The aim of the presented thesis is to map the influence of heart arrhythmia on patients´ lives and the possibility of using the conceptual model by Imogen King into the nursing care at the patient with arrhythmia. The set goals were accomplished on the basis of the empirical research which was processed by both quantitative and qualitative research methods. The first part of the research was performed by the quantitative method of collecting data from the survey. The aim of this survey was to map the quality of life of patients with the heart arrhythmia. The second part of the research was performed by the qualitative method of collecting data from the interview with the patient. Total of 127 of valid questionnaires were evaluated for the quantitative part of the research and 20 interviews with the patients with heart arrhythmia were performed for the qualitative part of the research. Based on the qualitative research was found out that the most significant symptom of arrhythmia is fast or irregular heartbeat, usually causing faintness, anxiety and uneasiness. The patients with arrhythmia are mostly limited during physical activities. There have not been found out any statistically significant differences between the persistence of arrhythmia and the health condition and the quality of life of the patient. That means that the persistence of arrhythmia in the researched group of patients does not influence the health condition and the life quality of the patients who took part in the survey ASTA. There was also monitored the relation between uneasiness (anxiety) and selected indicators (how the patients are able to work or study, concentrate or do physical activity). In this case were proven statistically significant differences. The qualitative research complemented the qualitative data. The quality of lives of the respondents was evaluated according to Imogen´s King conceptual framework and the responses of the respondents were ordered according to the framework system: personality system, interpersonal system and social system. As emerged from the responses of the respondents, the most negatively perceived symptom of arrhythmia is palpitation which causes anxiety, uneasiness and leads to sleeping disorders and lower physical activity. In contrast to the restrictions that have to be taken up in connection with the heart arrhythmia are only temporary and do not influence interpersonal and social relationships. The thesis brings a complex view of the problematics of the life quality of patients suffering from arrhythmia when this is not only a medical problem but it also influences patient´s mental and social well-being. The very important element which influences the successful cooperation of the arrhythmia patient and the doctor is the nurse who thanks to the emphatic attitude helps to build the faith in the good results of the medication - recovery and keeping the life quality. Using the conceptual framework in nursing, specifically during the treatment of arrhythmia patients helps to provide individualized nursing care and achieving improvement of the quality of the care provided and also the patient´s satisfaction.

Submitted by Maria Suzana Diniz (msuzanad@hotmail.com) on 2015-11-13T15:35:53Z No. of bitstreams: 1 arquivototal.pdf: 2342669 bytes, checksum: 129251a3eae0a9c99fa9a1026718f5bd (MD5) / Made available in DSpace on 2015-11-13T15:35:53Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 2342669 bytes, checksum: 129251a3eae0a9c99fa9a1026718f5bd (MD5) Previous issue date: 2015-02-25 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / Introduction: Palliative care is a philosophy of interdisciplinary care that aims to improve the quality of life of patients with life threatening diseases and families, acting in the physical, psychological, social and spiritual dimensions and bereavement support. This dissertation consists of two different articles, theoretical and empirical, whose central thematic focus between them are palliative care and bereavement. The first, theoretical, is entitled palliative and bereavement care: a bibliometric study. Objective: To analyze the scientific production published in online journals on palliative care and bereavement. Methodology: bibliometric review, whose sample consisted of articles published in the period from 2005 to 2014, available in LILACS, MEDLINE, IBECS, PubMed, SciELO and DOAJ. Results: We identified 48 studies disseminated in 37 journals, including the Journal Palliative Medicine Journal that was the most published on the subject, and the American Journal of Psychiatry showed the highest impact factor. Most of the papers produced by researchers of the medical area and predominated authors with the title of doctor. Conclusion: It was found that the production of knowledge involving palliative care and bereavement remains weak in the investigated period, which requires the expansion of knowledge on this theme and the issues surrounding it. The second study is a unique research, entitled: patients families Structure in palliative care about anticipatory grief: study based on the Calgary model. Objective: To analyze the structure of families of patients under palliative care about anticipatory grief in the light of Calgary Model. Methodology: This is a field of study with a qualitative approach, the participation of five families of patients under palliative care in a hospital in the city of João Pessoa - PB. To enable the collection of data, we used the genogram and eco-map. The empirical material was analyzed through the Calgary Model. Results: The results derived from research were described in two stages. The first, presented to the genogram and eco-map, from the stories told by the participating families of the research; and second, structural analysis of families in the light of the Calgary Model. Families highlighted the experience of a disease without therapeutic possibilities of cure as a process of profound loss, evidenced by the fragility that the disease imposes progressively and that lead them to experience a anticipatory grief. Conclusion: The utilization of family assessment model allowed for a larger view of the families included in the study and understanding of internal relations, external and context. Therefore, it is considered essential that nurses can work together with the family regarding the anticipatory grief to meet the needs and care of the person in palliative care. It is expected that the data obtained can support further research on the topic. / Introdução: Os cuidados paliativos constituem uma filosofia de cuidado interdisciplinar que objetiva aprimorar a qualidade de vida de pacientes e famílias que vivem e convivem com doenças ameaçadoras de vida, nas dimensões física, psicológica, social e espiritual e apoio ao luto. A presente dissertação é constituída de dois diferentes artigos, um teórico e um empírico, cujo enfoque temático central entre eles são os cuidados paliativos e o luto. O primeiro, teórico, intitula-se Cuidados paliativos e luto: um estudo bibliométrico. Objetivo: Analisar a produção científica publicada em periódicos online sobre os cuidados paliativos e o luto. Metodologia: Revisão bibliométrica, cuja amostra foi constituída de artigos, publicados no período de 2005 a 2014, e disponibilizados na LILACS, MEDLINE, IBECS, PUBMED, SciELO e DOAJ. Resultados: Foram identificados 48 estudos disseminados em 37 periódicos, dos quais, a Revista Medicina Paliativa Journal foi a que mais publicou sobre a temática, e o American Journal of Psychiatry apresentou o maior fator de impacto. A maioria das publicações foi produzida por pesquisadores da área de Medicina e predominaram autores com o título de doutor. Conclusão: Verificou-se que a produção do conhecimento que envolve os cuidados paliativos e o luto mantém-se reduzida no período investigado, o que demanda a ampliação do conhecimento acerca dessa temática e das questões que a envolvem. O segundo estudo é uma pesquisa original, intitulada: Estrutura de famílias de pacientes em cuidados paliativos acerca do luto antecipatório: estudo à luz do Modelo Calgary. Objetivo: Analisar a estrutura de famílias de pacientes sob cuidados paliativos acerca do luto antecipatório à luz do Modelo Calgary de Avaliação da Família. Metodologia: Trata-se de um estudo de campo com abordagem qualitativa, do qual participaram cinco famílias de pacientes sob cuidados paliativos internados em um hospital localizado na cidade de João Pessoa – PB. Para viabilizar a coleta dos dados, foram utilizados o genograma e o ecomapa. O material empírico foi analisado à luz do Modelo Calgary. Resultados: Os resultados advindos da pesquisa foram descritos em duas etapas. Na primeira, apresentaram-se o genograma e o ecomapa, a partir das histórias narradas pelas famílias participantes da pesquisa; e na segunda, a análise estrutural das famílias à luz do Modelo Calgary. As famílias ressaltaram a experiência de uma doença sem possibilidades terapêuticas de cura como um processo de profundas perdas, evidenciadas pela fragilidade que a enfermidade impõe progressivamente e que os levam a vivenciar um luto antecipatório. Conclusão: A utilização do modelo de avaliação familiar possibilitou uma visão ampliada das famílias inseridas no estudo e a compreensão das relações internas, externas e de contexto. Por conseguinte, considera-se essencial que o enfermeiro possa atuar junto com a família no que concerne ao luto antecipatório para atender às necessidades e aos cuidados da pessoa sob cuidados paliativos. Espera-se que os dados obtidos possam subsidiar novas investigações sobre a temática.

The purpose of this project was to evaluate the effects of relationship-based care (RBC) on patient satisfaction. RBC is a caring model that promotes a caring and healing environment by establishing and maintaining therapeutic relationships between patient, self, and coworker. The Centers for Medicare & Medicaid Services links Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores with reimbursement to hospitals. It is essential to not only achieve high patient satisfaction scores in order to ensure full financial reimbursement, but also to ensure high quality, patient-centered care. The current project assessed samples from 2 medical surgical groups, one system-wide and the other only patients from a single inpatient unit with sample sizes approximately 2,900 and 250 respectively. Data were collected retrospectively 3 times using the Press Ganey webpage at pre implementation, 6 months, and 12 months post RBC training. Results from an ANOVA indicated only a slight increase in post intervention HCAHPS scores with no statistical significant improvement. However, this increase indicates a positive trend, suggesting that the implementation of RBC may have assisted in improving patient responses. This evaluation has implications for the continued implementation for the enhancement of patient-centered care. These findings suggest that a nursing care model provides a collective belief to define a specific attitude to deliver care, facilitate professional development, and improve outcomes. By following RBC, nurses share a similar philosophy toward a caring environment.

The problems of buddhism on a care ward has been theme of our works, which we{\crq}ve devided in theoretical and practical part. In theoretical part, nurses and also wider public can acquiant with basic informations of buddhism. Theoretical part is devided into eight main chapters. In theoretical part we{\crq}ve reached for {\clqq}List dissimilarities in satisfying needs of buddhism confessors to health and diseases.`` In practical part we discuss reults of our research. To get data, we used technique of questionary. Content of third aim was {\clqq}Compare sister knowledge of Southbohemian and Centralbohemian region in specifications of buddhism confessor care.`` We set two hypotheses for this aim. Hypothesis no.1 considered, that nurses are able to satisfy needs of buddhist with their professionality and hypothesis no.2 considered, that nurses knowledge about care probleme in Southbohemian region is lower than in Centralbohemian region. Both hypotheses were confirmed after data processing. Pieces of knowledge from theoretical and practical part are included in the end of this work. There is also mentioned usage of work in practice {--} motivate nurses in attractive form, so they have interest to learn new informations about new cultures and ethnic communities. Nurses also to get wider general view, necessary at this time. In the end in separate chapter the {\clqq}Care specifications of buddhism confessors in sanitations`` is described, which was subject of second aim. For completion of this aim the standard of nursing care was elaborated: {\clqq}Principles of implementation on nursing care, confessing by buddhists in sanitations.``

Psoriasis is not an illness just of these days. 3-7% of world population suffers from this illness. This diploma work focuses on quality of life of ill people. We guess that it influences such a client in a holistic way. This illness interferes into personal, professional and social life. So psoriasis is not just an illness but also an everyday problem or handicap for those who get ill.Two questionnaires were made for this research, where first of those is focused on quality of life by a standard questionnaire and the second one was created on the base of analysis of D. Johnson model. Those questionnaires were given out to ill in South and Central Counties of Bohemia. The respondents were to chose, after their completing, which one is more sensitive to problems implying from this illness. The results are graphically shown and then paid attention in chapter Discussion.Finally I would like to say, those hypotheses were acknowledged. Psoriasis influences life in a holistic way, a nurse can have a significant influence on well-being of a client with this illness in area of her nursing interventions and D. Johnson model is an effective tool for providing those ill with psoriasis with care.

L’approche par compétences est de plus en plus choisie pour guider les curriculums universitaires de formation professionnelle. Accordant un intérêt primordial au développement des compétences, les responsables des programmes élaborés selon cette approche doivent déterminer les stratégies pédagogiques qui seront les plus efficaces et qui permettront une participation active de l’étudiant. Depuis plus de 30 années (Cameron et Mitchell, 1993; Wellard et Bethune, 1996), le journal d’apprentissage favorise la construction des savoirs en pratique clinique et le développement de la pensée réflexive, une compétence nécessaire à la pratique des infirmières qui s’inspirent d’une vision spécifique de la discipline, comme celle du modèle de McGill (Kravitz et Frey, 1989; Thorpe, 2003). Malgré cela, les études sur les perceptions d’étudiants relativement au journal d’apprentissage sont rares, et ce, surtout au Canada (Epp, 2008). Il importe de s’intéresser aux perceptions d’étudiants afin d’atteindre l’efficacité optimale de l’outil. Le but de cette étude était d’explorer les perceptions d’étudiants au baccalauréat en sciences infirmières de l’utilisation du journal d’apprentissage. Elle a été réalisée auprès d’étudiants de 2e et 3e année, selon un devis de type qualitatif exploratoire. Les participants (n=52) ont rempli un formulaire constitué d’une mise en situation comprenant 5 questions ouvertes. L’analyse des données a fait émerger trois thèmes principaux de l’utilisation du journal soit : un outil personnel, un outil de communication et un outil d’apprentissage de la pratique. Des recommandations pour la formation et la recherche sont formulées. / The competency-based approach is increasingly chosen to guide university curriculum. In according an essential interest to the competency development, the responsible for programs developed using this approach must determine the most effective learning strategy. In the last 30 years (Cameron et Mitchell, 1993; Wellard et Bethune, 1996), the learning journal promote the building of clinical knowledge and the development of reflexive thinking, a competency that is necessary to the practice nurses inspired by a specific vision of the discipline, like the McGill model (Kravitz et Frey, 1989; Thorpe, 2003). Despite this, the studies on the student’s perceptions on the learning journal are rare, especially in Canada (Epp, 2008). It is important to look at student’s perceptions to attain the optimal efficacy of the tool. The purpose of this study was to explore the perceptions of undergraduate students in nursing of the utilization of learning journal. It was realized with 2nd and 3rd year undergraduate students in nursing, using a qualitative exploratory research design. The participants (N=52) completed a form presenting a simulated situation that contained 5 open ended questions. The three main themes that emerged during data analysis on the utilization of the learning journal were: a personal tool, a communication tool and a learning practice tool. Recommendations for education and future research are offered.

L’approche par compétences est de plus en plus choisie pour guider les curriculums universitaires de formation professionnelle. Accordant un intérêt primordial au développement des compétences, les responsables des programmes élaborés selon cette approche doivent déterminer les stratégies pédagogiques qui seront les plus efficaces et qui permettront une participation active de l’étudiant. Depuis plus de 30 années (Cameron et Mitchell, 1993; Wellard et Bethune, 1996), le journal d’apprentissage favorise la construction des savoirs en pratique clinique et le développement de la pensée réflexive, une compétence nécessaire à la pratique des infirmières qui s’inspirent d’une vision spécifique de la discipline, comme celle du modèle de McGill (Kravitz et Frey, 1989; Thorpe, 2003). Malgré cela, les études sur les perceptions d’étudiants relativement au journal d’apprentissage sont rares, et ce, surtout au Canada (Epp, 2008). Il importe de s’intéresser aux perceptions d’étudiants afin d’atteindre l’efficacité optimale de l’outil. Le but de cette étude était d’explorer les perceptions d’étudiants au baccalauréat en sciences infirmières de l’utilisation du journal d’apprentissage. Elle a été réalisée auprès d’étudiants de 2e et 3e année, selon un devis de type qualitatif exploratoire. Les participants (n=52) ont rempli un formulaire constitué d’une mise en situation comprenant 5 questions ouvertes. L’analyse des données a fait émerger trois thèmes principaux de l’utilisation du journal soit : un outil personnel, un outil de communication et un outil d’apprentissage de la pratique. Des recommandations pour la formation et la recherche sont formulées. / The competency-based approach is increasingly chosen to guide university curriculum. In according an essential interest to the competency development, the responsible for programs developed using this approach must determine the most effective learning strategy. In the last 30 years (Cameron et Mitchell, 1993; Wellard et Bethune, 1996), the learning journal promote the building of clinical knowledge and the development of reflexive thinking, a competency that is necessary to the practice nurses inspired by a specific vision of the discipline, like the McGill model (Kravitz et Frey, 1989; Thorpe, 2003). Despite this, the studies on the student’s perceptions on the learning journal are rare, especially in Canada (Epp, 2008). It is important to look at student’s perceptions to attain the optimal efficacy of the tool. The purpose of this study was to explore the perceptions of undergraduate students in nursing of the utilization of learning journal. It was realized with 2nd and 3rd year undergraduate students in nursing, using a qualitative exploratory research design. The participants (N=52) completed a form presenting a simulated situation that contained 5 open ended questions. The three main themes that emerged during data analysis on the utilization of the learning journal were: a personal tool, a communication tool and a learning practice tool. Recommendations for education and future research are offered.

Submitted by Maike Costa (maiksebas@gmail.com) on 2016-12-09T14:32:11Z No. of bitstreams: 1 arquivo total.pdf: 5864026 bytes, checksum: fe05b3253ba50dbae240a09aa80b6357 (MD5) / Made available in DSpace on 2016-12-09T14:32:11Z (GMT). No. of bitstreams: 1 arquivo total.pdf: 5864026 bytes, checksum: fe05b3253ba50dbae240a09aa80b6357 (MD5) Previous issue date: 2016-05-27 / palliative care are presented as a therapeutic modality with an interdisciplinary approach, to be accomplished for the benefit of the patient, because it consists of a set of actions that aim to improve the quality of life and dignity of patients in treatment or in terminality process and their families with the diagnosis of a terminal disease, including counseling and support to mourning. The choice of the Calgary Model as theoretical basis for this study is due to the fact of integrating the structural, developmental and functional dimension, which allows a view of family dynamics in order to improve the planning of care provided to those involved in this process. Objective: to evaluate the structure, development and functionality of families of patients terminally ill in hospice care in light of the Calgary Model. Methodology: this is a field of study with a qualitative approach, based on the Calgary Family Assessment Model, performed in a hospital in the city of João Pessoa, Paraíba’s state capital. The survey sample consisted of ten families. Each was represented by patients with terminal illness and a family caregiver. In compliance with the ethical observances related to research involving human subjects, recommended by Resolution 466/2012 of the National Health Council, the project was assessed and approved by the Ethics Committee of the University Hospital Research Lauro Wanderley (HULW), the Federal University of Paraíba, under CAAE nº 33261114.1.0000.5183. Data were collected in the months of August, September and October 2014. For this, we used the interview technique, the recording system unit mp4, the field diary, the Palliative Performance Scale and the recommended tools for Calgary Model: the genogram and eco-map. The empirical material was analyzed qualitatively, in the light of the Calgary Model. Results: the results enabled the development of two articles. The first, entitled 'Assessing the structure, development and functionality of families of elderly with disease in terminal phase', in which it was possible to recognize that caring for elderly patients with end-stage disease affects the family structure and dynamics. With respect to the stages of life of families, all of them were in two stages: the family at the end of life and the children independency stage, they are getting their emancipation. The second article - 'Calgary Model Application for evaluation families of patient with terminal cancer' - enabled a holistic view of the patient's family with cancer in terminal illness of life, in which nurses may notice that each family is unique and presents dynamics of different adjustments in relation to the patient living with terminal cancer. It was found that most families is characterized as an extensive female single parent and overload of women in the family's role as caregiver. Conclusion: the survey results will support the planning of nursing care through the full evaluation of the family, and provide care which main focus is the quality of family life with a view to assist the group to comprehend own resources to deal the difficulties surrounding the family of patient with disease in late life stage. / los cuidados paliativos se presenta como una modalidad terapéutica con un enfoque interdisciplinario, a llevarse a cabo para el beneficio del paciente, ya que consiste en un conjunto de acciones que tienen como objetivo mejorar la calidad de vida y la dignidad de los pacientes en tratamiento o en la terminalidad proceso y sus familias con el diagnóstico de una enfermedad terminal, incluido el asesoramiento y el apoyo al duelo. La elección del modelo de Calgary como base teórica de este estudio es debido al hecho de integrar la dimensión estructural, desarrollo y funcional, que permite una vista de la dinámica familiar con el fin de mejorar la planificación de la atención prestada a las personas involucradas en este proceso. Objetivo: evaluar la estructura, el desarrollo y la funcionalidad de las familias de los pacientes con enfermedades terminales en cuidados paliativos a la luz del modelo de Calgary. Metodología: este es un campo de estudio con un enfoque cualitativo, basado en el Modelo de Evaluación de la Familia Calgary, realizado en un hospital de la ciudad de João Pessoa, capital del estado de Paraíba. La muestra de la encuesta consistió en diez familias. Cada estuvo representada por los pacientes con enfermedad terminal y un cuidador familiar. En cumplimiento de las observancias éticas relacionadas con la investigación en seres humanos, recomendado por la Resolución 466/2012 del Consejo Nacional de Salud, el proyecto fue evaluado y aprobado por el Comité de Ética del Hospital Universitario de Investigación Lauro Wanderley (HULW), la Universidad Federal de Paraíba, bajo CAAE nº 33261114.1.0000.5183. Los datos fueron recolectados en los meses de agosto, septiembre y octubre de 2014. Para ello, se utilizó la técnica de la entrevista, la unidad mp4 sistema de grabación, el diario de campo, la Escala de funcionamiento paliativos y las herramientas recomendadas para Calgary modelo: el genograma y económica mapa. El material empírico se analizó cualitativamente, a la luz del modelo de Calgary. Resultados: los resultados permitieron el desarrollo de dos artículos. El primero, titulado "Evaluación de la estructura, el desarrollo y la funcionalidad de las familias de personas mayores con enfermedad en fase terminal», en el que era posible reconocer que el cuidado de los pacientes ancianos con enfermedad en fase terminal afecta a la estructura y la dinámica familiar. Con respecto a las etapas de la vida de las familias, todos ellos estaban en dos etapas: la familia al final de la vida y la etapa de los niños independencia, que están recibiendo su emancipación. El segundo artículo - 'Calgary solicitud de modelo para las familias de evaluación del paciente con cáncer terminal' - activar una visión integral de la familia del paciente con cáncer en una enfermedad terminal de la vida, en el que las enfermeras pueden notar que cada familia es única y presenta la dinámica de los diferentes ajustes en relación con la vida del paciente con cáncer terminal. Se encontró que la mayoría de las familias se caracteriza por ser una extensa matriz sola hembra y la sobrecarga de las mujeres en el papel de la familia como cuidador. Conclusión: los resultados de la encuesta apoyar la planificación de los cuidados de enfermería a través de la evaluación completa de la familia, y proporcionar cuidado, que el foco principal es la calidad de la vida familiar con el fin de ayudar al grupo a comprender los recursos propios para hacer frente a las dificultades que rodean a la familia de los pacientes con enfermedad en etapa final de la vida. / os cuidados paliativos se apresentam como uma modalidade terapêutica com abordagem interdisciplinar, a serem realizados em benefício do paciente, porquanto consistem em um conjunto de ações que visam melhorar a qualidade de vida e a dignidade dos pacientes com o diagnóstico de uma doença terminal em tratamento no processo de terminalidade e suas famílias, incluindo aconselhamento e suporte ao luto. A escolha pelo Modelo Calgary como aporte teórico para este estudo deve-se ao fato de integrar a dimensão estrutural, desenvolvimental e funcional, o que permite uma visão da dinâmica familiar, com a finalidade de melhorar o planejamento dos cuidados dispensados aos envolvidos nesse processo. Objetivo: avaliar a estrutura, o desenvolvimento e a funcionalidade de famílias de pacientes em situação de terminalidade sob cuidados paliativos à luz do Modelo Calgary. Método: trata-se de um estudo de campo com abordagem qualitativa, consubstanciada no Modelo Calgary de Avaliação da Família, realizado em um hospital localizado na cidade de João Pessoa, Capital do Estado da Paraíba. A amostra da pesquisa foi constituída de dez famílias. Cada uma foi representada pelo paciente com doença terminal e um familiar cuidador. Em atendimento às observâncias éticas relacionadas à pesquisa que envolve seres humanos, recomendadas pela Resolução 466/2012 do Conselho Nacional de Saúde, o projeto foi apreciado e aprovado pelo Comitê de Ética em Pesquisa do Hospital Universitário Lauro Wanderley (HULW), da Universidade Federal da Paraíba, sob CAAE de nº 33261114.1.0000.5183. Os dados foram coletados nos meses de agosto, setembro e outubro de 2014. Para isso, foram utilizados a técnica de entrevista, o sistema de gravação em aparelho mp4, o diário de campo, a Escala de Performance Paliativa e os instrumentos recomendados pelo Modelo Calgary: o genograma e o ecomapa. O material empírico foi analisado qualitativamente, à luz do Modelo Calgary. Resultado: os resultados advindos possibilitaram a construção de dois artigos. O primeiro, intitulado “Avaliação estrutural, de desenvolvimento e funcional de famílias de idosos em fase terminal sob cuidados paliativos”, no qual foi possível reconhecer que cuidar de pacientes idosos com doença em fase terminal influencia a organização familiar e sua dinâmica. No que tange aos estágios de vida das famílias, todas elas estavam em dois estágios: o de família no fim da vida e o estágio de encaminhamento dos filhos, que estão adquirindo sua emancipação. O segundo artigo “Avaliação estrutural, desenvolvimental e funcional de famílias de pacientes com câncer em fase terminal sob cuidados paliativos” - possibilitou uma visão holística sobre a família de paciente com câncer na terminalidade da vida, em que o enfermeiro pode perceber que cada família é única e apresenta dinâmicas de ajustes distintas em relação à vivência de ente querido com câncer em fase terminal. Constatou-se que a maioria das famílias é caracterizada como monoparental feminina extensa e a sobrecarga do sexo feminino no desempenho do papel do familiar como cuidador. Conclusão: os resultados da pesquisa poderão subsidiar o planejamento da assistência de enfermagem, por meio da avaliação integral da família, e proporcionar um cuidado cujo principal enfoque seja a qualidade de vida familiar, na perspectiva de auxiliar o grupo a vislumbrar os próprios recursos para lidar com as dificuldades que circundam a família de paciente com doença em fase final de vida.

My thesis deals with the possibility of applying King?s model to client care at an orthopaedic department. King?s model is focused on interaction between a nurse and a patient. Achievement of harmony in interaction between a nurse and a patient/client creates better conditions for attainment of the care goals and thus saturation of his/her needs. In combination with Gordon?s model better satisfaction of needs and thus improvement of the care at the orthopaedic department would be achieved.

Cette recherche, traitera de la perception qu’ont les infirmières, œuvrant en milieu pédiatrique, de leur apport dans le processus de consentement aux soins et des enjeux éthique qui en découlent. L’analyse de leurs commentaires, fait voir une extension de la définition, plus classique, du concept même de consentement, pour y inclure la dimension d’un processus enclenché et poursuivi dans le dialogue et la né-gociation; un consentement sans cesse à répéter, à renégocier. Les participantes ne parlaient guère d’autonomie mais parlent surtout de ce consen-tement aux actes de soins, actes individuels, voire routiniers. Le but recherché par l’infirmière est moins une permission donnée par le patient pour que le soignant fasse son travail en toute immunité sur le plan légal, qu’une collaboration pour permettre une cogestion de la maladie. Très souvent, les infirmières discutent de l’importance qu’a pour elles le travail d’équipe, comme la façon logique de concevoir leur travail. Il devient logique aussi d’étendre aux parents et à l’enfant la participation à l’équipe thérapeutique. Ce n’est pas dire que tout se passe sans heurt. L’enfant peut s’opposer, ou le parent. Les conflits de valeurs surgissent: conflits et détresse morale suscités chez l’infirmière par la confrontation à des croyances et des valeurs culturelles et reli-gieuses différentes de celles auxquelles l’infirmière adhèrerait plus facilement. Mais souvent, l’infirmière fait montre d’une grande sensibilité culturelle et religieuse; et il lui arrive de faire appel à des collègues qui pourraient, plus qu’elle, connaître les sys-tèmes de valeurs qui posent question. Nous nous sommes servi d’un ensemble de référents interprétatifs initiaux à titre d’un cadre conceptuel intégrant des notions tirées du modèle de soins infirmiers de Corbin et Strauss, ainsi que de la perspective proposée par l’interactionnisme symbo-lique. / This research will address the perception that nurses working in a pediatric setting have of their contribution to the process of consent for care. Data analysis reveals an extension of the more conventional definition: here, the very con-cept of consent is perceived as to include the dimension of a process initiated and continued in dialogue and negotiation. Participants hardly spoke about autonomy but mostly of constantly repeated and renegotiated consent to individual or even routine acts of care. The intent of the nurse is less to obtain the patient’s permission for the caregiver to do his or her job with immunity, in legal terms; it is more to empower the child and his or her parents so as to obtain a collaboration to enable co-management of the disease. Very often, nurses discussed the importance for them of teamwork as the logical way to design their work. It is also logical to extend to parents and children an invitation to partici-pate in the therapeutic team. This is not to say that everything always goes smoothly. The child or the parent may raise opposition. Value conflicts then arise: conflicts and moral distress among nurs-es generated by the confrontation of beliefs and cultural and religious values differ-ent from those the nurse would more easily be comfortable with. But often, the nurse demonstrated a great cultural and religious sensitivity, and even would seek advice from colleagues who could know, more than she, about the value systems that raise questions. We used a set of interpretative initial referents as a conceptual framework that inte-grates concepts from the nursing model of Corbin and Strauss, as well as from the symbolic interactionism perspective.