Background: There has been wide interest shown in the manner in which ethical dimensions in nursing practice are approached and addressed. As a result a number of ethical decision making models have been developed to tackle these problems. However, in this thesis it has been argued that the ethical dimensions of nursing practice are still not clearly understood and responded in Brunei. Design and method: This thesis describes a qualitative analysis into the Bruneian nurses’ perceptions of ethical dimensions in nursing practice. Drawing on constructivist grounded theory as a method of inquiry, twenty eight practicing and administrative nurses were individually interviewed. The nurses described how ethical dimensions were perceived in their practice, by means of the difficulties they are facing in the real world of nursing practice; how they have responded to these difficulties, and why they make such responses. Findings: The nurses described three ethical dimensions in their practice, namely ‘nurse at work’ which illustrates the ethical dimensions within the work environment; ‘nurse and doctor’ that elucidates the ethical dimensions in the nurse and doctor relationship and ‘nurse and patient’ which further examines ethical aspects in patient care. ‘Taking responsibility’ and ‘shifting responsibility to others’ were identified as approaches that the nurses took in responding to the ethical dimensions with the aim of avoiding the conflict and maintaining ward harmony. These responses provide new insights into how nurses’ response to ethical dimension in the ward settings where it puts strong emphasis on the nurses’ understanding of responsibility placed upon them as a professional nurse. ‘Negotiating ethical responsibility’ emerged as a core category within the data which illustrate that nurses’ responses to the ethical dimensions form a continuous process, involving constant consideration of the two types of responses. The core category described that ethical dimensions in the nurses’ practice were contextualised in the ‘ethical responsibility’ that is placed upon them within the nursing organisation. This thesis has expanded the current theoretical knowledge of ethical dimensions by elaborating on the concerns experienced in nursing practice and the responses individual nurses utilise to negotiate and discharge their ethical responsibilities at work. The study has also extended emphasis to the reasoning and responses that nurses are engaged in, whilst at the same time, negotiating ethical responsibility regarding the context in which they are placed during their working hours. This core category provides a number of possible implications for future research, nursing practice, education and policy, which would facilitate the exploration of ethical understanding for nurses in Brunei, and enable the provision of an ethical environment, so making ethical dimensions more transparent.

O objetivo do presente trabalho foi investigar a relação profissional/paciente na área da Ortodontia. Foram estudados os aspectos éticos e legais que permeiam o tratamento ortodôntico. A literatura estudada permite afirmar que a busca de auxílio legal por pacientes descontentes aumentou significativamente nos últimos anos. E que a ortodontia é uma especialidade em que os tratamentos são de longa duração e onde se estabelece uma estreita relação profissional/paciente, envolvendo uma grande expectativa em relação aos resultados. A pesquisa foi realizada por meio de dois questionários, o primeiro dirigido a 10 profissionais da área de ortodontia e o segundo a 100 pacientes em tratamento ortodôntico dos respectivos profissionais. A análise das respostas obtidas demonstrou que a preocupação estética é a principal motivação que leva os pacientes aos consultórios ortodônticos (61%) Todos os profissionais acreditam existir fatores imprevisíveis que podem interferir no desenvolvimento e no resultado do tratamento ortodôntico (100%). Apesar deste fato, 40% dos profissionais asseguram ao paciente o sucesso do tratamento. Os profissionais afirmam fornecer esclarecimentos sobre o tratamento e seus possíveis desdobramentos, porém de forma verbal. Para ambos, profissional e paciente, o mais importante nesta relação é a capacidade técnica do profissional. Para os profissionais, o principal meio de defesa do ortodontista frente a um processo de responsabilidade civil é o prontuário completo. Porém, a grande maioria dos entrevistados (90%) não possui em seu prontuário a ficha de procedimentos executados com as intercorrências anotadas e com a assinatura do paciente. Concluiu-se que a principal motivação que leva o paciente ao consultório ortodôntico é a preocupação estética e que o bom relacionamento profissional/paciente com atitudes como fornecer esclarecimentos sobre o tratamento e seus desdobramentos e possuir um prontuário completo são condutas prudentes a fim de evitar que o profissional venha a ser objeto de uma ação civil indenizatória impetrada pelo paciente. / The major objective of the present research work was to investigate the relationship between the dentistry professional and his/her patient in the orthodontics area. Ethical and legal aspects involved in the orthodontics treatment were profoundly analyzed. In the last years the searching for legal aid by unsatisfied patients has significantly increased. The orthodontics area is normally characterized by long term treatments. At any orthodontic treatment a much closed professional/ patient relationship is established together with a huge expectation on results. This research was developed using two questionnaires. The first one was submitted to ten orthodontics professionals and the second questionnaire to one hundred patients treated by those ten professionals. The percentile analysis of the patients' reply (61%) has demonstrated that the aesthetic aspects are the main reason that impels the patients to the orthodontics doctor's office. All the interviewed professionals (100%) believe in the existence of unexpected factors that intervene in both the development and the results of the treatment. Despite the aforementioned fact 40% of the professionals assure to the patient a successful treatment. About 20% of those 40% professionals cited guarantee to the patients a treatment according to their expectations. Although orally mentioned only, all the professionals affirm to provide to the patients the necessary information about the development of the treatment and its eventual implications. For both, professional and patient, the most important aspect to attain a successful treatment is the technical knowledge of the orthodontics professional. For the majority of the orthodontics professionals the main means against any civil prosecution is the complete and detailed treatment documentation. However, the great majority (90%) of the professionals interviewed do not possess in their files the executed treatment procedures with the signature of the patient on them. Any sort of misunderstanding relationship among the orthodontics professional and his/her patient on keeping a well understood treatment may lead to legal problems. It is also very important to remark that the patient can carry out an indemnity question against the professional if he/she does not have a good understanding on the legislation.

<p>In human service organizations it is important to enlighten the significance of human encounters. The aim of this study was to explore nursing students experiences of developing empathy and professional relationship in encounters with patients and next of kin during their education. Interviews with five nursing students were carried out. The method of analysing content analysis was used. One main theme and five subthemes were presented. The main theme was described as a process of developing courage and awareness. The students challenged themselves and their beliefs and through this they gained self-knowledge and courage. During periods of clinical practice the usefulness of theoretic knowledge became evident for the students. The developing of awareness and the gain of courage made them more secure in human encounters. The result of this study lead to a deeper understanding of the significant elements for nursing students development towards a professional relationship in human encounters.</p>

In human service organizations it is important to enlighten the significance of human encounters. The aim of this study was to explore nursing students experiences of developing empathy and professional relationship in encounters with patients and next of kin during their education. Interviews with five nursing students were carried out. The method of analysing content analysis was used. One main theme and five subthemes were presented. The main theme was described as a process of developing courage and awareness. The students challenged themselves and their beliefs and through this they gained self-knowledge and courage. During periods of clinical practice the usefulness of theoretic knowledge became evident for the students. The developing of awareness and the gain of courage made them more secure in human encounters. The result of this study lead to a deeper understanding of the significant elements for nursing students development towards a professional relationship in human encounters.

Thesis (MNutr (Human Nutrition))--University of Stellenbosch, 2006. / INTRODUCTION: The objective of this study was to explore the barriers that doctors experience to referring patients to dietitians. The study sample (n = 700) included a selection of all practicing medical doctors and specialists in the Gauteng province of South Africa. Registration with the Health Professions Council of South Africa (HPCSA) was a prerequisite. METHOD: This was a quantitative study using a validated questionnaire e-mailed to participating doctors in order to determine factors affecting their referral practices. The first part of the questionnaire consisted of demographic and general information about the respondent and the second and third parts consisted of a series of closed-ended questions that related to specific issues of nutrition information and dietitian referral practices respectively. The questionnaire comprised a total of 21 questions. Subjects were sent the questionnaire by e-mail and given four weeks to respond. Three reminder e-mails were sent to encourage participation. Statistical analysis methods included: Kruskal-Wallis, Pearson Chi-square, likelihood ratios, linear-by-linear associations, as well as Goodman and Kruskal tau tests. RESULTS: Of the questionnaires sent out, 134 (19%) out of 700 were finally useable. Doctors who had a nutrition component in their training referred patients to dietitians more often than those who did not and older doctors referred to a dietitian less often (Chi-square tests, p < 0.05). A correlation was observed between the duration of medical practice and frequency of referral (p = 0.03) while gender had no influence on referral practice. A correlation (p < 0.001) was also found between frequency of referral and university of study with symmetric measures. Hyperlipidaemia, diabetes mellitus and obesity were identified as the conditions doctors would most likely refer to a dietitian. For 45% of the doctors insufficient time during consultation was the strongest barrier to providing nutrition councelling to their patients. The barrier identified most commonly was that doctors were unaware of dietitians in the vicinity of their practices (49%). Sixty four percent of doctors believed that better marketing by dietitians would increase their referrals, and 21.4% believed that the title ‘nutritionist’ or ‘nutrition specialist’ would be more suitable for the profession of dietetics. CONCLUSION: The findings of the study indicate that a number of factors contribute to the barriers that doctors experience to referring patients to dietitians. Although the study was limited by a small sample, it nevertheless draws attention to the responsibility of both dietitians and doctors to work together toward providing patients with a more efficient team approach treatment and care system. More qualitative studies are needed to explore the identified barriers further, especially within the South African context, as well as to establish appropriate recommendations to overcome the barriers to referral.

O objetivo do presente trabalho foi investigar a relação profissional/paciente na área da Ortodontia. Foram estudados os aspectos éticos e legais que permeiam o tratamento ortodôntico. A literatura estudada permite afirmar que a busca de auxílio legal por pacientes descontentes aumentou significativamente nos últimos anos. E que a ortodontia é uma especialidade em que os tratamentos são de longa duração e onde se estabelece uma estreita relação profissional/paciente, envolvendo uma grande expectativa em relação aos resultados. A pesquisa foi realizada por meio de dois questionários, o primeiro dirigido a 10 profissionais da área de ortodontia e o segundo a 100 pacientes em tratamento ortodôntico dos respectivos profissionais. A análise das respostas obtidas demonstrou que a preocupação estética é a principal motivação que leva os pacientes aos consultórios ortodônticos (61%) Todos os profissionais acreditam existir fatores imprevisíveis que podem interferir no desenvolvimento e no resultado do tratamento ortodôntico (100%). Apesar deste fato, 40% dos profissionais asseguram ao paciente o sucesso do tratamento. Os profissionais afirmam fornecer esclarecimentos sobre o tratamento e seus possíveis desdobramentos, porém de forma verbal. Para ambos, profissional e paciente, o mais importante nesta relação é a capacidade técnica do profissional. Para os profissionais, o principal meio de defesa do ortodontista frente a um processo de responsabilidade civil é o prontuário completo. Porém, a grande maioria dos entrevistados (90%) não possui em seu prontuário a ficha de procedimentos executados com as intercorrências anotadas e com a assinatura do paciente. Concluiu-se que a principal motivação que leva o paciente ao consultório ortodôntico é a preocupação estética e que o bom relacionamento profissional/paciente com atitudes como fornecer esclarecimentos sobre o tratamento e seus desdobramentos e possuir um prontuário completo são condutas prudentes a fim de evitar que o profissional venha a ser objeto de uma ação civil indenizatória impetrada pelo paciente. / The major objective of the present research work was to investigate the relationship between the dentistry professional and his/her patient in the orthodontics area. Ethical and legal aspects involved in the orthodontics treatment were profoundly analyzed. In the last years the searching for legal aid by unsatisfied patients has significantly increased. The orthodontics area is normally characterized by long term treatments. At any orthodontic treatment a much closed professional/ patient relationship is established together with a huge expectation on results. This research was developed using two questionnaires. The first one was submitted to ten orthodontics professionals and the second questionnaire to one hundred patients treated by those ten professionals. The percentile analysis of the patients' reply (61%) has demonstrated that the aesthetic aspects are the main reason that impels the patients to the orthodontics doctor's office. All the interviewed professionals (100%) believe in the existence of unexpected factors that intervene in both the development and the results of the treatment. Despite the aforementioned fact 40% of the professionals assure to the patient a successful treatment. About 20% of those 40% professionals cited guarantee to the patients a treatment according to their expectations. Although orally mentioned only, all the professionals affirm to provide to the patients the necessary information about the development of the treatment and its eventual implications. For both, professional and patient, the most important aspect to attain a successful treatment is the technical knowledge of the orthodontics professional. For the majority of the orthodontics professionals the main means against any civil prosecution is the complete and detailed treatment documentation. However, the great majority (90%) of the professionals interviewed do not possess in their files the executed treatment procedures with the signature of the patient on them. Any sort of misunderstanding relationship among the orthodontics professional and his/her patient on keeping a well understood treatment may lead to legal problems. It is also very important to remark that the patient can carry out an indemnity question against the professional if he/she does not have a good understanding on the legislation.

No description available.

<p>The social inclusion of adults with intellectual and developmental disabilities remains an elusive goal for many adults, their families, and allies. Many of the typical relational human interactions people without intellectual and developmental disabilities enjoy and take for granted, have been denied to adults with intellectual and developmental disabilities, largely because of harmful conceptualizations of what it means to live with a disability. These conceptualizations have not only influenced the development of public policy but they have also shaped the interactions and relationships between professionals and adults with intellectual and developmental disabilities. Equipped with the historical knowledge of how public policy was used to cultivate and maintain the mass institutionalization of adults living with intellectual and developmental disabilities – and then subsequently used to lead to it’s demise – this study set out investigate if and how public policy might influence the nature of professional relationships between service users with intellectual and developmental disabilities and service providers. Using qualitative methods guided by critical disability theory, this study looked specifically at how <em>Ontario Regulation 299/10</em> has already, and/or may in the future, change the interpersonal relationships that exist between adults living with intellectual and developmental disabilities and their care-givers at L’Arche Hamilton. Research methods included working with the policy document and also conducting face-to-face interviews with adults with intellectual and developmental disabilities and their caregivers. It was important for this study to include the voices of adults with intellectual and developmental disabilities and to examine the research question from their perspective because without their input it would not be possible to really understand the regulation’s impact.</p> <p>This study focused on the current experiences of three residents (core members) and three care-givers (assistants) at L’Arche. It was found that there exist genuine and caring relationships between the two; relationships shaped by the understanding of the assistants that adults with intellectual and developmental disabilities have something of value – a “gift” – to contribute to what they define as a mutual relationship. In addition, both core members and assistants point to the importance of human touch in care-giving interactions – touch that moves beyond the functional (e.g., assistance with personal care) to also include expressive touch (e.g., hugs) that conveys affection and love. However, the findings further suggest that <em>Ontario Regulation 299/10</em> threatens the ability of care-givers to engage in the intentional form of relationship which currently exists within the L’Arche service model. This form of relationship is understood to be restricted by the regulation under the guise of “protection” and as being “best practice”. The legislation recognizes that people living with disabilities have higher rates of abuse then those living without disabilities; in response to this reality the legislation attempts to reduce opportunity for such abuses to occur and, as a result, articulates clear boundaries around the type of relationships that are permissible. The assistants interviewed for this study also recognize these concerns but they also worry that these concerns overlook the reality of the limited opportunities for genuine relationships between adults with intellectual and developmental disabilities and those without. Further research, directed by adults with intellectual and developmental disabilities, is needed to unpack how this relationship is understood and experienced by both parties, and how each feels it should be maintained, especially in regards to the use of physical touch as an expression of relationship. Research which engages the core members in dialogue on what “safety” and “relationship” mean and looks like for them is needed in order to truly understand the potential impact limiting the professional relationship may have.</p> / Master of Social Work (MSW)

Bakgrund Endometrios är ett kroniskt sjukdomstillstånd som kan ge diffusa symtom som exempelvis svår menstruationssmärta, smärta vid samlag, fatigue och nedsatt fertilitet. Att leva med endometrios kan påverka individens fysiska, psykiska, sociala och existentiella välbefinnande i olika grad. För att främja hälsan hos patienter med endometrios och lindra deras lidande har sjuksköterskan en central roll i att erbjuda en trygg och god omvårdnad. En förutsättning för detta är att sjuksköterskan har insikt i patientens perspektiv. Syfte  Syftet var att beskriva patienters upplevelser av vårdrelationer vid endometrios. Metod En icke-systematisk litteraturöversikt som baserades på 17 vetenskapliga artiklar med kvalitativ, kvantitativ och mixad metodansats. Från databaserna PubMed och CINAHL inhämtades artiklar med hjälp av flera olika kombinationer av sökord. En kvalitetsgranskning av inkluderade artiklar har genomförts utifrån Sophiahemmet Högskolas bedömningsunderlag för vetenskaplig klassificering och kvalitet. Resultatet av de vetenskapliga artiklarna analyserades och sammanställdes med en integrerad dataanalys. Resultat Resultatet sammanställdes till två huvudkategorier; betydelsen av att få känna sig delaktig i vårdrelationen samt att få sina behov tillgodosedda. Resultatet belyser att patienter med endometrios upplever brister i sina vårdrelationer och en avsaknad av ett personcentrerat förhållningssätt. Slutsats Denna litteraturöversikt visade värdefulla insikter i hur patienter med endometrios kan gynnas av ett personcentrerat förhållningssätt i vårdrelationen. Sammanställningen identifierade att patienter upplever att hälso- och sjukvårdspersonal har bristande kunskap om endometrios, ger otillräcklig information och i många fall normaliserar deras symtom. Resultatet pekar på behovet av en förbättring inom endometriosvården. Ökad kunskap och förståelse för patientens upplevelse av vårdrelationen kan bidra till ökat välbefinnande. / Background Endometriosis is a chronic medical condition that can cause diffuse symptoms such as severe menstrual pain, pain during intercourse, fatigue and reduced fertility. Living with endometriosis can affect the individual’s physical, psychological, social, and existential wellbeing to varying degrees. To promote the health of patients with endometriosis and alleviate their suffering, the nurse has a central role by offering safe and good care. A prerequisite for this is that the nurse has insight into the patient’s perspective. Aim The aim of this study was to describe patients with endometriosis and their experience of patient-healthcare professional relationships. Method A non-systematic literature review based on 17 scientific articles with qualitative,quantitative and mixed methods. The articles were retrieved from the databases PubMed and CINAHL using various combinations of search terms. A quality review of included articles has been carried out based on Sophiahemmet University's assessment basis for scientific classification and quality. The results of the scientific articles were analyzed and compiled with an integrated data analysis. Results The results were compiled into two main categories; the importance of feeling involved in the patient-healthcare professional relationship and having one's needs met. The result highlight that patients with endometriosis experience shortcomings in their patient-healthcare professional relationships and a lack of a person-centered approach. Conclusions This literature review showed valuable insights into how patients with endometriosis can benefit from a person-centered approach in the patient-healthcare professional relationship.The compilation identified that patients feel that healthcare professionals have a lack of knowledge about endometriosis, provide insufficient information and, in many cases,normalize their symptoms. The result points to the need for an improvement in endometriosis care. Increased knowledge and understanding of the patient’s experience of the patient-healthcare professional relationship can contribute to increased well-being.

When young people are placed in residential care, the staff have a responsibility to ensure that the youth have a safe environment where they can thrive and develop. Residential staff also have responsibilities to ensure the rights of youth during the residential care. This study aims to examine how staff consider themselves to treat the youth in residential care. Furthermore the study aims to examine how the staff consider themselves to ensure youth their right to be heard and have an impact on their own lives, in agreement with Article 12 of the UN convention on the rights of the child (CRC). A qualitative method has been used in order to answer the study's purpose and issues. Five interviews were conducted with residential staff, four of which were environmental therapists and one who was a manager. The results show that the staff consider themselves to respond well to the youth, however, a good treatment is difficult to define and therefore hard to achieve. Furthermore, it appears that the knowledge about children’s rights varies among the staff, which can have negative effects on how they manage to reassure youth their rights to be heard and have an impact on their own lives, in agreement with Article 12 of the CRC.