Communication with healthcare providers (HCP’s) at the end-of-life (EOL) is a crucial process that can make a difference in the quality of the EOL experience for patients and their families. Targeting EOL communication interventions between patients, their families, and HCP’s is better informed from an understanding of what family members perceive as good and bad communication. The purpose of this study was to explore experiences related to communication with HCP’s in central Massachusetts during EOL care. Data from the parent study (n = 373) included responses from an open ended question at the end of the survey. The larger, qualitative descriptive study, from the parent study, (n = 218 ) that examined the open ended question revealed communication as the overarching theme. A secondary analysis of this open ended survey data using qualitative content analysis was used to describe next of kin’s perspectives of communication with HCP’s during the decedents’ end-of-life experience (n = 171). Family members (children = 38.4% and spouse = 22.0%) comprised the majority of the sample. Decedents were mostly 80 or older (47.6%), died in an acute care setting of mostly cancer (33.0 %) and cardiovascular disease (32.3%). Accessing information, emerged as the overarching theme. Continuum of information, healthcare provider sensitivity, having the answers and raising awarenesswere revealed as subthemes. The majority of respondents reported good aspects versus bad aspects of communication at the EOL. The framework for a good death (Emanuel & Emanuel (1998) under-girded the study but was not supported as it relates to these findings. The framework was useful in capturing the multidimensional process that each patient and their family could experience during the EOL process. The findings from this study provide insight for HCP’s about which aspects of communication are helpful at the EOL. Continuing education of the health care team on these identified helpful communication aspects will provide better access for patients and families for a quality EOL experience.

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Bakgrund   Sexuellt våld är ett utbrett folkhälsoproblem som drabbar kvinnor över hela världen. Det sexuella våldet kan komma att påverka kvinnors fysiska och psykiska hälsa livet ut. I vården sker möten ständigt och för hälso- och sjukvårdspersonal ingår det i den professionella hållningen att oavsett omständigheter främja ett gott bemötande gentemot patienten. Hälso- och sjukvården har ett stort ansvar i mötet med sexuellt våldsutsatta kvinnor, då mötet kan komma att påverka kvinnans möjligheter till stöd, återhämtning och tillit till vården. Syfte  Syftet med studien var att beskriva sexuellt våldsutsatta kvinnors upplevelser och erfarenheter av mötet med hälso- och sjukvården. Metod  En icke-systematisk litteraturöversikt genomfördes och resulterade i 15 vetenskapliga artiklar av kvalitativ och kvantitativ design. Artiklarna togs fram med hjälp av databaserna CINAHL och PubMed samt via manuella sökningar. De valda artiklarna kvalitetsgranskades med hjälp av Sophiahemmet Högskolas bedömningsunderlag och analyserades med hjälp av integrerad analys.  Resultat Resultatet visade att positiva upplevelser och erfarenheter präglades av god kommunikation som genomsyrades av empati, respektfullhet och lyhördhet. I sin tur präglades negativa upplevelser och erfarenheter av okunskap hos personalen, dömande attityder och väntetid. Likaså lyftes lugn och avskild vårdmiljö, möjlighet att välja personal samt tillräcklig uppföljning och stöd som faktorer som saknades i mötet.  Slutsats Sexuellt våldsutsatta kvinnor hade både positiva och negativa upplevelser och erfarenheter av hälso- och sjukvården och flera aspekter saknades i mötet. Med hjälp av ökad kunskap om kvinnors utsatthet och förbättrad förståelse för sexuellt våldsutsatta kvinnors upplevelser och erfarenheter kan nya riktlinjer kring omhändertagandet utformas och därmed förbättra vården och lindra lidande. / Background Sexual violence is a widespread public health problem affecting women around the world. Sexual violence may affect women's physical and mental health throughout life. In healthcare encounters occur regularly and for personnel within healthcare, it is part of the professional attitude to promote a rewarding treatment to the patient, regardless of the circumstances. Health services have a great responsibility in the encounter with sexually abused women, as the encounter may affect the woman's opportunities for support, recovery and trust for healthcare. Aim The purpose of this study was to describe sexually abused women’s experience of their encounter with healthcare. Method A non-systematic literature review was conducted and resulted in 15 scientific articles of both qualitative and quantitative design. The articles were retrieved from the databases CINAHL, PubMed and through manual searches. The included articles were reviewed using Sophiahemmet University’s template for quality assessment and the results were analyzed with a thematic analysis approach. Results The results showed that positive experiences were characterized by good communication based on empathy, respect and sensitivity. In contrast, negative experiences were characterized by ignorance among the staff, judgmental attitudes and waiting time. Likewise, a calm and secluded care environment, the freedom to choose staff and sufficient support and follow-up were highlighted as factors that were lacking in the encounter. Conclusions Sexually abused women had both positive and negative experiences of health care, and several aspects were missing in the encounter. With the help of increased knowledge about women's vulnerability and an improved understanding of sexually abused women experiences, new guidelines regarding care can be developed, and thereby improve care and alleviate suffering.

Based on the above findings, the researcher has the following suggestions: (1) The use of therapeutic settings and therapeutic relationships in working with clients should be strengthened in education and continuous professional training for Chinese psychotherapists, especially to those who do not have educational background in medical science. Simultaneously, it is important to enhance the reflectivity of Chinese psychotherapists on their work and life experience. (2) To emphasize the legitimacy of psychotherapy in China, we have to regulate the norms of the profession according to the professional Code. Further, the principle of "do no harm" should be given higher priority in psychotherapy, psychotherapist need to cope with the demands from reality using wisdom and reason, pay attention to the affective needs of clients and promote social justice. (3) In the development of psychotherapy in mainland China, special efforts should be made to preserve the positive elements in traditional Chinese culture for the helping professions, keeping a balance between technical rationality and humane concern. We should pay attention to the goals of enhancing individual development, respect for diversity and importance of equality in practice as well as utilize the Chinese tradition and culture in helping clients to develop compassion, having empathetic understanding on the needs of one another. The purpose of doing so is to develop a new culture valuing compassion and reason in relating to one another. / The major findings of this research are as follows. (1) The understanding on the role of the therapeutic settings by the therapists are different. In comparison, those with training in psychoanalysis tend to attach more importance on the role of therapeutic settings than those who do not have such training. (2) The mainland psychotherapists still emphasis the importance of affection in relating with clients, using special rather than standard treatment for particular clients, which may result from the "differential distance in interpersonal relationship" dominant in Chinese culture. (3) Professional ethics for communities of counseling practice is newly introduced into mainland China, and people are beginning to pay attention to its relevant ethics. Its development, however, is still in infancy stage. (4) The mainland Chinese psychotherapists emphasis more on building relationship with people than developing technical skills in psychotherapy. This may be related to the fact that Chinese culture attaches more importance to interpersonal relationships. / This research attempts to answer the following questions: (1) What are the understanding of mainland Chinese psychotherapists about the meaning of professional ethics and therapeutic relationships? (2) How do they establish therapeutic relationships with their clients? (3) Are there any patterns in their establishment of therapeutic relationships, and how they interpret these patterns? (4) In their views, what are the principles and main points in establishing a healthy therapeutic relationship? / This study has implications for the helping professions in mainland China that it reveals the experiences, feelings and cognition of some mainland Chinese psychotherapists in their embodied professional ethical norms and therapeutic relationships. It illustrates the characteristics of these psychotherapists in dealing with professional relationships in a country which still values relationships and human feelings. The study also examines the factors that have influenced these psychotherapists in the development of their characteristics, e.g. the country's history, modern cultural atmosphere, and the ordinary people's routine styles of interpersonal exchange in China. The findings of this study, as a preliminary exploration of the process of establishing ethical norms and principles in mainland China, would be helpful to the development of social work in mainland China. (Abstract shortened by UMI.) / This study is significant as it is the first qualitative inquiry of the therapeutic relationships between clients and psychotherapists in mainland China. It explores the the impact of Chinese cultural tradition and modern social development on the mentality of mainland Chinese psychotherapists. / Using social constructivism as the epistemological frame, ecological systems theory is chosen as the theoretical framework in conducting the study using qualitative research. In-depth interviews and on-site observations are the methods chosen to collect data. The main source of data comes from in-depth interviews with 15 psychotherapists in different institutes located in four cities in mainland China. Through careful analysis of the data, thick description is used to describe the data. And using thematic analysis for the interpretation of the findings. / 陳向一. / Source: Dissertation Abstracts International, Volume: 71-01, Section: A, page: 0332. / Thesis (doctoral)--Chinese University of Hong Kong, 2009. / Includes bibliographical references (p. 277-300). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. Ann Arbor, MI : ProQuest Information and Learning Company, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Abstracts in Chinese and English. / Chen Xiangyi.

Bakgrund: Ett bra bemötande karaktäriseras av ett respektfullt, kompetent och empatiskt samspel som är individanpassat. Patienter med substansbrukssyndrom är en grupp som uppfattas som vårdkrävande och är föremål för stigmatisering, därmed kan bemötandet ses som en utmaning. Patientcentrerad vård innebär att sträva efter individens välmående. Med hjälp av ett motiverande förhållningssätt kan sjuksköterskan öka patienternas empowerment. Syfte: Att undersöka hur patienter med substansbrukssyndrom upplever bemötandet från vårdpersonal, med fokus på sjuksköterskor. Metod: Litteraturöversikt där både kvalitativa och kvantitativa artiklar ingick. Resultat: Tre kategorier angående bemötande identifierades: att se hela individen, vårdande möte och stigma. Under varje kategori urskildes både positiva och negativa upplevelser av bemötande. Diskussion: Ett patientcentrerat förhållningssätt kan förstås som ett empatiskt, omtänksamt, engagerat och hjälpsamt bemötande. Många patienter hade upplevelser av diskriminering och stigmatisering inom vården, detta kunde delvis förklaras som en maktobalans i relationen mellan vårdgivare och patient.  Slutsats: Sjuksköterskans bemötande kan både öka och minska vårdlidande. Ett gott bemötande är betydelsefullt för att främja hälsa och optimera resultatet av vården. Omvårdnaden av personer med substansbrukssyndrom kan förbättras. / Introduction: The responsibility of the nurse is to have competence and to treat every patient with respect and empathy. Patients with substance use disorders are a group that can be viewed as a group with a large demand of care. They are exposed to stigmatization and therefor they need specialized care. The meaning of patient centered care is to strive to optimize every individual’s well-being. Nurses may increase patient’s empowerment through a motivating approach. Aim: To explore patients’ perceptions of the nurse-patient relation of patients with substance use disorder. Method: A literature review, including both qualitative and quantitative studies. Result: Three categories were identified: To see the whole person, caring encounter and stigma. Both positive and negative aspects of every category were discovered. Discussion: A patient centered approach can be understood as an emphatic, caring, committed and helpful encounter. Many patients had experiences of discrimination and stigma during care. This could partly be understood as an unbalanced power-control relationship between caregiver and patient. Conclusion: The nurses actions can increase as well as decrease patients suffering. A caring encounter is important to promote health and to optimize the results of care. There is room for development of nursing skills in care of patients with substance use disorders.

Diss. (sammanfattning) Stockholm : Univ., 2003. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 6 uppsatser.

Diss. (sammanfattning) Umeå : Univ., 2004. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Made available in DSpace on 2014-06-11T19:27:45Z (GMT). No. of bitstreams: 0 Previous issue date: 2005-12-13Bitstream added on 2014-06-13T19:15:10Z : No. of bitstreams: 1 goncalves_pe_me_araca.pdf: 343612 bytes, checksum: 732c1747b04c880385b3be6634947064 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Os aspectos bioéticos, éticos e legais não devem ser negligenciados pelos cirurgiões-dentistas durante o tratamento odontológico, pois este não se restringe apenas ao ato clínico, mas abrange desde a relação profissional/paciente até a documentação odontológica. Este estudo teve como objetivo avaliar o conhecimento dos cirurgiões-dentistas (n=163) que realizam curso de especialização na Universidade Estadual Paulista - UNESP, sobre esses aspectos. Foi realizado um estudo transversal descritivo, por meio de um questionário semi-estruturado. As respostas quantitativas foram analisadas pelo programa Epi Info 6.0.4, por meio de levantamento das porcentagens e as respostas qualitativas, através da análise de conteúdo, pela técnica de análise categorial, conforme preconizado por Bardin (1994). Em relação aos aspectos bioéticos, 88,1% citam que a decisão sobre o tratamento deve ser resultado em comum acordo entre o profissional e o paciente, porém 26,4% relatam que a participação do paciente e/ou seu representante legal pode interferir de maneira negativa, quando os mesmos optam pelo tratamento menos vantajoso. Já a atuação do profissional, quando o paciente escolhe um tratamento menos conveniente, 95,6% dos entrevistados tentam convencê-lo a optar pelo tratamento melhor. Apesar de todos os entrevistados considerar importante à interação profissional/paciente, 20,3% não souberam relacionar sua importância para o tratamento odontológico. Sobre os aspectos éticos, observamos que 89,4% alegam apresentar todas as alternativas de tratamento quando o caso possui mais de uma, mas a linguagem utilizada por 48,1% dos entrevistados é técnica, dificultando o entendimento do paciente. Antes do tratamento odontológico, apenas 22,6% obtém o consentimento livre e esclarecido, enquanto 48,4 % dos pesquisados adquirem a autorização do paciente. / The bioethics, ethicals and legals aspects should not be neglectful by the dentist-surgeons during dental treatment, because it doesn't limit to the clinical action, but it includes since the professional/patient relationship to the dental documentation. Our study aimed at evaluating dentist-surgeons' knowledge (n=163) when conducting specialization courses at São Paulo State University - UNESP, on these aspects. A descriptive traversal study was conducted, through a semi-structured questionnaire. The quantitative answers were analyzed by the program Epi Info 6.0.4, through survey of the percentages and the qualitative answers, through the content analysis, by category analysis technique as advocated by Bardin (1994). In relationship to bioethics aspects, Out of the people surveyed, 88.1% mentioned that a decision for the dental treatment should be made by mutual agreement between professionals and patients, however, 26.4% report that patients' or their legal representative's participation in treatment decision-making can cause negative interference, since they can choose a type of treatment that dentist-surgeons will not deem as the most proper one. On professionals' acting when patients choose a less suitable treatment, 95.6% of these try to convince patients that it is not the best choice and persuade them for a better one by keeping the paternalistic model. It was noticed that 20.3% did not know how to relate the importance of professionalpatient interaction as regards the dental treatment. About the ethical aspects, 89.4% alleged that they inform patients about all the alternatives of treatment when the case involves more than one. As regards the legal ethical test requested to patients prior to treatment, only 22.6% ask for the informed consent term, while 48.4% obtain the authorization.