Bakgrund: De medicinska insatser, omvårdnad och rehabilitering som erbjuds patienter i primärvård idag är vedertagna och vanligtvisevidensbaserade. Patienter kan få diagnos, behandling och ofta bot för många åkommor. En dimension som dock mindre ofta är tillvaratagen är effekterna av en genomtänkt fysisk miljö. Ett respektfullt bemötande i kombination med en genomtänkt vårdmiljö kan beskrivas som en god vårdatmosfär. Syftet med studien är att undersöka hur patienter upplever och uppfattar vårdatmosfären vid besök på en rehabiliteringsenhet i primärvård. Metod: Kvalitativaforskningsintervjuer och kvalitativ innehållsanalys Huvudresultat: En vårdatmosfär kan delas in i tre domäner: Fysisk miljö, Bemötande och Organisation. Inom domänerna finns ett antal kategoriermed variationer: Känsla av kontroll, Fysiska förutsättningar för att bli uppmärksammad, Subjektiva upplevelser av miljön, Kunskap om miljöns effekter, Uppmärksammar och bekräftar, Kommunicerar, Helhetssyn, Patienten i fokus, Delaktighet, Empati, Jämlikt möte, Att göradet ‖lilla extra‖, Innehåll och utbud, Tillgänglighet, Kontinuitet, Vårdkedjor och samverkan, Jämlik vård, Patientens rättigheter, Bemötandeandaoch förbättrings-och utvecklingsanda.Temat som framkommit är Att bli sedd, att vara värdefull. Slutsats: Till begreppet vårdatmosfär kan förutom vårdmiljö och bemötande, organisation läggastill. Organisationen ger förutsättningar eller kan försvåra. Ett tema håller samman alla kategorier och det är betydelsen av att bli sedd som ger budskap om att vara värdeful / Background: Medical treatment, care, and rehabilitation offered to patients in primary care settings are established and mostly evidence-based. Patients can receive diagnose, treatment and, quite often, cure. A dimension that receives less attention involves the effects of a carefully planned physical environment. Combined with a carefully planned environment, respectful interaction between patients and health professionals enhancesthe atmosphere of care settings. Aim: This study aimed to investigate how patients experience the atmosphere they encounter when visiting a rehabilitation unit within a primary care unit. Method: Qualitative research interviews and qualitative content analysisResults: The atmosphere in care settings encompasses three domains: physical environment, interaction between patients and health professionals, and the organization. Within these domains, categories include sense of control, physical conditionsfor to attract attention, subjective experience, knowledge of the effects of the environment, attention to and confirmation of the patient, communication, holistic view of the patient, patient in focus, participation, empathy, equality in the meeting, To do ―the little more‖, healthcare content, accessibility, continuity, cooperation, equal care, patient rights, spirit of interaction between patient and health professional, and spirit of improvement and development. The major themes that emerged were the patient’s need to be noticed and valued. Conclusion: Our results suggest that the organization should be added to the concepts of atmosphere in care settings. The organization can create and obstruct careconditions. The overarching theme of these categories is the patient’s need to be noticed and valued / <p>ISBN 978-91-86739-27-0</p>

Bakgrund: På världsbasis lever 36,7 miljoner människor med sjukdomen Humant Immunbrist Virus (HIV). Då forskningen och behandlingen gått framåt från att vara en dödlig till kronisk sjukdom med rätt behandling, kan patienter idag leva ett helt liv. Trots detta bemöts patientgruppen många gånger med stigmatiserande attityder då kunskapen om sjukdomen visat sig vara bristfällig hos hälso-och sjukvårdspersonal. Syftet: Var att beskriva hur patienter med diagnosen HIV upplever bemötandet inom hälso-och sjukvården, samt att granska undersökningsgrupperna i de inkluderade artiklarna. Metod: Litteraturstudie med deskriptiv design. Sökningar utfördes i PubMed och CINAHL. Totalt 14 artiklar med kvalitativ design och två med mixad metod, där endast den kvalitativa delen presenteras i resultatet. Analysmetoden som användes till studien var Evans beskrivande modell. Resultat: Två huvudteman identifierades i studien kunskapsnivå och attitydernas betydelse i mötet. Studien visade att kunskapsnivån har betydelse för bemötandet. Patienterna upplevde att när personal hade högre kompetens och positivare attityder resulterade det i bättre bemötande. Däremot okunskap hos personalen visade sig i form av negativa attityder och rädsla för patientgruppen,vilket resulterade i onödigt lidande och inget förtroende för vården. Undersökningsgruppen presenterades utifrån ålder, kön, antal år med HIV samt geografisk tillhörighet. Slutsatser: Negativa attityder i form av stigmatisering och diskriminering återstår inom hälso-och sjukvården av HIV positiva patienter. Positiva attityder visade sig vara starkt sammankopplat med kunskapsnivån hos personalen. Ämnet behöver därför belysas för att omvårdnaden ska utvecklas och ett professionellt förhållningssätt upprätthållas. / Background: In global basis 36, 7 million people living with the disease Human Immuno deficiency Virus (HIV). As the research and treatment progressed from being a fatal to chronic disease, with proper treatment, patients can now live a full life. Despite this the patient group are treated many times with stigmatizing attitudes as knowledge of the disease shown to be deficient among healthcare personnel. Purpose: Was to describe how patients diagnosed with HIV experiencing the meeting with healthcare personnel, as well as to review the study groups in the included articles. Method: Literature study with descriptive design. Searches were carried out in PubMed and CINAHL. A total of 14 articles with qualitative design and two with mixed method, where only the qualitative part is presented in the results. The analytical method used for this study was Evans descriptive model. Findings: Two main themes were identified in the study, knowledge level and attitude of the significance of the meeting. The study showed that the level of knowledge is important for the meeting. Patients experienced that when personnel had higher skills and more positive attitudes this resulted in better treatment. In contrast, ignorance of the personnel turned out in the form of negative attitudes and fear of the patient group, resulting in unnecessary suffering and no confidence in health care. The study group presented based on age, sex, number of years with HIV and geographic affiliations. Conclusions: Negative attitudes in the form of stigma and discrimination remains in health care of HIV positive patients. Positive attitudes were shown to have a strong correlation level with expertise of the health care personnel. The subject needs to be highlighted in order to developing care and maintain a professional attitude.

O presente estudo pretende construir uma reflexão sobre a função da confidencialidade para os profissionais de saúde que lidam com pessoas envolvidas em casos de incesto, na tentativa de avaliar os limites éticos destas intervenções. A metodologia utilizada constituiu-se por uma reflexão teórica baseada na experiência de trabalho da autora no CEARAS, referendada pela Bioética e pela Psicanálise e ilustrada por uma pesquisa realizada com os profissionais de saúde, incluindo os médicos, enfermeiras, técnicas e auxiliares de enfermagem e assistentes sociais do Pronto-Atendimento Pediátrico do Hospital Universitário da Faculdade de Medicina da Universidade de São Paulo. Entrevistas livres de exploração sobre a possibilidade de atendimento a crianças e adolescentes com suspeitas de abuso sexual e o modo de lidar com estas questões foram realizadas com os profissionais. As entrevistas foram gravadas e transcritas para serem analisadas através do método de análise de conteúdo. O atendimento de pacientes envolvidos em situações de abuso sexual é considerado pelos profissionais de saúde como um problema de difícil abordagem. A ausência do conflito entre a quebra do segredo profissional e a manutenção do vínculo de confiança entre profissional de Saúde e paciente em situações de incesto demonstra a dificuldade de os profissionais lidarem com tais casos e discriminarem a função de um profissional de saúde, pelo incesto se tratar justamente do tabu estruturante do ser humano. / This work intends to build up considerations about the confidentiality function for health professionals who deal with people involved in cases of incest, trying to evaluate the ethical limits of these interventions. The methodology used was a theoretical reflection based on Bioethics and Psychoanalyses and was illustrated by research with health professionals, including doctors, nurses, social workers and nurse assistants from Pediatric Emergency Room at University Hospital of São Paulo University. Free exploring interviews about the possibility of attending children and adolescents with suspects of sexual abuse and the way to deal professionally with such situation were conducted with those professionals. The interviews were recorded and transcribed for analysis through content analysis technique. The attendance of patients involved in sexual abuse situations is considered by health professionals as a difficult problem to approach. The absence of conflict between breaking professional secrecy and the maintenance of the reliance bond between the health professional and the patient on incest situations, shows the difficulties for the professionals to deal with people involved in those cases and, to discriminate the function of a health professional, by considering incest as a structuralizing taboo from the essence of human being.

O presente estudo pretende construir uma reflexão sobre a função da confidencialidade para os profissionais de saúde que lidam com pessoas envolvidas em casos de incesto, na tentativa de avaliar os limites éticos destas intervenções. A metodologia utilizada constituiu-se por uma reflexão teórica baseada na experiência de trabalho da autora no CEARAS, referendada pela Bioética e pela Psicanálise e ilustrada por uma pesquisa realizada com os profissionais de saúde, incluindo os médicos, enfermeiras, técnicas e auxiliares de enfermagem e assistentes sociais do Pronto-Atendimento Pediátrico do Hospital Universitário da Faculdade de Medicina da Universidade de São Paulo. Entrevistas livres de exploração sobre a possibilidade de atendimento a crianças e adolescentes com suspeitas de abuso sexual e o modo de lidar com estas questões foram realizadas com os profissionais. As entrevistas foram gravadas e transcritas para serem analisadas através do método de análise de conteúdo. O atendimento de pacientes envolvidos em situações de abuso sexual é considerado pelos profissionais de saúde como um problema de difícil abordagem. A ausência do conflito entre a quebra do segredo profissional e a manutenção do vínculo de confiança entre profissional de Saúde e paciente em situações de incesto demonstra a dificuldade de os profissionais lidarem com tais casos e discriminarem a função de um profissional de saúde, pelo incesto se tratar justamente do tabu estruturante do ser humano. / This work intends to build up considerations about the confidentiality function for health professionals who deal with people involved in cases of incest, trying to evaluate the ethical limits of these interventions. The methodology used was a theoretical reflection based on Bioethics and Psychoanalyses and was illustrated by research with health professionals, including doctors, nurses, social workers and nurse assistants from Pediatric Emergency Room at University Hospital of São Paulo University. Free exploring interviews about the possibility of attending children and adolescents with suspects of sexual abuse and the way to deal professionally with such situation were conducted with those professionals. The interviews were recorded and transcribed for analysis through content analysis technique. The attendance of patients involved in sexual abuse situations is considered by health professionals as a difficult problem to approach. The absence of conflict between breaking professional secrecy and the maintenance of the reliance bond between the health professional and the patient on incest situations, shows the difficulties for the professionals to deal with people involved in those cases and, to discriminate the function of a health professional, by considering incest as a structuralizing taboo from the essence of human being.

Bakgrund: Humant immunbristvirus (HIV) är en kronisk virusinfektion och en global pandemi. Med rätt behandling kan personer med HIV leva ett normallångt liv, men utan behandling övergår infektionen i acquired immunodeficiency syndrome (AIDS). Trots ökad kunskap om HIV blir personer med HIV ofta stigmatiserade och diskriminerade. Vårdpersonal har visats besitta bristfällig kunskap om HIV, stigmatiserande attityder gentemot patienter med HIV samt motvilja att vårda dem. HIV-relaterad stigmatisering motverkar minskning av smittspridningen och främjande av god hälsa för patientgruppen. Syfte: Sammanställa hur patienter med HIV beskriver upplevelser av bemötandet från hälso- och sjukvårdspersonal inom hälso- och sjukvård i vetenskaplig litteratur. Metod: En litteraturöversikt baserad på 13 kvalitativa artiklar och två med mixad metod hämtade från databaserna PubMed och CINAHL. Artiklarna kvalitetsgranskades och analyserades genom metasyntes. Materialet sammanställdes och tolkades genom Evans beskrivande metasyntes-modell. Resultat: Resultatet visade både positiva och negativa upplevelser av vårdpersonalens bemötande. Patienter beskrev att ökad kunskap och erfarenhet, samt visad empati, acceptans och respekt från vårdpersonal gav ett bättre bemötande. Negativa upplevelser var vanligt förekommande och beskrevs i form av bristfällig information, rädsla för smitta, stigmatisering, fördomar, stereotypering, diskriminering, nekad vård, inadekvat vård och bristande sekretess. Upplevelsen av bemötandet påverkade vårdupplevelsen, benägenheten att söka vård i framtiden och följsamheten till behandling.   Slutsatser: Kunskaps- och erfarenhetsnivå bland vårdpersonal har stor betydelse för hur bemötandet upplevs av patienter med HIV. Positiva upplevelser kopplades till kunnig och erfaren vårdpersonal. Negativa upplevelser av stigmatisering och diskriminering på grund av vårdpersonalens okunskap, rädsla och fördomar kvarstår. Mer utbildning om HIV bland vårdpersonal behövs för att minska stigmatiseringen kring patientgruppen och bedriva vård på lika villkor för dessa patienter. / Background: Human immunodeficiency virus (HIV) is a chronic viral infection and a global pandemic. With the right treatment, people with HIV can live a normal life. Without treatment, the infection turns into acquired immunodeficiency syndrome (AIDS). Despite increased knowledge about HIV, people with HIV often get stigmatised and discriminated. Health personnel have been shown to have poor knowledge about HIV, hold stigmatising attitudes towards patients with HIV and be reluctant to care for them. HIV-related stigmatisation is counterproductive in reducing the spread of HIV infection and in promoting good health for patients with HIV. Aim: To compile how patients with HIV describe experiences of interactions with health personnel in healthcare settings in scientific literature. Methods: A literature review based on 13 qualitative articles and two with mixed method that were collected from the databases PubMed and CINAHL. The articles were quality-reviewed and analysed using metasynthesis. The material was compiled and interpreted using Evan's descriptive metasynthesis model. Results: The result showed both positive and negative experiences of interactions with health personnel. Patients described that increased knowledge and experience, as well as demonstrated empathy, acceptance and respect from health personnel, were connected to a better experience. Negative experiences were common and described in terms of insufficient information, fear of contagion, stigmatisation, prejudices, stereotyping, discrimination, denied care, inadequate care and breaches of confidentiality. The attitude, behaviour and treatment by health personnel affected how patients viewed the healthcare experience, the tendency to seek care in the future and the patients’ adherence to treatment. Conclusions: Knowledge and experience among health personnel are of major importance for how the interaction is experienced by patients with HIV. Positive experiences were linked to knowledgeable and experienced health personnel. Negative experiences of stigmatisation and discrimination due to the health personnel’s ignorance, fear and prejudices persist. More education about HIV among health personnel is needed to reduce stigmatisation and to provide care on equal terms for these patients.

Introduktion: Psykisk ohälsa har ökat i samhället. Detta medför betydande konsekvenser för både livskvalitet och välbefinnande. Statistik visar att psykisk ohälsa medför allvarlig psykisk påfrestning, särskilt bland kvinnor. Dessa påfrestningar kan visa sig som oro, nedstämdhet, stress och känslor av hopplöshet. Stigmatisering är också ett vanligt förekommande problem som den här gruppen av kvinnor ställs inför. Därför är det viktigt att undersöka kvinnors upplevelser av bemötande i vården. För att få kunskaper om hinder, utmaningar och eventuella möjligheter för att förbättra bemötandet av kvinnor som har psykisk ohälsa. Travelbees omvårdnadteori användes som teoretisk referensram. Syfte: Syftet i det här arbetet var att undersöka kvinnors upplevelser av vårdpersonals bemötande och omvårdnad vid psykisk ohälsa. Metod: Det här arbetet använder sig av deskriptiv design med allmän litteraturöversikt som datainsamlingsmetod. Litteratursökningarna utfördes i databaserna PubMed och CINAHL. Deltagarna i undersökningarna och studierna ska vara kvinnor, över 18 års ålder och lid av någon form av diagnostiserad psykisk ohälsa. Kvalitetsgranskning för alla utvalda studier baserades på bedömningsmall av studier med kvalitativ metod som utvecklades av Statens beredning för medicinsk och social utvärdering. Popenoes analysmetod användes för att analysera arbetets resultat. Resultat: Resultatet visade att kvinnorna upplevde negativa och utmana hinder samt positiva och tillfredställande upplevelser inom vården och med vårdpersonalen. Tre huvudteman skapades, vilket var negativa upplevelser, positiva upplevelser samt upplevelser av hur vården kan förbättras. Negativa upplevelser som upplevdes var till exempel stigmatisering, bristande kommunikation och relationsskapande. Å andra sidan framkom positiva upplevelser som gott patientstöd, tillräcklig delaktighet samt goda upplevelser med vårdpersonalen. Slutsats: Negativa upplevelserna översteg de positiva upplevelserna på grund av stigmatiserande syner. För att bidra till positiva patientupplevelser är det viktig att sjuksköterskor håller en professionell roll och skapa en tillförlitlig relation till patienten. / Introduction: Mental illness has increased in society. This has significant consequences for both quality of life and well-being. Statistics show that mental illness causes serious psychological stress, especially among women. These stresses can manifest as anxiety, depression, stress and feelings of hopelessness. Stigmatization is also a common problem faced by this group of women. Therefore, it is important to examine these women's experiences of treatment in care. To gain knowledge about obstacles, challenges and possible opportunities to improve the treatment of women who have mental illness. Travelbee's nursing theory was used as a theoretical frame of reference. Aim: The aim of this study was to explore women’s experiences of healthcare professional’s treatment and care in case of mental illness. Method: This work uses descriptive design with general literature review as data collection method. The literature searches were performed in the databases PubMed and CINAHL. The participants in the examinations and studies must be women, over the age of 18 and suffering from some form of diagnosed mental illness. Quality review for all selected studies was based on the evaluation template of studies with a qualitative method that was developed by the National Committee for Medical and Social Evaluation. Popenoe's analysis method was used to analyze the results of the work. Results: The results showed that the women experienced negative and challenging obstacles as well as positive and satisfying experiences within the care and with the care staff. Three main themes were created, which were negative experiences, positive experiences and experiences of how care can be improved. Negative experiences experienced were, for example, stigmatization, lack of communication and relationship building. On the other hand, positive experiences emerged such as good patient support, sufficient participation and good experiences with the healthcare staff. Conclusion: The negative experiences exceeded the positive experiences due to stigmatizing views. In order to contribute to positive patient experiences, it is important that nurses maintain a professional role and create a reliable relationship with the patient.

Bakgrund: Varje år diagnosticeras flera miljoner människor med cancer. Cellerna i kroppen kan mutera och bilda tumörer. En elakartad tumör räknas som en cancertumör. Vid behandling av cancer tar ansvarig läkare ställning till ifall patientens cancersjukdom går att bota eller om behandling ska vara lindrande, det vill säga palliativ. Den palliativa vården ska ske på patientens villkor, utformat utifrån personcentrerad vård. Individen ska respekteras och bemötas som en unik person. Patienten har rätt till självbestämmande, tydlig information, att bevara sin integritet samt att få symtomlindring. Syfte: Syftet är att undersöka hur patienter med en cancersjukdom som vårdas palliativt på slutenvårdsavdelning upplever bemötandet från hälso- och sjukvårdspersonal. Metod: Databaserna CINAHL Complete och Medline with Full Text användes vid informationssökning. Införskaffat material granskades och godkändes av båda författarna. Resultat: Resultatet belyser patienters upplevelser av hälso-sjukvårdspersonalens bemötande. Studien resulterade i två teman. Tema ett: Hälso- och sjukvårdspersonalens förhållningssätt med två underteman: Närvaro och engagemang och förtroende och respekt. Tema två: Kommunikation och information, utan underteman. Diskussion: Resultatet diskuterades utifrån Rosemarie Rizzo Parses teori där begreppen tillit och misstro identifierades. Patienterna upplevde att engagemang, ärlighet och medlidande var viktigt i bemötandet. Upplevelserna diskuterades utifrån Parses teori om Human Becoming och annan litteratur. / Background: Millions of people are yearly diagnosed with a cancer disease. The cells in the body can for different reasons mutate and become tumours. If the tumour is determined as bad it’s considered cancerous. The responsible physician takes a stand if the cancer disease is treatable or if the treatment should be palliative. The palliative care should be shaped from the terms set by the patient. The patient ought to receive care from healthcare staff, where they respect the individual and treat them in a kind manner, so called person centered care. The patient is to be encouraged to have the freedom to control their own life, the right to information, preserve their integrity and receive adequate alleviation of symptoms.   Aim: A literature review over how patients with a cancer disease experience the encounters with healthcare professionals in inpatient palliative wards. Method: The databases CINAHL Complete and MEDLINE with Full text were used for information retrieval. The retrieved information was audited and approved by both authors. Results: The results highlight patient experiences of the professional-patient relation. The study resulted in two themes. The first theme: Healthcare Professional’s approachment with two subtopics: Presence and commitment and trust and respect. The second theme: Communication and information, without subtopics. Discussion: The results were discussed on the basis of Rosemarie Rizzo Parse's theory after the subjects trust and mistrust were identified. Patient experienced that involvement, honesty and benevolence were important. The experiences were discussed based on Parse's theory about Human Becoming and other literature.

Inledning: Bristfällig information till patienterna inför en MR-undersökning kan leda till att patienterna blir nervösa, stressade och känner obehag och därmed uteblir från bokade tider eller väljer att avbryta sina undersökningar i förtid. Med en tydlig information till patienten innan MR-Kaundersökningen startar ökar det patientens förståelse inför besöket. Det kan göra att patienterna kommer på sina bokade tider och därmed har möjlighet att få svar på oklara funderingar utifrån den skriftliga informationen med hjälp av en röntgensjuksköterska innan undersökningens start. Syfte: Syftet med studien var att sammanställa den information som ges till patienter inför en MR-undersökning samt betydelsen av informationen. Metod: Studien som genomförts är en allmän litteraturöversikt, där artiklarna hämtats från databaserna Pubmed och Cinahl. I studien ingår både kvantitativa och kvalitativa artiklar, som i sin tur har kvalitetsgranskats och analyserats utifrån syftet. Resultat: 10 stycken artiklar har delats in i tre kategorier som följer: skriftlig information, verbal information och digital information. Resultatet av studien visar på att oro och ångest hos patienterna kan ge rörelseartefakter med dålig bildkvalitet som följd, behov av upprepade undersökningar, att patienten väljer att avbryta eller vägrar att lägga sig i kameran. Detta kanresultera i försenad diagnos och behandling för patienten. Genom en kombination av skriftlig, verbal och digital information så ökar det förståelsen och tryggheten på ett bättre sätt än endast skriftlig information. Slutsats: Området är viktigt att belysa då information inför MRundersökning inte bara lindrar stress och ångest utan även ger trygghet till patienten och större möjlighet att få en så bra kvalitet på undersökning och bildframställning som möjligt. Studien tyder på att det finns ett behov av vidare forskning för att kunna utreda vilken information som patienten saknar inför sin MR-undersökning för att ge ökad trygghet. Men det finns stora möjligheter att kunna använda sig av förberedande information inför MR-undersökningar i form av appar och VR i framtiden. / Introduction: Inadequate information to patients prior to an MRI examination can lead to patients becoming nervous, stressed and feeling discomfort and thus absent from booked appointments or choosing to cancel their examinations. With clear information to the patient before the MRI examination starts, it increases the patient's understanding before the visit. This can mean that patients arrive at their booked times and thus have the opportunity to get answers to unclear thoughts based on the written information with the help of an X-ray nurse before the start of the examination. Aim: The purpose of the study was to compile the information given to patients prior to an MRI examination and the importance of the information. Method: The study conducted is a general literature review, where the articles were retrieved from the databases Pubmed and Cinahl. The study includes both quantitative and qualitative articles, which in turn have been quality reviewed and included in the work. Results: 10 articles have been divided into three categories:such as written information, verbal information and digital information. The results of the study show that anxiety and stress in patients may cause motion artifacts with poor image quality as a result, need for repeated examinations, that the patient chooses to interrupt or refuses to go to the camera. Through a combination of written, verbal and digital information, it increases understanding and security in a better way than just written information. Conclusion: The area is important to highlight as information prior to MRI examination not only relieves stress and anxiety but also provides security to the patient and greater opportunity to get the best quality of examination and imaging possible. The study indicates that there is a need for further research in order to be able to investigate what information the patient lacks prior to their MRI examination, in order to increase well-being. But there are great opportunities to be able to use preparatory information for MRI examinations in the form of apps and VR in the future.

Ce mémoire est un des segments d'une recherche de plus grande envergure sur le service Info-Santé, et qui se déroule au Centre de Santé et de Services sociaux de Laval. / Les services téléphoniques de consultation en soins infirmiers sont en progression partout dans le monde. On sait que les infirmières qui possèdent une plus longue expérience de pratique au téléphone obtiennent davantage d’informations sur la condition de santé du client qui les consulte que celles qui comptent moins d’années d’expérience. Nous pouvons présumer que les niveaux d’expertise décrits par Benner (1984) expliquent cette différence. Toutefois aucune étude à ce jour ne décrit comment se manifeste cette différence entre les niveaux d’expertise dans la conversation au cours d’une intervention entre l’infirmière et l’appelant. Le but de cette étude descriptive était d’identifier les manifestations de cette expertise dans la communication, lors de la consultation téléphonique. À l’aide du Roter Interaction Analysis System (RIAS), 190 enregistrements d’appels, entre infirmières (N = 15), de divers niveaux de compétence selon la nomenclature de Benner (1984) et les appelants qui les ont consultées, ont été analysés. Les appels étudiés, issus d’une étude de plus grande envergure, devaient être faits par le parent d’un enfant de moins de cinq ans, et devaient faire l’objet d’une première consultation. Il a été possible de nommer des caractéristiques, des forces et des faiblesses communes aux infirmières de chaque niveau d'expertise à l’étude. Bien qu’il existe des différences entre les moins expérimentées et celles qui ont une longue expérience clinique au téléphone, les résultats semblent indiquer que les infirmières de tous les niveaux d’expertise sont fortement centrées sur la tâche d’évaluation de la situation de santé de l’appelant, mais que leurs interventions incluent peu d’énoncés orientés vers l’établissement d’un réel partenariat avec l’appelant. Les résultats obtenus fournissent des informations qui pourraient être utilisées pour élaborer des stratégies de développement professionnel, et guider les administrateurs de ce service dans le choix des indicateurs d’évaluation de la qualité du service et de ses retombés sur sa clientèle. Toutefois un plus grand nombre d’infirmières participantes et un plus grand nombre d’appels permettraient de confirmer les résultats obtenus à partir de ces 190 appels. / Nurse telephone consultation services are rapidly progressing throughout the world. It is known that nurses with a greater experience in telephone practise obtain more information on the client’s health condition when in consultation, than nurses with less experience. We can presume that Patricia Benner’s «levels of nursing experience», (1984), will provide us with an explanation for these differences. Yet, to this day, no study describes how these differences between levels of experience are manifested in conversation during an intervention between the nurse and the client. The object of this descriptive study was to identify the manifestations of this communication expertise during a telephone consultation. Using the Roter interaction analysis system (RIAS), 190 recorded calls between nurses (N = 15) with differing levels of expertise, according to Benner’ nomenclature (1984), and the callers who have consulted them were analyzed. The calls that were studied, from a larger study, were first calls from parents regarding their child aged five years or less. It was possible to observe characteristics, strengths, and weaknesses common to nurses within each level of expertise in this study. Despite the fact that there are differences between nurses with fewer years of experience and nurses with more clinical telephone experience, results seem to indicate that, regardless of their experience, nurses are strongly centered on the task of assessing the caller’s health situation; however, their interventions include few phrases aimed at establishing a true partnership with the caller. Results obtained provide information that could be used to elaborate professional developmental strategies, and guide administrators in their choice of indicators when evaluating service quality and its effect on clientele. Nevertheless, an increased number of nurse participants and a greater number of calls would enable us to confirm the results obtained from these 190 calls.

Les services téléphoniques de consultation en soins infirmiers sont en progression partout dans le monde. On sait que les infirmières qui possèdent une plus longue expérience de pratique au téléphone obtiennent davantage d’informations sur la condition de santé du client qui les consulte que celles qui comptent moins d’années d’expérience. Nous pouvons présumer que les niveaux d’expertise décrits par Benner (1984) expliquent cette différence. Toutefois aucune étude à ce jour ne décrit comment se manifeste cette différence entre les niveaux d’expertise dans la conversation au cours d’une intervention entre l’infirmière et l’appelant. Le but de cette étude descriptive était d’identifier les manifestations de cette expertise dans la communication, lors de la consultation téléphonique. À l’aide du Roter Interaction Analysis System (RIAS), 190 enregistrements d’appels, entre infirmières (N = 15), de divers niveaux de compétence selon la nomenclature de Benner (1984) et les appelants qui les ont consultées, ont été analysés. Les appels étudiés, issus d’une étude de plus grande envergure, devaient être faits par le parent d’un enfant de moins de cinq ans, et devaient faire l’objet d’une première consultation. Il a été possible de nommer des caractéristiques, des forces et des faiblesses communes aux infirmières de chaque niveau d'expertise à l’étude. Bien qu’il existe des différences entre les moins expérimentées et celles qui ont une longue expérience clinique au téléphone, les résultats semblent indiquer que les infirmières de tous les niveaux d’expertise sont fortement centrées sur la tâche d’évaluation de la situation de santé de l’appelant, mais que leurs interventions incluent peu d’énoncés orientés vers l’établissement d’un réel partenariat avec l’appelant. Les résultats obtenus fournissent des informations qui pourraient être utilisées pour élaborer des stratégies de développement professionnel, et guider les administrateurs de ce service dans le choix des indicateurs d’évaluation de la qualité du service et de ses retombés sur sa clientèle. Toutefois un plus grand nombre d’infirmières participantes et un plus grand nombre d’appels permettraient de confirmer les résultats obtenus à partir de ces 190 appels. / Nurse telephone consultation services are rapidly progressing throughout the world. It is known that nurses with a greater experience in telephone practise obtain more information on the client’s health condition when in consultation, than nurses with less experience. We can presume that Patricia Benner’s «levels of nursing experience», (1984), will provide us with an explanation for these differences. Yet, to this day, no study describes how these differences between levels of experience are manifested in conversation during an intervention between the nurse and the client. The object of this descriptive study was to identify the manifestations of this communication expertise during a telephone consultation. Using the Roter interaction analysis system (RIAS), 190 recorded calls between nurses (N = 15) with differing levels of expertise, according to Benner’ nomenclature (1984), and the callers who have consulted them were analyzed. The calls that were studied, from a larger study, were first calls from parents regarding their child aged five years or less. It was possible to observe characteristics, strengths, and weaknesses common to nurses within each level of expertise in this study. Despite the fact that there are differences between nurses with fewer years of experience and nurses with more clinical telephone experience, results seem to indicate that, regardless of their experience, nurses are strongly centered on the task of assessing the caller’s health situation; however, their interventions include few phrases aimed at establishing a true partnership with the caller. Results obtained provide information that could be used to elaborate professional developmental strategies, and guide administrators in their choice of indicators when evaluating service quality and its effect on clientele. Nevertheless, an increased number of nurse participants and a greater number of calls would enable us to confirm the results obtained from these 190 calls. / Ce mémoire est un des segments d'une recherche de plus grande envergure sur le service Info-Santé, et qui se déroule au Centre de Santé et de Services sociaux de Laval.