Les interfaces haptiques permettent à un opérateur d'interagir avec un environnement virtuel ou distant via le sens du toucher.La majorité des interfaces de l'état de l'art restent au contact de l’utilisateur pendant toute la durée de la manipulation. La liaison permanente entre le robot et l’opérateur nuit à la qualité de l’interaction, notamment en réduisant la transparence en espace libre. Ce problème est d’autant plus prégnant dans le cadre des interfaces haptiques dextres.Cette thèse a pour objectif d'étudier la possibilité d'augmenter la transparence et le réalisme de l'interaction à travers le développement d’interfaces à contacts intermittents. Il s’agit de déconnecter le robot de l'utilisateur lorsqu’aucun contact avec l’environnement n’est nécessaire. Un état de l’art des performances de la manipulation humaine, des interfaces haptiques dextres ainsi que des travaux relatifs au contact intermittent, est d’abord présenté. Un effecteur plan pour le contact intermittent est ensuite conçu. Il est installé à l’extrémité distale d'une interface haptique et plusieurs solutions sont envisagées pour sa loi de commande. Les performances de dix utilisateurs sont comparées dans le cadre d'une tâche de détection de contact en utilisant d'une part l'effecteur adapté au contact intermittent, d'autre part une interface haptique classique. L'élaboration d'une interface permettant une interaction plus naturelle avec l'environnement est ensuite initiée par l'élaboration d'une méthodologie de choix des zones de contact de la main à prendre en compte dans la conception d'une interface haptique. Des perspectives sont finalement données quant à l'extension de ces résultats à une interface haptique dextre à contacts intermittents. / Haptic interfaces allow an operator to interact with a virtual environment through the sense of touch. Nowadays, most existing interfaces are mechanically connected to the user's hand throughout the simulation. Therefore he or she interacts with the virtual environment by means of a handle. Thus the interaction is neither natural nor intuitive, and the permanent connection between the robot and the operator is the source of perturbations which prevent the interaction from being perfectly transparent and realistic. The goal of this study is to increase transparency as much as possible by disconnecting the robot from the user when s/he is not in contact with the virtual environment, through the design of a dexterous haptic interface allowing for a more natural interaction than with a classical interface taking into account only one contact point. A state-of-the-art of dexterous haptic interfaces and another for intermittent contact devices are first gathered, and the human performances that should be taken into account for the design of a dexterous haptic interface are analysed. A bidirectional end-effector for intermittent contact is then devised. It is set up at the tip of a haptic interface and several solutions are tested for its control. The performances of six users are compared on the context of a contact detection task, first using the intermittent contact end-effector, then using a classical haptic device. A methodology for the choice of the hand contact areas that should be taken into account in the design of a dexterous haptic interface to enhance the naturalness of the interaction is proposed. Finally, some perspectives are given as for the extension of this study for the design of a dexterous encounter-type haptic interface.

[pt] Neste estudo, são analisados encontros de serviço desempenhados na central de reservas por telefone de uma companhia aérea brasileira. A análise realiza-se com base no arcabouço teórico da Sociolingüística Interacional em relação de interface com a Análise da Conversa. As interações foram coletadas no âmbito de uma metodologia de pesquisa etnográfica. Focaliza-se a manifestação de diferentes dinâmicas de enquadres e alinhamentos bem como a variação nos padrões de organização e construção de turnos de fala. Procura-se mostrar que esses aspectos (i) estão relacionados a diferentes tipos de atendimento e (ii) refletem uma realidade interacional complexa na central de reservas estudada. Tais fatos, conseqüentemente, dificultam a elaboração prévia de comportamento lingüístico na central de reservas, bem como o gerenciamento e controle desse comportamento através da prescrição de scripts de atendimento a clientes. / [en] This study analyzes service encounters held through the telephone in the reservation center of a Brazilian airline company. The analysis was conducted based on the Interactional Sociolinguistics framework interfaced with Conversational Analysis and the data collection was ethnographically oriented. Different dynamics of frames and footings are looked at, as well as the variation in organizational patterns and construction of discourse turns. This study aims to show that these aspects (i) are related to different kinds of attendance, (ii) reflect a complex interactional reality within the reservation center. Thus, these aspects make difficult the management process and as well as the previous control of sequences of linguistic behavior suggested by attendance scripts to clients.

Bakgrund: Befolkningen i Sverige blir allt äldre och fler önskar vårdas och dö i hemmet. Idag vårdas många inom allmän palliativ vård med stöd av distriktssköterskor. I den tidigare forskningen inom palliativ vård i hemmet har framför allt den specialiserade palliativa vården beskrivits. Få studier har undersökt mötet mellan distriktssköterskor och patienter och närstående inom allmän palliativ vård. Syfte: Att beskriva distriktssköterskors erfarenheter av mötet med patienter och dess närstående vid allmän palliativ vård i hemmet. Metod: Empirisk kvalitativ studie, deskriptiv design. Semistrukturerade intervjuer med åtta distriktssköterskor. Intervjuer mellan 35 till 45 minuter. Texten transkriberades och kategoriserades. Resultat: Sex kategorier bildades: Att skapa förtroende i mötet, att vara närvarande och vårdande i mötet, att vara familjefokuserad i mötet, förutsättningar i mötet, erfarenheter vid frustration och etiska dilemman i mötet, att pendla mellan bekräftelse och motgång i mötet. Det var viktigt att bygga relationer med patienter och närstående, skapa förtroende. Närvaro var förutsättningen för ett bra möte. Distriktssköterskorna visade hänsyn till närstående som genomgick en svår tid, närstående kunde ha svårt att hantera situationen. Patienterna hade behov av längre hembesök och prioriterades. Tillfredsställande att vara nära familjen, få deras förtroende. Distriktssköterskorna räckte inte alltid till, känslan av att inte räcka till var svår. Slutsats: Distriktssköterskors erfarenheter visade att närvaro var en förutsättning för ett bra möte. Det var betydelsefullt att skapa förtroende hos patienten och dess närstående. Det fanns ökat behov av stöd och omvårdnad. Inga extra resurser var avsatta trots att patienter inom palliativ vård skall prioriteras enligt prioriteringsordningen för svensk sjukvård. Klinisk betydelse: Distriktssköterskors arbete inom allmän palliativ vård behöver uppmärksammas för att säkra likvärdig vård till alla i livets slut. / Background: The population in Sweden is getting increasingly older and more elderly people wish to be nursed and to die in their homes. Today many people receive health care within the public palliative health care with support from district nurses. In earlier research within palliative health care at home has above all has the specialized palliative health care been described. Few studies have explored the encounter between district nurses and patients family members within public palliative health care. Aim: To describe experiences of the district nurses and their encounter with patients and family members related to palliative health care at home. Method: Empiric qualitative study, descriptive design. Semi-structured interviews were carried out with eight district nurses. Interviews lasted between 35 and 45 minutes. The text was transcribed and categorized. Result: Six categories were created all related to the encounter: to build confidence, to be present and caring, to be family focused, conditions of the encounter, experiences of frustration and ethical dilemmas, to vacillate between confirmation and setback. It was important to build relations with patients and family members, create confidence. Presence was a condition for a good encounter. The district nurses showed respect to family members who went through a difficult time, family members might have difficulties to handle the situation. The patients needed longer visits and this was prioritized. It was satisfying to be close to the family, to get their confidence. The district nurses sometimes had a feeling of insufficiency, which was hard to accept. Conclusion: The experiences of the nurses showed that presence was a condition in order to achieve a good encounter. It was important to build confidence towards the patients and family members. There was an increased need of support and care. No supplementary resources were allocated even though patients in the palliative health care should be prioritized according to the rule of prioritization of Swedish health care. Clinic signification: More attention should be drawn to the work of the district nurses within the palliative health care in order to ensure equal health care to all individuals at the end of life.

Thesis (MPH.) -- University of Limpopo, 2016. / Introduction and purpose: Midwives are the backbone of maternal and child health—the output of their action affect quality of life of mother and child. The purpose of the study was to describe the challenges encountered by one-year diploma student midwives while acquiring clinical skills at selected hospitals in Limpopo Province. Research design and method: A quantitative, descriptive cross-sectional research method was used in this study. The study population comprised all one-year diploma student midwives in selected hospitals in Limpopo Province, namely, Dilokong Hospital, Jane Furse Memorial Hospital, Mokopane Hospital, Philadelphia Hospital, Siloam Hospital and St Rita’s Hospital. The whole study population was used as the total population was small. Data were collected using a self-administered questionnaire. Informed consent was received from the participants as was ethical approval from the relevant authorities. Data were analyzed using SPSS version 22 with the aid of a statistician. Descriptive statistics were used to analyze and describe the data. Data were presented in tables and bar graphs.Findings: Respondents in this study indicated that they encountered the following challenges during their acquisition of clinical skills at the selected hospitals in the Limpopo Province: inadequate resources; inadequate mentoring. Male participants reported feelings of being more competent than their female counterparts. There was no relationship between acquisition of skills and marital status, and no correlation between age and acquisition of skills.

Introduktion: Psykisk ohälsa har ökat och är vanligt förekommande i Sverige idag. Personer med psykisk ohälsa har en ökad risk för att utveckla försämrad hälsa och är därför i större behov av somatisk vård. Forskning har visat att dessa personer har sämre tillgång till somatisk vård, vilket kan bero på brister i bemötandet mellan dem och vårdpersonal samt att sjukvården kan upplevas specialiserad. Det är viktigt att undersöka hur dessa personer upplever vårdpersonalens bemötande inom somatisk vård. Syfte: Att beskriva hur personer med psykisk ohälsa upplever bemötandet från vårdpersonal inom somatisk vård.  Metod: Litteraturöversikt med beskrivande kvalitativ design som grundar sig på tio original artiklar publicerade mellan 2005 och 2021. Databaserna PubMed och CINAHL har använts som sökmotorer. Travelbees omvårdnadsteori speglar arbetets teoretiska referensram.  Resultat: Resultatet utformade sig i tre kategorier: Upplevelser av diskriminering av vårdpersonal; Upplevelser av att det psykiska hamnar i fokus samt Positiva upplevelser av vårdpersonalens bemötande. Personer med psykisk ohälsa upplevde att de inte blev respekterade av vårdpersonalen. De kände frustration över att inte bli tagna på allvar och att vårdpersonalen ändrade sina attityder gentemot dem när personalen fick kännedom om deras psykiska ohälsa. Det framkom positiva upplevelser i bemötandet där vårdpersonalen upplevdes engagerade.  Slutsats: Personer med psykisk ohälsa upplever sig inte respekterade i bemötandet med vårdpersonal inom somatisk vård, vilket led till konsekvenser som utebliven hälso- och sjukvård. Forskning inom ämne är begränsad och det behövs mer för att öka förståelsen och kunskapen för att de personerna ska få en så god vård som möjligt. / Introduction: Mental health problems have increased and are common in Sweden today. Persons with mental health problems are at risk of developing deteriorating health and are therefore in greater need of somatic care. Research has shown that these people have less access to somatic care, which can depend on deficiencies in the encounter between them and the staff and healthcare can be experienced as specialized. It’s important to investigate how these persons experience the meeting with staff in somatic care. Aim: Describe how people with mental health problems experience the encounter from healthcare staff in somatic care. Method: Literature review with a descriptive qualitative design based on ten original articles published 2005-2021. The databases PubMed and CINAHLwere used. Travelbee's nursing theory was the theoretical frame. Results: The result formed three categories: The experiences of discrimination by healthcare staff; The experiences that the mental health is in focus and Positive experiences of encounter by the healthcare staff. Persons experienced that they weren't treated with respect by staff. They felt frustrated of not being taken seriously and the staff often changed their attitudes towards them when they became aware of their mental health. The positive experiences were that healthcare staff were perceived to be committed. Conclusion: Persons with mental health problems feel disrespected in the encounter from staff in somatic care, which leads to consequences such as absent healthcare. Research in the subject is limited and more is needed to increase knowledge to receive as good care as possible for these people.

Bakgrund: Missfall är en vanlig graviditetskomplikation som kan erfordra tillsyn från vården, ofta genom besök på en akutmottagning. Upptäckt av missfall är vanligast mellan graviditetsvecka 9 till 11 och orsakar ofta känslor av sorg och förlust hos kvinnan. Syfte: Syftet var att beskriva kvinnors upplevelser av omvårdnad på akutmottagningen i samband med missfall eller misstänkt missfall. Metod: En allmän litteraturstudie med induktiv ansats genomfördes. Tio vetenskapliga artiklar med kvalitativ ansats bearbetades i en innehållsanalys. Resultat: Innehållsanalysen resulterade i tre huvudkategorier: Behov av information i samband med missfall, Betydelsen av bemötande och emotionellt stöd samt Miljön på akutmottagningen – en utmaning. Flera kvinnor upplevde bristande information, bemötande och emotionellt stöd. Att vänta på akutmottagningen upplevde många som frustrerande. Brist i avskildhet och tidsbrist hos vårdpersonal framkom. Konklusion: Kvinnor upplevde genomgående bristande omvårdnad även om positiva upplevelser förekom i vissa fall. Sjuksköterskor kan åtgärda bristerna genom att ge adekvat information, bra bemötande och emotionellt stöd. / Background: Miscarriage is a common pregnancy complication which might require healthcare supervision, often by a visit to the emergency department (ED). Discovery of miscarriage is most common between the 9th and 11th week of pregnancy and often causes feelings of grief and loss among women. Aim: The aim was to describe women´s experiences of care at the ED while having a miscarriage or suspected miscarriage. Method: A general literature study with an inductive approach was implemented. Ten scientific articles with a qualitative approach were analyzed through content analysis. Results: The content analysis presents three maincategories: The need of information while experiencing a miscarriage, The importance of the encounter of healthcare professionals and emotional support and The environment at the emergency department – a challenge. Several women experienced a shortage of information, lacks in the encounter of healthcare professionals and an absence of emotional support. Many experienced the waitingtime at the ED as frustrating. Lack of privacy and time among healthcare staff was described as a problem. Conclusion: Over all women experienced lack of care even though positive experiences occurred in some cases. Nurses might remedy these shortages by giving accurate information, a proper encounter and emotional support.

Bakgrund: HIV är en kronisk immunsjukdom. Idag lever cirka 40 miljoner av världens invånare med HIV. Dagens effektiva behandlingsmetoder innebär att människor med HIV kan vara helt symtomfria utan risk att föra smittan vidare. Personer med HIV upplever att sjukdomen påverkar livssituationen på flera plan då stigmatisering och diskriminering fortfarande är vanligt förekommande i samhället. Syfte: Syftet är att beskriva hur personer med HIV upplever mötet med hälso- och sjukvårdspersonal. Metod: Litteraturöversikten genomfördes enligt Fribergs metod, där databassökning genomfördes i Medline och Cinahl Complete. Sökningarna resulterade i tio artiklar som besvarar studiens syfte. Artiklarna var både av en kvalitativ och kvantitativ design som genomgick en noggrann kvalitetsgranskning. Detta inkluderade även etiska aspekter för att säkerställa att artiklarna höll en hög vetenskaplig standard. Resultat: Resultatet visar att personer med HIV har upplevt både negativa och positiva möten med hälso- och sjukvårdspersonalen. Negativa möten orsakades av ett dåligt bemötande, stigmatisering och diskriminering samt bristfällig kommunikation och information. Positiva möten byggdes på goda kunskaper, lyhördhet, empati samt stöd. Resultatet presenteras i fem teman. Diskussion: Resultatet diskuterades utifrån vårdrelationens betydelse för omvårdnad. Konsensusbegrepp, Travelbees omvårdnadsteori samt hur information och kunskap påverkar patientens upplevelse av vårdmötet låg även i fokus för diskussionen. / Background: HIV is a chronic immune disease. Around 40 million people live with HIV in the world today. The effective treatments that exists today means that people with HIV can be completely symptom-free without the risk of passing on the disease. People with HIV feel that the disease affects different aspects of their lives, due to the fact that stigma and discrimination are still common in today's society. Aim: The aim is to describe how people with HIV experience the encounter with healthcare personnel. Method: The literature review was conducted according to Friberg´s method, where the database search was carried out in Medline and Cinahl Complete. The searches resulted in ten articles that answered the aim of the study. The articles were of both a qualitative and quantitative design that underwent a thorough qualitative review. Results: The results show that people with HIV have experienced both negative and positive encounters with healthcare personnel. Negative encounters were caused by poor attitudes, stigmatization, discrimination, inadequate communication and information. Positive meetings were built on good knowledge, responsiveness, empathy and support. The results are presented in five themes. Discussion: The results were discussed based on the importance of how the relationship between healthcare personnel and patients’ effects nursing and how information and knowledge among healthcare personnel affects the patient's experience of care. Consensus Concepts and Travelbee's nursing theory were also used in the discussion.

Objective: Chest pain is a common reason for an encounter in general practice. The present investigation was set out to characterize the consultation rate of chest pain, accompanying symptoms, frequency of diagnostic and therapeutic interventions, and results of the encounter. Materials and Methods: Cross‑sectional data were collected from randomly selected patients in the German Sächsische Epidemiologische Studie in der Allgemeinmedizin 2 (SESAM 2) and analyzed from the Dutch Transition Project. Results: Overall, 270 patients from the SESAM 2 study consulted a general practitioner due to chest pain (3% of all consultations). Chest pain was more frequent in people aged over 45 years. The most common diagnostic interventions were physical examination, electrocardiogram at rest and analysis of blood parameters. For the majority of cases, the physicians arranged a follow‑up consultation or prescribed drugs. The transition project documented 8117 patients reporting chest pain with a frequency of 44.5/1000 patient years (1.7% of all consultations). Physical examination was also the most common diagnostic intervention, and physician’s advice the most relevant therapeutic one. Conclusion: The most common causes for chest pain were musculoskeletal problems followed by cardiovascular diseases. Ischemic heart disease, psychogenic problems, and respiratory diseases each account for about 10% of the cases. However, acutely dangerous causes are rare in general practice.

Bakgrund: Att kvinnor utsätts för sexuellt våld är ett globalt problem. Kvinnor uppleva skuld och skam efter att ha utsatts för sexuellt våld vilket kan bidra till att de undviker att söka vård. Vårdpersonalen har en viktig roll i mötet med sexuellt våldsutsatta. Mötet bidrar till kvinnors uppfattning av vården och dess läkningsprocess utformas av mötet. Syfte: Syftet med denna studie var att beskriva sexuellt våldsutsatta kvinnors erfarenheter av mötet med vårdpersonalen inom olika vårdinstanser. Metod: Allmän litteraturöversikt som inkluderar 11 originalartiklar med kvalitativ ansats. Resultat: Redovisas i kategorier: Utmaningar i mötet och Det goda mötet. Utmaningar i mötet beskrivs i underkategorier: Att känna uppgivenhet och misstro samt Att vara till besvär. Det goda mötet beskrivs i underkategorier: Att uppleva stöd samt Att uppleva medkänsla och lyhördhet. Slutsats: Det finns förbättringsmöjligheter i vården gällande vårdpersonals möte med sexuellt våldsutsatta kvinnor. Vissa kvinnor upplever mötet som vårdande men majoriteten upplevde mötet som icke vårdande till följd av att vårdpersonal bland annat visade brist på empati. Genom att utöka kunskap och forskning av mötet med sexuellt våldsutsatta kvinnor möjliggörs förbättring av omvårdnad till denna patientgrupp. / Background: Women subjected to sexual violence is a global problem. Women can experience shame and guilt. This contributes to women not seeking healthcare. Healthcare staff has an important role in meeting with women who have suffered sexual violence. The meeting contributes to women's perception of healthcare and the healing process is shaped by the meeting. Aim: The aim of this study was to describe women's experiences of meeting with healthcare staff after being subjected to sexual violence in care agencies. Method: Literature review that included 11 original articles with a qualitative approach. Results: Presented in categories: Challenges in the meeting and The good meeting. Challenges in the meeting are described in subcategories: Feeling abandoned and distrustful and Being an inconvenience. The good meeting is described in subcategories: Feeling support and Feeling compassion and sensitivity in the meeting. Conclusion: There are improvements regarding healthcare staff encounters with women subjected to sexual violence. Some women experience the meeting as caring, the majority experience the meeting as non-caring due to healthcare staff’s lack of empathy etcetera. By expanding knowledge and research of the encounter with women who experienced sexual violence enables improvement of nursing.

Bakgrund: Personer med substansbrukssyndrom (SUD) är en stigmatiserad och marginaliserad population i samhället som har ett stort vårdbehov. Tidigare forskning visar på att hälso- och sjukvårdspersonal har stigmatiserade fördomar och attityder gentemot denna patientgrupp. Denna studies syfte var att undersöka och belysa hur personer med SUD upplever hälso- och sjukvårdens bemötande vid vårdkontakter. Metod: Med hjälp av en deskriptiv litteraturöversikt, har material samlats in från tre databaser, PubMed, PsycInfo och CINAHL. Elva artiklar valdes ut och analyserades för att identifiera individer med SUD och deras upplevelse av bemötande inom hälso- och sjukvården. Resultat: Både positiva och negativa upplevelser rapporterades av deltagarna. Av resultatet framkom det att upplevd stigmatisering, en sämre kommunikation mellan patient och personal, en upplevd misstro och en negativ relation med personalen bidrog till ett sämre uppfattat bemötande. Det kunde bidra till att deltagarna var mindre angelägna att uppsöka vård. Ett gott bemötandet beskrevs som öppet och empatiskt, icke-dömande, en god kommunikation och en relation med vårdpersonalen som grundades på tillit. Det kunde resultera i att deltagarna var mer angelägna att uppsöka vård. Åtta teman och fyra subteman framkom när materialet studerades och resultatet presenteras utifrån dessa teman. Slutsats: Hälso- och sjukvården har en betydande roll i sitt inflytande på denna patientgrupp och har en stor möjlighet att lindra lidandet samt främja en god omvårdnad genom sitt bemötande. / Background: People with substance use disorders (SUD) are stigmatized and marginalized in society with a great need for care. Previous research shows that healthcare professionals have stigmatized prejudices and attitudes towards this patient group. This study aimed to investigate and shed light on how people with SUD experience the health service’s treatment at care contacts. Method: Using a descriptive literature review, the material has been collected from three databases, PubMed, PsycInfo and CINAHL. Eleven articles were selected and analyzed to identify individuals' with SUD experience of treatment in healthcare. Results: The results showed that perceived stigma, poorer communication between patient and staff, perceived mistrust and a negative relationship with the staff contributed to a more negative experience of the encounter. This could contribute to the participants being less likely to seek care. The better encounter was described as open and empathetic, non-judgmental, good communication and a relationship with the care staff that was based on trust. This could result in the participants being more likely to seek care. Eight themes and four sub-themes emerged when the material for this study was reviewed, and the results are presented based on these themes. Conclusion: Healthcare has a significant role in its influence on this patient group and has a great opportunity to alleviate suffering and to promote good care through its treatment.