[Truncated abstract] This PhD project was comprised of three major studies. Study 1 utilised the Nominal Group Technique (NGT) to identify a typology of difficult patients in private practice physiotherapy and to determine strategies physiotherapists use and would like to improve, when dealing with such patients. Physiotherapists (n=37) also shared their expectations of patients and their perceptions of patient expectations of physiotherapy. Results showed that the two areas most difficult to manage were behavioural problems of patients followed by patient expectations. To assist in their interaction with difficult patients, physiotherapists identified communication skills and behaviour modification techniques as strategies they would most like to learn. While physiotherapists expressed the greatest number of expectations in the behavioural domain, identification of patient expectations was not elicited as a strategy to manage difficult patients. Results of this qualitative study contribute to the evolving literature relating to physiotherapist-patient interactions and form a useful basis for educational programs directed at improving the therapeutic relationship in private practice physiotherapy. Study 2 involved applying the NGT with separate groups of patients (n=26) to identify patient expectations of the qualities of a ‘good’ physiotherapist, and to ascertain the characteristics of good and bad experiences in private practice physiotherapy. Findings indicated that the qualities of a ‘good’ physiotherapist related to their communication ability, professional behaviour and organisational ability, and characteristics of the service provided. The most important expectations of patients were for example, symptomatic relief, self-management strategies and ‘hands on’ treatment; associated with the physical domain. When comparing equivalent groups from Study 1, with patient expectations, most patient groups identified that the most important expectations of physiotherapists would relate to patient behaviours such as; compliance, honesty, payment of their account, being punctual, cooperating, trusting and showing respect for their physiotherapist. However, physiotherapists’ rankings of the most important expectations held by patients were not congruent with patient rankings providing an explanation as to why problems may arise in the physiotherapistpatient interaction from the patient’s perspective. Based on the findings of Study 2 it was suggested that physiotherapists should actively seek to involve patients in their management. To do this effectively, physiotherapists would benefit from further training in communication skills to ensure that they can successfully adopt a patientcentred approach and to optimise the physiotherapist-patient interaction in private practice physiotherapy.

Made available in DSpace on 2015-03-05T18:12:38Z (GMT). No. of bitstreams: 0 Previous issue date: 4 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / O presente estudo tem por objetivo descrever as trocas interacionais entre um médico e seus pacientes diagnosticados/as com diabetes. Em pacientes com essa doença, a aderência ao tratamento é fator importante, topicalizado em todas as consultas. Uma alta aderência auxilia o/a paciente a atingir bons níveis de controle da doença e, consequentemente, melhor qualidade de vida. Por isso, objetivamos averiguar de que forma as questões de aderência emergem nas interações. Para tanto, dados foram coletados em dois postos de saúde do SUS localizados na região metropolitana de Porto Alegre e foram analisados através das ferramentas da Análise da Conversa (SACKS, 1992). De acordo com essa metodologia, os dados devem direcionar o olhar da pesquisadora para o que for mais relevante e/ou recorrente de ser analisado. Dessa forma, percebeu-se que momentos de negociação entre o médico e os/as pacientes eram bastante recorrentes e que esses momentos estavam pautados sobre diferentes tópicos relacionados ao tratamento. As anál / This study aims at describing interactional exchanges between a doctor and his patients with diagnosis of diabetes. For patients who have this illness, the adherence to the treatment is an important factor, being a topic in every consultation. High adherence helps the patient to reach good levels of control of the illness and, consequently, have a better quality of life. Therefore, we investigate how issues of adherence emerge in interactions. To do so, data were collected in two public health care buildings located in the metropolitan region of Porto Alegre and where later analyzed through the tools of Conversation Analysis (SACKS, 1992). According to this methodology, the data directs the eye of the researcher to what is more relevant and/or recurrent to be analyzed. Thus, they pointed that moments of negotiation were rather recurrent among the doctor and the patients and it was evident that these moments addressed different topics related to the treatment. The analyses show that these negotiations emerge w

Le projet ANR ACORFORMed, dans lequel s’inscrit cette thèse, a pour objectif la création (par des informaticiens) d’un agent conversationnel animé « patient » comme outil de formation à l’annonce, par la simulation et à l’aide d’un environnement virtuel. A l’aide de la méthodologie issue des études de la gestuelle et des apports de la littérature sur l’organisation des interactions, nous tentons de répondre à la question suivante : quelle est l’organisation structurelle globale de l’interaction patient-médecin, lorsque ce dernier se forme à l’annonce d’un dommage associé aux soins ? Les analyses menées dans cette thèse nous permettent de décrire l’interaction patient/médecin lors de formations à l’annonce en proposant différentes phases composants l’interaction, ainsi que des précisions quant à leur découpage et leurs articulations. Elles constituent une base indispensable et utilisable par les informaticiens pour concevoir et implémenter un agent conversationnel « patient » crédible qui pourra être utilisé dans la formation des médecins. Située au coeur d’un projet interdisciplinaire, cette thèse en linguistique permet donc de transposer les pratiques interactionnelles des médecins en vue de l’implémentation d’un agent virtuel par des informaticiens. / The ACORFORMed ANR project, in which this PhD project is integrated, aims at the creation (by computer scientists) of a "patient" animated conversational agent as a training tool for announcing, simulating and using a virtual environment. Using the methodology resulting from gestures studies and contributions of the literature on the organisation of interactions, we try to answer the following question: what is the overall structural organisation of the doctor/patient interaction, when this last is training to break the news of a damage associated with care? The analyses carried out in this thesis allow us to describe the doctor/patient interaction during training to break the news by proposing different phases that make up the interaction, as well as details about their division and their articulations. They are an indispensable and usable base for computer scientists to design and implement a credible "patient" conversational agent that can be used in physician training. Located at the heart of an interdisciplinary project, this thesis in linguistics makes it possible to transpose the interactional practices of physicians with a view to the implementation of a virtual agent by computer scientists.

Telecare has been an approach to care that, internationally, has experienced a generally rapid development during the last ten years. There are many examples of successful pilot projects where ICT applications have been used in the care of elderly: for improved remote consultation with health professionals, to improve the communication and support of the elderly person’s social network, and as intelligent sensors intended to improve the safety of the elderly person. Despite these successes, implementation has been slow. This research project was set up to provide additional knowledge on some of the important questions regarding quality and implementation aspects of the use of ICT application on the care of frail elderly persons. The overall aim of the research project is to illuminate reasoning and experiences of using applications of telecare for frail elderly persons. The research project comprised five studies that were conducted using qualitative research methods. Four of them were carried out within the framework of three telecare projects. Different qualitative research approaches such as content analysis, phenomenological hermeneutics and conversational and discourse analysis were used, in accordance with the research questions of each study. The experiences revealed in the findings of the studies indicate that it is possible to have communication of good quality via videoconferencing with frail elderly persons, even those that have mild or mid-level dementia, provided the conditions are right. Technical limitations of the videoconferencing media in transferring communication cues and the limitations on what the camera can expose place special demands on those communicating with the frail elderly and on the general setting. On the other hand, these limitations on the context of interaction in some situations also seem to be an advantage for demented elderly persons and contribute to increased attention. One example of meaningful remote communication with frail elderly persons was family members’ videophone conversations with their demented relatives when they were placed in nursing homes or homes for respite services. This communication gave new possibilities of being involved in caring for, and of maintaining a relationship with, their demented relative. An introduction of teleconsultations in the care of frail elderly persons will, according to the experiences recorded, affect the professional role and the practical spheres of involved health professionals. The perceptions and experiences of participating health personnel indicate that in order for ICT applications to become valuable assets in the care of frail elderly persons they have to be part of a care alternative that is viewed by all concerned as the best alternative, as a whole, for all affected parties. Further research is needed in order to confirm or refute the findings of this thesis and in order to further broaden our understanding of the use of ICT applications in the care of frail elderly persons. This could facilitate a development of ICT applications suitable for the care of frail elderly persons and their introduction into regular care activities, to the benefit of both the frail elderly persons and their carers.

The presence of a device meant to enhance the medical encounter may alter the nature of the doctor-patient interaction in a way that affects patient satisfaction. The focus of this study was to examine the social impact of introducing advanced exam-room technologies to the doctor-patient interaction. By comparing cohorts (young: 18-39 and older: 62-89) we examined a possible age-related interaction. Participants viewed one of several video conditions portraying a physician conducting a medical interview in which he uses one of various documenting technologies (Nothing, Pen and Paper, PDA, Desktop Computer, Wearable Computer). After viewing the interaction, participants completed a series of questionnaires evaluating their general satisfaction with the quality of care (QoC) given during the medical interview. Patient satisfaction levels did significantly vary depending on the technology condition, participant cohort, and participant gender. Overall, young adults and females rated the doctor more favorably. The favorability of ratings for each technology condition depended on the aspect of QoC examined.

In this thesis research, we investigate the usability of hand-held display (Tablet PC) and wearable head-mounted display (Google Glass) interfaces and their effect on doctor-patient interaction during clinical ward round in the hospital. We looked at existing literature to identify existing research about our topic. Using a User Centered Interaction Design process we developed a prototype hybrid system that used both a hand-held and head-mounted display. An evaluation of this prototype with a hand-held system and a paper based interface was performed in a simulated patient room with 20 doctors and 5 patients. The participants were observed, surveyed, and interviewed about their experiences. Generally, the patients had a high satisfaction rate and felt the interfaces were not causing the doctors to lose focus on them. The doctors found the hand-held display by itself and existing paper-based interface to be the most usable and least distracting interfaces for accessing patient information during clinical ward rounds.

Bakgrund   Nära en miljard människor i världen hade år 2019 ett psykiatriskt tillstånd. Detta inkluderade psykiska sjukdomar där depressiva syndrom och ångestsyndrom var vanligast, medan schizofreni var minst vanligt. Psykisk ohälsa inklusive psykiska sjukdomar medför stora ekonomiska samhällskostnader såväl som individuellt lidande. Somatiska sjukdomar och i synnerhet hjärt- och kärlsjukdomar har hög prevalens hos personer med psykisk sjukdom. Dessutom är överdödligheten av naturliga orsaker hög för denna patientgrupp, som därtill är stigmatiserad i samhället. Därmed kan dessa personers upplevelse av den somatiska vården och bemötandet som är en betydande aspekt av vården anses angeläget att studera. Syfte  Syftet var att beskriva hur personer med psykisk sjukdom upplever bemötandet från hälso- och sjukvårdspersonal vid somatiska besvär. Metod  För att besvara syftet genomfördes en icke systematisk litteraturöversikt. Urvalet avgränsades till peer-reviewed vetenskapliga originalartiklar publicerade på engelska under de tio senaste åren. Datainsamlingen gjordes i databaserna PubMed, CINAHL, och PsycInfo. Femton artiklar inkluderades och kvalitetsgranskades. Artiklarnas resultat sammanställdes med en integrerad dataanalys. Resultat Resultatet sammanställdes under fyra kategorier. Den första kategorin Att inte bli tagen på allvar inkluderade att vårdpersonal misstolkade somatiska symtom som psykiska. Den andra kategorin var Att vilja vårdas med ett helhetsperspektiv, där det framkom upplevelser av ett bristande holistiskt synsätt. Den tredje kategorin var Att vilja involveras i sin vård, och den inkluderade upplevelser av bristande information, delaktighet och tillit. Den sista kategorin var Positiva och negativa attityder från vårdpersonal, som handlade om varierande upplevelser av vårdpersonalens attityder i bemötandet.  Slutsats Resultatet visade främst på upplevelser som hindrade, men även upplevelser som främjade god somatisk vård. De beskrivna upplevelserna kan bidra till förbättrat bemötande samt ökad förståelse för patientgruppens perspektiv. Det behövs ytterligare forskning om bemötande och kommunikationen mellan vårdpersonal och personer med psykisk sjukdom, samt hur förbättringar kan implementeras i vården. / Background Globally, nearly one billion people had a mental disorder in 2019. This included mental illnesses of which depressive and anxiety syndromes were most common, while schizophrenia was least common. Mental ill health including mental illnesses cause significant economic societal costs, as well as suffering for the affected individual. Somatic illnesses, especially cardiovascular diseases, have a high prevalence for people with mental illness. Additionally, the excess mortality from natural causes is high for these patients who are also subject to social stigmatization. Thus, these patients’ experiences of somatic care and the interaction with healthcare professionals, which is an important part of healthcare, can be seen as an important topic of study. Aim The aim was to describe how persons with mental illness experience the interaction with healthcare professionals when receiving care for somatic issues. Method A non systematic literature review was carried out to fulfill the aim of the study. The sample was limited to peer reviewed scientific original articles published in English during the previous ten years. Data collection was conducted in the databases PubMed, CINAHL, and PsycInfo. Fifteen articles were included and quality checked. The findings were compiled using an integrated data analysis. Results The results were presented under four categories. The first category Not being taken seriously included experiences of health professionals misinterpreting somatic symptoms as psychological. The second category was Wanting holistic care, which included experiences of lacking holistic care. The third category was Wanting to be included which included experiences of lacking information, participation in care, and trust. The last category was Positive and negative attitudes from health professionals which included experiences of varying attitudes from healthcare professionals. Conclusions The results mainly showed experiences that hindered, but also experiences that facilitated satisfactory somatic care. The experiences described have potential to contribute to improved interaction with and understanding of patients with mental illness. Additional research is needed on the topic of communication and interaction between healthcare professionals and persons with mental illness, as well as on how improvements can be implemented in healthcare.

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Made available in DSpace on 2016-04-28T18:23:27Z (GMT). No. of bitstreams: 1 Ana Maria Rodrigues Alves Kuninari.pdf: 417495 bytes, checksum: 65973ea976a576fe0053d8f3a0602375 (MD5) Previous issue date: 2006-11-27 / The present work aims to reflect on the doctor-patient interaction based on the analysis of the fictional text Domingo a Tarde, a novel by Fernando Namora, written from October 1959 and October 1960. Its action is passed at a public hospital of Lisbon. The purpose of this study is to verify how the utterances multivocal character is esthetically constituted through the narrator's verbal communication with himself, with his friends and with a specific patient, in situations that happen in several spaces and in different times, in the narrative context of the romance. The research is justified because the analyzed work, presenting a graphic literary reconstitution of the doctor-patient interaction, makes available some of the main aspects of this interaction, one to which we can only have access as doctor and/or patient, for the contract implied there in is a private one which no researcher can violate, neither directly nor by means of questionaries interviews and so on. The methodology consisted on the chapters' organization from the perspective of the relation between text and context, from the point of view of dialogical relations: the narrator's memory, the comment that reviews his past, the self-criticism, the metaspeech, from the one hand, and the plot itself, the history, from the other. As analytical category, the work uses reported speech, according to Bakhtin and his Circle: trought the narrator's voice, other voices are recovered through direct, indirect and free indirect speechs. One can perceive that the literary text that constitutes the corpus of the research can be understood as an esthetic representation of social dissymmetries in the doctorpatient interaction (in the social-cultural context and in the historical moment of Domingo à Tarde). Besides, in the literary language of this novel one sees represented the transformation of the professional's posture that humanizes herself - and suffers due to her incapacity of saving and/or to cure incurable sick people -, when evaluating the "other" be the "other" the doctor-narrator himself, that recognizes and identifies in and by the "others" glance, or the other doctors, the patient, the friends, or patients in general / Este trabalho tem o objetivo de refletir sobre a interação médico-paciente, a partir da análise do texto ficcional Domingo à tarde, romance de Fernando Namora, escrito entre outubro de 1959 e outubro de 1960, e ambientado em um hospital público de Lisboa. A finalidade deste estudo é verificar como vai se constituindo, esteticamente, o caráter multivocal dos enunciados, por meio da comunicação linguageira do narrador consigo mesmo, com seus colegas, e com uma paciente específica, em situações que ocorrem em vários espaços e em diferentes tempos, no contexto narrativo daquele romance. A pesquisa se justifica, porque a obra examinada, ao apresentar uma vívida reconstituição literária da complexidade da interação médicopaciente, torna acessíveis alguns importantes aspectos dessa interação a que não se pode ter acesso direto exceto na condição de paciente e/ou médico - dada a natureza sigilosa do contrato entre os participantes, que exclui a presença de um pesquisador, seja diretamente ou na forma de, por exemplo, questionários, entrevistas, etc. A metodologia consistiu na leitura do livro e para a análise mantivemos a sub-divisão em capítulos, utilizada por Namora, de modo a se estabelecer a relação texto/contexto, sob a perspectiva de relações dialógicas: a memória do narrador, o comentário que retoma o seu passado, a autocrítica, o metadiscurso, de um lado, e a própria trama, a história, de outro. Como categoria de análise, foi usado o conceito teórico de discurso relatado, segundo Bakhtin e seu Círculo: pela voz do narrador, outras vozes são recuperadas por meio de discurso direto, discurso indireto e discurso indireto livre. O comentário final é que o texto literário - corpus desta pesquisa, pode ser entendido como representação estética de dessimetrias sociais na interação médico-paciente (no contexto sócio-cultural e no momento histórico de Domingo à tarde). Além disso, na linguagem literária deste romance está representada a transformação de postura do profissional que se humaniza - e sofre por sua incapacidade de salvar e/ou curar, doentes incuráveis -, ao valorizar o outro (seja o outro o próprio médico-narrador, que se reconhece e se identifica no e pelo olhar do outro ; sejam os outros os médicos, a paciente, a colega, ou os doentes)

Bakgrund: Anestesisjuksköterskan skall kunna skapa en god individuell relation till sin patient i en miljö som är både högteknologisk och ofta långt utanför patientens normala omgivningar. I den perioperativa vården är mötet med patienten dessutom ofta kort och intensivt med många moment som pågår samtidigt, detta ställer därför höga krav på anestesisjuksköterskans kompetens i omvårdnadsarbetet. Syfte: att belysa vad som kännetecknar en god interaktion mellan patient och anestesisjuksköterska pre- och perioperativt. Metod: En systematisk litteraturstudie med kvalitativ ansats där resultaten analyserats med hjälp av manifest och latent innehållsanalys. Totalt analyserades 11 artiklar. Resultat: Analysen resulterade i temat se-lyssna-känn vilket byggde på de två kategorierna; mellanmänskliga faktorer och yttre faktorer. Dessa byggde i sin tur på åtta underkategorier; kommunikation, inom synhåll och räckhåll, förberedelse och personkännedom, delaktighet, ansvar, förtroende, ha tid och vårda i teknisk miljö. Slutsats: Anestesisjuksköterskan måste arbeta utifrån ett personcentrerat arbetssätt där vården anpassas efter varje unik patient. Detta görs genom att se sin patient och dennes behov, lyssna till dess önskemål och lära känna sin patients personlighet och önskemål. Det krävs dessutom att anestesisjuksköterskan kan se bortom den tekniska miljön hon befinner sig i och dela sin uppmärksamhet mellan de medicinska arbetsuppgifter hon har och interaktionen som patienten behöver för att känna sig bekräftad och trygg under den perioperativa vårdtiden. / Background: A nurse anesthetist has to be able to create a good individual relationship with their patient, in an environment that is both highly technological and often far beyond what the patient is used to. In the perioperative care, the meeting with the patient and the nurse is often short and intense, with a lot of things happening at once. This place high demands on the nurse´s competence in anesthetic caring. Purpose: To illustrate what characterizes a good interaction between patient and nurse anesthetist pre- and intraoperatively. Method: A systematic literature review with qualitative approach where the results were analyzed using manifest and latent content analysis. A total of 11 articles were analyzed. Results: The analysis resulted in the theme see-listen-feel, that was built upon the two categories interpersonal factors, inner factors and outer factors. These, in turn built on eight subcategories; communication, within sight and reach, preparation and personal knowledge, participation, responsibility, trust, having time and caring in a technological environment. Conclusion: The nurse anesthetist must work from a person-centered approach where the care is adapted to each unique patient. This is done by seeing the patient´s needs, listening to their wishes and getting to know their patient´s personality and desires. It also requires the nurse anesthetist to be able to see beyond the technological environment she is working in and share her attention between the medical tasks that has to be done and the interaction the patient needs to feel safe and confirmed during the perioperative period.