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.

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

Background: Previous research shows that language barriers can make it difficult for patients and nurses to communicate and understand each other. Communication enables patients to express their suffering to nurses, but language barriers can prevent this and thus affect the nurse-patient relationship. Although there are language barriers, nurses can create trust by showing willingness to care. The purpose: The aim of the study is to describe nurses' experiences of how language barriers affects the nurse-patient relationship. The method: A qualitative systematic literature study with a descriptive synthesis. Results: The result presented two themes and four sub-themes. The theme Willingness to do good contained sub-men A willingness to care and To receive support to promote communication. The theme Obstacles in caring contained sub-men An emotional distance and Does not understand. Conclusion: Language barriers, on the one hand, were found to limit the possibility of establishing a nurse-patient relationship, on the other hand, a nurse-patient relationship could develop into a caring relationship despite language barriers. Interpreters were necessary to be able to make contact with the patients, while being able to create a distance between the nurses and the patients.

The present study was designed to investigate the hypothesis that female clients who tend to terminate therapy prematurely will have been assigned to a male therapist. The study also tested the hypothesis that female clients who defect from therapy will have reported a history of low self-disclosure to individuals of the same sex as their therapist. Neither hypothesis was supported by the results of this study, but findings suggest a possible bias in the manner by which male and female therapists select their clients for therapy. It also appears that female defectors may be over-identifying with their family of origin or that they may be overly dependent on it as a resource system. This may be the reason for their apparent difficulty in developing a prototype that will accommodate their therapist.

Thyroid disease, a chronic illness, affects nearly 200 million people worldwide and is more common among women than in men. Numerous factors make diagnosing and treating thyroid disease in women challenging. The standard blood test for diagnosing thyroid disease and determining treatment effectiveness is inconsistent in its accuracy. Many women with thyroid disease are misdiagnosed or struggle with symptoms even once receiving treatment. Although thyroid disease is highly prevalent among women and the doctor-patient relationship is known to influence treatment outcomes, there is a gap in the literature regarding the treatment experiences of women with thyroid disease and the doctor-patient relationship. The purpose of this phenomenological study was to explore female thyroid patients' experiences of treatment and the doctor-patient relationship. Sixteen female thyroid patients, ages 18 and older and members of an international online support group, were individually interviewed via online chat. Data interpretation was guided by social constructionism and feminist theory and was accomplished via Moustakas's analytic method. Themes related to the doctor-patient relationship were identified, including the culture of the medical profession, diagnostic bias, and gender differences in communication. Emergent themes included patient education level, patient self-advocacy behaviors, and the use of natural thyroid medication. The results of this study may contribute to positive social change by enhancing doctors' understanding of thyroid disease in women and the influence of the doctor-patient relationship in determining positive treatment outcomes, thus equipping doctors with enriched knowledge for providing their female thyroid patients with the highest quality of care.

ABSTRACT Notions of quality of life dictate philosophies and policies for services for people with developmental disabilities. There is an abundance of research on quality of life, much of which has influenced the significant amount of study of quality of life for people with developmental disabilities. According to specialist developmental disability nurses, however, this research has little meaning for one group of people with developmental disabilities with whom they work - people with severe multiple impairments. Nevertheless, judgements and decisions about the lives of this group continue to be driven by the idea of quality of life. While the literature review found that researchers are urged to seek the perceptions of people regarding their own quality of life by asking them, some authors have noted the difficulty in pursuing such a method with people, such as people with severe multiple impairments, who are unable to communicate in the usual ways. Given, then, that it is difficult to directly determine the views of people with severe multiple impairments, this study sought the perceptions of nurses about the quality of life of the people with whom they work. In order to discover and conceptualise nurses' views, a symbolic interaction perspective was chosen to guide this study and data were analysed using the grounded theory approach. The study was conducted in two stages. Stage One consisted of semi-structured indepth interviews with expert nurses to explore their perceptions of quality of life for the people with whom they worked. A significant finding in these interviews was that perceptions of quality of life are mediated by interaction. Consequently, Stage Two involved a participant observation study in which the interactions of nurses and people with severe multiple impairments were examined. Specialist developmental disability nurses have a unique view of quality of life for people with severe multiple impairments. They refer to it as 'just little things', a phrase which masks complex nursing knowledge and skills, and which can be described by four interrelated categories which emerged from the data: humans being, supporting, becoming intimate, and situated belonging. As nurses become more intimate with individuals, they perceive that people with severe multiple impairments are humans being as they wish, and that quality resides in supporting their everyday lives in a context of situated belonging. This thesis represents a new conceptualisation of quality of life for people with severe multiple impairments, a conceptualisation which may have significance for other groups and, indeed, for the whole quality of life enterprise. This conceptualisation draws on knowledge not usually related to quality of life, that is, knowledge of the body, of the emotions, of identity and of humanness. Such findings demonstrate the power of an interpretive approach in explicating the meanings nurses have regarding quality of life. Further, these findings have implications for how the question of quality of life is approached, for how different ways of thinking about people impact on quality of life, and for the importance of the life in quality of life.

The aim of this thesis is to study (1) the impact of physicians' locus of control (LOC) on their communication styles in interviews with cancer patients as well as (1) the impact of physicians' LOC on their acquisition of effective communication skills in a communication skills training program. LOC is a generalised belief regarding the extent to which life outcomes are controlled by an individual's actions (“internal” LOC) or by external forces such as luck, fate or other individuals (“external” LOC). (1) Although is it widely recognised that physicians' characteristics could influence their communication styles and may thus interfere with a patient-centred communication, no empirical evidence is currently available. No studies are available on the impact of physicians' LOC on their communication skills. It was hypothesised that physicians with an “external” LOC have a different communication style than physicians with an “internal” LOC. Eighty-one voluntary physicians with a practice in oncology were recorded performing an actual and a simulated interview with a cancer patient as wall as an actual and a simulated interview with a cancer patient and a relative. Physicians' communication skills were assessed using the Cancer Research Campaign Workshop Evaluation Manual. Physicians' LOC was assessed using the Rotter I-E scale. Communication skills of the upper and lower quartiles of physicians in respect of their scores on this scale were compared using Student's t-test. Results show that physicians with “external” LOC give more appropriate information than physicians with “internal” LOC in simulated interviews with a cancer patient (P=0.011) and less premature information than physicians with “internal” LOC in clinical interviews with a cancer patient (P=0.015). Moreover, in actual interviews with a cancer patient and a relative, physicians with an “external” LOC talked more to the relative (P=0.017) and used more utterances with an assessment function (P=0.010) than physicians with an “internal” LOC. In simulated interviews with a cancer patient and a relative, physicians with an “external” LOC used less utterances giving premature information (P=0.031) and used more utterances with a supportive function such as empathy and reassurance (P=0.029) than physicians with an “internal” LOC. (2) Although it is widely recognised that educational interventions may be more effective for people with an “internal” LOC compared to people with an “external” LOC, no study has yet assessed the influence of physicians' LOC on communication skills learning. This study aims to test the hypothesis that, in a communication skills training program, physicians with an “internal” LOC would demonstrate communication skills acquisition to a greater degree than those with an “external” LOC. A non-randomised longitudinal intervention study was conducted between January 1999 and April 2001. Sixty-seven volunteer physicians from private and institutional practice in Belgium participated to a learner-centred, skills-focused, practice-oriented communication skills training program. Communication skills changes were assessed in 2 standardised simulated interviews before and after training (one two-person and one three-person interview). Communication skills were assessed using the Cancer Research Campaign Workshop Evaluation Manual. Physicians' LOC was assessed using the Rotter I-E scale. Communication skills changes of the upper and lower third of physicians in respect of their scores on this scale were compared using group by time repeated measures of variance. In the two-person and three-person interviews, the increase in open directive questions was more important among physicians with an “internal” LOC compared to physicians with an “external” LOC (P=0.066 and P=0.004 respectively). In the three-person interview, the increase in directive questions (P=0.001), in assessing functions (P=0.002) and in the use of moderate feelings stated explicitly (P=0.011) was more important among physicians with an “internal” LOC compared to physicians with an “external” LOC. Conclusion. These results provide evidence that physicians' LOC can influence their communication styles as well as the efficacy of a communication skills training program. Physicians' awareness of first results constitutes a step towards a tailoring of their communication skills to every patient's and relative's concerns and needs and thus towards a patient-centred communication. The second results support the idea that a psychological characteristic such as "internal" LOC may facilitate communication skills acquisition through physicians' belief that communication with patients may be controlled by physicians themselves.

Objective: When caring for a patient with Anorexia Nervosa (AN) it is difficult for the registered nurses to develop a good nurse-patient relationship due to a lack of understanding for the illness.  It is important for the nurse to understand the suffering that the AN patients experience, and what makes them feel better, to be able to improve the patient-nurse relationship. This study aims to explore what makes patients with AN feel better during the illness and the process of recovery. Method: A qualitative scientific approach was used. Eight autobiographies were selected as data for this study. Both English and Swedish books were used. The data was analyzed using a qualitative method of data analysis. Results: The ways patients with AN could feel better are presented in seven themes: being seen as a whole individual behind the illness, being able to trust and find security, taking responsibility for recovery, finding motivation to keep fighting towards recovery, when one's suffering is noticed, filling a void, and the strengthening of the relationship between care giver and patient. This study may help registered nurses understand the needs of the patient recovering from AN and help them meet these needs in a better way. / Avsikt: För sjuksköterskor är det svårt att utveckla en bra sjuksköterske-patient relation när de vårdar patienter med anorexia nervosa (AN), eftersom det finns brister i deras förståelse för sjukdomen. För att kunna stärka relationen mellan sjuksköterskor och patienter är det viktigt för sjuksköterskan att förstå det lidandet som patienter med AN upplever och vad som kan lindra det.  Syftet med denna studie är att utforska vad som får patienter med AN att må bättre under sjukdomens lopp och tillfrisknandet. Metod: En kvalitativ metod valdes för att utföra studien. Sex självbiografier valdes som data till studien. Böcker skrivna på svenska och engelska användes. En kvalitativ dataanalys, enligt Dahlberg, användes för att tolka data. Resultat: Resultatet presenteras i sju teman: att bli sedd som en individ bakom sjukdomen, att kunna känna tillit och hitta trygghet, att ta eget ansvar för tillfrisknandet, att hitta motivation för att fortsätta kämpa mot tillfrisknandet, att ens lidande uppmärksammas, att fylla ett tomrum efter sjukdomen och att stärka relationen mellan vårdare och patient. Denna studie kan hjälpa allmänna sjuksköterskor att förstå de behov patienter med AN har och hjälpa dem att bemöta deras behov på ett bra sätt.

In the contemporary society, with the disintegration of political authoritarianism and the rise of democratic equality thoughts, as well as the flourishing information and popularity of medical knowledge, patients¡¦ autonomous consciousness and consumerist consciousness thus arise. In this information society, the boundless Internet brings a huge amount of information, and enables the general public to actively enrich themselves with professional medical knowledge, to have a online discussion with others, or to provide online support to each other. Such moves will transform the physician-patient relationship from the traditional ¡§professional led¡¨ interaction to different types of interaction, and hence the relationship between a physician and a patient generally deviates from the social hierarchy system in the past. Medical knowledge is no longer something that the physician can monopolize and enjoy exclusively. Accordingly, several types of physician-patient relationship have been developed. While the information revolution is generally striking the medical profession, in response to the future development and change in the medical field, some assistance should be given to medical students and practitioners to continuously learn new knowledge and new technology, as well as grasp and develop proper communication ability in this rapidly changing information age to build a solid foundation for their future role as a physician. Therefore, it leads to the author¡¦s query about ¡§what competence should a physician possess¡¨ to effectively manage the ¡§new physician-patient relationship management in the information society¡¨ mechanism, which becomes the motivation of making an in-depth study. It is hoped that the literature review and the in-depth interview in this study could help find out the way that physicians and patients ¡§adjust¡¨ to each others in these new types of physician-patient relationship in the information society. Moreover, physicians have to understand that only by improving the effect of their physician-patient relationship management can they create a win-win result under a harmonious physician-patient relationship.

<p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p> </p><p><strong>Objective:</strong> When caring for a patient with Anorexia Nervosa (AN) it is difficult for the registered nurses to develop a good nurse-patient relationship due to a lack of understanding for the illness.  It is important for the nurse to understand the suffering that the AN patients experience, and what makes them feel better, to be able to improve the patient-nurse relationship. This study aims to explore what makes patients with AN feel better during the illness and the process of recovery.</p><p><strong>Method: </strong>A qualitative scientific approach was used. Eight autobiographies were selected as data for this study. Both English and Swedish books were used. The data was analyzed using a qualitative method of data analysis.</p><p><strong>Results:</strong> The ways patients with AN could feel better are presented in seven themes: being seen as a whole individual behind the illness, being able to trust and find security, taking responsibility for recovery, finding motivation to keep fighting towards recovery, when one's suffering is noticed, filling a void, and the strengthening of the relationship between care giver and patient. This study may help registered nurses understand the needs of the patient recovering from AN and help them meet these needs in a better way.</p> / <p><strong>Avsikt:</strong> För sjuksköterskor är det svårt att utveckla en bra sjuksköterske-patient relation när de vårdar patienter med anorexia nervosa (AN), eftersom det finns brister i deras förståelse för sjukdomen. För att kunna stärka relationen mellan sjuksköterskor och patienter är det viktigt för sjuksköterskan att förstå det lidandet som patienter med AN upplever och vad som kan lindra det.  Syftet med denna studie är att utforska vad som får patienter med AN att må bättre under sjukdomens lopp och tillfrisknandet.</p><p><strong>Metod: </strong>En kvalitativ metod valdes för att utföra studien. Sex självbiografier valdes som data till studien. Böcker skrivna på svenska och engelska användes. En kvalitativ dataanalys, enligt Dahlberg, användes för att tolka data.<strong></strong></p><p><strong>Resultat: </strong>Resultatet presenteras i sju teman: att bli sedd som en individ bakom sjukdomen, att kunna känna tillit och hitta trygghet, att ta eget ansvar för tillfrisknandet, att hitta motivation för att fortsätta kämpa mot tillfrisknandet, att ens lidande uppmärksammas, att fylla ett tomrum efter sjukdomen och att stärka relationen mellan vårdare och patient. Denna studie kan hjälpa allmänna sjuksköterskor att förstå de behov patienter med AN har och hjälpa dem att bemöta deras behov på ett bra sätt.</p>