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Bakgrund: Femton procent av alla möten inom vården upplevs som besvärliga av vårdpersonal. Besvärliga möten inom vården har stora följdverkningar, inte bara för patienten utan även för vårdpersonalen. De “besvärliga” patienterna riskerar att få sämre vård och bemötas med mindre respekt än övriga patienter. Besvärliga patienter är inte någon väl definierad patientgrupp utan karaktäriseras av en mängd olika egenskaper och symptom. Det finns en kritik mot användandet av begreppet besvärlig patient då det riskerar att fungera stigmatiserande och diskriminerande. Syfte: Beskriva vilka strategier vårdpersonal har för att bemöta den “besvärliga patienten”. Metod: Uppsatsen är en litteraturöversikt av elva vetenskapliga artiklar. Artiklarna analyserades med avseende på likheter och skillnader i resultatet. Resultat: Fem kategorier framkom: Bygga relation, Kontakt och kommunikation, Närhet och distans, Stöd och support samt Undvikande och kontroll. Huvudfynden speglar de strategier som vårdpersonal använder i mötet med den “besvärliga” patienten. Där återfinns både strategier som främjar en god patientkontakt och strategier som i förlängningen leder till negativa konsekvenser för både patient och personal. Slutsats: Strategier vårdpersonal använder i mötet med patienter som upplevs som besvärliga handlar till stor del om att uppnå en fungerande kommunikation och en god relation. I detta ligger strategier som betonar att lyssna, ge tid samt uppträda empatiskt, respektfullt och ärligt. Det finns också strategier som kontrollerar patienten eller begränsar patientens personliga frihet. Klinisk betydelse: Kunskap om vilka strategier som finns ger vårdpersonalen viktiga verktyg i den kliniska vardagen i mötet med den så kallade besvärliga patienten. I slutändan kan detta leda till en ökad patientsäkerhet och en vård av högre kvalitet för en sårbar och utsatt patientgrupp, samt en förbättrad arbetsmiljö för vårdpersonalen. / Background: Fifteen percent of all encounters in hospitals or health care facilities are perceived by health care staff as difficult. Difficult encounters have wide range of consequences for both the patient and health care professionals. A “difficult” patient is more likely to receive inadequate treatment and be treated with less respect. What constitutes a difficult patient is not well-defned, and they may be characterized by a broad range of personal and behavioural characteristics as well as symptoms. There are critical arguments against the verbal use of the difficult patient concept, as it may have a stigmatizing and discriminating effect on such a patient. Aim: Describe the strategies used by health care professionals when dealing with the “difficult patient”. Methods: The study is a literature review, in which the results of eleven scientific journal articles are compared and contrasted. Results: The main results reflect the strategies health care staff use when dealing with the “difficult” patient. From the litterature, five strategic categories have emerged. These categories include: Build relationship, Contact and communication, Closeness and distance, Help and support and Avoidance and control. These include both strategies that promote a good relation with the patient and strategies that lead to negative consequences for both patients and health care professionals. Conclusions: Strategies used by health care professionals when caring for patients perceived as difficult focus on achieving effective communication and a good relationship. These strategies emphasize listening, giving time and acting with empathy, respect and honesty. There are also strategies that control the patient or restrict the patient’s personal freedom. Relevance to clinical practice: This thesis presents an overview of which strategies exist for dealing with so called difficult patients, knowledge of which is vital for health care professionals working in clinical practice. This can lead to improved patient safety and health care of higher quality for a vulnerable and exposed group of patients, as well as a better working environment for the health care staff.

Vad är det som gör att vi uppfattar vissa samtal som svåra och hur ska vi på bästa sätt hantera dessa när de uppstår? Syftet med studien har varit att beskriva hur ett antal förskollärare upplever och säger sig hantera svåra samtal i förskolan. Utifrån syftet har vi ställt oss följande frågor: Vad menas med svåra samtal, enligt förskollärares upplevelser? Hur ser förskollärarnas förberedelser ut inför svåra samtal? Hur säger sig förskollärarna hantera de samtal som de uppfattar som svåra? Studien bygger på en kvalitativ metod i form av intervjuer som genomfördes med åtta förskollärare. Frågorna som ställdes var både strukturerade och ostrukturerade. Studien tar sin utgångspunkt i ett livsvärldsfenomenologiskt perspektiv. I resultatet framgår det att samtal som förskollärare upplever som svåra är samtal som rör ett barns missgynnande livssituation. Det framgår också av resultatet att den kollegiala stöttningen är utmärkande när det rör sig om förskollärarnas förberedelser inför ett samtal som kan tänkas bli svårt. Resultatet visar att det även finns brister i hur förskollärarna skapar möjligheter för föräldrarna att bli delaktiga i planeringen av samtalen. Vidare framgår det att ett samtal kan väcka känslor hos förskolläraren som kan medföra att samtalet får en svår karaktär. Hur ett svårt samtal hanteras ser väldigt olika ut men att ha barnet i fokus är något som poängteras av samtliga förskollärare. Studien synliggör en komplex verklighet där samtalen mellan förskolan och hemmet kan beröra känsliga och svåra ämnen, samtal som förskollärarna förväntas kunna hantera och förhålla sig till. / What is it that makes us perceive certain conversations as difficult and how do we best handle these as they arise? The aim of the study is to describe how a number of preschool teachers experience and claims to handle difficult conversations in preschool? The questions we asked were of structured art with a relatively high degree of standardization. According to the aim of the study we have asked ourselves the following questions; What is meant by a difficult conversation, according to preschool teachers experiences? How do the preschool teachers prepare before difficult conversations? How do preschool teachers claim to handle the conversations that they perceive as difficult? The study is a qualitative method based on interviews conducted with eight preschool teachers. The questions asked were of both structured and unstructured. The study is based on a life-world phenomenological perspective. The result shows that conversations that preschool teachers are experiencing as difficult conversations are those dealing with a child's disfavored life situation. Furthermore it appears that a conversation can generate feelings within the preschool teacher, which can cause the conversation to be of difficult character. The management of a difficult conversation is varying, but to keep the child in focus is something that is emphasized by all respondents. The study reveals a complex reality where a conversation between preschool and home involves sensitive and difficult subjects, conversations that preschool teachers are expected to handle and relate to.

Syftet med min undersökning var att få svar på hur Armémuseum i Stockholm representerar temat krig i basutställningen och hur museipersonalen förhåller sig till denna representation. Jag önskade även veta vad för sorts kulturarv Armémuseums anställda ansåg vara problematiskt att presentera. Jag intervjuade fyra personer från Armémuseum och via metoden “thick description” och Aronssons flanörperspektiv som grundar sig i promenadetnografin, gjort utförliga anteckningar av mina observationer från deras basutställning. Studien grundar sig i ett musei- och kulturarvsvetenskapligt perspektiv, där studier om hur kulturarv presenteras på museer är ett vanligt ämne. Mina teoretiska grundpelare har bland annat varit Gregory Ashworth, Sharon MacDonald, Laurajane Smith, Rihannon Mason och Peter Aronsson som alla menar att synen och bearbetningen av mörkt kulturarv påverkas av politiska värderingar, tiden och hur det framställs på museer. Resultatet av studien kommer fram till att Armémuseums anställda vill förmedla att krig är hemskt och som ofta går hand i hand med lidande, död och orättvisor. Armémuseum vill problematisera krig genom att presentera de “vanliga” soldaterna och deras familjers liv under krig, eftersom de var dem som ofta fick lida krigets bitterhet. Armémuseums personal vill inte bara visa upp vapen utan även visa de vardagliga objekten och situationerna eftersom de förmedlar den mänskliga närvaron i basutställningen. Därför har Armémuseums personal utformat basutställningen på ett sådan sätt att man som besökare ska känna sympati för dem som fick och fortfarande får lida på grund av krig. Ofta använder museet sig av iscensatta miljöer med dockor för att ge en tredimensionell bild av dessa människor. Armémuseums anställda har inte funnit några objekt svåra att ställa ut, vilket kanske kan bero på att de har den inställningen att krig bör problematiseras. Vem och vilka det är som egentligen tjänar på krig är frågor som är tidlösa. Det går exakt lika bra att fråga samma frågor idag som för några hundra år sedan, svaren är kanske densamma. Och det är det som Armémuseum vill förmedla till sina besökare: “Varför krigar människan?”, “För vilka krigar vi?” “Vilka är det som får lida?” och “Vilka representeras vanligtvis i historien och på museer?”. För som sagt, dessa frågor tycks ständigt vara aktuella och återkommande. Armémuseum vill väcka besökarnas intresse och åsikter angående krig, vart man ställer sig i diskussionen är upp till besökarna själva att avgöra. / In this thesis I examine how Army Museum in Stockholm, Sweden, exhibits the heritage of war in their permanent exhibition “War and Peace”. The museum is a governmental activity. The aim of my research is to study how the Army Museum employees relate to the representation of war and how this is expressed in the permanent exhibition. I have chosen to focus on the representation of war at the permanent exhibition and therefore chosen only to interview people who have worked on the design of the permanent exhibition. No visitors were interviewed because it was how the staff relates to the representation of war that I wanted to study. I use qualitative methods in my study using observations at the study site and interviews with the museum employees. I'm using a museum and cultural scientific perspective in my study, which is the study of how society sorts out, preserves and convey cultural heritage. Researchers who have figured as my theoretical counsellors include; Sharon MacDonald, Gregory Ashworth, Laurajane Smith. All those researchers mean that the view and adaption of “dark heritage” are influenced by political values, time and how it is presented in the exhibit. The study comes to the conclusion that the Army Museum wants to convey that war is horrible, especial for those who live with it in their everyday life. Army Museum exhibits war in such a way that it is not glorified. Instead they have chosen to problematize war and let its horrors be presented. The museum employees think it is important to encourage visitors to understand that war often goes hand in hand with death and suffering. The staffs do not think any item, so far, has been difficult to exhibit. This thesis is a two years master’s thesis in Museum and Cultural heritage.

This thesis analyses the difficulties in reading modern poetry that arise out of not the references but the unconventional use of language, and presents them in a theoretical framework based on Julia Kristeva&rsquo / s semanalytic theory and Melanie Parsons&rsquo / s application of it to a comparison of Nonsense literature and twentieth century poetry. Then aspects of the works of G. M. Hopkins, Dylan Thomas and Edith Sitwell are discussed and poems by these poets are analysed within this framework.

[Truncated abstract] This PhD project was comprised of three major studies. Study 1 utilised the Nominal Group Technique (NGT) to identify a typology of difficult patients in private practice physiotherapy and to determine strategies physiotherapists use and would like to improve, when dealing with such patients. Physiotherapists (n=37) also shared their expectations of patients and their perceptions of patient expectations of physiotherapy. Results showed that the two areas most difficult to manage were behavioural problems of patients followed by patient expectations. To assist in their interaction with difficult patients, physiotherapists identified communication skills and behaviour modification techniques as strategies they would most like to learn. While physiotherapists expressed the greatest number of expectations in the behavioural domain, identification of patient expectations was not elicited as a strategy to manage difficult patients. Results of this qualitative study contribute to the evolving literature relating to physiotherapist-patient interactions and form a useful basis for educational programs directed at improving the therapeutic relationship in private practice physiotherapy. Study 2 involved applying the NGT with separate groups of patients (n=26) to identify patient expectations of the qualities of a ‘good’ physiotherapist, and to ascertain the characteristics of good and bad experiences in private practice physiotherapy. Findings indicated that the qualities of a ‘good’ physiotherapist related to their communication ability, professional behaviour and organisational ability, and characteristics of the service provided. The most important expectations of patients were for example, symptomatic relief, self-management strategies and ‘hands on’ treatment; associated with the physical domain. When comparing equivalent groups from Study 1, with patient expectations, most patient groups identified that the most important expectations of physiotherapists would relate to patient behaviours such as; compliance, honesty, payment of their account, being punctual, cooperating, trusting and showing respect for their physiotherapist. However, physiotherapists’ rankings of the most important expectations held by patients were not congruent with patient rankings providing an explanation as to why problems may arise in the physiotherapistpatient interaction from the patient’s perspective. Based on the findings of Study 2 it was suggested that physiotherapists should actively seek to involve patients in their management. To do this effectively, physiotherapists would benefit from further training in communication skills to ensure that they can successfully adopt a patientcentred approach and to optimise the physiotherapist-patient interaction in private practice physiotherapy.

<p>I det dagliga arbetet och som en del av omvårdnaden måste sjuksköterskan samtala med patienterna. Samtal kan vara väldigt svåra, vissa samtal är svårare än andra. För att oerfarna sjuksköterskor lättare skall kunna relatera och hantera dessa samtal i yrkeslivet var syftet med studien att beskriva vad sjuksköterskor anser vara det svåraste i svåra samtal. Ett fåtal studier beskriver vad sjuksköterskor anser vara svåra samtal och ingen studie har funnits som beskriver vad de anser vara det svåraste i dessa samtal. En kvalitativ metod valdes och innehållsanalys användes som metodanalys. Studien innefattar intervjuer med sex sjuksköterskor från ett sjukhus i västra Sverige. Resultatet av analysen visar sex huvudkategorier som innehåller sex sjuksköterskors beskrivning av vad det svåraste är i svåra samtal. Kategorierna är: samtal när personkemin inte stämmer, hoppfulla samtal vid negativa besked, samtal med arga patienter, känsliga samtal, försonande samtal med anhöriga och närvara i samtal under tidsbrist. Alla sjuksköterskorna upplevde att det svåraste i alla samtalen var att vara närvarande i samtalet för att behålla patientens hopp och få patienten att försonas med sin situation.</p> / <p>In the daily work of a nurse, talking to patients is part of the nursing care. Communication can be very difficult, and some conversations are harder than others. To make it easier for inexperienced nurses to relate and handle these conversations it’s important to establish what conversations nurses consider difficult and what the most challenging aspects are, and this was the aim of this study. Only a few previous studies describe what nurses consider difficult communication, and none of them focus on what the nurses perceive as the most challenging aspects. A qualitative method was chosen and content analysis was used as an analyze method. The study comprises interviews with six nurses in one hospital in the west of Sweden. The results of the analysis show six main categories which contain six nurses’ descriptions of what they consider to be the most difficult communication. The categories are: communication when the personal chemistry don’t match, hopeful communication when delivering negative notification, communicating with angry patients, sensitive communication, conciliating communication with relatives, and being presence in communication under stress. What all nurses found most challenging was, to be present in the conversation to keep the patients hope and help the patient accept their situation.</p>

Dans une économie globalisée actuelle, où l’environnement entrepreneurial est défini comme incertain et turbulent, les entreprises choisissent les stratégies de coopétition pour avoir des avantages et performances. Mais, selon la littérature spécialisée, si les avantages et les performances, sont mis en avant pour justifier la pertinence des stratégies de coopétition, la notion d’opportunisme du partenaire est elle aussi largement investie et identifiée par des recherches comme un frein à la coopétition. C’est de cette façon, qu’on peut constater dans cette littérature, deux thèses différenciées qui caractérisent les analyses sur la coopétition ; une relation entre concurrents, source de performances hors normes et une relation fragile et instable à tout instant, à raison de l’opportunisme présumé du partenaire. L’opportunisme du partenaire s’avère particulièrement problématique en ce qu’il conduirait à limiter les performances et avantages attendus de la coopétition. L’objectif de cette recherche est d’établir un lien entre la performance de la coopétition et le capital social. Partant de l’opportunisme du partenaire, nous avons posé que la performance d’une coopétition est fonction de deux préalables : la réduction de l’opportunisme et l’augmentation de l’engagement des acteurs en relation. Une étude empirique est menée auprès des coopétitions des TPE minières exploitant le diamant au Kasaï, en République Démocratique du Congo. Une méthodologie qualitative permet le recueil des données par entretiens semi-directs, puis l’exploitation des termes des discours en se servant de l’outil lexicometrique, « Iramuteq ». L’objectif est de repérer les éléments déterminés de manière théorique, et qui traduisent soit les enjeux de la coopétition pour les TPE d’un environnement difficile, soit la pertinence du capital social dans la performance de la coopétition. Des liens établis entre la réduction de l’opportunisme, l’augmentation de l’engagement et les avantages tirés de la coopétition avec le capital social, constituent l’apport de cette recherche. Apport qui concerne les connaissances tant en management de la coopétition, que relatives aux TPE de contexte difficile. La variable-clé, « opportunisme » du partenaire, est la source du lien constaté entre la performance de la coopétition et le capital social. La logique suivie se décline en réponse aux interrogations formulées dans la littérature par différents auteurs au sujet de l’opportunsme qui conduit à la fragilité et à l’instabilité de la coopétition. Ce qui nous autorise de formuler un modèle vertueux de la performance de la coopétition par le capital social. A l’issu de notre étude empirique, une discussion sur des implications managériales est menée, aboutissant à une forme spécifique de coopétition mobilisant deux niveaux de réseau et des préconisations sont envisagées. / In today’s global economy, where the entrepreneurial environment is defined as uncertain and turbulent, companies choses coopétition strategies to have advantage and performance. But, according to the specialized literature, if the advantage and the performance are highlighted to justify the relevance of the strategies of coopetition, the notion of opportunism of the partner is also widely invested and identified by research as a brake on coopetition. It is in this way that we can see in this literature two differentiated theses which goods the analyses on coopetition; a relationship between competitors, a source of exceptional performance and a fragile and unstable relationship at all times, on account of the supposed opportunism of the partner. The opportunism of the partner is particularly problematic in that it would lead to limiting the performance and advantages from expected coopetition. The aim of the research is to establish a link between the performance of coopetition and social capital. Based on the opportunism of the partner, we have posited that the performance of a coopetition depends on two prerequisites: the reduction of opportunism and the increase in the commitment of the actors in relationships. Year empirical study is being carried out on the coopetition of very small mining companies of diamond in kasaï in Democratic Republic of Congo. A qualitative methodology allows the collection of data by semi direct interviews and the operation of the terms of speech using the lexicon metric tool “Iramuteq”. The objective is to identify the theoretically determined elements, which reflect either the stakes of coopétition for very small mining companies in a difficult environment or the relevance of social capital in the performance of coopetition. The link between the reduction of opportunism, the increase in commitment and the advantages of coopetition with social capital are the contribution of the research, contribution that concerns the knowledge both in management if coopetition, and relating to the very small mining companies of difficult context. The key variable “opportunism” of the partner is the source of the link between the performance of coopetition and social capital. The logic followed us in response to the questions raised in the literature by different authors about the risk of opportunism that leads to the fragility and instability of coopetition. This allows us to formulate a virtuous model of the performance of coopetition through social capital. At the end of our empirical study, a discussion on managerial implications is conducted; leading to a specific form of coopetition invoicing two levels of network and recommendations are envisaged.

In my work on the theme External Aspects Affecting Obesity Did shoot on obesity globally as a disease,which influences the life of patient and whole society too. The teoretical part my diploma work be concerned with the account of the notion of obesity, prevalence, classification and diagnostic of obesity, types of obesity, causes of obesity,prevention and treatment. There is also allusion to the organizations and institutions,which help persons try to find a solution this problem. The practical part is over the general cause of obesity with the specialization on the stress. The results are compere by obese people with normal people.

Submitted by Geandra Rodrigues (geandrar@gmail.com) on 2017-12-22T12:26:02Z No. of bitstreams: 1 camilafariabalduti.pdf: 2485442 bytes, checksum: d00f9beeb408b251ce5ad6a4932da6ee (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2017-12-22T13:01:35Z (GMT) No. of bitstreams: 1 camilafariabalduti.pdf: 2485442 bytes, checksum: d00f9beeb408b251ce5ad6a4932da6ee (MD5) / Made available in DSpace on 2017-12-22T13:01:35Z (GMT). No. of bitstreams: 1 camilafariabalduti.pdf: 2485442 bytes, checksum: d00f9beeb408b251ce5ad6a4932da6ee (MD5) Previous issue date: 2017-03-28 / Esta dissertação tem como objetivo descrever e analisar os fatores que dificultam a utilização do Sistema Mineiro de Administração Escolar (Simade) em sua integridade pelos usuários nas escolas da rede estadual de Minas Gerais. A Resolução SEEMG nº 1180, de 28 de agosto de 2008 tornou obrigatória a utilização do sistema em todas as escolas da referida rede e sua versão para internet foi gradativamente disponibilizada para as escolas a partir do mesmo ano. Apesar de o sistema ser utilizado por todas as 3.660 escolas da rede estadual de Minas Gerais, os usuários ainda apresentam dúvidas no manuseio do Simade e não utilizam o sistema em sua totalidade. Os objetivos específicos deste trabalho foram: descrever o caso do Simade, com foco nos elementos críticos para a plena utilização dos seus recursos pelos usuários das escolas; descrever o perfil dos usuários do Simade nas escolas; levantar as condições do uso do Simade nas escolas; identificar as principais dificuldades dos usuários em relação ao uso do Simade; e analisar os fatores críticos que dificultam a utilização do Simade, por meio da relação entre o perfil dos usuários, as condições de uso e as principais dificuldades dos usuários. A questão de investigação foi: Que fatores dificultam a utilização do Simade pelos usuários do sistema nas escolas?. Para responder esta questão, foi realizado um estudo empírico, que aconteceu em duas fases. Na primeira fase, qualitativa, foram realizadas oito entrevistas, sendo quatro com Diretores e quatro com funcionários das secretarias das escolas. Na segunda fase, quantitativa, foram enviados os links de dois questionários para o e-mail institucional de todas as escolas da rede estadual de Minas Gerais, com obtenção de 414 respostas no questionário do Diretor e 487 respostas no questionário do funcionário da secretaria da escola. Além disto, foi feita uma fundamentação teórica sobre o caso pesquisado e a proposição de um Plano de Ação Educacional (PAE) a partir do estudo empírico. / This dissertation has as an objective to describe and analyze the factors that makes it difficult about the uses of the Sistema Mineiro de Administração Escolar (SIMADE) [Minas Gerais School Administration System (SIMADE)] in its entirety by the users in the schools of Minas Gerais state. The SEEMG Resolution nº 1180, of August 28, 2008 made it obligatory to use the system in all the schools of said network and its version for internet was gradual available to schools in the same year. Although the system is used by all the 3.660 schools in the state of Minas Gerais, users still having doubts about the handling of Simade and does not use the system in its entirety. The mainly objectives of this work were: to describe the case of Simade, focusing on the critical elements for the full use of its resources by the users of the schools; Describe the profile of Simade users in schools; To raise the conditions for the use of Simade in schools; Identify the main difficulties that users faces while using Simade; And analyze the critical factors that makes it difficult to use Simade, through the relationship between users' profile, conditions of use and the users’s most difficulties. The research question was: What factors make it difficult for the system’s users to use Simade in schools? To answer this question, an empirical study was conducted, which took place in two phases. In the first qualitative phase, eight interviews were made, four of them with directors and four with employees from the schools secretariats. In the second quantitative phase, the links of two questionnaires were sent to the institutional e-mail of all the schools in the state of Minas Gerais, obtaining 414 responses in director’s questionnaire and 487 answers in the official questionnaire of school secretary. In addition, a theoretical foundation was made about the casethat was studied and the proposal of an Plano de Ação Educacional (PAE) [Educational Action Plan (PAE)] from the empirical study.