Diversos autores referem que a realização da consulta médica associa-se a melhores resultados quando apoiada nos pressupostos do modelo centrado no paciente dentre os quais se destaca a inclusão da perspectiva do paciente. O objetivo deste estudo foi analisar se o modelo de ensino adotado no Ambulatorial Geral de Pediatria (AGEP) permite ao residente de pediatria, após um ano de estágio, conduzir uma consulta com a inclusão da perspectiva dos pais. O estágio no AGEP dos residentes de primeiro ano, do Departamento de Pediatria da Faculdade de Medicina da Universidade de São Paulo (USP), ocorre no Hospital Universitário da USP que é um serviço de atendimento secundário. Este ambulatório tem como objetivo ensinar uma forma de atendimento ampliado e não centrado na doença. Em 2007, foram selecionados 10 residentes para serem filmados durante a realização de uma consulta no início e no final do estágio. Os dados foram analisados por metodologia qualitativa por meio de técnica exploratória envolvendo, independentemente, três juízes. Adotando-se como referencial teórico pressupostos do modelo centrado no paciente, elaboraram-se as categorias gerais: (1) Compreensão da queixa principal referida pelos pais; (2) Compreensão de outras queixas; (3) Compartilhamento das orientações e decisões. Os residentes tinham em média 26 anos de idade, graduados em diversas faculdades do país e referiam formação em atendimento ambulatorial de pequena duração. Como resultado, observou-se que na categoria (1) a maioria dos residentes explora precocemente a primeira queixa referida pelos pais. No final do estágio alguns residentes incluem na anamnese, de modo insuficiente, a exploração dos sentimentos envolvidos com a queixa. Na categoria (2), poucos residentes exploram ativamente outras preocupações e observou-se pouca valorização da agenda dos pais. Na categoria (3), os residentes mantiveram ao longo do curso a forma não compartilhada das orientações e decisões durante a consulta. A observação das consultas permitiu a elaboração de categorias empíricas: (a) interação com a criança; (b) explicação do roteiro de anamnese; (c) prontuário como principal fonte de informação; (d) momentos de silêncio na consulta; (e) explicações a respeito dos procedimentos do exame físico. Dentre elas, a interação com a criança foi a mais significativa e constatou-se que a maioria dos residentes estabelece pouca comunicação com as crianças. Os residentes que buscam um diálogo com a criança restringem-se aos aspectos da rotina de vida e atividades escolares. Apenas uma residente explora o problema de saúde diretamente com a criança. Chamou a atenção a procura ativa da criança pela comunicação com os residentes durante a consulta, porém a maioria deles não demonstra ter entendido esse comportamento. Concluiu-se que o modelo de ensino do AGEP em 2007 não capacitava os residentes para a realização de consultas com a inclusão da perspectiva dos pais. As explicações para esse fato podem relacionar-se com as dificuldades em mudanças de comportamento, por parte dos residentes, decorrentes da formação na graduação com predomínio do modelo biomédico e a ausência de estratégias específicas para o ensino de pressupostos do modelo centrado no paciente e das habilidades de comunicação durante o estágio no AGEP / Several authors report that the outcome of the medical consultation is associated with better results when based on patient-centered model among which stands out the inclusion of the patient\'s perspective. The aim of this study was to examine whether the teaching model adopted in the Ambulatório Geral de Pediatria (AGEP), a general Pediatric outpatient clinic, capacitates, after one year, the resident of pediatrics to conduct a consultation which includes the parents perspective. The AGEP is a secondary health care facility located at the University Hospital of the University of São Paulo (USP), Brazil, and offers a course for the first year of the residency program of the Department of Pediatrics of the School of Medicine of USP. This clinic aims to teach a form of extended care, not focused on the disease. In 2007, 10 residents were selected to be videotaped while performing a consultation at the beginning and at the end of the course. The data was analyzed through qualitative methodology by exploratory technique involving three judges independently. Using as reference the patient-centered care, general categories were elaborated: (1) Understanding of the parents main complaints, (2) Understanding of other complaints and (3) Sharing decision-making. The residents had an average age of 26 years-old, graduated from different colleges in the country and referred outpatient training only for short periods. As a result it was observed that in category (1), the majority of residents explore precipitously the first parents complaint. At the end of the course some residents, although insufficiently, include in the anamneses the parents concerns involved with the complaint. In Category (2), few residents actively explore other complaints and the parents agenda was neglected. In category (3), residents maintained throughout the course a non-shared decision-making practice. The observation of consultations enabled the development of empirical categories: (a) interaction with the child, (b) explanation of the anamnese guide, (c) use of the records as the main source of information, (d) moments of silence during the consultation, (e) lack of explanation of the procedures of the physical examination. Among which, the interaction with the child was the most significant and it was found that most residents establish little communication with the children. Residents seeking a dialogue with the child are limited to the routine aspects of life and school activities. Only one resident explores the health problem directly with the child. Children actively tried to communicate with the residents during the consultation, but most residents appeared not to have understood their behavior. It was concluded that the teaching model of AGEP in 2007 does not enabled residents to do consultations including the parents perspective. The explanations for this may relate to the difficulties in changing residents behavior due to their former training during medical school in which there is a predominance of the biomedical model. Another reason was the absence of specific strategies for teaching patient-centered care and communication skills during the course in AGEP

Diversos autores referem que a realização da consulta médica associa-se a melhores resultados quando apoiada nos pressupostos do modelo centrado no paciente dentre os quais se destaca a inclusão da perspectiva do paciente. O objetivo deste estudo foi analisar se o modelo de ensino adotado no Ambulatorial Geral de Pediatria (AGEP) permite ao residente de pediatria, após um ano de estágio, conduzir uma consulta com a inclusão da perspectiva dos pais. O estágio no AGEP dos residentes de primeiro ano, do Departamento de Pediatria da Faculdade de Medicina da Universidade de São Paulo (USP), ocorre no Hospital Universitário da USP que é um serviço de atendimento secundário. Este ambulatório tem como objetivo ensinar uma forma de atendimento ampliado e não centrado na doença. Em 2007, foram selecionados 10 residentes para serem filmados durante a realização de uma consulta no início e no final do estágio. Os dados foram analisados por metodologia qualitativa por meio de técnica exploratória envolvendo, independentemente, três juízes. Adotando-se como referencial teórico pressupostos do modelo centrado no paciente, elaboraram-se as categorias gerais: (1) Compreensão da queixa principal referida pelos pais; (2) Compreensão de outras queixas; (3) Compartilhamento das orientações e decisões. Os residentes tinham em média 26 anos de idade, graduados em diversas faculdades do país e referiam formação em atendimento ambulatorial de pequena duração. Como resultado, observou-se que na categoria (1) a maioria dos residentes explora precocemente a primeira queixa referida pelos pais. No final do estágio alguns residentes incluem na anamnese, de modo insuficiente, a exploração dos sentimentos envolvidos com a queixa. Na categoria (2), poucos residentes exploram ativamente outras preocupações e observou-se pouca valorização da agenda dos pais. Na categoria (3), os residentes mantiveram ao longo do curso a forma não compartilhada das orientações e decisões durante a consulta. A observação das consultas permitiu a elaboração de categorias empíricas: (a) interação com a criança; (b) explicação do roteiro de anamnese; (c) prontuário como principal fonte de informação; (d) momentos de silêncio na consulta; (e) explicações a respeito dos procedimentos do exame físico. Dentre elas, a interação com a criança foi a mais significativa e constatou-se que a maioria dos residentes estabelece pouca comunicação com as crianças. Os residentes que buscam um diálogo com a criança restringem-se aos aspectos da rotina de vida e atividades escolares. Apenas uma residente explora o problema de saúde diretamente com a criança. Chamou a atenção a procura ativa da criança pela comunicação com os residentes durante a consulta, porém a maioria deles não demonstra ter entendido esse comportamento. Concluiu-se que o modelo de ensino do AGEP em 2007 não capacitava os residentes para a realização de consultas com a inclusão da perspectiva dos pais. As explicações para esse fato podem relacionar-se com as dificuldades em mudanças de comportamento, por parte dos residentes, decorrentes da formação na graduação com predomínio do modelo biomédico e a ausência de estratégias específicas para o ensino de pressupostos do modelo centrado no paciente e das habilidades de comunicação durante o estágio no AGEP / Several authors report that the outcome of the medical consultation is associated with better results when based on patient-centered model among which stands out the inclusion of the patient\'s perspective. The aim of this study was to examine whether the teaching model adopted in the Ambulatório Geral de Pediatria (AGEP), a general Pediatric outpatient clinic, capacitates, after one year, the resident of pediatrics to conduct a consultation which includes the parents perspective. The AGEP is a secondary health care facility located at the University Hospital of the University of São Paulo (USP), Brazil, and offers a course for the first year of the residency program of the Department of Pediatrics of the School of Medicine of USP. This clinic aims to teach a form of extended care, not focused on the disease. In 2007, 10 residents were selected to be videotaped while performing a consultation at the beginning and at the end of the course. The data was analyzed through qualitative methodology by exploratory technique involving three judges independently. Using as reference the patient-centered care, general categories were elaborated: (1) Understanding of the parents main complaints, (2) Understanding of other complaints and (3) Sharing decision-making. The residents had an average age of 26 years-old, graduated from different colleges in the country and referred outpatient training only for short periods. As a result it was observed that in category (1), the majority of residents explore precipitously the first parents complaint. At the end of the course some residents, although insufficiently, include in the anamneses the parents concerns involved with the complaint. In Category (2), few residents actively explore other complaints and the parents agenda was neglected. In category (3), residents maintained throughout the course a non-shared decision-making practice. The observation of consultations enabled the development of empirical categories: (a) interaction with the child, (b) explanation of the anamnese guide, (c) use of the records as the main source of information, (d) moments of silence during the consultation, (e) lack of explanation of the procedures of the physical examination. Among which, the interaction with the child was the most significant and it was found that most residents establish little communication with the children. Residents seeking a dialogue with the child are limited to the routine aspects of life and school activities. Only one resident explores the health problem directly with the child. Children actively tried to communicate with the residents during the consultation, but most residents appeared not to have understood their behavior. It was concluded that the teaching model of AGEP in 2007 does not enabled residents to do consultations including the parents perspective. The explanations for this may relate to the difficulties in changing residents behavior due to their former training during medical school in which there is a predominance of the biomedical model. Another reason was the absence of specific strategies for teaching patient-centered care and communication skills during the course in AGEP

<p>Caring for children at hospital with palliative care needs arouses different reactions in nurses and depends on what prior knowledge and experience nurses have. To besides shift focus from to care children palliative to care curative is further a strain and an emotional changeover. The aim of this study was to illuminate nurse’s</p><p>perceptions about caring for children at hospital with palliative care needs, and how they shift focus of care between children with palliative care needs and children with curative care needs. The study has a qualitative approach and data were collected with interviews from two focus groups. The interviews were performed in two different hospitals in the middle of Sweden, and analyzed with a manifest content analysis. Five themes were created from the analysis: create confidence and individualized relations, difference in meeting of children with unlike care needs, acquired experience and ability to reflect, need of support, supervision and distance,</p><p>difficulties to enforce a balance in changing between different care need. The conclusion was that nurses who shift between caring for children with a palliative care or curative care needs are exposed to psychological strain which may lead to psychological ill- health. This is important to prevent through for example continuous supervision which may contribute to the possibility for nurses to obtain more time for reflection and regain new strength.</p> / <p>Sjuksköterskor som arbetar på en barnavdelning möter ofta barn med ett palliativt vårdbehov, vilket väcker olika reaktioner hos sjuksköterskorna beroende på tidigare kunskap och erfarenhet. Att dessutom skifta fokus från att vårda barn palliativt till att vårda kurativt är ytterligare en påfrestande och känslomässig omställning. Syftet med denna studie var att belysa sjuksköterskors uppfattningar om hur det är att vårda barn på barnavdelning i sluten vård med palliativt vårdbehov samt hur det är att växelvis vårda barn med palliativt vårdbehov gentemot barn med kurativt vårdbehov. Studien har en kvalitativ ansats och data har samlats in via intervjuer i två</p><p>fokusgrupper. Intervjuerna genomfördes på två olika sjukhus i mellersta Sverige och analyserades med manifest innehållsanalys. Utifrån analysen skapades fem teman: skapa förtroende och att individanpassa relationen, skillnader i bemötande av barn med olika vårdbehov, förvärvad erfarenhet och förmåga att reflektera, behov av stöd, handledning och distans, svårigheter att upprätthålla en balans i växlingen mellan olika vårdbehov. Slutsatser som drogs var att sjuksköterskor som växelvis vårdar barn med palliativt eller kurativt vårdbehov utsätts för psykiska påfrestningar, vilket kan leda till psykisk ohälsa. Detta är viktigt att förebygga genom att sjuksköterskorna får till exempel kontinuerlig handledning vilket ger tid till reflektion och möjlighet att inhämta nya krafter.</p>

Caring for children at hospital with palliative care needs arouses different reactions in nurses and depends on what prior knowledge and experience nurses have. To besides shift focus from to care children palliative to care curative is further a strain and an emotional changeover. The aim of this study was to illuminate nurse’s perceptions about caring for children at hospital with palliative care needs, and how they shift focus of care between children with palliative care needs and children with curative care needs. The study has a qualitative approach and data were collected with interviews from two focus groups. The interviews were performed in two different hospitals in the middle of Sweden, and analyzed with a manifest content analysis. Five themes were created from the analysis: create confidence and individualized relations, difference in meeting of children with unlike care needs, acquired experience and ability to reflect, need of support, supervision and distance, difficulties to enforce a balance in changing between different care need. The conclusion was that nurses who shift between caring for children with a palliative care or curative care needs are exposed to psychological strain which may lead to psychological ill- health. This is important to prevent through for example continuous supervision which may contribute to the possibility for nurses to obtain more time for reflection and regain new strength. / Sjuksköterskor som arbetar på en barnavdelning möter ofta barn med ett palliativt vårdbehov, vilket väcker olika reaktioner hos sjuksköterskorna beroende på tidigare kunskap och erfarenhet. Att dessutom skifta fokus från att vårda barn palliativt till att vårda kurativt är ytterligare en påfrestande och känslomässig omställning. Syftet med denna studie var att belysa sjuksköterskors uppfattningar om hur det är att vårda barn på barnavdelning i sluten vård med palliativt vårdbehov samt hur det är att växelvis vårda barn med palliativt vårdbehov gentemot barn med kurativt vårdbehov. Studien har en kvalitativ ansats och data har samlats in via intervjuer i två fokusgrupper. Intervjuerna genomfördes på två olika sjukhus i mellersta Sverige och analyserades med manifest innehållsanalys. Utifrån analysen skapades fem teman: skapa förtroende och att individanpassa relationen, skillnader i bemötande av barn med olika vårdbehov, förvärvad erfarenhet och förmåga att reflektera, behov av stöd, handledning och distans, svårigheter att upprätthålla en balans i växlingen mellan olika vårdbehov. Slutsatser som drogs var att sjuksköterskor som växelvis vårdar barn med palliativt eller kurativt vårdbehov utsätts för psykiska påfrestningar, vilket kan leda till psykisk ohälsa. Detta är viktigt att förebygga genom att sjuksköterskorna får till exempel kontinuerlig handledning vilket ger tid till reflektion och möjlighet att inhämta nya krafter.

Inom vård av personer med demenssjukdom är vårdarens bekräftelse av personens värdighet och välbefinnande grundläggande. Bekräftelsens effekt avgörs av vad och hur vårdaren väljer att bekräfta. Då den inte är anpassad riskerar personens värdighet och välbefinnande att reduceras, skadas eller gå förlorad. Syfte: Syftet med studien var att beskriva vårdpersonals föreställningar om att bekräfta värdighet och välbefinnande hos personer med demenssjukdom. Vårdarens synsätt och antagande om personen med demenssjukdom, om att vårda samt innebörd av värdighet och välbefinnande antogs ha en betydande roll för vårdarens val att bekräfta. Metod: Tio informanter intervjuades kring sina uppfattningar av att bekräfta värdighet och välbefinnande hos personer med demenssjukdom. Analysen genomfördes utifrån fenomenografisk metod i fyra steg där informanternas uppfattningar presenterades i ett utfallsrum av beskrivningskategorier med underkategorier. Resultat: Resultatet visade att bekräftelse uppkommer i ett samspel av faktorer, vilka kan påverka bekräftelsen både positivt och negativt. Vårdarnas bekräftelse skedde med utgångspunkt i vårdarens föreställningar via sekundära värden, mot övergripande värden, i en kontext av omgivningsfaktorer och utifrån ett kommunikativt feedbacksystem. Vårdarna hade såväl underlättande som hindrande förställningar vilka kopplades till tid och organisatoriska förutsättningar, till vårdtagarens förmågor, kommunikation och uttryck. Reflektion och klinisk implikation: Studien ger kunskap om hur vårdpersonal tänker kring värdighet och välbefinnande.  Skillnader i vårdens utförande kan förstås utifrån ett livsvärldsperspektiv och kan användas som underlag för utbildning, handledning och reflektion. / In caring for people with dementia confirmation of dignity and wellbeing is essential. How and in what way the nurse chooses to confirm determines the effect on the confirmation itself. If not individually adjusted to the person with dementia there’s a risk of dignity and wellbeing being reduced, damaged or lost. Aim: The aim of the study was to describe nurses’ personal beliefs and constructs on confirming dignity and wellbeing in people suffering from dementia. The nurses views on the person with dementia, personal beliefs on caring and on the meaning of dignity and wellbeing was predicted to have a significant role on the way he or she confirms the person. Method: Ten informants were interviewed on their personal experiences on confirming dignity and wellbeing. The narrations were analysed using a phenomenographic methodology in four different steps. The informants’ experiences were presented in an outcome space consisting sets of categories and subcategories of description. Result: Confirmation takes place within an interplay of factors with the potentiality to effect in a positively or negatively way. The nurses’ confirmation took place on the basis of their personal beliefs and constructs through secondary values, towards overall values, within a context of external factors and from a communicative system of feedback. The nurses had both enabling and hindering personal beliefs and constructs which were linked to time and organisational factors and to cognitive and physical abilities, communication and expression of the patient. Reflections and clinical implications: The study brings knowledge on nurses’ personal beliefs and constructs on confirming dignity and wellbeing. The differences in nursing among the nurses can be further viewed and understood from a life-world perspective and contribute to nursing education, supervision and reflection.

Bakgrund Inom dialyssjukvården möts dialyssjuksköterskor och patienter regelbundet flera gånger varje vecka, kanske under flera år. Detta medför många möten där relationer uppstår. Syfte Att beskriva dialyssjuksköterskors upplevelser och erfarenheter av långvariga vårdrelationer med personer med kronisk njursjukdom som kräver hemodialysbehandling. Metod Tolv dialyssjuksköterskor i Mellansverige intervjuades. Kvalitativ innehållsanalys genomfördes. Resultat Tillfredsställelsen av långa vårdrelationer med dialyspatienter berikar dialyssjuksköterskan både professionellt och som person. Möten med patienter under lång tid ger många positiva känslor och det är roligt att få följa patienternas utveckling. Upplevelsen av Komplexiteten i långa vårdrelationer, att möta och nötas mot samma patienter över lång tid, ibland över flera år kunde upplevas utmanande att i professionen hantera dessa på ett bra sätt. Strategier att hantera gränser i professionen, att ha verktyg för att hantera gränssättningen mellan det professionella och patienten. Exempel är reflektion och handledning med kollegor för att detta kan underlätta att inte bli för privat i relationen med patienten och känna sig professionell. Kollegornas betydelse i arbetet är en viktig del med erfarenhetsutbyte och stöd för att hantera relationer och situationer som kan uppstå. Avslutande kommentar Det är berikande och positivt att arbeta med patienter i långa vårdrelationer. De komplexa situationer som uppstår kan påverka dialyssjuksköterskorna och det ses som värdefullt att ha tillgång till forum där frågor om vården av patienterna kan diskuteras och att riktlinjer sammansatta av arbetsgruppen är en trygghet att luta sig mot. / Background In the dialysis nurses and patients meet regularly every week, sometimes over several years. This makes it possible for relations to occur. Aim Describing dialysis nurses perceptions and experiences of long-term care relations with persons with chronic renal disease who requires hemodialysis. Method Twelve dialysis nurses at hospitals in the middle of Sweden were interviewed. Qualitative content analysis was performed. Results The satisfaction with long-term care relations with patients in hemodialysis enrich the dialysis nurse both professional and as a person. The encounter with patients during a long time gives many positive emotions and it is joyful to be able to follow the patient development. The experience of the Complexity in long term relations, to meet and be rubbed against the same patients over time, sometimes several years could be a challenge experience in the profession to deal with in a good way. Strategies to manage the boundaries of the profession are to have tools to handle the boundaries between the professional role and the patient. Examples of tools are reflection and coaching session with colleagues since this can make it easier to avoid to be too private in the relation and to feel professional. Colleagues' role in the work is an important part with exchange of experiences and support to deal with the relations and the situations that may occur, in these relations. Concluding comment It is enriching and positive to work with patients in long-term relations. The complex situations that occur can affect the dialysis nurses and it seems important to have access to forum where questions can be discussed and to have guidelines that is put together by the workgroup to rely on.

Bakgrund: Varje år diagnosticeras flera miljoner människor med cancer. Cellerna i kroppen kan mutera och bilda tumörer. En elakartad tumör räknas som en cancertumör. Vid behandling av cancer tar ansvarig läkare ställning till ifall patientens cancersjukdom går att bota eller om behandling ska vara lindrande, det vill säga palliativ. Den palliativa vården ska ske på patientens villkor, utformat utifrån personcentrerad vård. Individen ska respekteras och bemötas som en unik person. Patienten har rätt till självbestämmande, tydlig information, att bevara sin integritet samt att få symtomlindring. Syfte: Syftet är att undersöka hur patienter med en cancersjukdom som vårdas palliativt på slutenvårdsavdelning upplever bemötandet från hälso- och sjukvårdspersonal. Metod: Databaserna CINAHL Complete och Medline with Full Text användes vid informationssökning. Införskaffat material granskades och godkändes av båda författarna. Resultat: Resultatet belyser patienters upplevelser av hälso-sjukvårdspersonalens bemötande. Studien resulterade i två teman. Tema ett: Hälso- och sjukvårdspersonalens förhållningssätt med två underteman: Närvaro och engagemang och förtroende och respekt. Tema två: Kommunikation och information, utan underteman. Diskussion: Resultatet diskuterades utifrån Rosemarie Rizzo Parses teori där begreppen tillit och misstro identifierades. Patienterna upplevde att engagemang, ärlighet och medlidande var viktigt i bemötandet. Upplevelserna diskuterades utifrån Parses teori om Human Becoming och annan litteratur. / Background: Millions of people are yearly diagnosed with a cancer disease. The cells in the body can for different reasons mutate and become tumours. If the tumour is determined as bad it’s considered cancerous. The responsible physician takes a stand if the cancer disease is treatable or if the treatment should be palliative. The palliative care should be shaped from the terms set by the patient. The patient ought to receive care from healthcare staff, where they respect the individual and treat them in a kind manner, so called person centered care. The patient is to be encouraged to have the freedom to control their own life, the right to information, preserve their integrity and receive adequate alleviation of symptoms.   Aim: A literature review over how patients with a cancer disease experience the encounters with healthcare professionals in inpatient palliative wards. Method: The databases CINAHL Complete and MEDLINE with Full text were used for information retrieval. The retrieved information was audited and approved by both authors. Results: The results highlight patient experiences of the professional-patient relation. The study resulted in two themes. The first theme: Healthcare Professional’s approachment with two subtopics: Presence and commitment and trust and respect. The second theme: Communication and information, without subtopics. Discussion: The results were discussed on the basis of Rosemarie Rizzo Parse's theory after the subjects trust and mistrust were identified. Patient experienced that involvement, honesty and benevolence were important. The experiences were discussed based on Parse's theory about Human Becoming and other literature.

As Testemunhas de Jeová têm preceitos religiosos que sustentam a recusa da transfusão de sangue e, frequentemente, vivenciam situações nas quais essa recusa pode ser sustentada por aspectos científicos, legais e bioéticos. Este estudo teve como objetivo analisar a relação médico-paciente Testemunha de Jeová, sob a potencial recomendação de transfusão de sangue durante a internação hospitalar. Além disso, também buscou investigar o momento e a forma da identificação do paciente Testemunha de Jeová; analisar a conduta dos médicos frente a um eventual impasse na relação com os pacientes e analisar as escolhas dos pacientes na relação com os médicos; verificar as condutas realizadas após o processo de tomada de decisão entre médico e seu paciente; e verificar se os médicos conhecem o parecer n.º 007/2004 - \"Orientação sobre Recusa de Transfusão de Sangue da Testemunha de Jeová\", da Comissão de Bioética (CoBi) do Hospital das Clínicas da FMUSP. A pesquisa foi realizada no Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP) no período de fevereiro de 2007 a maio de 2009. Foram selecionados 46 pacientes e 48 médicos, buscando-se entrevistar o paciente e seu respectivo médico. Trata-se de um estudo de caso exploratório, em pesquisa clínica, com abordagem qualitativa e com uso de dados quantitativos. A análise dos dados revelou que 89,6% passaram por cirurgia e 29,2% estiveram em iminente risco de morte. Foram transfundidos 12,5%, e 8,3% chegaram a óbito. Ao se analisar as posturas dos médicos e pacientes entrevistados, quanto à maneira de lidar com a questão das escolhas foi possível identificar cinco categorias de dados, sendo 3 delas para os médicos - deliberador, pragmático e autonomista e 2 para os pacientes Testemunhas de Jeová - liberal e ortodoxo. Os dados revelaram que existe uma busca genuína dos médicos em disponibilizar técnicas alternativas para evitar a transfusão, porém, quando se trata de iminente risco de morte, a decisão é pela transfusão. Observou-se que a identificação dos pacientes como TJ ocorre tardiamente (79,2% somente após a internação) e, em situações de impasse, sempre que envolvido iminente risco de morte, a maioria dos médicos afirmou que optariam pela transfusão, mesmo sem o consentimento do paciente (91,7%). Também foi identificado que há um conhecimento limitado dos médicos sobre as leis e sobre o parecer 007/2004, sendo que 50% dos médicos entrevistados declararam conhecer a comissão de bioética, enquanto e 64,6 % declaram não conhecem o parecer. A maioria dos médicos (72,9%) é favorável a uma conduta padronizada para os pacientes Testemunhas de Jeová. Além disso, outros dados revelaram que pacientes e médicos fazem uso de documentos para salvaguardar suas decisões. Entretanto, na prática, esses documentos se mostram ineficazes, já que não evitam processos contra médicos, nem transfusões em pacientes. Salvar a vida do seu paciente é o principal compromisso da maior parte dos médicos. / Jehovah\"s Witnesses have religious beliefs that support their refusal to blood transfusion which frequently lead them to experience situations in which such refusal may be based on scientific, legal and bioethical principles. The goal of this study is to analyze the relation between physician and Jehovah\"s Witness patient under the potential recommendation of blood transfusion during hospitalization. Besides this goal, the study also sought to investigate the moment and the manner of identifying a Jehovah\"s Witness patient as so; to analyze the physicians\" procedures when facing an impasse in their relation with patients and analyze the patients\" choice in their relation with the physician; analyze the procedures performed after the decision-making process between the physician and his patient; and establish whether physicians know Recommendation No. 007/2004 \"Guidelines about refusal of blood transfusion by Jehovah\'s Witness patients\", from the Bioethics Committee (CoBi) of Hospital das Clínicas da FMUSP. This research was carried out at Clínicas Hospital of University of São Paulo Medical School (HCFMUSP) between February 2007 and May 2009.A total of 46 patients and 48 physicians were interviewed, always trying to interview the patient and his/her respective physician. It is a case-study of exploratory nature in clinical research using a qualitative approach with quantitative data. Data analysis revealed 89.6% of patients underwent surgery and 29.2% were under life threat. A total of 12.5% received blood and 8.3% died. When analyzing physicians`and patient` postures in relation to way they dealt with the issue of choices, five categories were found : three for physicians - deliberator, pragmatic, autonomist - and two for Jehovah\'s Witness patient - liberal and orthodox. The analysis of scientific aspects showed there is a genuine pursuit by the doctors to make alternative techniques available to avoid transfusion, but if there is an imminent risk of death the decision is to use transfusion. Results show the patients identification as JW happens late in the admission process (79.2% only after admission) and, in an impasse, whenever there is an imminent risk of death the majority of the doctors state they would choose to use transfusion even without the patient\'s consent (91.7%). Data also revealed a limited knowledge of doctors about laws and about Recommendation No. 007/2004, with 50% of interviewed doctors affirming they did not know the bioethics committee, and 64.6% did not know the recommendation. Most physicians (72.9%) favor a standard procedure to deal with Jehovah\'s Witnesses patients. Other data show patients and doctors use documents to secure their decisions.However, in practical termos these documents prove to be inefficient as they neither prevent lawsuits against physicians nor transfusions in patients.Saving the patient\'s life is the main commitment for the majority of doctors

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Background: Cancer is one of the most common diseases in Sweden. When illness can no longer be cured, the patient is transferred to palliative care. The majority of palliative care is performed in hospitals. The goal of palliative care is to alleviate suffering and promote quality of life. Research has shown clear insufficiency in palliative care. From a patient perspective, insufficiency is mostly common in pain relief, communication and care environments. Aim: The aim of the literature review was to describe patients' experiences of palliative care in hospitals in the event of cancer. Method: This general literature review was based on twelve original articles with a qualitative approach that were analyzed using thematic analysis. Results: Three themes were identified: The importance of being seen as a whole person, The importance of pain relief and The importance of a good care environment. The patients were generally satisfied with the palliative care in the hospital. The importance of good pain relief and a good care environment at the hospital as well as a functioning communication with the care staff was emphasized. Conclusions: The patients who were cared for in the palliative care ward had different nursing experiences. Through patient experiences of palliative care, the nurse can increase the understanding of the patient's care needs. The knowledge can be used to give the patient an improved quality of life and alleviate suffering. / Bakgrund: Cancer är en av de vanligaste sjukdomarna i Sverige. När sjukdom inte längre går att bota övergår vården till att bli palliativ. En stor del av palliativ vård utförs på sjukhus. Målet med den palliativa vården är att lindra lidande och främja livskvaliteten. Forskning har påvisat tydliga brister inom den palliativa vården. Ur patientperspektiv är det framför allt brister inom smärtlindring, kommunikation och vårdmiljöns utformning. Syfte: Syftet med litteraturöversikten var att beskriva patienters upplevelser av palliativ vård på sjukhus vid cancersjukdom. Metod: En allmän litteraturöversikt baserad på tolv originalartiklar med kvalitativ ansats som analyserades med hjälp av tematisk analys. Resultat: Tre teman identifierades: Betydelsen av att bli sedd som en hel människa, Vikten av smärtlindring och Vikten av en god vårdmiljö. Patienterna var överlag nöjda med den palliativa vården på sjukhus. Vikten av en god smärtlindring och en bra vårdmiljö på sjukhuset samt en fungerande kommunikation med vårdpersonalen betonades. Slutsats: Patienterna som vårdades på palliativ vårdavdelning hade olika vårdupplevelser. Genom patientupplevelser av den palliativa vården kan sjuksköterskan öka förståelsen för patientens vårdbehov. Kunskapen kan användas för att ge patienten förbättrad livskvalité́ och lindra lidande.