Les services téléphoniques de consultation en soins infirmiers sont en progression partout dans le monde. On sait que les infirmières qui possèdent une plus longue expérience de pratique au téléphone obtiennent davantage d’informations sur la condition de santé du client qui les consulte que celles qui comptent moins d’années d’expérience. Nous pouvons présumer que les niveaux d’expertise décrits par Benner (1984) expliquent cette différence. Toutefois aucune étude à ce jour ne décrit comment se manifeste cette différence entre les niveaux d’expertise dans la conversation au cours d’une intervention entre l’infirmière et l’appelant. Le but de cette étude descriptive était d’identifier les manifestations de cette expertise dans la communication, lors de la consultation téléphonique. À l’aide du Roter Interaction Analysis System (RIAS), 190 enregistrements d’appels, entre infirmières (N = 15), de divers niveaux de compétence selon la nomenclature de Benner (1984) et les appelants qui les ont consultées, ont été analysés. Les appels étudiés, issus d’une étude de plus grande envergure, devaient être faits par le parent d’un enfant de moins de cinq ans, et devaient faire l’objet d’une première consultation. Il a été possible de nommer des caractéristiques, des forces et des faiblesses communes aux infirmières de chaque niveau d'expertise à l’étude. Bien qu’il existe des différences entre les moins expérimentées et celles qui ont une longue expérience clinique au téléphone, les résultats semblent indiquer que les infirmières de tous les niveaux d’expertise sont fortement centrées sur la tâche d’évaluation de la situation de santé de l’appelant, mais que leurs interventions incluent peu d’énoncés orientés vers l’établissement d’un réel partenariat avec l’appelant. Les résultats obtenus fournissent des informations qui pourraient être utilisées pour élaborer des stratégies de développement professionnel, et guider les administrateurs de ce service dans le choix des indicateurs d’évaluation de la qualité du service et de ses retombés sur sa clientèle. Toutefois un plus grand nombre d’infirmières participantes et un plus grand nombre d’appels permettraient de confirmer les résultats obtenus à partir de ces 190 appels. / Nurse telephone consultation services are rapidly progressing throughout the world. It is known that nurses with a greater experience in telephone practise obtain more information on the client’s health condition when in consultation, than nurses with less experience. We can presume that Patricia Benner’s «levels of nursing experience», (1984), will provide us with an explanation for these differences. Yet, to this day, no study describes how these differences between levels of experience are manifested in conversation during an intervention between the nurse and the client. The object of this descriptive study was to identify the manifestations of this communication expertise during a telephone consultation. Using the Roter interaction analysis system (RIAS), 190 recorded calls between nurses (N = 15) with differing levels of expertise, according to Benner’ nomenclature (1984), and the callers who have consulted them were analyzed. The calls that were studied, from a larger study, were first calls from parents regarding their child aged five years or less. It was possible to observe characteristics, strengths, and weaknesses common to nurses within each level of expertise in this study. Despite the fact that there are differences between nurses with fewer years of experience and nurses with more clinical telephone experience, results seem to indicate that, regardless of their experience, nurses are strongly centered on the task of assessing the caller’s health situation; however, their interventions include few phrases aimed at establishing a true partnership with the caller. Results obtained provide information that could be used to elaborate professional developmental strategies, and guide administrators in their choice of indicators when evaluating service quality and its effect on clientele. Nevertheless, an increased number of nurse participants and a greater number of calls would enable us to confirm the results obtained from these 190 calls. / Ce mémoire est un des segments d'une recherche de plus grande envergure sur le service Info-Santé, et qui se déroule au Centre de Santé et de Services sociaux de Laval.

<p>Men’s violence against women is a universal issue affecting health, human rights and gender-equality. In pregnancy, violence is a risk for both the mother and her unborn child.</p><p>The overall aims were: to determine the prevalence of such violence in a Swedish pregnant population, to investigate pregnant women’s attitudes to questioning about exposure to violence, and to evaluate experience gained by antenatal care midwives having routinely questioned pregnant women regarding violence.</p><p>All women registered for antenatal care in Uppsala, Sweden, during 6 months were assessed regarding acts of violence. The Abuse Assessment Screen (AAS) was used twice during pregnancy and again after delivery when the women were asked an open-ended written question regarding attitudes to questioning about violence. Midwives’ experiences regarding routine assessment were evaluated in focus group discussions.</p><p>The AAS questions were answered by 93% (1,038) of those eligible. Physical abuse by a partner or relative during or shortly after pregnancy was reported by 1.3%, and by 2.8% when the year preceding pregnancy was included. Lifetime sexual abuse was reported by 8.1%. Repeated questioning increased the abuse detection rate. Abused women reported more previous ill-health, and women physically abused during pregnancy more pregnancy terminations than did non-abused women. Abuse assessment was found entirely acceptable by 80%, both acceptable and unacceptable/disagreeable by 5% and solely unacceptable/ disagreeable by 3%, while 12% were neural. Abused and non-abused women did not differ regarding disinclination to answer the abuse questions. According to the midwives the delicacy of the subject and the male partners’ presence were the most prominent remaining obstacles to routine determination of violence. </p><p>Routines are required to make questioning about violence an integral part of antenatal care. This would necessitate a private appointment for the woman, knowledge among care providers about the nature of men’s violence, and awareness of referral options.</p>

Men’s violence against women is a universal issue affecting health, human rights and gender-equality. In pregnancy, violence is a risk for both the mother and her unborn child. The overall aims were: to determine the prevalence of such violence in a Swedish pregnant population, to investigate pregnant women’s attitudes to questioning about exposure to violence, and to evaluate experience gained by antenatal care midwives having routinely questioned pregnant women regarding violence. All women registered for antenatal care in Uppsala, Sweden, during 6 months were assessed regarding acts of violence. The Abuse Assessment Screen (AAS) was used twice during pregnancy and again after delivery when the women were asked an open-ended written question regarding attitudes to questioning about violence. Midwives’ experiences regarding routine assessment were evaluated in focus group discussions. The AAS questions were answered by 93% (1,038) of those eligible. Physical abuse by a partner or relative during or shortly after pregnancy was reported by 1.3%, and by 2.8% when the year preceding pregnancy was included. Lifetime sexual abuse was reported by 8.1%. Repeated questioning increased the abuse detection rate. Abused women reported more previous ill-health, and women physically abused during pregnancy more pregnancy terminations than did non-abused women. Abuse assessment was found entirely acceptable by 80%, both acceptable and unacceptable/disagreeable by 5% and solely unacceptable/ disagreeable by 3%, while 12% were neural. Abused and non-abused women did not differ regarding disinclination to answer the abuse questions. According to the midwives the delicacy of the subject and the male partners’ presence were the most prominent remaining obstacles to routine determination of violence. Routines are required to make questioning about violence an integral part of antenatal care. This would necessitate a private appointment for the woman, knowledge among care providers about the nature of men’s violence, and awareness of referral options.

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Bakgrund: Den äldre individen kommer att bli en allt större grupp av befolkning. Med en stigande ålder ökar även risken av att drabbas av en eller flera sjukdomar, vilket kommer att ställa högre krav på sjukvården. Svensk lag säger att vården har en skyldighet att främja patientens integritet, delaktighet och självbestämmande, dock brister detta inom vården av de äldre. Många komplexa sjukdomstillstånd hos en äldre person gör att omvårdnaden behöver ges utifrån patientens individuella behov. Personcentrerad omvårdnad handlar om ett partnerskap mellan individen och vårdpersonalen, där individen sätts i centrum för vården. Syfte: Att belysa den äldre patientens upplevelse av vård utifrån ett personcentrerat perspektiv. Metod: Examensarbetet är utformat som en litteraturöversikt. Artiklar söktes fram via databaserna CINAHL och PubMed, 13 artiklar med kvalitativ metod valdes ut. Resultat: Resultatet visade att det fanns likheter och skillnader i hur den äldre upplevde sin vård: Dessa upplevelser kunde delas in i tre huvudkategorier, nämligen självbestämmande, delaktighet och integritet. Den äldre patienten hade en längtan efter självständighet och självbestämmande, dock slogs detta tillbaka på grund av en tids- och kompetensbristande vård. De äldre hade en önskan om att vara delaktiga i sin vård, där relationen och kommunikationen var en viktig grund för att skapa delaktighet. Många av de äldre kände sig ej bekräftade som en unik individ av omvårdnadspersonalen. Slutsats: För att kunna främja de äldres roll i en personcentrerad vård måste ett helhetsperspektiv och ett personcentrerat förhållningssätt appliceras, där den äldre respekteras som en unik individ. Med den äldre individen i centrum för sin vård, stärks dennes rätt till självbestämmande, delaktighet samt integritet, som i sin tur kan leda till en ökad livskvalité. / Background: The elderly is a group that will be a major part of the population in the future. With increasing age, the risk of suffering from one or more diseases increases, which will place higher demands on healthcare. Swedish law states that healthcare has an obligation to promote patient integrity, participation and self-determination, but this is invalid in the care of the elderly. Many complex illnesses in an elderly person necessitate nursing based on the patient's individual needs. Person-centered nursing is about a partnership between the individual and healthcare staff, where the individual is at the center of care. Aim: To highlight the elderly patient's experience of care based on a person-centered perspective. Method: A literature review was conducted and the data was found in the databases CINAHL and PubMed, 13 articles with qualitative method were selected. Result: The results showed that there were similarities and differences in how the elderly patient experiences their care. These experiences can be divided into three main categories: self-determination, participation and integrity. The elderly patient had a longing for independence and self-determination, however, this was reversed due to a lack of time and competence shortage. The elderly had a desire to be involved in their care, where the relationship and communication were an important basis for creating participation. Many of the elderly did not feel confirmed as a unique individual of nursing staff. Conclusion: In order to promote the role of the elderly in their care, must a holistic perspective and a person-centered approach be applied, where the elderly is respected as a unique individual. With the older individual at the heart of his care, his right to self-determination, participation and integrity is strengthened, which in turn can lead to an increased quality of life.