Made available in DSpace on 2014-07-29T15:29:09Z (GMT). No. of bitstreams: 1 dissertacao neuma chaveiro.pdf: 649444 bytes, checksum: d3750880f000a36831603adf63db4ea9 (MD5) Previous issue date: 2007-09-12 / This dissertation was built in the modality scientific article and it has three articles: the first and second ones of systematic revision of literature about the theme of the study and the third article consist of the experimental part of the dissertation. The first article, accepted in Revista da Escola de Enfermagem da USP, has as title Literature Revision about the attendance of the deaf patient by health professionals, with emphasis on the communication between deaf patient and health professional. In the second one, accepted to publish in Revista Brasileira de Otorrinolaringologia and entitled Relation between deaf patient and the doctor, the legal and sociocultural aspects of the relation between deaf patient and the doctor were presented. The third article, submitted to Revista de Saúde Pública, with the title Meeting of deaf patient who uses sign language with health professionals, has as content the object of this dissertation and has as purpose to evaluate the meeting of the deaf patient who use sign language with health. It was developed in a qualitative approach, of descriptive-analytical nature. Eleven deaf people, who use the Brazilian Sign Language to communicate, including 8 males and 3 females, with ages between 19 and 36 years old, had participated of the research. For data collection a half-structured interview was used and it had questions that approach the expectations of the death person about the meeting with health professionals, the means of communication used, the presence of a Brazilian Sign Language interpreter as a mediator and what the person judges necessary to favor a good relation. The data were organized using the content analysis, proposed by Bardin, that allowed to identify three categories: Established Communication, Interpreter Presence and Lack of Autonomy. In the first category, two sub-categories had been distinguished: facilities and difficulties. As facilitator the visual resources stood out and as difficulties inefficiency in the communication, even reaching the extreme of feeling hindered to search assistance. Other difficulties were the written language and non capable professionals to attend. The category Interpreter Presence presents as eminence the complexity of this mediator. In some moments his presence is valued, while in others it turned to a barrier. In Lack of Autonomy, it was verified that their rights haven t been respected and they stay apart from the decisions taken mainly by the family. It followed that deaf patients face a lot of barriers in the meeting with health professional, since the appointment, the moment of the meeting, until the decurrent unfoldings. And in many stories it was verified that they can t solve their problems and they can t comprehend the reason of the attitudes taken by professionals, so they feel excluded and not respected in their autonomy. So an effective participation of the deaf patient in clinical meetings requires special attention from the health professionals. / Dissertação construída na modalidade artigos científicos e consta de três artigos, sendo o primeiro e o segundo de revisão sistemática da literatura sobre o tema do estudo e o terceiro tem por conteúdo a parte experimental da dissertação. O primeiro artigo, aceito pela Revista da Escola de Enfermagem da USP tem como título: Revisão de literatura sobre o atendimento ao paciente surdo pelos profissionais da saúde com ênfase na comunicação entre paciente surdo e profissional da saúde. No segundo, aceito pela Revista Brasileira de Otorrinolaringologia, intitulado Relação do paciente surdo com o médico, foram abordados os aspectos legais e socioculturais da relação do paciente surdo com o médico. O terceiro, submetido à Revista de Saúde Pública, com o título Encontro do paciente surdo que usa língua de sinais com os profissionais da saúde, que tem por conteúdo o objeto desta dissertação, cujo objetivo foi analisar o encontro entre pacientes surdos que utilizam a língua de sinais e os profissionais da saúde. Desenvolvido numa abordagem qualitativa de natureza descritivo-exploratória. Participaram 11 pessoas surdas, que utilizam a Língua Brasileira de Sinais para se comunicar, sendo 8 do sexo masculino e 3 do sexo feminino, com idades entre 19 e 36 anos. Para a coleta de dados foi utilizada uma entrevista semi-estruturada, contendo questões que abrangiam as expectativas da pessoa surda quanto ao encontro com os profissionais da saúde, os meios de comunicação utilizados, a presença de um intérprete da Língua Brasileira de Sinais como mediador da relaçao e o que julga necessário para favorecer uma boa relação. Os dados foram organizados utilizando a técnica de análise de conteúdo, proposta por Bardin, que permitiu identificar três categorias: Comunicação Estabelecida, Presença do Intérprete e Falta de Autonomia. Na primeira categoria destacaram-se duas subcategorias: facilidades e dificuldades. Como facilitador sugiram os recursos visuais e, como dificultador, ineficiência na comunicação, podendo chegar ao extremo de sentirem-se impedidos de buscar assistência. Outras dificuldades apontadas foram a língua escrita e profissionais não capacitados para atendê-los. A categoria Presença do Intérprete apresentou como destaque a complexidade deste mediador. Em alguns momentos sua presença é valorizada, enquanto, em outros, torna-se uma barreira. Na Falta de Autonomia, verificou-se que os direitos dos pacientes surdos não estão sendo respeitados, ficando à parte nas decisões tomadas principalmente pela família. Concluiu-se que os pacientes surdos deparam-se com muitas barreiras no encontro com profissionais da saúde, desde o agendamento, o momento do encontro, até os desdobramentos decorrentes e, em muitos relatos verificou-se que eles não conseguem resolver seus problemas, não compreendem o porquê das atitudes tomadas pelos profissionais, sentindo-se excluídos, não respeitados em sua autonomia. Portanto, a participação efetiva dos pacientes surdos nos encontros clínicos necessita especial atenção por parte dos profissionais da saúde.

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Luk, Pik Shan Yvonne. / Thesis (M.Phil.)--Chinese University of Hong Kong, 2007. / Includes bibliographical references (leaves 134-146). / Abstracts in English and Chinese ; some text in appendix also in Chinese. / Abstract (English version) --- p.ii-iii / Abstract (Chinese version) --- p.iv / Acknowledgement --- p.v / List of Table --- p.vi / Appendices --- p.vii / Chapter 1 --- Introduction --- p.1-5 / Chapter 2 --- Literature Review / Introduction --- p.6-7 / Psychological Distress --- p.7-13 / Health-related Quality of Life --- p.13-25 / Marital Relationship --- p.26-31 / Summary --- p.31-34 / Chapter 3 --- Aims & Methodology / Aims & Objectives --- p.35-37 / Operational Definition --- p.37-38 / Research Design --- p.38-39 / Setting & Sample --- p.39-40 / Instrument / Psychological Distress --- p.41-43 / Health-related Quality of Life --- p.43.44 / Marital Relationship --- p.44-46 / Demographic Data --- p.47 / Data Collection Procedure --- p.4748 / Ethical Consideration --- p.48-50 / Data Analysis --- p.50-51 / Pilot Study --- p.51-52 / Chapter 4 --- Findings / Introduction --- p.53-54 / Sociodemographic Characteristics --- p.54-56 / Psychological Distress --- p.57-58 / Health-related Quality of Life --- p.59-61 / Marital Relationship --- p.62-65 / Normality of the Outcome Variables --- p.65-66 / Relationships between the Study Outcomes and Sociodemographic Data --- p.66-68 / "Relationships between Anxiety, Depression, Health-Related Quality of Life and Marital Relationship" --- p.68-76 / Summary --- p.16-78 / Chapter 5 --- Discussion / Introduction --- p.79 / Socio-demographic and Clinical Characteristics of CAPD patients --- p.79-84 / Psychological Distress of CAPD Patients --- p.84-85 / Components of Psychological Distress: Anxiety --- p.85-86 / Components of Psychological Distress: Depression --- p.86-88 / Gender differences of the Levels of Anxiety and Depression among CAPD Patients --- p.88-89 / Cultural Difference of Anxiety and Depression among CAPD Patients --- p.89-90 / Health-related Quality of Life among CAPD Patients / Health-related Quality of Life of CAPD Patients Affected by Renal Symptoms --- p.90-91 / Health-related Quality of Life of CAPD Patients Affected by the effects of Kidney Disease --- p.91-93 / Health-related Quality of Life of CAPD Patients Affected by the burden of / Having Kidney Disease --- p.93-94 / Health-related Quality of Life of CAPD Patients Affected by the General Physical Health --- p.94-96 / Health-related Quality of Life of CAPD Patients Affected by the General Mental Health --- p.96-97 / Gender differences of the Levels of Health-related Quality of Life among CAPD Patients --- p.97-98 / Cultural Difference of Health-related Quality of Life among CAPD Patients --- p.98-99 / Sexual Issues and Marital Relationship of CAPD Patients / Sexual Issues of CA PD Patients --- p.100-102 / CAPD Patients' Perception of the Marital Relationship --- p.102-104 / Gender Differences in Perception of the Marital Relationship among CAPD Patients --- p.104 / Cultural Difference in Perception of the Marital Relationship among CAPD Patients --- p.105-106 / "Relationships between Participants' Characteristics and Psychological Distress," / HRQoL and Marital Relationship / "Relationships of Income with Anxiety, Depression and General Mental Health" --- p.107-108 / Relationship between Duration of Receiving Dialysis and Health-related Quality of Life --- p.108-109 / Relationship between Occupational Status and General Mental Health --- p.199.110 / "Relationships among Anxiety, Depression, HRQoL and Marital Relationship" / The Relationship between Anxiety and Depression --- p.110-111 / "The Relationship between Anxiety, Depression and HRQoL" --- p.112 / "The Relationship between Anxiety, Depression and Marital Relationship" --- p.112-113 / The Relationships among Domains of Health-related Quality of Life --- p.113-114 / The Relationship between Health-related Quality of Life and Marital Relationship --- p.114-115 / Predictors of Health-related Quality of Life among CAPD Patients / Anxiety and Depression as Predictors of Health-related Quality of Life --- p.116-118 / Marital Relationship as Predictors of Health-related Quality of Life --- p.118-119 / Summary --- p.119-121 / Chapter 6 --- Conclusion / Limitations / Validity of Participants' Responses --- p.122-123 / Generalization of the Study's Findings --- p.123-124 / Psychometric Property of the Chinese Version of KDQOL-36 --- p.124-125 / The Sexual Items ofKDQOL-SF --- p.125 / Appropriateness of Using HADS and Multiple Correlations --- p.126 / Implications of the Study Findings / Implications for nursing knowledge --- p.126-128 / Implications on the Nursing Practice --- p.128-130 / Recommendations for Further Research --- p.130-132 / Conclusion --- p.132-133 / Chapter 7 --- Reference --- p.134-146 / Chapter 8 --- Appendix --- p.147-179

Problématique. L’importance de la qualité de la relation entre de jeunes adultes présentant un trouble concomitant de santé mentale et lié aux substances et leurs intervenants pour la santé de ces jeunes est bien documentée. Or, ce phénomène complexe a surtout été étudié dans une perspective individuelle plutôt que systémique alors que plusieurs des résultats d’études antérieures soutiennent le caractère systémique de cette relation. But. Cette étude vise à mieux comprendre, selon une perspective systémique, le phénomène complexe de la relation entre les jeunes adultes atteints d'un trouble concomitant de santé mentale et lié aux substances et les intervenants. Méthode. Une revue intégrative basée sur un cadre théorique systémique a été effectuée. Six bases de données ont été consultées, une recherche de littérature grise et une vérification des références ont bonifié le processus. Résultats. Sur un total de 532 écrits recensés, 44 ont été inclus. L’analyse thématique a fait ressortir deux thèmes, soit a) le système de santé : un environnement contraignant et b) la relation au coeur des soins. Le premier thème décrit le contexte de la relation alors que le deuxième concerne l’influence des soins prodigués, de la confiance réciproque et du caractère hiérarchique de la relation sur la qualité de cette relation. Conclusion. Cette étude corrobore le rôle conjoint joué par le jeune et l’intervenant dans le développement et le maintien de leur relation. Elle peut donc constituer d’assise pour le développement d’interventions infirmières mettant à l’avant plan la relation selon une perspective systémique. / Problem. Importance of a quality relationship between young adults living with dual diagnosis and their health care providers is well documented. However, this complex phenomenon was mostly studied with an individual perspective instead of systemic perspective even if the results addressed the systemic nature of this relationship. Objective. This study aims to better understand the relationship between young adults living with dual diagnosis and their health care providers with a systemic perspective. Method. An integrative review framed by a systemic approach was completed. Six data bases were consulted, manual research in grey literature and references screening enhanced the process. Results. On a total of 500 studies and 32 reports identified, 44 were included in the review. Thematic data analysis was realized, and two themes were identified: (a) the health care system: a constraining environment and (b) the relationship: at the heart of care. The first theme describes the context of the relationship, and the second theme addresses the influence of cares, mutual confidence, and hierarchic relationship on the quality of this relationship. Conclusion. This study supports the joint role played by both young adult and health care provider on the development and the maintenance of their relationship. This integrative review can represent the foundation of future nursing interventions that brought the relationship to the forefront of nursing cares with a systemic approach.

La literatura científica sitúa la autonomía del paciente en la toma de decisiones en el ámbito clínico, en una encrucijada entre dos posiciones éticas; el paternalismo y la elección informada. Analizar los textos de los registros de las historias clínicas y los discursos de las enfermeras, mediante una metodología cualitativa y desde la perspectiva de la ética foucaultiana, permite conocer los factores que determinan el poder de decisión de los pacientes. Este estudio revela que el paciente no es autónomo en la toma de decisiones sobre sus cuidados debido; a una determinada institucionalización de la atención, que marca los ritmos de las decisiones, a las características de las relaciones interprofesionales y a las dinámicas relacionales que se establecen entre los profesionales, en particular, de la enfermera con el paciente y la familia. Se debe liberar al paciente de las reglas impuestas, promoviendo su propia conducta, su propio estilo de vida. / The scientific literature places the patient autonomy in decision-making in the clinical setting, at a crossroads between two ethical positions, paternalism and informed choice. Analyze records of clinical histories and nurses discourses, using a qualitative methodology and from the perspective of foucauldian ethics, allows knowing the factors that determine the power of patient decision. This study reveals that the patient is not autonomous in making decisions about your care because, to a certain institutionalization of care, which marks the rhythms of the decisions, the characteristics of the interprofessional-relationships and relational dynamics that exist between professionals, in particular, of the nurse with the patient and family. It should free the patient from the rules imposed by promoting their own behavior, their own lifestyle. / La literatura científica situa l'autonomia del pacient en la presa de decisions en l'àmbit clínic, en una cruïlla entre dues posicions ètiques, el paternalisme i l'elecció informada. Analitzar els textos dels registres de les històries clíniques i els discursos de les infermeres, mitjançant una metodologia qualitativa i des de la perspectiva de l'ètica foucaultiana, permet conèixer els factors que determinen el poder de decisió dels pacients. Aquest estudi revela que el pacient no és autònom en la presa de decisions sobre les seves cures a causa, a una determinada institucionalització de l'atenció, que marca els ritmes de les decisions, a les característiques de les relacions interprofessionals i les dinàmiques relacionals que s'estableixen entre els professionals, en particular, de la infermera amb el pacient i la família. Cal alliberar el pacient de les regles imposades, promovent la seva pròpia conducta, el seu propi estil de vida.