Psykisk ohälsa är ett växande problem i samhället och allmänsjuksköterskan möter i sitt arbete dagligen människor med psykisk ohälsa. Dessa människor upplever sig ofta osynliga i samhället och upplever även förutfattade meningar i mötet med sjuksköterskan. Forskning idag utgår mindre ofta från perspektivet hos människor med psykisk ohälsa, vilket behövs för att omvårdnaden ska kunna utvecklas. Problematiken är att sjuksköterskan många gånger möter människor utifrån deras psykiska diagnos, istället för att möta dessa människor utifrån ett helhetsperspektiv. Examensarbetet beskriver hur vuxna människor med psykisk ohälsa kan uppleva mötet med sjuksköterskan. Två teman framkommer efter sammanställning av befintlig forskning. Vuxna människor med psykisk ohälsa upplever antingen sig sedda i mötet med sjuksköterskan eller en känsla av osynlighet. Känslan av att vara sedd uppkommer när sjuksköterskan bekräftar individen genom att vara öppensinnad. Sjuksköterskan lägger ner tid i mötet genom att lyssna och att försöka förstå personens situation. En känsla av osynlighet i mötet uppkommer när sjuksköterskan förminskar personen till en diagnos. De med psykisk ohälsa upplever hinder i relationen genom att sjuksköterskan utövar makt och behandlar dem som barn. De känner sig ensamma när sjuksköterskan inte har tid för dem och inte tyckts bryr sig om dem. Genom denna studie kan sjuksköterskan få en ökad förståelse för hur vuxna människor med psykisk ohälsa upplever mötet med dem. Ökad förståelse kan förbättra relationen mellan människor med psykisk ohälsa och sjuksköterskan. Det kan även leda till en ökad känsla av hälsa hos människor med psykisk ohälsa. / Background: Mental illness has in recent years increased in society. It has since centuries been seen as a shameful disease and mental illness has not been a high priority in health care. Aim: The aim of this study was to describe how adult humans with mental illness experiences the meeting with the nurse.Method: The method that was used was a literature based study with basis in analysis of qualitative research. 11 articles with a qualitative approach was analyzed. Result: The result showed two main theme. The first theme was a feeling of being seen in the meeting when an open dialogue was used and a relationship was created. The second theme was a feeling of invisible because they felt reduced to a diagnosis and encountered obstacles in the relation. Conclusion: Adult humans with mental illness could experience the meeting in different ways. A good meeting with the nurse could increase the human with mental illness trust in healthcare. It could improve the care and relationship between human with mental illness and the nurse.

The aim was to elucidate the social construction of chronic pain as a cause of work absence in the UK, focusing on negotiation of sickness certification and return to work, in the context of recent policies to tackle rising sick-listing rates, including a national educational programme about the health benefits of work, and introduction of the ‘fit note’. Following a literature review, two qualitative studies were conducted from a symbolic interactionist perspective. The first comprised semi-structured interviews with doctors and chronic pain patients, leading to a second study in which employers and employees with chronic pain were interviewed. Interviews were transcribed verbatim and analysed according to constructivist grounded theory principles. The first study revealed tensions in the doctor-patient relationship as the process of sickness certification was negotiated. The indeterminacy of chronic pain rendered the biomedical approach to diagnosis and assessment of capability for work problematic, while a shift to the psychosocial model could generate feelings of invalidation in patients. A wide range of moral and socio-cultural factors was invoked by doctors and patients to contest sick-listing decisions. The second study identified difficulties that can emerge when chronic pain patients return to work. Employees discussed how managers failed to understand their problems or make sustained adaptations; employers reported difficulty reconciling the needs of employees with organisational imperatives and argued that employees and doctors colluded in sanctioning low resilience. All stakeholder groups supported the fit note’s focus on capacity not incapacity, but were skeptical about whether it would surmount the tensions and difficulties that arise in sickness certification and return to work for chronic pain patients. Struggles for meaning and construction of identities are difficult for policy to address, but deeper understanding of the processes behind them and rich accounts of stakeholders’ views, may nudge the system towards more appropriate responses.

Maintaining the proper physician-patient relationship in health care is vital to the well-being of patients, especially when considering end of life decisions such as euthanasia. Because this topic has been in the forefront of media in recent years, there appears to be a need to understand how the relationship between physician and patient works in these practical situations, as well as understand what the most appropriate model of patient care is in regards to maintaining patient autonomy. However, before this can be done this paper will begin with a brief look at the overall permissibility of euthanasia, using the arguments of Dan Brock and Leon Kass. Once the issue of permissibility is discussed, I continue by investigating three main models of patient care presented by Linda and Ezekiel Emanuel: informative, interpretive, and deliberative. Each of these models presents a different view of patient autonomy that changes how the physician and patient interact. By discussing the philosophical requirements of autonomy presented by philosophers such as Harry Frankfurt, Susan Wolf, and Andrea Westlund, I argue that the deliberative model of patient care provides the most sufficient view of autonomy while also protecting the physician-patient relationship and patient well-being.

Today patients are more aware of their rights regarding their own care. They are more informed, more engaged and have more and individual requirements, which leads to increased demands for information and participation increases. The Health Act sets out the patients´ right to participation. Participation increases patient satisfaction with care, promotes healing and increases adherence to health care advise. The patient doesn´t always experience participation in their own care to the extent they wish, which suggests that nurse’s does not always succeed in getting the patient involved. The purpose of this study is to describe factors that are important for patient participation in nursing care in a nurse- and patient perspective. Nine research articles were analyzed with qualitative content analysis. The analysis resulted in two themes: health care relationships and communication. Through various acts of nursing care, patients experienced themselves as being seen and confirmed. Patients experienced a sense of security and trust, which is the essence of a trusting relationship, which in turn is the basis for caring and patient participation in their own care. Patient participation requires a sophisticated interaction between nurse and patient, a quest of a safe relationship that can lead the patient to see themselves seen and confirmed.       Keywords: patient participation, nurse-patient relationship, nurse, care

Background: Communication allows people to gain understanding of themselves and their surroundings, which is a prerequisite for good health. The nurse may in her communication help patients develop a feeling that they are not alone in their situation. If the patients cannot express themselves and make themselves understood, it can lead the patients to feel left out which emphasizes the suffering at having aphasia. Aim: The aim of this study was to identify the components which affect nurse’s communication with patients with aphasia. Analysis method: A literature review was made based on eleven scientific articles in which similarities were pointed out. Results: The result of this study is presented in three main categories: Time, Environment and Strategies. Eighth subcategory emerged: Knowledge and patient under Time; Physical and psychosocial under Environment; and Verbal, Nonverbal, Augmentative and Alternative Communication (AAC) and Individual Care under Strategies. Conclusion: This study reveals how nurses can provide the opportunity for patients to increase self-confidence. The result suggests that a person-centered communication care plan as a basic instrument to facilitate patient and caregiver interaction is needed.

No description available.

The media is an important information source regarding psychiatric nursing care. There has been limited English language research that has specifically explored the nurse-patient relationships that were depicted in film between psychiatric nurses and the people for whom they cared. Using an interpretive visual inquiry method, fifteen films were selected and analyzed using a relational ethics framework. The films were: Cosi (Joffe, 1996), Frances (Clifford, 1982), Girl, Interrupted (Mangold, 1999), Gothika (Kassovitz, 2003), Harvey (Koster, 1950), High Anxiety (Brooks, 1977), One Flew Over the Cuckoo’s Nest (Forman, 1975), Persona (Bergman, 1966), Snake Pit (Litvak, 1948), Terminator 2: Judgement Day (Cameron, 1991), The Caretakers (Bartlett, 1963), The Cobweb (Minnelli, 1955), The Jacket (Maybury, 2005), The Sleep Room (Wheeler, 1998), and Titicut Follies (Wiseman, 1967). The roles of the nurses were described using Peplau’s (1952/1988) role descriptions. These included the roles of stranger, resource person, teacher, leader, surrogate, counsellor, consultant, tutor, safety agent, mediator, administrator, recorder, observer, and researcher. Exemplars were drawn from the films to discuss each of the following relational ethics themes: mutual respect, engagement, embodied knowledge, environment, and uncertainty. Two primary discourses were found embedded within the relational ethic themes: otherness and power/control. Within these discourses, sub-discourses relating to stigmatization, prejudice, domination, and marginalization were also found. Nursing must be attentive to the messages contained within the depictions of psychiatric nursing care. Nurses can no longer afford to be silent; as these images have consequences for the patients, their families, and the nurses working in this complex specialty area.

This thesis is a qualitative study investigating the communication about sexual health between HIV-positive gay men and their doctors and other health care providers. The study was conducted in 2007 and 2008 in Sydney, Australia. Data was collected through in-depth interviews with eleven HIV-positive gay men, and analysed according to a modified grounded theory approach. The study aims to explore the men??s needs, expectations and experiences in relation to how sexual health is addressed in clinical consultations. While previous research has documented that HIV/AIDS is a diagnosis that poses significant physical, emotional and social challenges for People Living With HIV/AIDS (PLWHA) which may impact on their sexual health and well-being, this thesis examines whether, and to what extent this is communicated between HIV-positive gay men and their doctors. In doing so the study identifies and describes the ways in which HIV-positive gay men understand sexual health, how they currently talk to their clinicians about sexual health issues, the priority that such issues have for these men, and barriers and ??incentives?? to sexual health being discussed within HIV treatment settings. The study reveals that the men??s communication about sexual health with their doctors is essentially limited to discussions about sexually transmissible infections (STIs), which represent a common understanding of what constitutes sexual health. The emotional and social aspects of sexual health and well-being are rarely discussed in doctor-patient communication. Instead, the men rely on sources outside the health system, such as friends, peers, partners, gay and HIV community organizations and the gay and HIV media for sexual health information, advice and support. This indicates that broad, holistic sexual health has a low priority in discussions between patients and their doctors, and that social networks therefore play an important role in how HIV-positive gay men take care of their sexual health.

This thesis is a qualitative study investigating the communication about sexual health between HIV-positive gay men and their doctors and other health care providers. The study was conducted in 2007 and 2008 in Sydney, Australia. Data was collected through in-depth interviews with eleven HIV-positive gay men, and analysed according to a modified grounded theory approach. The study aims to explore the men??s needs, expectations and experiences in relation to how sexual health is addressed in clinical consultations. While previous research has documented that HIV/AIDS is a diagnosis that poses significant physical, emotional and social challenges for People Living With HIV/AIDS (PLWHA) which may impact on their sexual health and well-being, this thesis examines whether, and to what extent this is communicated between HIV-positive gay men and their doctors. In doing so the study identifies and describes the ways in which HIV-positive gay men understand sexual health, how they currently talk to their clinicians about sexual health issues, the priority that such issues have for these men, and barriers and ??incentives?? to sexual health being discussed within HIV treatment settings. The study reveals that the men??s communication about sexual health with their doctors is essentially limited to discussions about sexually transmissible infections (STIs), which represent a common understanding of what constitutes sexual health. The emotional and social aspects of sexual health and well-being are rarely discussed in doctor-patient communication. Instead, the men rely on sources outside the health system, such as friends, peers, partners, gay and HIV community organizations and the gay and HIV media for sexual health information, advice and support. This indicates that broad, holistic sexual health has a low priority in discussions between patients and their doctors, and that social networks therefore play an important role in how HIV-positive gay men take care of their sexual health.

Orientador: Lino Lemonica / Banca: Norma Sueli Modolo / Banca: Reynaldo Ayer de Oliveira / Resumo: Nas últimas décadas profundas mudanças têm ocorrido no tocante à revelação de informações aos pacientes, em especial àqueles com diagnósticos de doenças que ameacem a vida, como o câncer. Porém no Brasil, e em muitos países em desenvolvimento, ainda é a regra a atitude paternalista dos profissionais da saúde ao oferecer uma mentira solidária, ao invés de informar o diagnóstico real de câncer. Objetivos: Descrever as preferências em relação à revelação do diagnóstico e prognóstico entre os profissionais de saúde (médicos e enfermeiros) e avaliar se esses profissionais oferecem aos seus pacientes a mesma conduta que gostariam de receber se estivessem com uma doença que ameaça a vida. Metodologia: Após consentimento livre esclarecido, foram aplicados questionários contendo oito questões sobre preferências acerca da revelação de informações sobre diagnóstico e prognóstico para 50 médicos e 50 enfermeiros. Resultados: Noventa e sete por cento dos profissionais da saúde acredita que sempre ou quase sempre se deve contar o diagnóstico aos pacientes e 80% o prognóstico. Quando se refere às preferências pessoais, 96% querem saber, em qualquer circunstância, seu próprio diagnóstico e 92% o prognóstico. Dentre os profissionais entrevistados 35% acreditam que existam situações em que mentir ou omitir informações aos pacientes é justificável, porém 90% não admitiriam que algum profissional da saúde lhes mentisse/omitisse informações. Quarenta e sete por cento crêem que a família deve ser envolvida no processo de informação do diagnóstico estes também envolveriam a própria família em caso de doença que ameaça a vida. 12 Conclusão: Pelo presente estudo é possível demonstrar que os médicos e enfermeiros, em uma perspectiva de bioética aplicada à clínica, estão cada vez mais se aproximando das expectativas dos pacientes, embora ainda haja um longo caminho a percorrer. / Abstract: Last decades, deep changes have occurred on disclosure of informations to the patients, especially those with diagnosis of life threatening diseases like cancer. Beside this fact, in Brazil and in many other countries in development, the paternalistic attitude of health professionals is still the rule; they rather offer a solidary lie instead of full disclosure of cancer. Objectives: To describe the preferences among the disclosure of diagnosis and prognosis of health professionals (nurses and physicians) and evaluate if these professionals offer the their patients the same attitude they would like to receive in case they face a lifethreatening disease. Methodology: After informed consent, an eight questions questionnaire about preferences of disclosure of diagnosis and prognosis was offered to 50 physicians and 50 nurses. Results: Ninety-seven percent of health professionals believe that diagnosis must be told always or almost always to their patients and 80%, the prognosis. When considered personal preferences, 96% want full disclosure of diagnosis in any circumstance and 92% of prognosis. Between the interviewed professionals, 35% believe that there are situations when lying or withhold informations from a patient is justified, but 90% would not admit that any health professional lie or withhold informations. Forty seven percent believe that family must be involved in any point of diagnosis disclosure process, and they also would involve their own family in case of their own illness. Conclusion: By this study it is possible to demonstrate that physicians and nurses, on a perspective of clinical bioethics, are almost reaching their patients expectations, although there is still a long way to go. / Mestre