Compassion fatigue är ett psykiskt och fysiskt tillstånd som utvecklas över tid när sjuksköterskan känner medkänsla och empati för sina patienter, då resultatet visar att stödjande insatser kan hjälpa att förebygga tillståndet hos sjuksköterskor borde detta fenomen lyftas fram. Compassion fatigue kan påverka sjuksköterskans koncentrations- och bedömningsförmåga och resultera i att olika misstag i arbetet begås. Compassion fatigue är ett problem för sjukvården i stort, eftersom tillståndet påverkar omvårdnaden, arbetssituationen samt den enskilda sjuksköterskan negativt. Syftet med litteraturstudien var att belysa compassion fatigue ur ett sjuksköterskeperspektiv, i vilken studiens teoretiska utgångspunkt var Joyce Travelbees interaktionsteori. Studien genomfördes som en allmän litteraturstudie, databassökning gjordes systematiskt med sökord som var relevanta för syftet. Litteraturstudien baserades på tre kvalitativa och åtta kvantitativa artiklar som analyserades och kvalitetsgranskades. Resultatet visade att Bidragande orsaker till compassion fatigue, Upplevelser relaterat till compassion fatigue och Att förebygga compassion fatigue. Med en insikt om att hög arbetsbelastning och en hög stressnivå hos sjuksköterskor kan leda till compassion fatigue går det att arbeta preventivt, vilket är det mest effektiva. Detta skulle bespara både vårdpersonal och patienter lidande och förbättra kvaliteten i omvårdnaden. Vidare forskning skulle kunna ligga till grund för fortsatt förbättringsarbete inom klinisk verksamhet. / Compassion fatigue is a mental and physical condition that develops over time when the nurse feels compassion and empathy for her patients, since the results show that supportive interventions can help prevent the condition, this phenomenon should be emphasized. Compassion fatigue can lead to changes in the nurse's ability to concentrate and judge and result in various mistakes in the work. Compassion fatigue is a major concern for healthcare as the condition adversely affects the nursing, the work situation and the individual nurse. The purpose of the literature study was to emphasize compassion fatigue from a nursing perspective, in which the theoretical starting point of the study was Joyce Travelbee's interaction theory. The study was conducted as a general literature study, database search was done systematically with keywords that were relevant to the aim. The literature study was based on three qualitative and eight quantitative articles that were analyzed and quality-reviewed. The results show Contributing causes of Compassion Fatigue, Experiences Related to Fatigue and Preventing Compassion Fatigue. With an insight that high workload and a high levels of stress in nurses can lead to compassion fatigue, one can work preventively, which is most effective. This would save both healthcare and patients suffering and improving the quality of nursing care. Further research could provide a basis for continued improvement work in clinical operations.

Submitted by Kely Alves (kely.alves@unifenas.br) on 2018-07-31T18:14:09Z No. of bitstreams: 1 Dissertação Edson Dell Amore Filho.pdf: 708297 bytes, checksum: d624f6ac7e0eb9fcbdcd4058c5e05da6 (MD5) / Made available in DSpace on 2018-07-31T18:14:09Z (GMT). No. of bitstreams: 1 Dissertação Edson Dell Amore Filho.pdf: 708297 bytes, checksum: d624f6ac7e0eb9fcbdcd4058c5e05da6 (MD5) Previous issue date: 2018-03-12 / The medicine dehumanization has been largely attributed to the medicine schools, which privilege scientific aspects to the detriment of those theoreticians and focus on the humanism. The medicine schools were driven to review their curricula, emphasizing disciplines and organizing interventions for recovering of the humanism in medical practice. The general objective of the dissertation was to identify the actions proposed or developed in medicine courses for resumption of humanization in the medical practice. The specific objectives were to highlight the main attributes of the humanism and to describe the main educational interventions adopted for the humanism development in medical practice. A systematic revision of the literature was carried out for the attainment of the study objectives, by means of researching in the databases of the Latin American and Caribbean Health Sciences Literature and Pub Med, from 2010 to 2016, in Portuguese and English languages. The research resulted in the selection of 23 publications. The results showed that the humanism main attribute is the empathy, which the schools of medicine are developing as main actions the changes in the curriculum of the courses. The main educational implemented actions involve, besides the curricular changes, exchanges and extension programs, through the inclusion of new disciplines, the use of play activities and cultural contexts that are distinct from those of the students' origin. It was concluded that the range of the measures is still small, considering the universe of the medicine courses and its lack of results for more objective analysis. / A “desumanização” da medicina tem sido atribuída em grande parte às escolas de medicina, que privilegiam aspectos científicos, em detrimento daqueles teóricos e voltados ao humanismo. As escolas de medicina se viram impelidas a rever seus currículos, enfatizando disciplinas e organizando intervenções para retomada do humanismo na prática médica. O objetivo geral da dissertação foi identificar as ações propostas ou desenvolvidas nos cursos de medicina para a retomada da humanização na prática médica. Os objetivos específicos foram evidenciar os principais atributos do humanismo e descrever as principais intervenções educacionais adotadas para o desenvolvimento do humanismo na prática médica. Para a consecução dos objetivos do estudo, foi realizada uma revisão sistemática de literatura, mediante pesquisa nas bases de dados da Literatura Latino-Americana e do Caribe em Ciências da Saúde e PubMed, no período de 2010 a 2016, nos idiomas português e inglês. A pesquisa resultou na seleção de 23 publicações. Os resultados mostraram que o principal atributo do humanismo é a empatia e que as escolas de medicina estão desenvolvendo como principais ações alterações nos currículos dos cursos. As principais ações educacionais implementadas envolvem alterações curriculares, intercâmbios e programas de extensão, mediante a inclusão de novas disciplinas, uso de atividades lúdicas e atuação em contextos culturais distintos dos de origem dos estudantes. Concluiu-se que a abrangência das medidas ainda é pequena, considerando-se o universo dos cursos de medicina, e seus resultados carecem de análise mais objetiva.

Bakgrund: Brister i kommunikation och informationsöverföring är en av de största orsakerna till vårdskador. För att arbeta mot en säkrare vård måste patienterna bli delaktiga. Delaktiga patienter är nyckeln till personcentrerad och säker vård. Ett sätt att involvera patienterna är genom att de får delta i bedsiderapportering. Syfte: Att beskriva patienters upplevelser när sjuksköterskor använder bedsiderapportering vid skiftbyten.  Metod: En litteraturöversikt med induktiv ansats, baserad på sju artiklar med kvalitativ design och tre artiklar med mixad design. Artiklarna är hämtade från CINAHL och Medline. Resultat: Analysen resulterade i två teman, inkluderande vårdrelation och samtal på lika villkor. Patienterna upplevde att bedsiderapportering kunde främja delaktighet i vården, patienterna fick vara en del av informationsutbytet och bidra med meningsfull information. Patienternas känsla av trygghet ökade och sjukhusupplevelsen förbättrades vid säkerställandet av informationsutbytet. Däremot framkom även önskan från patienterna om ökat deltagande, bibehållen konfidentialitet och bli inbjuden i bedsiderapporteringen av sjuksköterskorna. Slutsats: Resultatet framhäver både positiva och negativa upplevelser. Bedsiderapportering kan vara ett steg mot mer personcentrerad vård men ytterligare riktlinjer behövs som berör hur konfidentialiteten bör hanteras. Framtida forskning behövs för att studera om metoden är lämplig för alla patientgrupper. / Background: Healthcare related injuries are often caused by insufficient communication and poor transferring of information. To make healthcare better the patients need to be included in the process. Keeping the patients involved is the key to patient-centred and safer health care. One way to involve the patient is through implementing “bedside handover”. Aim: To describe patient’s experiences when nurses implement bedside handover during shift change. Method: The study is a literature review with an inductive approach, based on seven articles with a qualitative method and three articles with mixed methods. The articles were taken from the databases CINAHL and Medline. Results: The results generated in in two themes: healthcare relationship and conversations on equal terms. The patients experienced that bedside handover could promote participation in care, patients could be a part of the information exchange and contribute with meaningful information. Patients' sense of security increased, and the hospital experience improved when they could secure the information. However, some patients wished for increased participation, maintained confidentiality and to be more invited to participate in the nursing bedside handover. Conclusion: The result highlights both positive and negative experiences. Bedside reporting can be a step toward more person-centered care, but additional guidelines are needed that address how confidentiality should be handled. Future research is needed to study whether the method is appropriate for all patient groups.

This study was designed to determine the effect of touch on the interpersonal attraction between therapist and patient. Four instruments were used to measure the effect, those measurements included "Client's Personal Reaction Questionnaire," "Attitudes Toward Psychotherapy and Psychotherapists Scale," actual physical distance and actual timed verbal measure. The general nature of the research hypotheses stated that the touch technique would increase the interpersonal attraction of the patients toward the therapist as indicated by the four measures. The results of the study led to the conclusion that touch during a single interview session effects statistically significant change in interpersonal attraction when measured by actual physical distance. However change in interpersonal attraction was not found when measured by the "Client's Personal Reaction Questionnaire," "Attitudes Toward Psychotherapy and Psychotherapists Scale" and an actual timed verbal measure. Implications of the study, based on observations of the experimenter, were that touch is successful in helping hospitalized neuropsychiatric patients increase their interpersonal attraction and that this attraction cannot always be measured by global questionnaires and specific amounts of verbalization. A similar study should be replicated with subjects other than neuropsychiatric patients, such as hospitalized medical patients, college students and children.

This thesis investigates the legal validity of living wills (advance directives) in South Africa. The study explores the current status of living wills in South Africa and contains recommendations on how legal enforceability of living wills can be improved in the South African context. The Constitution of the Republic of South Africa, 1996, the common law and the National Health Act, 61 of 2003, serve as basic points of departure for this investigation. Shortcomings in the current South African legislation and proposed draft legislation including the Law Commission’s Draft Bill on End of Life Decisions, 1998, and The National Health Amendment Bill, 2019, as well as shortcomings in the common law, the field of medical ethics and medical practice are indicated and recommendations for an improved framework are made. For purposes of a legal comparative methodology, the legal frameworks of living wills in the Netherlands, England and Canada are investigated. Specific circumstances which could potentially hamper the legal enforcement of living wills are discussed, including: emergency situations, do-not-resuscitate orders, permanent vegetative states, dementia, cessation of artificial hydration and feeding, pregnancy, euthanasia, assisted suicide, palliative care, pain relief and organ donation. It is argued that a living will could be an important tool in enhancing the doctor-patient relationship, not only to the benefit of the autonomous patient whose dignity and other fundamental human rights should be protected, but also to the benefit of the doctor as the medical care provider. / Thesis (LLD)--University of Pretoria, 2019. / Public Law / LLD / Unrestricted

Background The care relationship is central for psychiatric nursing. People with a psychosis diagnosis encounter symptoms that result in difficulties for the interpersonal communication. Stigma and previous experiences of compulsory care are obstacles that hinder or complicate the patient's participation in their care. A person-centered caring relationship increases adherence and the patient's possibility to be a part of their recovery. Therefore it is important for the psychiatric nurse to gain a deeper understanding of what specific strategies and practices the nurse uses to enhance the potential of the care relationship and provide a person-centered care. Aim The aim of the study is to describe the nurse´s experience of the care relationship with people who have a psychosis diagnosis. Method The study was conducted at two outpatient facilitations in Sweden. Eight nurses were asked about their experiences of the care relationship during individual semi-structured interviews. The data was analyzed by using a qualitative content analysis. Results The result was presented in three categories; Trust - essential for a supportive care relationship, Careful perception of the person's boundaries and conditions and Structural possibilities and limitations. The three categories consisted of six subcategories that emphasized the importance of the nurse creating trust and an equal meeting. The care relationship was related to getting to know the person’s history by using the nurse’s personal characteristics and how the nurse handled challenging conditions. Difficulties in creating such a relationship could be demands from the organization or the power dynamics within the health care facilitation. Conclusion By creating trust and an equal meeting the nurse is able to get to know the person’s history and thereby provide a person-centered care for people with psychosis diagnosis.

Bakgrund: Det har länge rapporterats om brister i bemötande i hälso- och sjukvården, inte minst inom psykiatrin. Vårdpersonal möter patienter med psykisk ohälsa oavsett arbetsplats. Patienternas uppfattning av vårdkvalitet inom psykiatrin har knappt undersökts i Sverige då det tidigare funnits en skepticism kring om en person som har varit tvångsvårdad eller lider av en störd verklighetsuppfattning varit kapabel till att ge ett trovärdigt svar. Patienterna anser att en god relation mellan patient och personal är grundläggande för god vårdkvalitet.Syfte: Syftet med denna litteraturstudie var att undersöka hur vuxna patienter med psykossjukdom upplever hälso- och sjukvården.Metod: Syftet besvarades genom en deskriptiv litteraturstudie. Artiklar som har inkluderats var av kvalitativ ansats. Inkluderade artiklar har genomgått en kvalitetsanalys med resultatet hög eller medelhög kvalitet.Resultat: I resultatet framkom följande teman: bemötande, patient-vårdpersonalrelation, behandling, delaktighet och information samt miljö. Patienterna beskrev att de upplevt bristande bemötande från vårdpersonal. De beskrev önskvärda egenskaper hos vårdpersonal och vad som gjorde det möjligt att bygga en god relation. Vidare beskrev patienterna vikten av att få information och av att vara delaktiga i sin vård, samt upplevelsen av bristerna gällande detta.Slutsats: Det är tydligt att det finns brister i hälso- och sjukvården ur ett patientperspektiv och att mer forskning inom området krävs. De problemområden som upptäcktes var bemötande, patient-vårdpersonalrelation, miljö, behandling och delaktighet/ information.Nyckelord: Psykossjukdomar, upplevelse av bemötande, sjuksköterske-patient relation

Tekniken är en stor del av dagens samhälle. Allt fler tjänster och saker blir digitaliserade, nu även sjukvården. Denna avhandling kommer att introducera dig till e-hälsa och hur digitaliseringen av sjukvården påverkar relationen mellan doktor och patient samt vilka förtroendeproblem som kan uppstå.E-hälsopplikationerna behöver vara användarvänliga och enkla att använda för patienterna. Patienterna behöver känna sig trygga och säkra. För att undersöka användarupplevelsen i de olika kanalerna jämförde vi de två olika flödena: personligt möte med videosamtal.Det finns många olika leverantörer av e-hälsoapplikationer i Sverige, Kry och Min Doktor är två av de mest populära. Digitaliseringen av sjukvården påverkar inte bara patienterna utan läkarna är lika involverade. För att få en läkares åsikt ställde vi ett par frågor till läkare om bedömning av patienter via videosamtal. Ett frågeformulär gjordes för att samla in information om patienternas förhållande, användning och erfarenhet av e-hälsoapplikationer.Frågeformuläret visade att det finns delade åsikter om e-hälsoapplikationerna. Vissa patienter tror att e-hälsapplikationerna kommer att gynna samhället och kan själva tänka sig att använda en e-hälsoapplikation för mindre åkommor. Andra patienter är starkt emot e-hälsa och de flesta av dem instämmer i att det är ett slöseri med skattepengar. En annan vanlig orsak emot e-hälsa är att patienter tycker att deras åkommor är för komplexa eller att de inte litar på att läkaren ger dem korrekt vård genom en applikation. / Technology is a big part of today's society. At this time more things and services become digitized, now even healthcare. This thesis will introduce you to e-health and how to digitize healthcare will affect the doctor-patient relationship and the trust issue that may occur. E-Health applications need to be user-friendly and easy to use. The user needs to feel comfortable and safe. To investigate the cross-channel user experience we compared the two different flows: in-person appointment and video conference. There are many different providers for e-health applications in Sweden, most popular are Kry and Min Doktor. This digitizing not only affects the patients, but the doctors are also equally involved. We questioned doctors about their approach towards assistance through an application. A questionnaire was done to gather information about the patient's relationship and usage of e-health applications. The questionnaire showed that there are some divided opinions regarding e-health applications. Some patients think that e-health applications will benefit society and may use an e-health application for minor complaints. Other patients are strongly against e-health, and most of them agree that it is a waste of tax money. Another common reason against e-health is that patients think that their complaints are too complex or that they do not trust the doctor to provide them the accurate assistance through an application.

Communication Skills of Novice Psychiatric Nurses with Aggressive Psychiatric Patients by Rose L. Moss MS, University of Hartford, 1996 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University March 2015 The transition from novice nurse to a competent psychiatric staff nurse is often associated with major communication challenges, primarily when caring for aggressive patients. Guided by Peplau's theory, this quantitative study assessed the communication skills of novice psychiatric nurses (N = 25) who worked 24 months or less in the state psychiatric hospital with aggressive psychiatric patients. Additionally, certain demographic data such as gender, age range, level of education, and length of time working were analyzed to determine their impact on communication skills. The survey consisted of 20 questions which assessed demographic data, communications skills, and hospital-based orientation. Based on ANOVA, novice nurses did not differ on hospital-based orientation based on gender, age, level of education, or length of time working. Novice nurses' communication skills did not differ by gender, age or level of education; however, novice psychiatric nurses who had worked 19-24 months had stronger communication skills than those working less time with aggressive patients (F = 6.9, p < 0.005). A communication skills class during hospital orientation to prepare novice nurses to communicate effectively with aggressive patient was recommended to nursing leadership and staff. A communication skills class held during hospital orientation could enhance the nurse-patient relationship, cultivate a safer and secure milieu, and improve patient outcomes. The findings have implications for positive social change for staff development to improve the hospital orientation for novice psychiatric nurses to become better equipped as effective communicators with aggressive psychiatric patients.

Bakgrund Uppskattningsvis 100 miljoner människor världen över lever i hemlöshet och orsakerna ärindividuella, komplexa och multifaktoriella. Att vara hemlös förknippas med ett försämrathälsotillstånd, såväl psykiskt som fysiskt, och likaså en överdödlighet i jämförelse medövriga befolkningen. Många hemlösa undviker att söka vård, eller väntar tills symtomenhar blivit så pass allvarliga att de behöver uppsöka akutsjukvård. Förhoppningen meddenna litteraturöversikt är därför att bidra med kunskap om hur hemlösa ska bemötas. Syfte Att beskriva hemlösas erfarenheter och upplevelser av hälso- och sjukvården. Metod En icke-systematisk litteraturöversikt utfördes och baserades på 15 vetenskapligaoriginalartiklar med kvalitativ metodansats. Inkluderade artiklar inhämtades fråndatabaserna PubMed och CINAHL. Artikelsökningarna utfördes med hjälp av sökord somtagits fram utifrån föreliggande syfte och därefter tillämpades avgränsningar. Artiklarnakvalitetsgranskades utifrån Sophiahemmet Högskolas bedömningsunderlag och derasresultat analyserades med en integrerad dataanalys. Resultat Den integrerade analysen av artiklarnas resultat gav upphov till två huvudkategorier:Bemötande och praktiska svårigheter att erhålla vård. Centrala fynd var hemlösasbeskrivna upplevelser av diskriminering i vården samt vikten av ett värdigt och flexibeltbemötande. Hemlösa uttryckte även praktiska svårigheter i vårdsökandet, både påindividnivå samt på samhälls- och organisationsnivå. Slutsats Vårdpersonals nedvärderande och dömande bemötande beskrevs som diskriminerande ochhämmade hemlösas vårdsökande. Däremot angavs relationen främjas då hemlösainvolverades i sin egen vård, och då vårdpersonalen var flexibel och lyssnade aktivt. För attförse hemlösa med adekvat vård krävs kunskap om deras upplevelser av hälso- ochsjukvården. / Background Approximately 100 million people are homeless worldwide and the causes are individual, complex, and multifactorial. Homelessness is associated with poor physical and mental health. In addition, the mortality rate among homeless people is elevated compared to the rest of the population. Many homeless people avoid seeking medical care or wait until symptoms are severe enough to require emergency medical care. The hope with this review is therefore to contribute with knowledge about how homeless people should be cared for. Aim The aim of this study was to describe homeless people's experiences with health care. Method A non-systematic literature review, based on 15 scientific qualitative articles, was conducted. The articles were obtained from PubMed and CINAHL databases. The searches were performed using keywords developed based on the aim of the study. The quality of the articles was checked using Sophiahemmet University assessment basis. The articles’ results were subjected to integrated data analysis. Results The integrated analysis of the articles’ results gave rise to two main categories: Experiences of patient-healthcare provider encounters and practical difficulties in obtaining care. Central findings were homeless peoples’ described experiences of discrimination in care and the importance of dignified and flexible treatment. The homeless also expressed practical difficulties in seeking care, both at the individual level as well as at the societal and organizational level. Conclusions Attitudes from healthcare staff that were demeaning and judgmental were described as discriminatory and as a barrier to homeless people seeking care. On the other hand, it was stated that the relationship was promoted when the homeless were involved in their own care, and when the health care staff were flexible and listened actively. In order to provide the homeless with adequate care, knowledge of their experiences of health care is required.