para a necessidade de integração de outras dimensões do cuidado ao paciente inserido em programas de cuidados paliativos, além do foco estritamente físico e biomédico. Nesse sentido, a espiritualidade vem sendo apontada como importante aspecto da dimensão existencial, causadora de grandes impactos na saúde física, sobretudo, em doentes no final da vida. Este trabalho tem por objetivo compreender a clínica psicológica e a experiência da espiritualidade de pacientes inseridos em programa de cuidados paliativos em hospital público da cidade do Recife através de pesquisa qualitativa, com recorte de amostra intencional devido às especificidades do tema. Buscou apresentar os princípios dos cuidados paliativos apontando o manejo da equipe de saúde ao paciente fora de possibilidade terapêutica de cura; identificar as reflexões apresentadas pela Psicologia entre a prática psicológica e a experiência de espiritualidade; apresentar contribuições que possibilitem reflexão no cuidado integral oferecido ao paciente gravemente enfermo, tendo em vista a oferta de melhor qualidade de vida / With the advancement of scientific technological resources of medicine, life expectancy has increased substantially in recent decades. Diseases that were once fatal are now treatable. Diseases that had no prospect of cure had changed its course and development ensuring an increase in patient survival. The search for the extension and maintenance of life over time, it was shaping up as efforts of distancing and denial of death, sometimes through obstinate and futile treatments. The expansion of the quantity of life has come to occupy a privileged place on the tour. Given the increase in critically ill patients or out of therapeutic possibilities, the struggles of the scientific community about the quality of life turn to the need to integrate other dimensions of patient care inserted in palliative care programs, and focus strictly physical and biomedical. In this sense, spirituality has been identified as an important aspect of existential dimension, causing great impacts on physical health, especially in patients at the end of life. This work aims to understand the psychological clinic and experience the spirituality of patients enrolled in palliative care program at a public hospital in Recife through qualitative research, purposeful sampling clipping due to the specific theme. Sought to present the principles of palliative care by pointing the management of the health team to the patient without therapeutic possibility of cure; identify the comments made by the practice of psychology and the psychological experience of spirituality; present contributions that enable reflection in the comprehensive care offered to patients seriously patient, in order to offer a better quality of life

Made available in DSpace on 2017-06-01T18:08:41Z (GMT). No. of bitstreams: 1 dissertacao_Waleska_Medeiros.pdf: 1453485 bytes, checksum: 4cc5ac8b2be5d64bac1fa8bc60dfe416 (MD5) Previous issue date: 2012-03-21 / With the advancement of scientific technological resources of medicine, life expectancy has increased substantially in recent decades. Diseases that were once fatal are now treatable. Diseases that had no prospect of cure had changed its course and development ensuring an increase in patient survival. The search for the extension and maintenance of life over time, it was shaping up as efforts of distancing and denial of death, sometimes through obstinate and futile treatments. The expansion of the quantity of life has come to occupy a privileged place on the tour. Given the increase in critically ill patients or out of therapeutic possibilities, the struggles of the scientific community about the quality of life turn to the need to integrate other dimensions of patient care inserted in palliative care programs, and focus strictly physical and biomedical. In this sense, spirituality has been identified as an important aspect of existential dimension, causing great impacts on physical health, especially in patients at the end of life. This work aims to understand the psychological clinic and experience the spirituality of patients enrolled in palliative care program at a public hospital in Recife through qualitative research, purposeful sampling clipping due to the specific theme. Sought to present the principles of palliative care by pointing the management of the health team to the patient without therapeutic possibility of cure; identify the comments made by the practice of psychology and the psychological experience of spirituality; present contributions that enable reflection in the comprehensive care offered to patients seriously patient, in order to offer a better quality of life / Com o avanço dos recursos científico-tecnológicos da medicina, a expectativa de vida vem crescendo de forma substancial nas últimas décadas. Doenças, que no passado eram letais, são hoje passíveis de tratamento. Enfermidades que não apresentavam perspectiva de cura tiveram seu curso e evolução alterados assegurando um aumento na sobrevida dos pacientes. A busca pelo prolongamento e manutenção da vida ao longo dos tempos, foi se configurando como esforços de distanciamento e negação da morte, por vezes, através de tratamentos obstinados e fúteis. A ampliação da quantidade de vida passou a ocupar lugar privilegiado na assistência. Diante do aumento de pacientes gravemente enfermos ou fora de possibilidade terapêutica, os embates da comunidade científica acerca da qualidade de vida se voltam para a necessidade de integração de outras dimensões do cuidado ao paciente inserido em programas de cuidados paliativos, além do foco estritamente físico e biomédico. Nesse sentido, a espiritualidade vem sendo apontada como importante aspecto da dimensão existencial, causadora de grandes impactos na saúde física, sobretudo, em doentes no final da vida. Este trabalho tem por objetivo compreender a clínica psicológica e a experiência da espiritualidade de pacientes inseridos em programa de cuidados paliativos em hospital público da cidade do Recife através de pesquisa qualitativa, com recorte de amostra intencional devido às especificidades do tema. Buscou apresentar os princípios dos cuidados paliativos apontando o manejo da equipe de saúde ao paciente fora de possibilidade terapêutica de cura; identificar as reflexões apresentadas pela Psicologia entre a prática psicológica e a experiência de espiritualidade; apresentar contribuições que possibilitem reflexão no cuidado integral oferecido ao paciente gravemente enfermo, tendo em vista a oferta de melhor qualidade de vida

The marginalisation of palliative and pastoral care practices by conventional approaches to care for terminally ill patients, motivated the research curiosity. The significance of terminal patient's spirituality, their language practices and communities of concern are endorsed as being the major contributing factor to meaningful 'living' with terminal illness. Listening to stories has been the qualitative research practice, revealing meaning-making, quest stories. Feminist theology and post-modern ideas and discourses have assisted me, and the participants, in the deconstruction of power, patriarchy and dualism as the primary contributing factors to marginalisation of people due to illness, race, gender, poverty, culture and education. Pastoral care practices and feminist theology have guided us to emphasise the necessity to recognise the God of Grace as an important part to ensuring holistic patient care. Recognising the 'God-Self, respectful narrative and pastoral care practices paved the way to honour sacred spaces and voice stories of terminal illness. / Practical Theology / M.Th (Specialisation Pastoral Therapy)

Introdução: A maioria dos pacientes acometidos pela neoplasia que envolve a confluência biliopancreática é diagnosticada em fase avançada. A Colangiopancreatografia Retrógrada Endoscópica (CPRE) é o método de escolha para a drenagem da via biliar obstruída. Todavia, existe um índice de insucesso em torno de 10%. Nesses casos, técnicas alternativas serão aplicadas, como drenagem percutânea trans-hepática e drenagens cirúrgicas. Objetivo: Avaliar o sucesso técnico, clínico, qualidade de vida e sobrevida da drenagem biliar pela cirurgia convencional e técnica endoscópica ecoguiada em pacientes portadores de neoplasia maligna da confluência biliopancreática. Método: No período de abril de 2010 a setembro de 2013, foram estudados 32 pacientes portadores de neoplasia maligna da confluência biliopancreática. Todos os que foram incluídos nesse estudo apresentaram falha na drenagem biliar por CPRE. Três deles foram excluídos por insucesso técnico (falha na confecção da anastomose hepaticojejunal e da formação da fístula coledocoduodenal ecoguiada). O Grupo I foi formado por 15 pacientes submetidos à Hepaticojejunostomia (HJT) em \"Y\" de Roux e derivação gastrojejunal. O Grupo II foi formado por 14 pacientes submetidos à coledocoduodenostomia ecoguiada (CDT). O sucesso clínico foi avaliado pela queda da bilirrubina sérica total em mais de 50% nos sete primeiros dias após o procedimento. A qualidade de vida foi avaliada pelo questionário SF-36 e a sobrevida pela curva de Kaplan-Meier. Resultados: O sucesso técnico foi de 93,75% (15/16) no Grupo I e de 87,5% (14/16) no Grupo II (p = 0,598). O sucesso clínico ocorreu em 14 (93,33%) pacientes pertencentes ao Grupo I e em 10 (71,43%) do Grupo II. Não houve diferença estatisticamente significativa (p = 0,169). O comportamento médio dos escores de qualidade de vida foi estatisticamente igual entre as técnicas ao longo do seguimento (p > 0,05 Técnica * Momento). Houve alteração média estatisticamente significativa ao longo do seguimento nos escores de capacidade funcional, saúde física, dor, aspectos sociais, aspectos emocionais e saúde mental em ambas as técnicas (p < 0,05). O escore de saúde mental foi, em média, estatisticamente maior nos do Grupo II (CDT) em todos os momentos (p = 0,035). O tempo médio de sobrevida daqueles pertencentes ao Grupo I foi de 82,27 dias e os do Grupo II, de 82,36 dias. Sessenta por cento dos pertencentes ao Grupo I faleceram até 90 dias após o procedimento cirúrgico. Por outro lado, 42,9% dos submetidos à CDT faleceram no mesmo período. Não houve diferença estatisticamente significativa no tempo de sobrevida entre os Grupos (p = 0,389). Conclusão: Os dados relacionados aos sucessos técnico, clínico, qualidade de vida e sobrevida foram semelhantes em ambos os grupos, não se verificando diferença estatisticamente significativa / Introduction: Most patients with neoplasm in the biliopancreatic junction are diagnosed at an advanced stage. Endoscopic retrograde cholangiopancreatography (ERCP) is the method of choice for drainage of obstructed biliary tract. However, there is a failure rate of about 10%. In such cases, alternative techniques, such as, percutaneous transhepatic drainage and surgical drainage are applied. Aim: To evaluate the technical and clinical success, quality of life and patient survival of biliary drainage by conventional surgery and endosonography-guided technique in patients with malignant neoplasm of the biliopancreatic junction. Methodology: From April 2010 to September 2013, 32 patients with malignant neoplasm of the biliopancreatic junction were studied. All patients included in this study had failed biliary drainage by ERCP. Three patients were excluded due to technical failure (failure in the construction of hepatico-jejuno anastomosis and formation of endosonography-guided choledochoduodenal fistula). Group I comprised of 15 patients who underwent Roux-en-Y hepaticojejunostomy (HJT) and gastrojejunal bypass. Group II consisted of 14 patients who underwent endosonography-guided choledochoduodenostomy (CDT). Clinical success was assessed by the decrease of more than 50% in total serum bilirubin in the first seven days after the procedure. Quality of life was assessed by SF-36 questionnaire and survival by Kaplan-Meier curve. Results: Technical success rate was 93.75% (15/16) in group I and 87.5% (14/16) in group II (p = 0.598). Clinical success occurred in 14 (93.33%) patients in group I and 10 (71.43%) patients in group II. There was no significant statistically difference (p = 0.169). The average quality of life score were statistically equal between the techniques during follow-up (p > 0.05 * Technical Moment). There were statistically significant mean changes during follow-up of functional capacity score, physical health, pain, social functioning, emotional and mental health aspects in both techniques (p < 0.05). The mental health score was, on average, statistically higher in group II (CDT) at all times (p = 0.035). The median survival time of patients in group I was 82.27 days and Group II patients was 82.36 days. Sixty percent of patients in group I died within 90 days after the surgical procedure. On the other hand, 42.9% of the patients who underwent CDT died in the same period. There was no statistically significant difference in survival time between the groups (p = 0.389). Conclusion: Data relating to technical and clinical success, quality of life and survival were similar in both groups and there were no statistically significant differences