Bakgrund  Begreppet placebo har tidigare associerats som en overksam behandling utan terapeutisk effekt som i stor utsträckning omtalats som ett oetiskt tillvägagångssätt. Begreppet har dock i samtida forskning erkänts som en kraftfull mekanism: Placebo handlar inte om vad som tillförs patienten, utan om hur det tillförs. Denna insikt ger plats åt länken mellan omvårdnad och placeboeffekt samt idén om hur omvårdnad kan anpassas för att till fullo dra nytta av den fysiologiska mekanismen. Vid sidan om detta framhåller forskning att denna länk ännu inte gjort inträde i klinisk praxis.  Syfte  Syftet var att belysa hur åtgärder inom omvårdnad kan anpassas för att påverka placeboeffekt.  Metod  För att möta syftet utformades en icke-systematisk litteraturöversikt med induktiv ansats och integrerad analys.  Resultat  Resultatet presenteras i fem kategorier vilka i olika grad besvarar hur omvårdnad kan anpassas för att både optimera och modulera placeboeffekt i kliniska miljöer: icke-verbal kommunikation, verbal kommunikation, framhållning av patientens autonomi, anpassning av omvårdnadens estetik samt uppmuntran till somatiskt fokus.  Slutsats  Litteraturöversiktens resultat pekar på sjuksköterskans möjligheter att förstärka placeboeffekt och minska noceboeffekt, samt genom dessa förbättra individanpassad omvårdnad, öka patientens välbefinnande och optimera behandlingsresultat. Med detta ges ökad förståelse för omvårdnadens centrala roll kring placeboeffekt, placeboeffektens värde i omvårdnadskontext samt det för vårdkedjan viktiga sammanlänkandet. / Background  The term placebo has earlier been regarded as an ineffective treatment without therapeutic effect and widely referred to as an unethical method. However, the concept has through today’s research been recognized as a powerful mechanism: Placebo is not about what is administrated to the patient, but rather how it is added. This insight provides space for the link between nursing care and placebo effect, as well as the idea of how nursing care can be adapted to take full advantage of the physiological mechanism. In addition to this, research emphasizes that this link has not yet been accessed in clinical practice. Aim  The aim was to illustrate how placebo effect can be achieved by adaptations of interventions in nursing care.  Method  To meet the purpose a non-systematic literature review was designed with an inductive approach and an integrated analysis.  Results  The results are presented in five categories of which to varying degrees answer how nursing care can be adapted to optimize as well as modulate the placebo effect in clinical environments: non-verbal communication, verbal communication, emphasis on the patient's autonomy, adaptation of the aesthetics of nursing and encouragement of somatic focus.  Conclusions  The results of the literature review point to the nurse’s opportunities to strengthen the placebo effect, reduce the nocebo effect and through these improve individualized nursing care, increase the patient’s well-being and optimize treatment outcome. This provides an increased understanding of nursing care as a central part in placebo effect, the placebo effect’s value within the context of nursing care, and their significant interconnection within caregiving.

Cette thèse vise à comprendre les freins à l’achat des médicaments génériques chez les patients-consommateurs. Plus particulièrement, notre recherche vise par le biais d’une étude qualitative et quantitative à améliorer l’efficacité des communications des acteurs de santé pour réduire le risque perçu à l’achat des génériques. Il s’agit plus précisément d’étudier les variables susceptibles d’expliquer l’attitude envers la substitution, mais aussi de comprendre les mécanismes impliqués, et de mettre en lumière les variables les plus à même à expliquer l’intention d’achat d’un médicament générique (vs princeps). Ainsi, nous avons cherché à explorer les facteurs explicatifs de la perception et de la réduction du risque envers les génériques à travers des entretiens semi-directifs individuels menés auprès de 24 patients-consommateurs. Les résultats de l’étude quantitative menée auprès de 303 personnes, soulignent que (1) le risque perçu envers la substitution et l’attitude envers les génériques médiatisent la relation entre le risque perçu envers les génériques et l’attitude envers la substitution, (2) la confiance dans la source d’informations (pharmacien et médecin) modère la relation entre l’attitude envers la substitution et l’intention d’achat d’un médicament générique (vs princeps) et (3) l’effet d’interaction entre le capital marque du médicament générique : faible (vs fort), la chronicité de la maladie : non chronique (vs chronique) et le taux de remboursement : 65% (vs 100%) sur l’intention d’achat d’un médicament générique (vs princeps) est validé. Sur un plan théorique, la recherche permet d’éclairer la littérature sur le risque perçu en matière de santé, notamment en mobilisant un concept issu de la médecine « l’effet nocebo». Les implications managériales sont multiples, tant pour les laboratoires pharmaceutiques génériqueurs, d’une part, que pour les pharmaciens, les médecins et enfin les pouvoirs publics décideurs des politiques de communication en faveur des médicaments génériques, d’autre part. / This thesis aims to understand the obstacles to the purchase of generic drugs in patients-consumers. More specifically, it aims, through a qualitative and a quantitative study, to improve the efficiency of communication of health actors to reduce the perceived risk in buying generics. More precisely, it intends to examine the variables that explain the patients-consumers attitudes towards the substitution, to understand the mechanisms involved in this process and to highlight the most likely variables that explain the intention of purchasing a generic (vs brand name) drug. Thus, we aimed to explore the factors that explain the perception and reduction of risks towards the generic drugs by conducting individual semi-structured interviews with 24 patients-consumers. The results of the quantitative study of 303 individuals point out that (1) the perceived risk towards the substitution and the attitude towards generic drugs mediate the relationship between the perceived risk towards generic drugs and attitude towards substitution, (2) the trust in the information source (pharmacist and physician) moderates the relationship between the attitude towards substitution and the intention of purchasing a generic (vs brand name) drug and (3) the interaction effect between the brand equity of generic drug : low (vs strong ), the chronicity of disease : non chronic (vs chronic) and the repayment rate : 65% (vs 100%) on the intention purchase generic (vs brand name) drug is validated. Theoretically, the research sheds light on the literature on the perceived risk in health, including mobilizing a concept from the medicine "Nocebo effect". The managerial implications are manifold for generic pharmaceutical industry as well as for pharmacists, physicians, and, finally government makers of communications policies for generic drugs.