Este estudo teve como proposições: compreender o processo da interação entre profissionais de saúde e usuários estrangeiros nas Unidades Básicas de Saúde (UBS) e Programa Saúde da Família (PSF); conhecer o significado da experiência dos profissionais de saúde ao interagir com os usuários estrangeiros; evidenciar questões bioéticas na experiência de interação entre profissionais e usuários estrangeiros. Utilizou-se como referencial teórico o Interacionismo Simbólico e como referencial metodológico a Teoria Fundamentada nos Dados, até a codificação axial. A análise dos dados, apresentada como ordenamento conceitual, levou à definição de quatro grandes temas: (1) procurando comunicar-se; (2) percebendo limites; (3) percebendo interação como processo; (4) percebendo perspectivas diferentes. O percurso de interação profissional usuário estrangeiro foi desencadeado a partir de uma escolha: atender a todos indiscriminadamente, tornando possível a aproximação. Perceber ou não no usuário estrangeiro sua dignidade de pessoa humana parece ser determinante na abertura do profissional à interação, na sua disposição a buscar estratégias. / This study had the following objectives: to understand the interaction processes among health professionals and foreign users in the Unidades Básicas de Saúde (UBS) and the Program for Family Health (PSF); to get to know the significance of the health professionals experience as they interact with foreign users; to put in evidence bioetiques issues in the experience of professionals and foreign users interaction.It was used as a theorical referential the Symbolic Interacionism and as methodological reference a Grounded Theory up to an axial coding. Data analysis presented as conceptual ordering, lead to the definition of four great issues: (1) trying to communicate; (2) detecting limits; (3) recognizing interaction as a process; (4) recognizing different perspectives. The route of professional foreign users interaction was developed from one choice: attend everyone (indiscriminately) making approximation possible. To recognize or fail to recognize in the foreign user the dignity of human person seems to be the determining factor for the openness of the professional to the interaction, in his disposition to seek strategies.

Thesis advisor: Sharlene N. Hesse-Biber / This dissertation seeks to understand obstetricians’ lived experience of decision-making in childbirth and investigate how the organizational context within which obstetricians work influences how they make treatment decisions. Understanding how obstetricians make decisions in childbirth is important because maternity care in the United States is in crisis. Our system is failing women on multiple accounts: between 1990 and 2013, maternal mortality more than doubled in the United States, and is higher than most other high-income countries. Furthermore, women continue to suffer from abusive practices by maternity care providers who dismiss their concerns and sometimes outright refuse to honor their self-determination in childbirth. Today multiple stakeholders acknowledge a need for maternity care reform; this creates new challenges for health care policy and opportunities for social science research. Obstetrician-gynecologists provide the majority of maternity care to American women, and this dissertation examines their lived experience of decision-making in birth and analyzes how a range of social forces affect this process. To investigate this phenomenon I performed 50 in-depth interviews with obstetricians from Massachusetts, Louisiana and Vermont about how they make patient care decisions in birth. The specific research questions and analysis for each chapter evolved through an iterative process that combined analytical grounded theory and template analysis. I present this in a three-article format. In article one I show how shift-work models of labor and delivery pose challenges to using a patient-centered approach to decision-making. Obstetricians either work shifts in labor and delivery or they work on-call for their patients’ births. The current thinking is that shifts are good because they allow work-life balance for doctors, reduce fatigue, and reduce convenience-based decisions. Shift work models assume that doctors and patients are interchangeable because doctors will follow protocols and standards of care produced by medical professional organizations. I argue shift work does not work in practice the way it does in theory. I explain how there are not standards for many decisions in birth, instead these decisions are characterized by medical uncertainty. In these cases, doctors rely on patient-centered approaches to make decisions. But shift work limits doctors’ ability to use patient-centered approaches. I found that shift-work models of hospital care do not provide doctors the opportunity to get to know their patients and understand their preferences. In practices that do not depend on shift work, the doctor patient relationship is far less fragmented and doctors tend to experience less conflict with their patients and are less likely to rely on stereotypes that reproduce social inequality. In article two I examine obstetricians’ understandings of convenience as a motivation in decision-making. Anecdotal evidence suggests that obstetricians sometimes make clinical care decisions less out of concern for their patients and more out of concern for their own time and schedule. This may be a particular problem in on-call models. In this paper I show doctors’ stories match anecdotal evidence: Some obstetricians make clinical decisions in birth based partially on their own convenience. Yet others actively resist the temptation of convenience, even in on-call care. A key dimension of this difference lies in doctors’ understandings of the nature of time in labor and the safety of interventions. Some doctors have a faster-the-better approach to birth and believe the routine use of interventions is the best way to practice in labor and delivery. These doctors frame their own convenience as legitimate because it overlaps with the idea that speeding up the labor is inherently good. Alternatively, other doctors believe time in labor is productive, and that interventions should be used judiciously because they increase risk of harm. These doctors cannot easily legitimize convenience because it conflicts with the reduction of interventions as a key dimension of this philosophy. I argue that because shift work poses serious challenges to patient-centered care, cultural change is a better avenue for reducing births of convenience. Article three addresses an ongoing question in medical sociology about whether physicians maintain control over their clinical work amidst challenges to their authority. Patient empowerment and standardization are two movements that sociologists have theorized in terms of weakening of doctors’ clinical discretion. I uncover how obstetricians draw on the conflicting nature of these approaches strategically to maintain their power in the face of a threat. Standards and patient empowerment act as countervailing powers; they drew on one to off set the challenge to their authority posed by the other. / Thesis (PhD) — Boston College, 2017. / Submitted to: Boston College. Graduate School of Arts and Sciences. / Discipline: Sociology.

The purposeof the study was to investigate whether occupational therapists find that therapy dogs can affect the relationship with the client and client´s participation in activity. The methodused was a qualitative study with ten participants who were contacted via recommendations and via the social network Facebook. The questions concerned the occupational therapists' experience of working with therapy dogs and their experiences of whether the therapy dog ​​can be a tool to help create relationship with the client and motivate for activity. The resultshowed that the experience was predominantly positive and that the therapy dog ​​made the client contact stronger. The occupational therapists experienced that they could go further in their interventions with the help of the dog and that the clients opened up more and were more motivated to participate in activities when the dog was present. It also showed that education, planning, goal setting and journaling were important to demonstrate the effect of therapy dogs. Conclusion:The result showed positive situations in which the therapy dog ​​was an aid for the occupational therapists' success in the intervention. The study showed that contact with the client was strengthened with the help of the therapy dog ​​and that the motivation to participate in activities increased. / Syftet med studien var att undersöka omarbetsterapeuter upplever att terapihundarkan påverkarelationen till klienten samtklientensdelaktighet i aktivitet. Metodensom användes var en kvalitativ studie med tiodeltagare som kontaktades via rekommendationer och via det sociala nätverket Facebook. Frågorna berörde arbetsterapeuternas upplevelse kring att arbeta med terapihund och deras erfarenheter om huruvida terapihunden kan vara ett hjälpmedel för att hjälpa till att skapa relation till klienten och motivera till aktivitet. Resultatetvisade att erfarenheterna var övervägande positiva och att terapihunden gjorde att klientkontakten blev starkare. Arbetsterapeuterna upplevde att de kunde komma längre i sina interventioner med hjälp av hunden och att klienterna öppnade upp sig mer och var mer motiverade till att delta i aktiviteter närhunden var närvarande.Det visade också att utbildning, planering, målsättning och journalföring var viktigt för att visa på terapihundarnas effekt.Slutsats: Resultatet visade positiva situationer där terapihunden varit ett hjälpmedel för arbetsterapeuternas framgång i interventionen. Studien visade att kontakten till klienten stärktes med hjälp av terapihunden och att motivationen att delta i aktiviteter ökade

O foco deste estudo está nas possíveis transformações na relação de poder estabelecida entre médico e paciente representada em três comunidades virtuais com tema em saúde-doença. Trata-se de uma pesquisa qualiquantitativa com uso da técnica do Discurso do Sujeito Coletivo (DSC), o que possibilita a construção de discursos coletivos distintos que expressam as representações sociais de uma coletividade. Como resultado é possível verificar: (i) porque as pessoas participam de comunidades virtuais; (ii) como as pessoas participam; (iii) como se organizam essas comunidades; (iv) quais tipos de informações são mais buscados; (v) quais conteúdos informacionais existem nos fóruns de discussão (vi) como se dá a interação entre integrantes da comunidade; (vii) como as relações de poder estabelecidas entre médico e paciente são tratadas nas comunidades; (viii) identificação de possíveis transformações na relação de poder estabelecida entre médico e paciente. Conclui-se que a maior parte dos integrantes das comunidades analisadas está em um nível associativo-participativo de compartilhamento das informações e experiências. Esse nível, apesar de não se constituir em ação de cooperação e prática de produção coletiva, permite aos integrantes se tornarem pacientes mais ativos em seus processos de saúde e doença. Os resultados sugerem que o princípio ético da autonomia está, legalmente e na prática, mais fortalecido, contribuindo com a constituição de um indivíduo integrante, interativo, mais autônomo / Possible changes in the power relationship established between doctor and patient represented in three online communities which address the subject of health and illness is the focus of this study. This is a qualitative and quantitative research using the Collective Subject Discourse (DSC), which allows the construction of separate collective discourse, which expresses the social representations of a collectivity. As a result, it is possible to verify: (i) why people participate in such virtual communities , (ii) how people participate, (iii) how those communities are organized, (iv) what types of information are most searched, (v) which information exist in those discussion forums (vi) how community members interact, (vii) how the power relations established between doctor and patient are treated in these communities, (viii) identification of possible changes in the relationship established power between doctor and patient. We conclude that most members of the communities studied are in an associative-participatory level regarding information and experiences sharing. This level, though is not considered as an action of mutual cooperation and collective production practice, allows members of such communities to become more active as patients in their processes of health and disease. The results suggest that the principle of autonomy is, legally and in practice, more energized, contributing to the constitution of an individual, integral, interactive, and increasingly autonomous

There are numerous empirically described problems of communication in healthcare. The doctor/patient relationship is fundamental to many such problems. The changing nature of healthcare and the doctor/patient relationship is explored in this thesis. An increasing evidence base demonstrates that patient outcomes in healthcarea re directly relatedt o clinical communication. However, more fundamental than patient outcomes is the very nature of personhood and the effects illness has on individual autonomy. A theory of human need provides the foundation for discussion. Autonomy in healthcare is discussed in these terms and is argued as a basic human need. Moreover, human communication is argued as a basic human need using the same theoretic approach. It therefore follows logically that health professionals have the same duties and responsibilities to meet basic human communication needs on the same terms as those for autonomy. The relationship between autonomy and communication is shown to be a reflexive one. A theory of democratic communication is drawn on to describe the type of communication that will meet autonomy and communication needs. This is set in the context of healthcare. Consent in healthcare is used to show how far we have come in meeting communication and autonomy needs. Given the arguments o far it is reasonable to expect medical education to respond to the changing and recognised needs of the users of healthcare. The role of effective communication in medical education programmes is explored. Finally, a strategic approach to organising and delivering a communication curriculum is proffered which tries to meet both the philosophically and democratically argued basic needs. The resulting communication curriculum combines theoretic foundations with a pragmatic approach to the problems of clinical practice. If the approaches in this thesis are followed then communication can no longer be perceived as something doctors do after they have completed other medical tasks. Effective doctors have to be effective communicators in order to meet patients' needs.

This study was made in Northern Thailand among the Karen minority group during Feb-April 2011. The Karen people consist of two different kinds of Karen, the Paw and the Skaw. They live on the border between Burma and Thailand, but none of the countries want to take care of them. The aim of the study was to examine what experiences people in this minority group had from hospital care and to let them tell their stories with their own words. A qualitative method with an inductive approach and narrative interview methodology was used and the analysis followed the model described by Lundman and Hällgren Granheim (2008). Six interviews with participants from three different villages, three women and three men, in the age span 29 to 78 years participated. The interviewees had different experiences of the nurses treatment and the result is divided into two content areas, “experienced good treatment at the hospital” and “experienced bad treatment at the hospital”. In the study it is shown that the interviewees experiences, bad or good, to a large extent depended on how well they could communicate with the nurses and retrieve information about their situation. The author thinks it is important to see what role the nurse-patient relationship plays in the care process, and that good care includes taking time with the patient. To ensure such treatment for everyone it is important that every patient is listened to and treated with respect and dignity, independent of their ethnic background. / Program: Sjuksköterskeutbildning

Ickeheterosexuella har en sämre hälsa än heterosexuella, framför allt en sämre psykisk hälsa. Rädsla för ett negativt bemötande kan leda till att dessa patienter undviker vård. Därmed påverkas också hälsan. När sjuksköterskan möter dessa patienter i sitt arbete är det därför viktigt att vårdrelationen utvecklas på ett så bra sätt som möjligt. En positiv vårdrelation är väsentlig för att patienten ska kunna uppnå hälsa. Syftet med studien är att beskriva ickeheterosexuella patienters upplevelser och erfarenheter av vårdpersonalens bemötande samt vårdpersonals/vårdstudenters attityder och känslor gentemot denna patientgrupp. Metoden är en litteraturöversikt med analys av både kvantitativ och kvalitativ forskning.Ickeheterosexuella patienter upplever att vårdpersonalen tar för givet att alla är heterosexuella vilket medför att patienterna känner sig utanför, annorlunda och att de inte passar in. De väljer om, när och hur de ska komma ut som ickeheterosexuella. Negativt bemötande förekommer men förväntningarna om ett negativt bemötande är större än ett faktiskt negativt bemötande. Vårdpersonalen har både positiva och negativa attityder/känslor gentemot ickeheterosexuella patienter. Dock skulle en tredjedel av vårdpersonalen avstå från att vårda en homosexuell om de hade möjlighet.Vården är heteronormativ vilket medför att ickeheterosexuella blir osynliggjorda och inte tagna på allvar. Sjuksköterskan måste verka för att bryta patienternas förväntningar om ett negativt bemötande. Ickeheterosexuella patienter skapar strategier för att garantera ett gott bemötande och tar därmed ett stort ansvar för att vårdrelationen ska bli positiv. Vårdpersonalens negativa inställning gentemot ickeheterosexuella kan bero på osäkerhet. Osäkerheten gör att de inte tar ansvar för vårdrelationen. Vårdpersonal behöver mer kunskap om ickeheterosexuella patienter för att kunna verka för en positiv vårdrelation och därmed underlätta för ickeheterosexuella patienter att uppnå hälsa. / <p>Program: Sjuksköterskeutbildning</p><p>Uppsatsnivå: C</p>

Efter psykiatrireformen i mitten av 1990-talet övergick Sverige från den tidigare institutionsbaserade vården till den idag kommunbaserade vården. Vi som vårdare kan nu träffa på människan med schizofren sjukdom var vi än jobbar, då människan med schizofren sjukdom även får kroppsliga sjukdomar. Schizofreni är en sjukdom som ofta innefattar en värld som kan upplevas främmande, svår att förstå och långt ifrån den livsvärld vi som vårdare vanligtvis möter. Om förståelsen hos oss som vårdare brister i hur människan med schizofren sjukdom upplever sin livsvärld kan det påverka bemötandet och vården negativt. För att kunna ge ett värdigt och respektfullt bemötande behövs kunskap och förståelse om hur människan med schizofren sjukdom upplever sin livsvärld och mötet i vården.Syftet med litteraturstudien är att belysa hur människan med schizofren sjukdom upplever sin livsvärld och mötet i vården. Tre biografier skrivna av människor som själva har upplevt schizofreni har använts som grund för analys, enligt Fribergs (2006) modell för att analysera berättelser (narrativer). I diskussionen av studiens resultat har även fem stycken artiklar använts som grund för diskussion.Resultatet har delats in i åtta olika kategorier, upplevelsen av: den andra världen, mellan världar, rädsla för förändrad identitet, negativ identitet, negativa röster, positiva röster, dålig vård, bra vård.I diskussionen diskuteras den för studien valda metoden och fynden från analysen tillsammans med de fem artiklar som ligger till grunden för diskussionen. / <p>Program: Sjuksköterskeutbildning</p><p>Uppsatsnivå: C</p>

A presente tese tem por objetivo estudar alguns aspectos semióticos de paixão e persuação na relação médico-paciente, uma relação sempre marcada pela verticalização e pela complexidade - de um lado, o poder de persuasão de quem detém o conhecimento; de outro, a fragilidade de quem está doente e precisa da cura. Para esse estudo, será apresentado, em uma primeira parte, um panorama da história da Medicina ocidental, bem como comparações entre os médicos atuais e os xamãs e feiticeiros de antigas civilizações. Verificar-se-á que o prestígio do profissional da Medicina atual assemelha-se ao respeito de que gozava o xamã naquelas sociedades: tanto um quanto o outro, ao estabelecer a cura de um doente, possibilitam sua reintegração ao grupo social a que pertencia e do qual foi separado em razão de sua enfermidade. Em seguida, serão apresentados os modelos teóricos presentes nos escritos de A. J. Greimas e C. T. Pais para que se estudem três casos narrados por médicos de três diferentes especialidades - um ortopedista, um cirurgião de cabeça e pescoço e uma cardiologista. Com a análise semiótica das narrativas, chegar-se-á ao estudo da \"visão de mundo\" subjacente aos citados casos e seus desdobramentos, bem como a análise do comportamento dos sujeitos envolvidos na busca do objeto de valor: o restabelecimento da saúde. De um lado, o profissional da Medicina, que deve seguir os preceitos de sua profissão, bem como os mandamentos da chamada Bioética, para que seja sancionado positivamente pela sociedade da qual faz parte; de outro, o paciente, que freqüentemente deposita no médico mais expectativas de cura do que esse profissional pode alcançar. Serão levadas em conta, também, as teorias de J. Campbell sobre o \"mito do herói\", bem como a teoria dos \"arquétipos\" de C. Jung. Em suma, este trabalho procurou analisar, sob o ponto de vista da semiótica e da bioética, as condições em que se pode desenvolver a relação entre médico e paciente. Assim, esperamos poder contribuir, de alguma forma, para estudos posteriores que se proponham a investigar o universo da Medicina / This thesis intends to study some semiotics aspects of passion and persuasion in the doctor-patient relationship, a relationship marked by verticalization and complexity - on the one hand, the power of persuasion of a doctor who has the know-how; on the other hand, the fragility of someone who is ill and needs to be cured. On this study, a synthetic history of Western Medicine will be shown, including a comparison between the modern doctors and old witch doctors from primitive tribes. It´ll be clear that the status of the modern doctors has not changed from that time because both of them, when they get to cure a person, can bring back the patient to his social group, since any ill person is separated from his family and friends due to the ilness. After that, the theoric patterns of Greimas and Pais will be shown in order to study three cases told by three different doctors from three different areas of Medicine: Orthopedics, Head and Neck Surgery and Cardiology. With the semiotic analysis of the cases, the \"interpretation of the world\" will be identified according to the relationship studied, as well as the analysis of the behavior of the characters searching their goals: the recovering from the illness. We will find the doctor who must obey the laws of his profession, as well the commandments of Bioethics, to be approved by the social group in which he lives; but we will find, too, the patient who often expects more than he should from his doctor. J. Campbell´s theories about \"The mith of the hero\" and Jung´s \"Theory of the Archetypes\" will be important to this work too. In short, this work tried to study, considering Semiotic and Bioethic, the conditions and problems envolving the relationship between doctor and patient. We hope we can give some contribuiton to future works that may intend to investigate the Medicine world.

Este trabalho volta-se ao estudo das diretivas antecipadas sobre o fim da vida na relação médica no Brasil. Pretende-se verificar a legitimidade bioética e a legitimidade e possibilidade jurídicas da prática das diretivas antecipadas sobre o fim da vida como objetivo central. Busca-se aferir a adequação, bioética e jurídica, das diretivas antecipadas como veículo próprio de autodeterminação da pessoa diante de suas possibilidades existenciais e da formulação de seu projeto de vida e de morte digna. Ademais, especificamente, procura-se determinar a possibilidade jurídica das diretivas antecipadas no Ordenamento brasileiro: a coerência com as garantias constitucionais e a existência de institutos aptos a tal prática. Propõe-se sustentar a legitimação jurídica das diretivas antecipadas no Brasil, indicando possíveis caminhos às soluções interpretativas no plano jurídico, e os efeitos na relação médica a partir, também, das considerações bioéticas. Com essa finalidade, pretende-se averiguar a compatibilidade entre as normas deontológicas de origem bioética e as normas jurídicas de status constitucional de proteção à pessoa humana. A tese também propõe a análise do contexto em que as diretivas antecipadas são utilizadas para (i) problematizar as ideias de capacidade e competência para a prática desse ato de autonomia pessoal, (ii) problematizar sobre como a perspectiva familiar, a perspectiva técnica dos profissionais da saúde e a perspectiva do Poder Judiciário contingenciam a liberdade desse ato e (iii) aferir a eficácia desses atos no espaço clínico e familiar. Para tanto, será empreendido estudo teórico mediante pesquisa bibliográfica e de referências, que levantará as publicações, nacionais e internacionais, sobre os temas da tese. O levantamento bibliográfico compreenderá, preferencialmente, obras sobre filosofia, ética, bioética e direito, que permitam a análise das questões teóricas envolvidas no estudo. O desenvolvimento do trabalho estrutura-se em três capítulos. O primeiro pretende estabelecer as bases conceituais e os fundamentos legais das diretivas antecipadas. O segundo capítulo apresentará a sistematização entre os valores bioéticos e jurídicos que se relacionam a tal prática. O capítulo três apresentará as questões fundamentais pertinentes à validade e eficácia da prática das diretivas antecipadas no Brasil. A partir das premissas construídas ao longo do desenvolvimento, o desfecho da pesquisa pretende reforçar seu argumento central demonstrando, então, a legitimação bioética e a legitimidade e a possibilidade jurídicas das diretivas antecipadas sobre o fim da vida no atual contexto brasileiro.