Thesis (Ph. D.)--University of Washington, 1994. / Vita. Includes bibliographical references (leaves [193]-200).

Background: When the patient is critically ill the family is in a vulnerable position. The nurse's role is to support and help the family to find meaning in the difficult situation and to provide realistic hope. Balancing between the patient's and the family's needs is difficult. Knowledge about how nurses experience difficulties in the interaction with family is required in order to grant good care too critically ill patients and their family-members. Aim: To describe nurses' perceived difficulties in the interaction with family-members of critically ill patients. Method: The study is a qualitative literature-based study based on qualitative research. Results: The analysis resulted in four main themes; difficult disunion, environmental constraints, interpersonal difficulties and communicative difficulties. Conflicts, disagreement and expectations in the interaction with family-members are difficult. There are environmental constraints in the form of family's presence, lack of space and time constraints. Nurses find it difficult to manage their emotions, family who get to close and to support the family. Information, comprehension, knowledge, language barriers and cultural differences represents communicative difficulties. Conclusion: There is a lack of knowledge among nurses about how to handle difficult situations where family is involved. Doctors and nurses need to collaborate more. Conflicts, disagreements and expectations can put severe pressure on the nurse. It is difficult for the nurse to strike a balance between being professional and being personal. Environmental constraints are an organizational problem which creates difficulties for the nurse in the interaction with family.

Atualmente, já é consolidada a idéia de que as condições de saúde-doença dos membros da família e a família enquanto unidade influenciam-se mutuamente. A Entrevista de 15 minutos foi desenvolvida como uma forma condensada do Modelo Calgary de Avaliação e Intervenção com famílias, objetivando contribuir para o estabelecimento de um relacionamento entre enfermeiro e família de modo que, mesmo em uma breve interação, possibilite intervenções que promovam saúde e alívio de sofrimento. O Programa/Estratégia Saúde da Família (PSF) foi implantado em 1994 para reorganizar o Sistema Único de Saúde no Brasil, preconizando que a família e seu espaço social sejam eleitos como núcleo básico de abordagem no atendimento à saúde. Esse estudo objetivou conhecer a experiência de enfermeiros do Programa de Saúde da Família no uso da Entrevista de 15 minutos nas visitas domiciliares realizadas no período puerperal. Para tanto, foi realizada uma pesquisa qualitativa que ocorreu em três etapas: Etapa 1 treinamento dos participantes, Etapa 2 utilização da Entrevista de 15 minutos pelos enfermeiros, Etapa 3 entrevistas com os enfermeiros. Os dados foram coletados por meio de entrevistas semi-estruturadas, totalizando oito participantes, e foram analisadas através de Análise Temática. Dois temas centrais foram evidenciados: VIVENDO O DESAFIO DE UMA NOVA EXPERIÊNCIA e AVALIANDO A EXPERIÊNCIA. Ao enfrentar o desafio de utilizar a Entrevista de 15 minutos em sua prática profissional o enfermeiro do PSF percebe o impacto positivo dessa nova ferramenta em seu relacionamento com as famílias atendidas, ampliando seu olhar sobre elas como uma unidade e aprofundando o vínculo entre família e profissional. Esse olhar ampliado contribui para uma avaliação mais precisa das necessidades e anseios da família, facilitando a implementação de novas intervenções, como o uso de elogios e orientações. Por outro lado, o profissional vivencia dificuldades ao construir os genogramas e ecomapas e também ao perceber que aquele momento não é adequado para a realização da entrevista com a família. Esse trabalho evidencia que a Entrevista de 15 minutos pode atuar como um contexto que facilita o aprofundamento das relações entre enfermeiros e famílias no PSF, o que aproxima a preconização da família como foco de atenção no atendimento à saúde da sua concretização. / The idea that the conditions of health-illness of the members of a family influence one another mutually is widely known nowadays. The 15 minute family interview was developed as a condensed form of the Calgary Family Assessment and Intervention Models, aiming to contribute to the establishment of a therapeutic relationship between nurse and family and the implementation of interventions to promote health and the relief of suffering, even in a brief interaction. The Family Health Program (FHP) was implemented to reorganize the National Health System in Brazil, recommending that the family and their social space to be elected as the nucleus of approach in health care. This study investigated the experience of nurses from the Family Health Program in the use of the 15 minutes family interview on home visits in the postpartum. Thus, a qualitative study was conducted and took place in three stages: Stage 1 Participants Training Program, Stage 2 Utilization of the 15-minute family interview by participants and Stage 3 Interviews with participants. The data were collected through semi-structured interviews with the nurses, a total of eight participants, and were analyzed using thematic analysis. Two main themes were highlighted: Living the challenge of a new practice and Evaluating the assignment. Facing the challenge of using the 15-minute family interview in his/her practice, the nurse realizes the positive impact of this new tool in his/her relationship with the families, broadening his/her view of them as a unit and deepening the bond with the families. This expanded view of the family contributes to a more accurate assessment of the familys needs and wishes, facilitating the implementation of new interventions, as the use of commendations and orientations. On the other hand, the professional also experiences difficulties in constructing genograms and ecomaps and when realizes that that moment is not suitable for the 15-minute family interview. This work shows that the 15-minute family interview can serve as a context that facilitates the deepening of relations between nurses and families in the FHP, which approximates the proposal of the family as the focus of attention in health care of its fulfillment.

This study explores the phenomenon of the relationships between practitioners and families who have a child with a chronic illness. Using a heremeneutic phenomenological method informed by the writings of Martin Heidegger [1889-1976] and Hans-Georg Gadamer [1900-2002], this study provides an understanding of the meaning of 'being in relationship' from the perspective of both families and practitioners.Study participants include ten family groups who have a child with a chronic illness and twelve practitioners from the disciplines of nursing, medicine, dietetics, physiotherapy and speech therapy who work with children with chronic illness. Narrative audiotaped interviewing was the means by which the participants told their stories about times that relationships worked well and when they did not. These stories uncover the every day realities of 'being in relationship' and provide another understanding of the relationship between family and practitioner.The findings of this thesis suggest that chronic childhood illness 'throws' families and practitioners together into a web of relationships that must work for the sake of the child. The relationship is primarily conducted between adults. Children are usually excluded. In order to understand and manage the child's illness, practitioners and families 'go around' and act 'in-between' relationships. While the quality of the relationship from the family perspective is not essential to the chronic illness journey, relationships are more successful when practitioners recognise the uniqueness of each family web. The nature of the relationship is often simple, yet it co-exists with complexity. This thesis proposes that a 'companion relationship' between practitioners and family may offer a more effective and satisfying way of working. It also challenges practitioners to consider the voice of children within health care relationships.

<p> </p><p>The purpose of this study was to investigate registered nurses experiences about giving support to relatives to patients within palliative home care. This study was descriptive with qualitative approach. The data collection was made in the form of semi structured qualitative interviews which took place in a Swedish city of medium size, in an area for palliative homecare. Six registrated nurses were interviewed which all gave informed consent. The study suffered no losses and permission from the director of the concerned department had been given prior to the start of this study. The interviews were transcribed and analyzed whereupon three themes followed by seven categories entered.</p><p>In the main results difficulties appeared, such as when the family of a patient was unwilling to realize the situation. However the results also showed opportunities, for example the importance of the support which the nurses constituted. Many informants witnessed about the individual needs that existed among the relatives.  Foremost emphasize was on the importance of relatives and how the contact with them took place. Finally the study shows a picture of the supporting aspects that exists, for example to be able to sense the relatives needs and se their unspoken demands.</p><p> </p> / <p> </p><p>Syftet med studien var att undersöka sjuksköterskors upplevelser av att ge stöd till anhöriga till patienter inom palliativ hemsjukvård. Studien var deskriptiv med kvalitativ ansats. Datainsamling skedde i form av semistrukturerade intervjuer utifrån ett intervjuschema, intervjuerna spelades in på band. Detta ägde rum i en medelstor svensk stad i en verksamhet för palliativ hemsjukvård. Sex legitimerade sjuksköterskor intervjuades, varav samtliga lämnade informerat samtycke. Studien erfor inget bortfall och tillstånd från berörd verksamhetschef hade erhållits innan studiens start. Intervjuerna transkriberades och analyserades vartefter tre teman med sju kategorier kom fram.</p><p>I huvudresultatet framkom svårigheter som när anhöriga har en ovilja att inse situationen. Även möjligheter, till exempel betydelsen av det stöd som sjuksköterskorna utgjorde för de anhöriga belystes.   Många informanter vittnade om individuella behov bland de anhöriga. Framförallt betonades vikten av anhöriga och hur kontakten med dem skede. Slutligen gavs en bild av vilka stödjande aspekter som fanns till exempel sjuksköterskornas förmåga att kunna känna av de anhöriga och se deras osagda behov.</p><p> </p>

The purpose of this study was to investigate registered nurses experiences about giving support to relatives to patients within palliative home care. This study was descriptive with qualitative approach. The data collection was made in the form of semi structured qualitative interviews which took place in a Swedish city of medium size, in an area for palliative homecare. Six registrated nurses were interviewed which all gave informed consent. The study suffered no losses and permission from the director of the concerned department had been given prior to the start of this study. The interviews were transcribed and analyzed whereupon three themes followed by seven categories entered. In the main results difficulties appeared, such as when the family of a patient was unwilling to realize the situation. However the results also showed opportunities, for example the importance of the support which the nurses constituted. Many informants witnessed about the individual needs that existed among the relatives.  Foremost emphasize was on the importance of relatives and how the contact with them took place. Finally the study shows a picture of the supporting aspects that exists, for example to be able to sense the relatives needs and se their unspoken demands. / Syftet med studien var att undersöka sjuksköterskors upplevelser av att ge stöd till anhöriga till patienter inom palliativ hemsjukvård. Studien var deskriptiv med kvalitativ ansats. Datainsamling skedde i form av semistrukturerade intervjuer utifrån ett intervjuschema, intervjuerna spelades in på band. Detta ägde rum i en medelstor svensk stad i en verksamhet för palliativ hemsjukvård. Sex legitimerade sjuksköterskor intervjuades, varav samtliga lämnade informerat samtycke. Studien erfor inget bortfall och tillstånd från berörd verksamhetschef hade erhållits innan studiens start. Intervjuerna transkriberades och analyserades vartefter tre teman med sju kategorier kom fram. I huvudresultatet framkom svårigheter som när anhöriga har en ovilja att inse situationen. Även möjligheter, till exempel betydelsen av det stöd som sjuksköterskorna utgjorde för de anhöriga belystes.   Många informanter vittnade om individuella behov bland de anhöriga. Framförallt betonades vikten av anhöriga och hur kontakten med dem skede. Slutligen gavs en bild av vilka stödjande aspekter som fanns till exempel sjuksköterskornas förmåga att kunna känna av de anhöriga och se deras osagda behov.

This study explores the phenomenon of the relationships between practitioners and families who have a child with a chronic illness. Using a heremeneutic phenomenological method informed by the writings of Martin Heidegger [1889-1976] and Hans-Georg Gadamer [1900-2002], this study provides an understanding of the meaning of 'being in relationship' from the perspective of both families and practitioners.Study participants include ten family groups who have a child with a chronic illness and twelve practitioners from the disciplines of nursing, medicine, dietetics, physiotherapy and speech therapy who work with children with chronic illness. Narrative audiotaped interviewing was the means by which the participants told their stories about times that relationships worked well and when they did not. These stories uncover the every day realities of 'being in relationship' and provide another understanding of the relationship between family and practitioner.The findings of this thesis suggest that chronic childhood illness 'throws' families and practitioners together into a web of relationships that must work for the sake of the child. The relationship is primarily conducted between adults. Children are usually excluded. In order to understand and manage the child's illness, practitioners and families 'go around' and act 'in-between' relationships. While the quality of the relationship from the family perspective is not essential to the chronic illness journey, relationships are more successful when practitioners recognise the uniqueness of each family web. The nature of the relationship is often simple, yet it co-exists with complexity. This thesis proposes that a 'companion relationship' between practitioners and family may offer a more effective and satisfying way of working. It also challenges practitioners to consider the voice of children within health care relationships.

Licentiatavhandling (sammanfattning) Stockholm : Karol. inst., 2005. / Härtill 2 uppsatser.

Thesis (PhD) -- Auckland University of Technology, 2004. / Also held in print (250 leaves, col. ill., 30 cm.) in Akoranga Theses Collection (T 618.92 DIC)

Atualmente, já é consolidada a idéia de que as condições de saúde-doença dos membros da família e a família enquanto unidade influenciam-se mutuamente. A Entrevista de 15 minutos foi desenvolvida como uma forma condensada do Modelo Calgary de Avaliação e Intervenção com famílias, objetivando contribuir para o estabelecimento de um relacionamento entre enfermeiro e família de modo que, mesmo em uma breve interação, possibilite intervenções que promovam saúde e alívio de sofrimento. O Programa/Estratégia Saúde da Família (PSF) foi implantado em 1994 para reorganizar o Sistema Único de Saúde no Brasil, preconizando que a família e seu espaço social sejam eleitos como núcleo básico de abordagem no atendimento à saúde. Esse estudo objetivou conhecer a experiência de enfermeiros do Programa de Saúde da Família no uso da Entrevista de 15 minutos nas visitas domiciliares realizadas no período puerperal. Para tanto, foi realizada uma pesquisa qualitativa que ocorreu em três etapas: Etapa 1 treinamento dos participantes, Etapa 2 utilização da Entrevista de 15 minutos pelos enfermeiros, Etapa 3 entrevistas com os enfermeiros. Os dados foram coletados por meio de entrevistas semi-estruturadas, totalizando oito participantes, e foram analisadas através de Análise Temática. Dois temas centrais foram evidenciados: VIVENDO O DESAFIO DE UMA NOVA EXPERIÊNCIA e AVALIANDO A EXPERIÊNCIA. Ao enfrentar o desafio de utilizar a Entrevista de 15 minutos em sua prática profissional o enfermeiro do PSF percebe o impacto positivo dessa nova ferramenta em seu relacionamento com as famílias atendidas, ampliando seu olhar sobre elas como uma unidade e aprofundando o vínculo entre família e profissional. Esse olhar ampliado contribui para uma avaliação mais precisa das necessidades e anseios da família, facilitando a implementação de novas intervenções, como o uso de elogios e orientações. Por outro lado, o profissional vivencia dificuldades ao construir os genogramas e ecomapas e também ao perceber que aquele momento não é adequado para a realização da entrevista com a família. Esse trabalho evidencia que a Entrevista de 15 minutos pode atuar como um contexto que facilita o aprofundamento das relações entre enfermeiros e famílias no PSF, o que aproxima a preconização da família como foco de atenção no atendimento à saúde da sua concretização. / The idea that the conditions of health-illness of the members of a family influence one another mutually is widely known nowadays. The 15 minute family interview was developed as a condensed form of the Calgary Family Assessment and Intervention Models, aiming to contribute to the establishment of a therapeutic relationship between nurse and family and the implementation of interventions to promote health and the relief of suffering, even in a brief interaction. The Family Health Program (FHP) was implemented to reorganize the National Health System in Brazil, recommending that the family and their social space to be elected as the nucleus of approach in health care. This study investigated the experience of nurses from the Family Health Program in the use of the 15 minutes family interview on home visits in the postpartum. Thus, a qualitative study was conducted and took place in three stages: Stage 1 Participants Training Program, Stage 2 Utilization of the 15-minute family interview by participants and Stage 3 Interviews with participants. The data were collected through semi-structured interviews with the nurses, a total of eight participants, and were analyzed using thematic analysis. Two main themes were highlighted: Living the challenge of a new practice and Evaluating the assignment. Facing the challenge of using the 15-minute family interview in his/her practice, the nurse realizes the positive impact of this new tool in his/her relationship with the families, broadening his/her view of them as a unit and deepening the bond with the families. This expanded view of the family contributes to a more accurate assessment of the familys needs and wishes, facilitating the implementation of new interventions, as the use of commendations and orientations. On the other hand, the professional also experiences difficulties in constructing genograms and ecomaps and when realizes that that moment is not suitable for the 15-minute family interview. This work shows that the 15-minute family interview can serve as a context that facilitates the deepening of relations between nurses and families in the FHP, which approximates the proposal of the family as the focus of attention in health care of its fulfillment.