Esta pesquisa foi orientada por dois objetivos. O primeiro foi conhecer e analisar os sentidos atribuídos pelos usuários às mensagens dos cartazes da campanha “Empoderamento dos Pacientes”. O segundo objetivo foi analisar os fatores implicados na produção desses sentidos e sua influência na adesão dos usuários à esperada atitude vigilante frente ao profissional da saúde – no que tange à prática da higienização de mãos. O estudo, de cunho qualitativo, do tipo exploratório-descritivo, foi desenvolvido a partir de uma campanha intitulada “Empoderamento dos Pacientes”.. Essa campanha, intermediada por um cartaz fixado nas enfermarias do Hospital de Clínicas de Porto Alegre, esperava uma atitude de protagonismo dos usuários para demandar dos profissionais a higienização de mãos. A coleta das informações foi realizada por meio de entrevistas, tendo como sujeitos os usuários de uma unidade de internação do Hospital de Clínicas de Porto Alegre. A unidade escolhida foi a destinada à internação de portadores de doenças infecto-contagiosas, em sua maioria portadores de germes multirresistentes (GMR). A análise dos dados foi embasada no referencial teórico dos Estudos Culturais, articulando-se os conceitos de representação cultural e modos de endereçamento. Os resultados obtidos sugerem que a fixação do cartaz da campanha “Empoderamento dos Pacientes” na enfermaria não garante que ele será lido. Outro aspecto importante a destacar é a produção de diversas representações para a higienização de mãos, tanto como expressão quanto como ação. Por meio da análise de informações foi possível argumentar também que, no contexto estudado, os usuários portadores de GMR podem relativizar a importância da higienização de mãos em meio ao conjunto de ações de precaução de contato. A resposta do usuário à esperada atitude vigilante frente ao profissional da saúde é influenciada por diversos fatores, dentre os quais as representações da higienização de mãos, as representações dos profissionais da saúde e das relações entre esses profissionais e os usuários. / This research was driven by two main goals. The first was to find and analyze the meanings understood by users from the messages included in the “Empoderamento dos Pacientes” (Patient Empowerment) campaign posters. The second goal was to analyze the factors involved in the production of those meanings and their influence in engaging users to employ the desired vigilant attitude towards healthcare professionals to sanitize their hands. The research, of a qualitative as well as explanatory-descriptive nature, was developed based on an awareness campaign entitled “Empoderamento dos Pacientes” (Empowering Patients), which through a poster hung in the infirmary encouraged users to take a proactive attitude and demand healthcare professionals to sanitize their hands. Data was collected by means of interviews with users of one of Hospital de Clínicas de Porto Alegre's wards dedicated to the care of patients with contagious infectious diseases, most of them involving multi-resistant germs. Data analysis was based on the Cultural Studies theoretical framework, applying the concepts of cultural representation and ways of address. The results obtained suggest that the fact the "Empoderamento dos Pacientes" campaign poster was on display would not guarantee that people would actually read it. Another aspect worth mentioning is the production of different representations for the term "sanitize hands" as expression and action. After analyzing the data collected, we were able to also argue that, in the context investigated, users infected with multi-resistant germs might relativize the importance of sanitizing hands in the midst of the set of actions applied to prevention. The user response and vigilant attitude expected towards healthcare professionals were influenced by a number of factors, which include different representations of sanitizing hands, healthcare professionals and the relations between these professionals and the users. / Esta encuesta fue orientada por dos objetivos. El primer objetivo fue conocer y analizar los sentidos producidos por los usuarios a los mensajes de los carteles de la campaña “Empoderamiento de los Pacientes”. El segundo objetivo fue analizar los factores implicados en la producción de estos sentidos y su influencia en la adhesión de los usuarios a la esperada de actitud vigilante frente al profesional de la salud, en lo que se refiere a la práctica de la higienización de manos. El estudio, de cuño cualitativo, del tipo exploratoriodescriptivo , fue desarrollados a partir de una campaña titulada “Empoderamiento de los Pacientes” que, intermediada por un cartel fijado en la enfermería, esperaba una actitud de protagonismo de los usuarios para demandar de los profesionales la higienización de manos. La recolección de las informaciones se dio por medio de entrevistas, teniendo como sujetos, los usuarios de una unidad de internación del Hospital de Clínicas de Porto Alegre destinada a la internación de portadores de enfermedades infectocontagiosas, en su mayoría, portadores de gérmenes multirresistentes. El análisis de los datos se embasó en el referencial teórico de los Estudos Culturales, articulando los conceptos de representación cultural y modos de derivación. Los resultados obtenidos sugieren que la fijación del cartel de la campaña “Empoderamiento de los Pacientes” en la enfermería, no garantiza su lectura. Otro aspecto importante por destacar es la producción de diversas representaciones para la higienización de manos, como expresión y acción. Por medio del análisis de informaciones fue posible argumentar también que en el contexto estudiado, los usuarios portadores de GMR pueden relativizar la importancia de la higienización de manos en medio al conjunto de acciones de precaución de contacto. La respuesta del usuario a la esperada actitud vigilante frente al profesional de la salud es influenciada por diversos factores, entre ellos, se puede destacar las representaciones de la higienización de manos, las representaciones de los profesionales de la salud y de las relaciones entre esos profesionales y los usuarios.

Esta pesquisa foi orientada por dois objetivos. O primeiro foi conhecer e analisar os sentidos atribuídos pelos usuários às mensagens dos cartazes da campanha “Empoderamento dos Pacientes”. O segundo objetivo foi analisar os fatores implicados na produção desses sentidos e sua influência na adesão dos usuários à esperada atitude vigilante frente ao profissional da saúde – no que tange à prática da higienização de mãos. O estudo, de cunho qualitativo, do tipo exploratório-descritivo, foi desenvolvido a partir de uma campanha intitulada “Empoderamento dos Pacientes”.. Essa campanha, intermediada por um cartaz fixado nas enfermarias do Hospital de Clínicas de Porto Alegre, esperava uma atitude de protagonismo dos usuários para demandar dos profissionais a higienização de mãos. A coleta das informações foi realizada por meio de entrevistas, tendo como sujeitos os usuários de uma unidade de internação do Hospital de Clínicas de Porto Alegre. A unidade escolhida foi a destinada à internação de portadores de doenças infecto-contagiosas, em sua maioria portadores de germes multirresistentes (GMR). A análise dos dados foi embasada no referencial teórico dos Estudos Culturais, articulando-se os conceitos de representação cultural e modos de endereçamento. Os resultados obtidos sugerem que a fixação do cartaz da campanha “Empoderamento dos Pacientes” na enfermaria não garante que ele será lido. Outro aspecto importante a destacar é a produção de diversas representações para a higienização de mãos, tanto como expressão quanto como ação. Por meio da análise de informações foi possível argumentar também que, no contexto estudado, os usuários portadores de GMR podem relativizar a importância da higienização de mãos em meio ao conjunto de ações de precaução de contato. A resposta do usuário à esperada atitude vigilante frente ao profissional da saúde é influenciada por diversos fatores, dentre os quais as representações da higienização de mãos, as representações dos profissionais da saúde e das relações entre esses profissionais e os usuários. / This research was driven by two main goals. The first was to find and analyze the meanings understood by users from the messages included in the “Empoderamento dos Pacientes” (Patient Empowerment) campaign posters. The second goal was to analyze the factors involved in the production of those meanings and their influence in engaging users to employ the desired vigilant attitude towards healthcare professionals to sanitize their hands. The research, of a qualitative as well as explanatory-descriptive nature, was developed based on an awareness campaign entitled “Empoderamento dos Pacientes” (Empowering Patients), which through a poster hung in the infirmary encouraged users to take a proactive attitude and demand healthcare professionals to sanitize their hands. Data was collected by means of interviews with users of one of Hospital de Clínicas de Porto Alegre's wards dedicated to the care of patients with contagious infectious diseases, most of them involving multi-resistant germs. Data analysis was based on the Cultural Studies theoretical framework, applying the concepts of cultural representation and ways of address. The results obtained suggest that the fact the "Empoderamento dos Pacientes" campaign poster was on display would not guarantee that people would actually read it. Another aspect worth mentioning is the production of different representations for the term "sanitize hands" as expression and action. After analyzing the data collected, we were able to also argue that, in the context investigated, users infected with multi-resistant germs might relativize the importance of sanitizing hands in the midst of the set of actions applied to prevention. The user response and vigilant attitude expected towards healthcare professionals were influenced by a number of factors, which include different representations of sanitizing hands, healthcare professionals and the relations between these professionals and the users. / Esta encuesta fue orientada por dos objetivos. El primer objetivo fue conocer y analizar los sentidos producidos por los usuarios a los mensajes de los carteles de la campaña “Empoderamiento de los Pacientes”. El segundo objetivo fue analizar los factores implicados en la producción de estos sentidos y su influencia en la adhesión de los usuarios a la esperada de actitud vigilante frente al profesional de la salud, en lo que se refiere a la práctica de la higienización de manos. El estudio, de cuño cualitativo, del tipo exploratoriodescriptivo , fue desarrollados a partir de una campaña titulada “Empoderamiento de los Pacientes” que, intermediada por un cartel fijado en la enfermería, esperaba una actitud de protagonismo de los usuarios para demandar de los profesionales la higienización de manos. La recolección de las informaciones se dio por medio de entrevistas, teniendo como sujetos, los usuarios de una unidad de internación del Hospital de Clínicas de Porto Alegre destinada a la internación de portadores de enfermedades infectocontagiosas, en su mayoría, portadores de gérmenes multirresistentes. El análisis de los datos se embasó en el referencial teórico de los Estudos Culturales, articulando los conceptos de representación cultural y modos de derivación. Los resultados obtenidos sugieren que la fijación del cartel de la campaña “Empoderamiento de los Pacientes” en la enfermería, no garantiza su lectura. Otro aspecto importante por destacar es la producción de diversas representaciones para la higienización de manos, como expresión y acción. Por medio del análisis de informaciones fue posible argumentar también que en el contexto estudiado, los usuarios portadores de GMR pueden relativizar la importancia de la higienización de manos en medio al conjunto de acciones de precaución de contacto. La respuesta del usuario a la esperada actitud vigilante frente al profesional de la salud es influenciada por diversos factores, entre ellos, se puede destacar las representaciones de la higienización de manos, las representaciones de los profesionales de la salud y de las relaciones entre esos profesionales y los usuarios.

Face à la mondialisation et à une demande accrue de ressources humaines hautement qualifiées, les pays en voie de développement, en général, font face à une mobilité internationale de leurs professionnels de la santé vers les pays développés. L’objectif de cette thèse est d’étudier les déterminants des intentions liées à la mobilité internationale des professionnels de la santé d’origine étrangère (hors U.E) résidant en France. À cet effet, un modèle de recherche a été élaboré à partir de la théorie de l’adaptation interculturelle et des travaux conduits sur le management des carrières et la théorie des ancres de carrières. Notre recherche prend ainsi en compte trois grandes composantes : (i) l’adaptation interculturelle (au travail, à l’interaction, et générale), (ii) le plafonnement de carrière structurel et la satisfaction dans la carrière, et enfin (iii) le rôle des ancres de carrière principalement les ancres de « stabilité géographique » et « internationale ». Il s’agit de préciser l’incidence de ces 3 composantes sur l’intention (a) de retour au pays d’origine, (b) de partir dans un pays tiers, (c) de rester en France. À la suite d’une revue de la littérature, des hypothèses de recherche ont été émises. Les données ont été collectées, par questionnaires, auprès des professionnels de la santé d’origine étrangère résidant en France (PSOE). Les analyses statistiques ont été effectuées sur un échantillon de 317 réponses. Les principaux résultats obtenus montrent d’une part que l’adaptation interculturelle en France n’a pas un effet significatif ni sur l’intention de retour au pays d’origine, ni sur l’intention de partir dans un pays tiers. Par contre, l’adaptation à l’interaction a un effet significatif et positif sur l’intention de rester en France. D’autre part, le plafonnement de carrière structurel est significativement et positivement associé à l’intention de retour au pays d’origine et à l’intention de partir dans un pays tiers. On notera que la satisfaction vis-à-vis de la carrière est seulement significativement reliée à l’intention de rester en France. La justice organisationnelle distributive a quant à elle une influence significative et positive sur l’adaptation générale et sur le sentiment de satisfaction dans la carrière, et d’autre part un effet négatif et significatif sur le sentiment de plafonnement de carrière structurel. Nos résultats soulignent enfin l’influence des ancres de carrière sur les intentions liées à la mobilité internationale. Des variables de contrôle d’ordre sociodémographique, décisionnel, et contextuel jouent également un rôle dans la dynamique de la mobilité internationale des PSOE. Les résultats obtenus nous ont permis de dégager, entre autres, des implications managériales et pratiques susceptibles d’encourager, d’une part, le retour des PSOE dans leur pays d’origine mais aussi leur maintien en France. Des limites et des perspectives futures de recherche sont également soulignées dans la conclusion. / In the context of globalization and a growing demand for highly qualified human resources, many healthcare professionals from the developing countries are now moving on their own initiative to the developed countries. The purpose of this thesis is to examine the determinants of international mobility intentions among foreign-born (outside the UE) healthcare professionals living in France. In this respect, we have built a research model based on the research on careers management and the theories related to cross-cultural adjustment and career anchors. Our research takes into account three main dimensions: (i) cross-cultural adjustment (to work, to interacting with host nationals, and to the general environment), (ii) hierarchical career plateauing and career satisfaction, and (iii) the role of career anchors, specially «geographical stability» and «internationalism». In fact, we seek to clarify the influence of each of these three dimensions on the intention (a) to return to the country of origin, (b) to go to another, (c) to stay in France. Following a review of the literature, research hypotheses were formulated. Data was collected, by questionnaires, from foreign-born healthcare professionals living in France. Statistical analyses were based on a sample of 317 responses. The main results show, on the one hand, that cross-cultural adjustment in France has no significant effect neither on the intention to return to the country of origin nor on the intention to go to another country. However, interaction adjustment has a positive and significant effect on the intention to stay in France. On the other hand, hierarchical career plateauing is positively and significantly related to the intention to return to the country of origin and to the intention to go to another country. It should be noted that career satisfaction is significantly related to the intention to stay in France. Distributive justice, for its part, has a positive and significant influence on general adjustment and career satisfaction but has a negative and significant effect on hierarchical career plateauing. Finally, our results underline the influence of career anchors on the intentions related to international mobility. When it comes to control variables, we see that personal characteristics, decision-making aspects, and contextual elements play a role in the international mobility dynamic of the foreign-born healthcare professionals living in France. Based on our results, we have formulated managerial and practical implications that could encourage the foreign-born healthcare professionals to return to their country of origin but also to stay in France. Limitations and vision statement for the future research are underlined in the conclusion.

L’objectif de la thèse était de développer un indicateur mesurant l’accessibilité spatiale des premiers soins (nommé Index of Spatial Accessibility : ISA) pour les femmes enceintes, à partir de sources de données collectant des informations en routine. Ce travail a pour vocation de mettre en évidence les limites des indicateurs existants tout en apportant des améliorations. Une attention particulière a consisté à étudier l’impact de l’effet des contours administratifs (ou effet de bord), la limite pointée dans de nombreuses études portant sur l’accès aux soins. L’indicateur d’accessibilité aux professionnels de santé que nous avons développé a pour objectif de mettre en évidence les disparités spatiales à une échelle géographique fine afin d’identifier les zones géographiques dans lesquelles il faudrait intervenir en priorité. Ce travail s’est concentré tout d’abord sur les professionnels de santé intervenant dans le suivi de la grossesse : médecins généralistes, sages-femmes et gynécologues. Les résultats mettent en évidence qu’en combinant la disponibilité avec la proximité des soins, les besoins en matière de santé et la mobilité, l’ISA permet de fournir une meilleure mesure d’accessibilité. L’ISA a été construit afin de pouvoir interroger l’accès aux soins pour d’autres pathologies ou d’autres populations. L’analyse de l’impact de l’effet de bord met en évidence que : 1) la moyenne et l'écart-type sont légèrement inférieurs avec effet de bord que sans, quel que soit le type des professionnels de santé ; 2) La variation d’ISA est plus marquée pour les sages-femmes et les gynécologues, et pour les zones rurales. Nous avons également menée une étude pilote sur le recours aux soins des femmes enceinte, à partir des données SNIIRAM afin d’étudier la relation entre le recours aux soins et l’indicateur ISA. / This paper developed an improved indicator: the Index of Spatial Accessibility (ISA) to measure geographical healthcare accessibility at the census blocks level, and seeks to assess the effect of edge on the accuracy of defining healthcare provider access by comparing healthcare provider accessibility accounting or not for the edge effect, in a real-world application. The indicator of accessibility to health professionals developed aims to highlight spatial disparities measured at a fine geographical scale and to identify area where actions are needed in priority. This work focused first of all on the health professionals involved in the follow-up of the pregnancy: general practitioners, midwives and gynecologists. The main finding is that by combining availability with proximity to services, health needs and mobility, and by calculating at the smallest feasible geographical scale, ISA provides a better measure of accessibility. ISA was conceived so that we could question the access to care for other pathologies and other populations. When we compare the variation of ISA with and without edge effect, we found that (1) mean and standard deviation are slightly below when offer and demand outside are taken in to account, whichever health professionals considered; 2) the variation of ISA is higher for midwives and gynecologists, and for rural areas. In addition, we also conducted a pilot study on the health use of pregnant women, using SNIIRAM data to examine the relationship between use of care and the ISA indicator.

<p><b>Background:</b> Shared decision-making (SDM) increases patients’ involvement in their healthcare, extending the goal of patient-centered care provision. However, SDM is underexplored in women’s reproductive health, where choices about contraception and pregnancy are frequently value and lifestyle-dependent. Furthermore, limited research exists on SDM outside of the patient-physician dyad, preventing insight into how non-physician community-based healthcare professionals (HCPs) engage women in practice. Finally, little research takes a social-ecological approach to SDM, despite interaction of multiple levels of influence in women’s reproductive healthcare decision-making. Therefore, the purpose of this study was to explore women’s and HCPs’ experiences with SDM, including the various factors associated with how women make their reproductive healthcare choices.</p><p> </p><p><b>Methods: </b>This study consisted of three distinct, but interconnected phases. Phase 1 consisted of 6 focus groups (Sept-Dec, 2019) with women aged 18-45 living in Indiana who sought community-based or private healthcare for women’s reproductive healthcare needs. Phase 2 included 20 key-informant interviews with non-physician HCPs (i.e., NP, RN, CNM, doula, pharmacist, chiropractor) living in Indiana (September 2019-May 2020) who provided community-based women’s reproductive healthcare. Focus groups and interviews were audio-recorded, transcribed, and analyzed using an expanded grounded theory framework. Constant comparative analysis identified emergent themes in both phases. Phase 3 consisted of an online survey. Women (18-45 years) living in Indiana who sought reproductive healthcare completed the survey (N=432). Multiple linear regression, chi-square analyses, and structural equation modeling were utilized to identify ecological factors associated with pregnancy and contraceptive shared decision-making.</p><p> </p><p><b>Results:</b><i> Phase 1)</i> Participants (n=22) wanted to be invited into healthcare discussions. Additionally, they wanted conversations to proceed organically, where HCPs listened to their needs, and supported and validated their choices. Though these behaviors did not always occur, they provided recommendations to enhance these experiences. Additionally, participants described quality of time was more important than quantity of time during appointments. Prior negative healthcare experiences specifically tied to HCP-interactions decreased women’s healthcare engagement. Additionally, social support system experiences were influential on women’s choices. Race also emerged as impactful toward decision-making, including Black women feeling less respected in care and making choices about their reproductive healthcare to ensure their voices were heard, such as enlisting Black doulas. <i>Phase 2)</i> HCPs noted patient-centered care was important to community-based care. They also noted the importance of contextualized decision-making approaches to ensure they could meet women’s varied needs. Results identified that outcome-oriented SDM concepts, including patient buy-in and investigative listening, were important for increasing SDM. HCPs suggested SDM improved healthcare experience beyond one visit. <i>Phase 3) </i>Structural equation modeling revealed access, social support, and patient-HCP relationship had significant relationships with contraceptive and pregnancy SDM. These models demonstrated good global and component fit, suggesting the importance of context in women’s health choices. Further, regression results demonstrated SDM was associated with higher reproductive healthcare quality. Additionally, utilizing community-based healthcare for reproductive health was associated with decreased contraceptive SDM scores.</p><p> </p><p><b>Conclusion: </b>Findings from this study provide practical considerations for extending SDM work in women’s reproductive health. In particular, results supported shifting SDM beyond the patient-physician dyad to include non-physician HCPs and HCPs in community-based healthcare settings. Women frequently access these services when seeking reproductive healthcare; thus, findings improve our understanding of the practical considerations researchers, policy-makers, and HCPs must make when promoting SDM in these settings. Furthermore, results revealed SDM use across multiple touchpoints, including community-based services, is imperative for women to achieve partnership in their healthcare. Thus, SDM provides a broader opportunity to enhance patient involvement across the spectrum of women’s reproductive healthcare. Incorporating women’s contextual needs and preferences improves HCPs’ insight into women’s experiences to further personalize care. Findings emphasize the importance of decisional space that include the various factors, agents, healthcare settings, and options that exist in reproductive health decision-making as these can shape women’s choices, and, subsequently, their SDM experiences. This mixed methods study allowed thorough insight into multiple stakeholder groups engaged in healthcare decision-making; thus, the results offer guidance on the verbiage, resources, and strategies to engage in SDM and strengthen patient involvement reflective of women’s lifestyle needs and HCPs’ existing workflow. Findings drive SDM practice into community-based healthcare and position it as the standard of care across healthcare settings.</p><br>

Introduktion: Våld i nära relationer är ett samhällsproblem som resulterar i allvarliga konsekvenser. Var tredje kvinna i världen drabbas av fysiskt, psykiskt eller sexuellt våld. I Sverige har under 2022 mer än 38 000 misshandelsbrott mot kvinnor rapporterats. Hälso- och sjukvårdspersonal har en viktig roll i att upptäcka och stödja våldsutsatta kvinnor. Syfte: Att beskriva röntgensjuksköterskans roll i att identifiera och bemöta våldsutsatta kvinnor i nära relationer. Metod: Denna studie har genomförts som en allmän litteraturöversikt där data samlades in från två olika databaser, PubMed och CINAHL. Tolv vetenskapliga kvalitativa och kvantitativa studier kvalitetsgranskades, analyserades och presenterades i form av tre kategorier. Resultat: De kategorier som uppkom i resultatet var identifikation av våldets struktur och sammansättning, hinder för upptäckt och bemötandet av våldsutsatta. Resultatet visade att våldsrelaterade fysiska skador uppstår oftast i huvudet, nacken och övre extremiteter. Dessa skador varierar beroende på våldets mekanism och allvarlighetsgrad. Psykiskt våld påverkar kvinnors välmående. Det har visat sig att brist på kunskap, riktlinjer och tid kan hindra våldsutsatta kvinnor och vårdpersonal från att arbeta mot våldsutsatthet. Ett empatiskt och respektfullt bemötande ansågs vara viktigt gentemot våldsdrabbade kvinnor. Slutsats: Kunskap om hur fysiskt och psykiskt våld visar sig är avgörande för upptäckt och hantering av våldsutsatthet. Dessutom kan ett empatiskt bemötande hjälpa våldsutsatta kvinnor att känna sig trygga och villiga att prata om sin utsatthet. Det är viktigt att ha tydliga rutiner och riktlinjer som främjar bättre arbetssätt och säkerställer att adekvata åtgärder vidtas. / Introduction: Violence in close relationships is a problem in society that results in serious consequences. Every third woman in the world suffers from physical, psychological or sexual violence. In Sweden, during 2022, more than 38,000 crimes of assault against women have been reported. Healthcare professionals have an important role in detecting and supporting abused women. Purpose: To describe the radiographer’s role in identifying and encountering abused women in close relationships. Method: This study has been conducted as a general literature review where data were collected from two different databases, PubMed and CINAHL. Twelve scientific qualitative and quantitative studies were quality reviewed, analyzed and presented in the form of three categories. Results: The categories that emerged in the results were identification of the structure and composition of the violence, barriers to detection and encountering victims of violence. The results showed that violence-related physical injuries occur most often in the head, neck and upper extremities. These injuries vary depending on the mechanism and severity of the violence. Psychological violence affects women's well-being. It has been shown that a lack of knowledge, guidelines and time can prevent abused women and healthcare professionals from working against violence. An empathetic and respectful encounter was considered important towards women affected by violence. Conclusion: Knowledge of how physical and psychological violence manifests is crucial for the detection and management of violence. In addition, an empathetic encounter can help abused women feel safe and willing to talk about their situation. It is important to have distinct routines and guidelines that promote better working methods and ensure that adequate measures are taken.

Studiens syfte var att ur ett socialt perspektiv utforska erfarenheter och konsekvenser som svensk vårdpersonal upplever efter de valt att inte vaccinera sig mot Covid-19. Speciellt fokus har riktats mot hur de upplever att valet påverkar deras välbefinnande och om de erfar arbetsrelaterade eller sociala konsekvenser av att välja bort vaccinet.  Elva semistrukturerade intervjuer genomfördes. Analysen baserades på en kvalitativ innehållsanalys som resulterade i tre kategorier och tretton underkategorier. Resultatet visar på olika konsekvenser och erfarenheter av att inte vaccinera sig mot Covid-19, som stigmatisering, polarisering, diskriminering och mobbing. Upplevelser beskrivs på individ- och gruppnivå, både på arbetsplatser och inom en social kontext. Resultatet visar även på att välbefinnandet har påverkats i både positiv och negativ riktning av att välja bort vaccinen. Denna studie visar att en sjukdomspreventiv intervention i form av massvaccination samtidigt kan inverka negativt på hälsofrämjande faktorer som välbefinnande och social trygghet för de som väljer att inte vaccinera sig.

Que ce soit pour soigner une blessure, faire des examens médicaux, ou pour recevoir des traitements, les enfants subissent plusieurs procédures médicales qui sont associées à des niveaux importants de douleur et de détresse. Plusieurs interventions pharmacologiques et non-pharmacologiques sont utilisées dans les milieux de soins pédiatriques dans un contexte de gestion de la douleur et de la détresse procédurales. Parmi les interventions non-pharmacologiques soutenues empiriquement, la communication dérivée de l’hypnose consiste à utiliser des techniques de communication hypnotique sans induction d’une transe. Bien que la littérature fasse état de l’efficacité des interventions hypnotiques, la majorité des recherches en pédiatrie étudie l’efficacité d’une intervention menée par un spécialiste de l’hypnose accompagnant le soignant qui effectue la procédure. Or, cette façon de faire est très dispendieuse et n’est pas organisable dans les milieux hospitaliers pédiatriques. Il est donc primordial d’élaborer des formations pour ceux qui prodiguent les soins, comme les infirmiers(ères), afin de leur permettre d’utiliser des techniques de communication hypnotique simples dans leur pratique clinique quotidienne. L’objectif principal de cette thèse est d’élaborer une formation aux techniques de communication dérivées de l’hypnose clinique pour le personnel infirmier pédiatrique afin de réduire la douleur et la détresse de jeunes patients lors de procédures médicales douloureuses et anxiogènes. La présente thèse est composée de trois articles. Les deux premiers articles découlent d’une étude de test de concept et de faisabilité. Le premier article a comme objectifs d’élaborer une formation aux techniques de communication dévirées de l’hypnose pour les infirmiers(ères) pédiatriques, d’évaluer leur maîtrise des compétences de communication hypnotique suite à la formation et d’évaluer leur expérience en ce qui a trait au programme de formation. L’étude de test de concept et de faisabilité pré-post-suivi, réalisée auprès de 6 infirmières pédiatriques et 33 de leurs patients atteints d’un cancer, a montré que, suite à une brève formation, les infirmières maîtrisent les compétences relationnelles et techniques de communication hypnotique et que ces compétences sont maintenues dans le temps. Les résultats ont également révélé que deux infirmières ont augmenté leurs compétences de communication hypnotique de manière plus importante que les autres infirmières. Lors des entretiens individuels, les infirmières ont identifié des composantes positives et négatives de la formation et ont proposé des suggestions d’amélioration. Le second article a comme objectif d’évaluer les effets d’une telle formation aux techniques de communication dérivées de l’hypnose sur la douleur et la détresse procédurales de patients pédiatriques d’une clinique de jour d’Hématologie-Oncologie. Pour l’ensemble de l’échantillon (88 interactions infirmière-patient chez 22 patients), aucune différence significative n’a été observée au niveau de la douleur et la détresse, à l’exception d’une diminution significative de la détresse perçue par le parent en post-formation. En explorant l’hétérogénéité des compétences des infirmières au niveau de la douleur et de la détresse des patients, des améliorations significatives ont été observées suite à la formation pour la douleur auto-rapportée par le patient, la douleur et la détresse perçues par le parent et la douleur observée chez les patients des infirmières avec une maîtrise supérieure des compétences. Bien que ces changements observés au niveau de la douleur et la détresse n’ont pas été maintenus au suivi, ces derniers peuvent être attribués à des changements des compétences chez les infirmières. Finalement, sur la base de cette étude de test de concept et de faisabilité, une nouvelle formation a été élaborée. Le troisième article, découlant d’une étude de développement-raffinement, a comme objectifs d’élaborer une formation manualisée à la communication dérivée de l’hypnose à destination du personnel infirmier pédiatrique, de pré-tester cette formation auprès d’infirmiers(ères) d’oncologie pédiatrique et de raffiner la formation en fonction des suggestions d’amélioration des infirmières. La formation manualisée Rel@x est constituée de deux séances de 4h : une séance sur les aspects relationnels et une autre, présentant une des deux techniques de communication hypnotique proposées, l’« endroit agréable » ou le « gant magique ». Lors du pré-test, cinq infirmières ont pris part à l’ensemble des séances. Les évaluations quantitatives et qualitatives ont révélé que les infirmières ont apprécié la formation. Les infirmières ont proposé des suggestions d’amélioration par rapport au contenu, à la forme et au matériel de la formation, et ces suggestions ont été intégrées à la version finale de la formation. Cette formation Rel@x est maintenant prête à être testée dans une étude pilote. / Whether it is to treat an injury, undergo a medical exam, or receive treatment, children go through many medical procedures that are associated with significant levels of pain and distress. Several pharmacological and non-pharmacological interventions are used in pediatric care settings in the context of procedural pain and distress management. Among the empirically supported non-pharmacological interventions, hypnosis-derived communication consists of using hypnotic communication techniques without the induction of a trance. Although the literature shows the efficacy of hypnotic interventions, the majority of research in pediatrics studies the efficacy of an intervention conducted by a hypnosis specialist accompanying the healthcare professional performing the procedure. However, this way of doing is very expensive and cannot be organized in pediatric hospital settings. It is therefore essential to develop training for those who provide care, such as nurses, to enable them to use simple hypnotic communication techniques in their daily clinical practice. This thesis's main objective is to develop a training in communication techniques derived from clinical hypnosis for pediatric nursing personnel to reduce young patients' pain and distress during painful and anxiety-provoking medical procedures. This thesis is composed of three articles. The first two articles stem from a test of concept and feasibility study. The first article aims to develop a training in communication techniques derived from hypnosis for pediatric nurses, to evaluate their mastery of hypnotic communication skills following the training, and to evaluate their experience with the training program. The pre-post follow-up test of concept and feasibility study, conducted with 6 pediatric nurses and 33 of their cancer patients, showed that, following brief training, nurses master the relational and technical hypnotic communication skills and that these skills are maintained over time. Results also revealed that two nurses increased their hypnotic communication skills more importantly than the other nurses. In the individual interviews, nurses identified both positive and negative components of the training and offered suggestions for improvement. The second article aims to evaluate the effects of such hypnosis-derived communication training on pediatric patients' procedural pain and distress in a Hematology-Oncology daycare clinic. For the whole sample (88 nurse-patient interactions among 22 patients), no significant differences were observed for pain and distress, except for a significant decrease in distress perceived by the parent in the post-training. When exploring the heterogeneity of nurses' skills in regard to patient pain and distress, significant improvements were observed following the training for patient's self-reported pain, pain and distress perceived by the parent, and observed pain in patients of nurses with a higher skill mastery. Although these observed changes in pain and distress were not maintained at follow-up, they can be attributed to changes in nurses' skills. Finally, on the basis of this test of concept and feasibility study, a new training was developed. The third article, stemming from a development-refinement study, aims to develop a manualized hypnosis-derived communication training for pediatric nurses, pre-test the training with pediatric oncology nurses, and refine the training based on nurses' suggestions for improvement. The manualized Rel@x training consists of two 4-hour sessions: one session on relational aspects and another, presenting one of the two hypnotic communication techniques proposed, the “pleasant place” or the “magic glove”. During the pre-test, five nurses took part in all the sessions. The quantitative and qualitative evaluations revealed that the nurses appreciated the training. Nurses proposed suggestions for improvement in regards to the training’s content, format and materials, and these suggestions were integrated into the final version of the training. This Rel@x training is now ready to be tested in a pilot study.

No / Aims and objectives To (1) investigate the organisation, provision and practice of oral care in typical UK stroke units; (2) explore stroke survivors', carers' and healthcare professionals' experiences and perceptions about the barriers and facilitators to receiving and undertaking oral care in stroke units. Cerebrovascular disease and oral health are major global health concerns. Little is known about the provision, challenges and practice of oral care in the stroke unit setting, and there are currently no evidence-based practice guidelines. Design Cross-sectional survey of 11 stroke units across Greater Manchester and descriptive qualitative study using focus groups and semi-structured interviews. Methods A self-report questionnaire was used to survey 11 stroke units in Greater Manchester. Data were then collected through two focus groups (n = 10) with healthcare professionals and five semi-structured interviews with stroke survivors and carers. Focus group and interview data were recorded, transcribed verbatim and analysed using framework approach. Results Eleven stroke units in Greater Manchester responded to the survey. Stroke survivors and carers identified a lack of oral care practice and enablement by healthcare professionals. Healthcare professionals identified a lack of formal training to conduct oral care for stroke patients, inconsistency in the delivery of oral care and no set protocols or use of formal oral assessment tools. Conclusion Oral care post-stroke could be improved by increasing healthcare professionals' awareness, understanding and knowledge of the potential health benefits of oral care post-stroke. Further research is required to develop and evaluate the provision of oral care in stroke care to inform evidence-based education and practice.

Within medical facilities in South Africa, including the Western Cape, language barriers often exist between healthcare professionals and their patients. This can cause a barrier to efficient patient treatment. In order to address this problem, educational institutions in the Western Cape have started to introduce Xhosa language facilitation for healthcare professionals. In order to facilitate the learning of this additional language, the use of e-learning as a complement to traditional classroom lectures was investigated. The students who participated in this Xhosa language facilitation were specifically identified. This study was quantitative in nature and questionnaires were used. It was concluded that the combination of lectures and the complementary e-learning component helps to improve the student’s ability to learn an additional language, in this case Xhosa. Recommendations were made that would possibly alleviate the problem of language barriers in healthcare settings in the Western Cape. / Curriculum and Instructional Studies / M. Ed. (Curriculum Studies)