Orientador: Erotildes Maria Leal / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-23T11:15:02Z (GMT). No. of bitstreams: 1 Pereira_MarianaBarbosa_M.pdf: 1307849 bytes, checksum: 05a077e135913d36e1aa3121499be1b3 (MD5) Previous issue date: 2013 / Resumo: A reformulação e qualificação da assistência a indivíduos com transtornos mentais no Brasil, impulsionada pelo movimento da Reforma Psiquiátrica, pressupõe a centralidade e valorização das experiências singulares dessas pessoas para a compreensão do adoecimento. Partindo dessa premissa, o presente estudo procurou compreender um elemento da experiência de adoecimento da esquizofrenia - o Insight - a partir da perspectiva de pessoas com esse diagnóstico. A pesquisa teve como objetivo principal descrever e analisar os modos pelos quais os indivíduos narram a autopercepção acerca de sua experiência de adoecimento, e as estruturas de significado que organizam essa percepção. Utilizando referencial teórico-metodológico da fenomenologiahermenêutica, e como conceitos-chave Experiência de adoecimento (Illness) e Insight, foram analisadas narrativas de pessoas com diagnóstico de esquizofrenia em tratamento em um Centro de Atenção Psicossocial da cidade de Campinas. O procedimento metodológico consistiu nas seguintes etapas: leitura livre das narrativas; identificação de unidades de significado relativas ao Insight, de acordo com a concepção teórica adotada; condensação das unidades de significado em expressões concretas e concisas; agrupamento das unidades para formulação de categorias temáticas de significado. Foram identificadas quatro categorias temáticas que estruturaram as narrativas de Insight: Relações familiares/interpessoais; Espiritualidade/religiosidade/misticismo; Sensações; Efeitos/conseqüências do adoecimento e impacto do diagnóstico e tratamento. A análise dos resultados encontrados indicou que a autopercepção, ou Insight, em relação à experiência de adoecimento apresentou-se, nas narrativas analisadas, a partir da construção e atribuição de significados para o adoecimento, suas manifestações, conseqüências e necessidade de restituição / Abstract: The new arrangements and qualification of health care regarding individuals with mental problems in Brazil, animeted by the Psychiatric Reform movement, assume that their unique experiences have a central place in the process of understanding the disorder. In this way, the present study aimed to comprehend a specific element of illness experience of schizophrenia - Insight - by the perspective of individuals who had been given this diagnosis. The main purpose of this research was to describe and analyze the ways by which self-perception about the illness is narrated, as well as the meaning structures that organize the referred perception. Using the hermeneutical-phenomenology referential, and key concepts Illness experience and Insight, narratives of individuals with schizophrenia diagnoses that are in process of treatment in a public health service in the city of Campinas/SP were analyzed. The methodological procedure was consisted by the following steps: free reading of the narratives; identification of meaning units related to Insight, according to the theoretical framework adopted; condensation of the meaning units in concrete and concise expressions; gathering of units and formulation of thematic categories of meaning. Four thematic categories that organize Insight narratives were identified: Family and Interpersonal relationships; Spirituality/religion/mysticism; Sensations; Consequences/effects of the disorder and impact of diagnoses and treatment. Analysis of the results indicated that self-perception, or Insight, regarding illness experience of schizophrenia was presented, in the narratives studied, in terms of construction and attribution of meaning for the illness, its manifestations, consequences and need for restitution / Mestrado / Política, Planejamento e Gestão em Saúde / Mestra em Saúde Coletiva

Despite advances in health care over the past decades, medical errors and omissions remain significant threats to patient safety and health. A large number of these mistakes are made by trainees, persons who are just beginning to build the case-based experiences that will transform them from novices to expert practitioners. Clinicians use both intuitive and deductive problem-solving skills in caring for patients and they acquire expertise in applying these skills through interaction with many and varied cases. The contemporary heath care environment, with decreased lengths of stay for patients and reduced duty hours for trainees, makes getting optimal patient exposure difficult. Virtual patients (VPs), online, interactive patient cases, may help close the case exposure gap. Evidence has shown that VPs improve clinical reasoning skills, but no formal instructional design theory of VPs has been advanced. The goal was to conduct formative research to develop an instructional design theory of VPs to help novice clinicians cultivate clinical reasoning and diagnostic skills. The instructional design theory, goal-based scenarios (GBS), grounded in the learning theory, Case-based Reasoning, provided methods that promised to be appropriate to the goal. An existing, two-module, multimedia VP, Matt Lane, A Pressure Ulcer Prevention Virtual Patient, was tested with 10 medical trainees to determine which methods of GBS it incorporated and which of its methods were not part of GBS. Leaners' experience of what worked and didn't work to promote learning in the VP was analyzed. The VP was found to incorporate all GBS methods and one significant method, the Life Model, that was not part of GBS. The Life Model Method involved replicating, with a high degree of fidelity, the experiences of a real patient in creating the VP scenario. Recommendations for customization of GBS for VPs included more explicit advertisement of learning goals and leverage of Internet search engines to provide just-in-time resources to support problem-solving. Incorporation of the Life Model was also recommended along with the Simplifying Conditions Method from Elaboration Theory to manage the complexity inherent in the Life Model. The resultant, enhanced GBS theory may be particularly relevant in teaching patient-centered care.

abstract: Sensitive data sharing presents many challenges in case of unauthorized disclosures, including stigma and discrimination for patients with behavioral health conditions (BHCs). Sensitive information (e.g. mental health) warrants consent-based sharing to achieve integrated care. As many patients with BHCs receive cross-organizational behavioral and physical health care, data sharing can improve care quality, patient-provider experiences, outcomes, and reduce costs. Granularity in data sharing further allows for privacy satisfaction. Though the subjectivity in information patients consider sensitive and related sharing preferences are rarely investigated. Research, federal policies, and recommendations demand a better understanding of patient perspectives of data sensitivity and sharing. The goal of this research is to enhance the understanding of data sensitivity and related sharing preferences of patients with BHCs. The hypotheses are that 1) there is a diversity in medical record sensitivity and sharing preferences of patients with BHCs concerning the type of information, information recipients, and purpose of sharing; and 2) there is a mismatch between the existing sensitive data categories and the desires of patients with BHCs. A systematic literature review on methods assessing sensitivity perspectives showed a lack of methodologies for characterizing patient perceptions of sensitivity and assessing the variations in perceptions from clinical interpretations. Novel informatics approaches were proposed and applied using patients’ medical records to assess data sensitivity, sharing perspectives and comparing those with healthcare providers’ views. Findings showed variations in perceived sensitivity and sharing preferences. Patients’ sensitivity perspectives often varied from standard clinical interpretations. Comparison of patients’ and providers’ views on data sensitivity found differences in sensitivity perceptions of patients. Patients’ experiences (family history as genetic data), stigma towards category definitions or labels (drug “abuse”), and self-perceptions of information applicability (alcohol dependency) were influential factors in patients’ sensitivity determination. This clinical informatics research innovation introduces new methods using medical records to study data sensitivity and sharing. The outcomes of this research can guide the development of effective data sharing consent processes, education materials to inform patients and providers, granular technologies segmenting electronic health data, and policies and recommendations on sensitive data sharing. / Dissertation/Thesis / Doctoral Dissertation Biomedical Informatics 2020

Bakgrund: Hemodialys är en livslång behandling av njursvikt som är en allvarlig kronisk sjukdom. Hemodialyspatienter har frekventa möten med sjuksköterskor och utvecklar ofta en nära kontakt som kan sträcka sig över flera år. Sjuksköterskan behöver arbeta personcentrerat för att främja patienternas hälsa. Syfte: Syftet med studien var att belysa kroniskt njursjuka patienters upplevelser av att leva med hemodialys.Metod: Litteraturstudie med kvalitativ ansats. Olika sökblock byggdes upp baserade på forskningsfrågan och sökningar utfördes i databaserna CINAHL och PubMed. Efter att ha relevans- och kvalitetsgranskats befanns 12 artiklar vara relevanta för analys. Forsberg och Wengströms förenklade innehållsanalys användes för att analysera materialet.Resultat: Fem teman trädde fram: Tiden då, nu och framåt, Uppfattningen om jaget och kroppen, Relationer, Beroenden och begränsningar samt Förlust, acceptans och tacksamhet.Konklusion: Livet med hemodialys påverkar patienterna både socialt, mentalt och fysiskt. Patienterna upplevde sig begränsade, i beroendeposition och deras sociala relationer förändrades. Sjuksköterskan behöver finnas tillgänglig för patienten för att denne ska uppleva hälsa.Nyckelord: Hemodialys, mellanmänskliga relationer, patient, personcentrerad vård upplevelse. / Background: Hemodialysis is a lifelong treatment of chronic kidney failure - a severe and demanding disease. Patients going through hemodialysis have frequent interaction with nurses and often develop a personal relationship which can continue for several years. The nurse has to apply patient centered care to promote health for the patient.Aim: The aim of this study was to illuminate the lived experience of patients with chronic kidney failure receiving hemodialysis.Method: This study was conducted as a literature review with a qualitative approach. The database searches were conducted in CINAHL and PubMed. 12 articles passed the relevance- and quality review. A content analysis method of five steps was used to analyse the material.Result: Five themes emerged; The past, the now and the future, The perception of self and the body, Relationships, Dependency and limitations and Loss, acceptance and gratitude.Conclusion: Life on hemodialysis affects the patients both socially, mentally and physically. The patients felt restricted, in dependency and that their social relationships were changed. The nurse has to be there for the patient in order for the patient to experience healthKeywords: Experience, hemodialysis, human-to-human relationship, patient, patient centered care.

Bakgrund Sömn är ett mänskligt grundläggande behov och essentiellt för upplevd hälsa. Under sömnen sker kroppens fysiska och psykiska återhämtning. Inom slutenvård är det vanligt att patienter drabbas av sömnbrist och sjuksköterskans roll blir viktig för att hjälpa patienter till förbättrad sömn. Genom att sammanställa kunskap från patienters upplevelser av olika sömnrelaterade omvårdnadsåtgärder kan viktig kunskap för sjuksköterskans profession genereras. Syfte Syftet var att beskriva patienters upplevelse av omvårdnadsåtgärder vid sömn inom slutenvård. Metod Studien bestod av en icke-systematisk litteraturöversikt där artiklar inhämtats genom systematiska databassökningar i två databaser. Studiens resultat baseras på 17 vetenskapliga originalartiklar som analyserats utifrån Sophiahemmet Högskolas bedömningsunderlag för kvalitetsgranskning. Genom integrerad analys som vald metod för dataanalys presenterades resultatet översiktligt utifrån kategorier. Resultat I resultatet redovisades tre huvudkategorier med sju subkategorier. Inom slutenvård framkom det att icke-farmakologiska omvårdnadsåtgärder som dämpar ljud och ljus förbättrar sömnkvaliteten. Likväl även personcentrerade omvårdnadsåtgärder. Genom att lyssna på den enskilda och individanpassa sömnrelaterade omvårdnadsåtgärder kan en förbättrad sömnkvalitet inom slutenvården uppnås. Utifrån patienters upplevelser inom slutenvård är även upplevt välbefinnande av betydelse för sömnkvaliteten. Vidare betonades sjuksköterskans rutinmässiga omvårdnadsåtgärder. Från patienters upplevelser anses nattliga observationer/rutinkontroller försvåra en sammanhängande sömn. Därför är det viktigt att omvårdnadsåtgärder planeras tillsammans med patienten och därefter utförs med dennes kännedom och delaktighet. Slutsats Från den här litteraturstudien framkom det att det finns utmärkande sömnrelaterade omvårdnadsåtgärder som patienter gemensamt anser förbättra sömnen inom slutenvård trots att både sömnbehov och sömnrutiner har en stor individuell spridning. Genom att sjuksköterskan ser och tar del av patienters upplevelser av sömn inom slutenvård, kan en ökad medvetenhet och kunskap gällande vilka sömnrelaterade omvårdnadsåtgärder som patienter anser främja sömn leda till att de prioriteras. Därmed kan sjuksköterskan öka patienternas möjligheter till förbättrad sömnkvalitet inom slutenvården och bidra till ökat välmående och förbättrad hälsa. / Background Sleep is a basic human need and essential for perceived health. During sleep, physical and mental recovery takes place. It is common among inpatients to suffer from sleep deprivation and the nurse's role becomes important in helping patients improve sleep. By listening to inpatients' experience of sleep-related nursing interventions, important knowledge for the nurse's profession can be generated. Aim The aim was to describe patients' experience of nursing interventions regarding sleep in inpatient care. Method The study consisted of a non-systematic literature review. The results of the study are based on 17 original scientific articles, which have all been analyzed according to Sophiahemmet University's assessment basis for quality review. Through integrated analysis, results were presented in an overview based on main- and subcategories. Results The result reported three main categories with seven subcategories. In inpatient care, it was found that non-pharmacological nursing interventions that reduce sound and light improve sleep quality. Among the non-pharmacological nursing interventions was also personcentered care mentioned as helpful for inpatients sleep. From patients' experiences, it also clarified that experience well-being is important for the quality of sleep. Furthermore, the routine regarding nursing interventions were emphasized including that nocturnal observations were considered disturbing for coherent sleep and involving the patient in the planning of their care was mentioned as sleep-promoting. Conclusions From this literature study, it became evident that whilst both sleep needs and routines have a significant individual spread there are various sleep-related nursing interventions that patients unanimously consider as sleep-promoting. By listening to patients’ experiences of sleep in inpatient care, an increased knowledge regarding sleep-related interventions can be gained and interventions that promote sleep can be prioritized. With more knowledge, the nurse can increase patients' opportunities for improved sleep quality in inpatient care and contribute to increased well-being and improved health.

Patient-centredness and patient empowerment have been gaining importance in health policy and society already since the 1990s (Fumagalli et al. (2015), Castro et al. (2016)). For example, increasing patient empowerment has been one of the declared national health objectives in Germany since 2003 because patient orientation and participation provide important impulses for a demand-oriented and efficient design of healthcare systems and services (Bundesministerium für Gesundheit (2018)). A transition is taking place from an institution-based view of care provision to a more patient-based view that considers patients as co-managers of their individual care process and well-being (Kayser et al. (2019)). This transition also encompasses the developments towards integrated care1, i. e. a closer coordination between inpatient, outpatient and home care services, broadening the traditional focus from acute care to better integrate healthpromoting, preventive and post-treatment or palliative services as part of the whole continuum of care across sector boundaries (Minkman (2012), World Health Organization (2016), Expert Group on Health Systems Performance Assessment (2017)). These developments are particularly relevant for patients with long-term, chronic diseases or multimorbidities as their needs are often more complex and not exclusively medically determined (Smith and O’Dowd (2007), Hujala et al. (2016)).

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Bakgrund: Den svenska hälso- och sjukvården eftersträvar att arbeta personcentrerat. En del i att arbeta personcentrerat är att patienten ska få vara delaktig. Att arbeta med patientdelaktighet i hemsjukvården kan vara utmanande eftersom sjuksköterskan har regler och rutiner att följa. Om inte patientdelaktighet främjas riskerar det att patientens vård inte blir personcentrerad och därmed möter den kommunala hemsjukvården inte lagstadgade krav. Syfte: Att belysa sjuksköterskans erfarenheter av att främja patientdelaktighet för att uppnå en personcentrerad vård inom kommunal hemsjukvård. Metod: En kvalitativ intervjustudie med induktiv design valdes för att svara på studiens syfte. Datamaterialet inhämtades genom åtta semistrukturerade intervjuer med fem distriktssköterskor och tre sjuksköterskor. Datamaterialet analyserades inspirerat av Graneheim och Lundmans kvalitativa innehållsanalys.   Resultat: Analysen resulterade i två huvudkategorier och åtta underkategorier.  Sjuksköterskorna beskrev hur de arbetar för att bjuda in patienten i mötet, det gjordes genom att skapa och upprätthålla ett förtroende i mötet med patienten, lyssna in patienten, samarbeta med patienten, delge information, ge tid för patienten och att se patientens resurser. Sjuksköterskorna lyfte organisationens betydelse, hur de hade lagar och riktlinjer att följa och hur samverkan skedde både med och utan patienten. Slutsats: Patienten ska få tillåtas vara en aktiv medskapare i sin vård. Det finns en förbättringspotential för hur vården ska arbeta med patientdelaktighet för att möta lagstadgade krav. Det finns en otydlighet om vad patientdelaktighet innebär och sjuksköterskorna behöver vägledning och stöd från organisationen. / Background: The Swedish health service strives to work person-centered. Part of working person-centered is that the patient should participate. Working with patient participation in home care can be challenging because the nurse has rules and guidelines to follow. Unless patient participation is promoted, there is a risk that the patient's care will not become person-centred and thus the municipal home care does not meet legal requirements. Aim: To highlight the nurses experience in promoting patient participation in achieving person-centered care in municipal home care.  Method: A qualitative interview study with inductive design was chosen to answer the purpose of the study. The data was obtained through eight semi-structured interviews from five district nurses and three nurses. The data was analysed inspired by Graneheim and Lundman's qualitative content analysis.   Results: The analysis resulted in two main categories and eight subcategories. The nurses described how they work to invite the patient into the meeting, it was done by creating and maintaining a trust in the meeting with the patient, listening to the patient, collaborating with the patient, sharing information, giving time for the patient and seeing the patient's resources. The nurses emphasized the importance of the organization, how they had laws and guidelines to follow and how collaboration took place both with and without the patient. Conclusion: The patient should be allowed to be an active co-creator in their care. There is potential for improvement in how healthcare should work with patient participation to meet legal requirements. There is a lack of clarity about what patient participation means and nurses need guidance and support from the organisation.

Objectives: 1) To evaluate the impact of an interprofessional blended learning course on pharmacy and medical students’ communication skills; 2) To compare pre- and post-course communication skills across cohorts. Method: Pharmacy (N = 57) and medical (N = 67) students enrolled in a required Communication Skills for Health Professionals course completed asynchronous online modules and face-to-face standardized patient interview sessions over the course of 1 semester. Students completed pre- and post-course objective structured clinical examinations with standardized patients and were evaluated by trained faculty using the validated Common Ground Instrument. Communication skill domains evaluated on a 1 to 5 scale included: rapport building, agenda setting, information management, active listening, addressing feelings, and establishing common ground. Nonparametric statistical tests were used to examine paired pre-/post-course domain scores within professions and pre- and post-course scores across professions. Results: Performance in all communication skill domains increased significantly for pharmacy and medical students (p valuesImplications: The blended learning Communication Skills for Health Professionals course improved students’ interpersonal communication skills across multiple domains. Fostering communication skill development in medical and pharmacy students could improve the extent to which future health care professionals engage in patient-centered communication.

Sjuksköterskans professionella ansvar är att främja människors hälsa, förebygga sjukdom, återställa hälsa samt att lindra lidande, detta kan ske genom personcentrerad vård. Vid personcentrerad vård är det människan som är i behov av vård som ska sättas i centrum. Akutsjukvård innebär inte bara att ge kritiskt sjuka patienter snabb vård, den ska också vara individanpassad utifrån den patient som söker vård. Våld i nära relation är ett globalt problem som drabbar både kvinnor och män. Det kan ge konsekvenser genom det direkta fysiska traumat samt en rad följdsjukdomar som kan ha en mer psykisk påverkan på offrets livskvalité. För samhället kostar det stora summor årligen. Alla konsekvenser av våld i nära relation kan leda personen som blir utsatt för våld i nära relation till att uppsöka sjukvård, där sjuksköterskor på akutmottagningar har en möjlighet identifiera dessa patienter. Det finns flera kartlagda faktorer som påverkar detta, några är främjande och andra är barriärer som hindrar identifiering och personcentrerad vård.   Syftet med denna studie var att beskriva sjuksköterskors erfarenheter av faktorer som kan påverka mötet med patienter som utsatts för våld i nära relation.   Studien var en intervjustudie med kvalitativ ansats. Åtta intervjuer (inklusive en pilotintervju) genomfördes på akutmottagningar på tre sjukhus i Mellansverige med hjälp av semistrukturerade intervjuer. Rådata analyserades genom induktiv innehållsanalys.   Resultatet visade på faktorer som påverkade mötet med patienter som utsatts för våld i nära relation och delades upp i två kategorier “Sjuksköterskans upplevda arbetssituation” och “Sjuksköterskans kunskap”. Faktorerna var knutna till den specifika arbetsplatsen och den interprofessionella stöttningen från kollegor i situationer som behöver få ta tid. De handlade också om sjuksköterskans egna förvärvade kunskap och de upplevda brister på kunskap som fanns generellt inom akutkliniken kring att möta patienter som utsatts för våld i nära relation. Faktorerna kunde ses som goda förutsättningar för att ge personcentrerad vård samt barriärer mot personcentrerad vård till patienter som är utsatta för våld i nära relation.   De intervjuade sjuksköterskorna använde personcentrerad vård för att vårda patienter som utsatts för våld i nära relation. Det fanns en kunskapsbrist och det saknades fastslagna rutiner samt kunskap om befintliga rutiner för hur sjuksköterskan skulle och kunde agera i mötet med patienter som utsatts för våld i nära relation. Ofta saknades en tydlig förankring angående problematiken kring våld i nära relation hos klinikledningen. Samarbete både med kollegor, andra professioner och andra instanser var något som kunde vara både en barriär mot att ge personcentrerad vård men också en främjande faktor. / The nurses’ professional responsibility is to further people's health, prevent disease, reconstruct health and ease pain, this can be done through person centered care. In person- centered care it is the person in need of care that should be in the center. Emergency medical service means not only to give critically ill patients fast care, it should also be fitted to the individual seeking care. Intimate partner violence [IPV] is a global problem that affects both women and men. It can cause consequences though the direct physical trauma and a range of secondary diseases that can have a more psychological influence on the victim’s quality of life. To the society it causes high costs yearly. All the consequences of IPV can cause the person affected to seek health care, where nurses at the Emergency department [ED] have an opportunity to identify these patients. There are several charted factors that affect this, some are encouragement, and some are barriers that inhibits identification and person-centered care.   The aim of this study was to describe nurses experience of factors that can affect the meeting with patients subjected to intimate partner violence.   This study has a qualitative research design. Eight semi structured interviews were conducted at Emergency Departments at three hospitals in the middle of Sweden. The raw data was the analyzed with inductive content analysis.   The results showed factors that affected the meeting with patients subjected to IPV and was split into two categories “Work Environment” and “Knowledge”. The factors were connected to the specific workplace and the interprofessional support from colleagues in situations that needed to take time. They also dealt with the nurses own acquired knowledge and the perceived inadequacies that was generally in the ED about meeting patients subjected to IPV. The factors could be regarded as good pre-requisites to give person centered care and barriers against person centered care towards patients subjected to IPV.   The nurses that were interviewed used person-centered care to give care to patients subjected to IPV. There were a lack of education and a lack of established routines and knowledge about existing routines for how the nurse should and could act in meeting patients subjected to IPV. There were often lacking a clear establishment about the problematics surrounding IPV at the clinic management. Collaboration with both colleges, other professions and other authorities was something that could be both a barrier against giving person centered care but also an encouragement.