This research has been a study in amazement. Initially an agnostic physics graduate, the researcher undertook training in the person-centred approach (pca) to self-development and counselling, during which she came to experience strange personal experiences which she could neither gainsay nor fit into her then worldview. Sketching these briefly, exceptional human experiences (EHEs) and synchronicities increasingly happened until (shockingly) they declared a seeming spirit guide (Mungo) to her, also juxtaposed in time with her first-ever chance encounter with dowsing. Thereafter these phenomena, combined with randomisable image-cards, tutored her into a physically observable method of 'discussion' with them (alone or with another) conducted with pca values. This PhD involved researching that phenomenon-complex through 'discussions' with 35 participants. The methodology used was heuristics and its heuristic self-search inquiry specialism (HSSI) whose attention to personal experiencing, indwelling to contact tacit knowledge, and incubatory rest phases to foster illuminatory new 'ahaa!' apprehensions suited this nascent mysterious subject. Both participants and researcher experienced coincidences weaving the 'discussions' and their wider lives together. Thus synchronicity became equal-partner research-topic, being studied as it occurred and, through affecting certain choices, becoming part of the methodology itself. The phenomenon-complex was experienced as fostering ethical living, creativity, personal development and science-spirituality interconnection in ways wellpitched and paced for each experiencer. The phenomena were also experienced as synergizing with each other, and as fostering integration within and between persons. After work on the participant sessions was completed, the writings of further thesis chapters were 'butted into' by in-the-moment relevant synchronicities, not just singly but in flows and patterns in which the researcher found herself discerning overarching meanings. Given this exceptional opportunity the researcher (in effect doing a bonus research-section) tracked her experiencing of these synchronistic flows and her responses thereto wherever they led, using Sela-Smith's first-person heuristic self-search inquiry (HSSI) methodology. Each synchronistically-influenced chapter was experienced as exploring certain themes, with themes building as the thesis progressed. Heuristics and HSSI are usually transformative. This researcher was transformed from the ground up from agnosticism to credence in 'something more' through her experiencings (both alone and inter-relationally with participants). Their 'package deal' presented personal shadow-work alongside help in life difficulties, and great fascination but darker times too. In total she came to feel part of an interconnected, spiritually-intelligent and compassionate cosmic domain, and existentially happier.

The introduction of Education, Health and Care (EHC) plans proposed in the Children and Families Act 2014 has aimed to give parents and children who are going through the assessment process greater control and choice in decisions, and enhance the multi-professional collaboration between education, health services and social care. This research seeks to evaluate to what extent parents’, children and young people’s, and professionals' experiences correspond to these values at an early stage of implementation. The methodology of this thesis is based on a realistic evaluation framework informed by the work of Pawson and Tilley (1997). Realistic evaluation aims to construct a programme theory which links three distinct broad aspects of a programme: its context, mechanisms and outcomes (C-M-Os). This research employs a programme theory of how an EHC assessment is conducted and has been developed from the current literature on person-centred theory. Person-centred theory has been chosen because of its corresponding value base to the SEND reforms and the recommendation of its use in a number of government policy documents including the SEND Code of Practice (DfE, 2014). The programme theory has been used to devise questionnaires that have sought to gain professionals' experiences of the assessment process, particularly in relation to multi-agency working, and their perceptions of the person-centred nature of the assessment. In addition, five case studies have explored these issues in more depth to ascertain whether the EHC assessment process in this authority is meeting the core aims of the Children and Families Act 2014. Semi structured interviews and card sorting tasks were devised using the programme theory and conducted with a total of one child, five families and five professionals from five individual EHC assessments. This analysis goes beyond a description of the facilitating factors and barriers to person-centred support and examines how person-centred outcomes arise from specific contexts and mechanisms. Findings suggest that experiences of face-to-face multi-professional collaboration were positive within the EHC assessment group. Nevertheless, professionals expressed frustration that in some cases colleagues were not able to attend meetings due to time constraints, capacity within their services and the commissioning arrangements of their services. Parental and professional experiences of the process appear to be positive. The research demonstrates one case study where a person centred planning approach was utilised very successfully from the perspective of all involved. However, there are significant concerns raised in both phases of this study as to the way in which children and young people are provided with opportunities of contributing to their EHC assessment. The findings are relevant to the development of the EHC assessment process in the local authority (LA) in which I am employed, and will contribute to the debate about the role of educational psychologists (EPs) in evaluating this national policy.

Syfte Syftet med studien var att utforska distriktssköterskors användning av MI för livsstilsförändringar hos patienter med svårläkta bensår. Design Kvalitativ intervjustudie med en induktiv ansats. Metod Författarna intervjuade åtta distriktsjuksköterskor som arbetar på vårdcentral. Dessa distriktsjuksköterskor arbetade med patienter med bensår. Författarna använde sig av en kvalitativ design där data insamlades genom semistrukturerade intervjuer som spelades in på band och transkriberades. Resultat I studien framkom det att patienter som tog till sig råd om livsstilsförändringar upplevde distriktssköterskorna hade en högre livskvalité. Dock kunde distriktssköterskorna uppleva en lägre livskvalité hos patienter som hade mycket smärta av såren, trots att de tog till sig de råden om livsstilsförändringar. Distriktssköterskorna arbetade personcentrerat och använde sig av MI i sina samtal under besök, dock användes endast vissa delar och inte hela konceptet av MI. De delar man använde sig av var öppna frågor, bekräftelse och sammanfattning. Slutsats I studien framkommer det att det är av stor vikt att arbeta personcentrerat vid behandling av sår, samt att motivera patienten att vara delaktig i sin behandling för bästa resultat. Författarna tror att med mer utbildning i MI och att MI används som hjälpmedel för att motivera varje enskild individ för livsstilsförändringar ger en förbättrad möjlighet till att få patienten mer motiverad, delaktig i sin vård och därmed få en förbättrad livskvalité och förbättrad läkning av det svårläkta bensåret. / Purpose The purpose of the study was to explore district nurses' use of MI for lifestyle changes in patients with severe leg ulcers. Design Qualitative interview study with an inductive approach. Method The authors interviewed eight district nurses working at the health center. These district nurses worked with patients with leg ulcers. The authors used a qualitative design and data was gathered through semi structured interviews that were recorded on tape and transcribed. Results The study found that according to the interviewed nurses, patients who receive advice about lifestyle changes experience a higher quality of life. Patients with a lot of pain due to leg ulcers, experience a lower quality of life even after undertaking the advice of life style changes. District nurses worked with person-centred care and use MI in their conversations during patient appointments. However, only certain parts of the MI is used and not the entire concept. The parts used are open questions, confirmation and summary. Discussion The study found that it is of great importance to use person-centred care in the treatment of wounds, as well as to motivate the patient to be involved in his treatment for best results. The authors believe that increased education on the use of MI and actual increased use of MI provide a big opportunity to get the patients more motivated, involved in their own care and thereby an improved quality of life and improved healing of the severe leg wound.

Sammanfattning Bakgrund: Antalet sköra äldre personer kommer att öka i hela världen. I Sverige kommer antalet äldre personer över 80 år stiga från cirka 500 000 år 2014 till 800 000 år 2030. Genom en ökad medellivslängd ökar behovet av kommunal hälso- och sjukvård. För att kunna möta olika behov hos de sköra äldre som bor hemma behöver vården vara personcentrerad. Syfte: Syftet med denna studie är att beskriva distriktssköterskors upplevelse av kommunikation med sköra äldre personer inom kommunal hälso- och sjukvård.   Metod: En kvalitativ studie med induktiv ansats. Intervjuer gjordes med 12 distriktssköterskor utifrån en semistrukturerad intervjuguide, de analyserades med kvalitativ innehållsanalys. Resultat: Resultatet visat att distriktssköterskorna har många och varierande erfarenheter av att kommunicera mer sköra äldre personer. När distriktsköterskorna kommunicerar med den sköra äldre personen, kan olika hinder uppstå som distriktssköterskorna försöker hitta lösningar på för att uppnå målet med ett respektfullt bemötande i personcentrerad omvårdnad. Slutsats: Kommunikationen mellan distriktssköterskan och den sköra äldre patienten är komplex med utmaningar som tidsbrist, fysisk och kognitiv nedsättning hos den sköra äldre personen. / Summary Background: The number of frail elderlies will increase worldwide. In Sweden, the number of elderly persons over the age of 80 will rise from 500 000 in 2014 to 800 000 in 2030. Increased life expectancy increases the need for municipal health care. In order to meet different needs of the frail elderly persons who live at home, the care needs to be person-centred. Purpose: The purpose of this study is to describe how the district nurse communicate with frail elderly people in municipal health care. Method: A qualitative study with an inductive approach. Interviews were made with 12 district nurses based on a semi-structured interview guide, they were analysed with qualitative content analysis. Result: The results show that the district nurses have varied experiences of communication with frail elderly people. When the district nurses communicate with frail elderly person, they encounter various obstacles that they try to find solutions for in order to achieve the goal of respectful treatment in persons-centred care. Conclusion: Communication between the district nurse and the frail elderly person is complex with challenges such as lack of time, physical and cognitive impairment in the frail elderly person.

Bakgrund: Andelen äldre i befolkningen ökar nationellt och internationellt, och med ökande ålder ökar både fysisk och psykisk ohälsa. Äldre personer med ohälsa i form av kognitiv svikt (oftast demenssjukdom) kan bli beroende av vård och omsorg i särskilda boenden för äldre för att kunna känna trygghet och välbefinnande samt ha ett gott liv, i gemenskap med andra. Dock visar utvärderingar av särskilda boenden för äldre att vården ofta kan vara uppgiftscentrerad och inte motsvara de äldres individuella behov och önskemål. Personcentrerad vård är en vårdmodell som beskrivs kunna tillgodose äldre personers multidimensionella behov och önskemål, genom att personens livshistoria, personlighet, kapacitet och perspektiv uppmärksammas, respekteras och inkluderas i vården. Den vetenskapliga litteraturen inom området visar dock att det finns begränsad kunskap om förekomsten av personcentrerad vård i särskilda boenden för äldre i Sverige och internationellt, liksom om vilka faktorer som är mest betydelsefulla för att särskilda boenden för äldre ska bedriva en personcentrerad vård. Syfte: Syftet med denna avhandling var att beskriva faktorer som samvarierar med förekomst av personcentrerad vård i särskilda boenden för äldre i Sverige. Metod: Samtliga delstudier var tvärsnittstudier och data samlades in genom enkäter till äldre med kognitiv svikt och personal i särskilda boenden för äldre i Sverige. I studie I bestod insamlad data av skattningar av personcentrerad vård från vårdpersonal (n=1465) i 182 särskilda boendeenheter. I studie II insamlades data i form av vårdpersonalens (n=1169) skattningar av personcentrerad vård och proxyskattningar av de äldres (n=1261) livskvalitet, ADL-förmågor, smärta, depressiva symtom och agitation i 151 särskilda boendeenheter. Delstudie III baserades på data i form av personalskattningar (n=1169) av personcentrerad vård, tillfredställelse med arbete och vård, samvetsstress, arbetsbelastning och psykosocialt klimat i samma 151 särskilda boendeenheter. Även delstudie IV baserades på data från de 151 särskilda boendeenheterna och inkluderade skattningar av de äldre och vårdpersonal, men också skattningar av organisation och miljö vid dessa enheter (n=151). Samtliga studiernas data analyserades med hjälp av statistiska analyser, beskrivande, bivariata och multivariata analysmetoder. Resultat: Studie I visade att enkätinstrumentet The Person-Centred Care Assessment Tool (P-CAT) har tillfredställande psykometriska egenskaper för intern konsistens och test-retest-reliabilitet. Instrumentet består av två subskalor: Individualisering av vården och Stöd från organisation och miljö. Delstudie II visade att de boendes ADL-förmågor och livskvalitet skattades bättre vid enheter som kan beskrivas som mer personcentrerade. Delstudie III visade att en mer personcentrerad vård har samband med att personalen upplever ett positivt psykosocialt klimat, mindre samvetsstress, lägre arbetsbelastning samt högre tillfredställelse med vård och arbete. Studien visade också att personcentrerad vård var positivt relaterat till i vilken omfattning vårdarna hade vidareutbildning i demensvård. Delstudie IV visade att vårdmiljön var mest betydelsefull för förekomsten av personcentrerad vård vid boendeenheterna och att en gynnsam vårdmiljö innebar att personal upplevde att det var ett positivt psykosocialt klimat på enheten, att de hade tid att prata med eller bara vara med de boende samt att de upplevde sig ha en gemensam värdegrund, låg arbetsbelastning och en fysisk miljö som var anpassad till de boendes behov. Slutsatser: Resultaten i avhandlingen visar att den svenska versionen av P-CAT kan användas för valida och reliabla utvärderingar av personcentrerad vård samt att den kan rekommenderas för fortsatt forskning och vårdutveckling inom särskilda boenden för äldre. Resultatet visar också att den vård- och arbetsmiljö som omger de äldre och vårdpersonal i särskilda boenden för äldre är betydelsefull för förekomsten av personcentrerad vård. Dessa aspekter behöver fokuseras ytterligare för att kunna erbjuda en personcentrerad vård. Vidare är det psykosociala klimatet och förekomsten av en upplevd gemensam värdegrund viktig att förstå och prioritera om vården ska utvecklas mot en ökad personcentrering. Fortsatt forskning och kliniskt utvecklingsarbete behövs för att operationalisera och implementera de komponenter som bidrar till ett positivt psykosocialt klimat och en personcentrerad värdegrund på särskilda boenden för äldre. Dessutom behövs en ökad förståelse för hur en sådan värdegrund kan omsättas i personcentrerade interaktioner, handlingar, aktiviteter och prioriteringar. Det vore alltså önskvärt att äldrevården utvecklades mot ett mer personcentrat förhållningssätt, eftersom avhandlingens resultat visar att högre grad av personcentrerad vård i särskilda boenden för äldre var positivt relaterat till välbefinnande och tillfredställelse för såväl de äldre som för vårdpersonal. / Introduction: The proportion of older people in the population increases nationally and internationally, with a declining physical and mental health often accompanying older age. Older people with health issues such as cognitive impairment or dementia often become dependent upon residential aged care to feel safe, experience well being and a good life with others. However, it has been shown that residential aged care can largely be taskoriented and not tailored to residents' needs and wishes. Person-centred care is a contemporary best practice model of care that can meet the multidimensional needs and preferences of older people dependent on care, by acknowledging, respecting and including each person’s life story, personality, capacities, and perspective in care. Nevertheless, the research literature indicates a limited knowledge on the extent to which residential aged care units are person-centred in Sweden and internationally, as well as a limited knowledge into factors of importance for person-centred care in residential aged care units. Aim: The overall aim of this thesis was to describe factors that associate with person-centred care in Swedish residential aged care units. Methods: The thesis consists of four studies with cross-sectional designs, and data was collected through resident and staff surveys in Swedish residential aged care units. Study I collected data consisting of ratings of person-centred care from staff (n=1465) in 182 residential aged care units. Study II collected data consisting of staff (n=1169) ratings of person-centred care and proxy ratings of resident (n=1261) quality of life, ADL-capacity, pain, depressive symptoms and agitated behaviours, in 151 residential aged care units. Study III was based on staff (n=1169) ratings of person-centred care, satisfaction with care and work, job strain, stress of conscience, and perceived psychosocial climate in the same 151 residential aged care units as in study II. Study IV was also based on data from the 151 residential aged care units as described in study II and III, and included ratings of resident and staff variables, as well as variables related to the organization and environment at the units. Data was analyzed using statistical analyses such as descriptive, bivariate, and multivariate methods. Results: Study I showed that the Person-Centred Care Assessment Tool (PCAT) has satisfactory psychometric properties relating to internal consistency and test-retest reliability. The tool consists of two subscales: Extent of personalizing care and Amount of organizational and environmental support. Study II showed that residents were rated as having higher quality of life and better ability to perform activities of daily living in units described as being more person-centred. Study III highlighted that person-centred care was associated with higher staff satisfaction, less job strain, less stress of conscience, and a positive psychosocial unit climate. Person-centredness of care was also positively associated with the extent to which staff had continuing education in dementia care. Study IV showed that the environment is the most influential factor for person-centred care, and that an environment facilitating person-centred care consists of a positive psychosocial unit climate, where staff perceives having time to spend being with residents, where staff perceives a shared philosophy of care, a low job strain, and a physical environment adapted to residents’ needs. Conclusions: The results of the thesis show that the Swedish version of the P-CAT can be used for valid and reliable assessment of unit personcentredness, and that it can be recommended for further research and practice development in residential aged care. The results of the thesis also show that the environment of care and work that encapsulates residents and staff in residential care units is important for person-centred care. These aspects need further focus to enable person-centred care in residential aged care units. Furthermore, the psychosocial climate and the presence and content of a shared philosophy of care are important to understand and prioritize if care is to move towards increased person-centredness. Further research and practice development work is needed to operationalize and implement the components that contribute to a positive psychosocial climate and a person-centred philosophy in residential aged care units, as well as to increase the knowledge of how such a philosophy of care can be translated into person-centred actions, interactions, activities and priorities. strive towards developing person-centredness further within aged care is desirable, as the results in this thesis indicate that residential aged care units

Recent decades have seen increasing recognition of the importance of patient involvement during patient-professional interactions and promotion of preventative and long term approaches to healthcare for those with long-term conditions. The concepts of 'shared decision making' and 'personalised care planning' have both been advocated by patient groups, policy-makers, professional bodies and academia as best practice. During shared decision making, patients and healthcare professionals work in equal partnership to decide the best course of action. Shared decision making is a central tenet of personalised care planning, as it aims to foster partnerships between patients and healthcare professionals when making decisions, but personalised care planning also describes an overall approach to healthcare that is forward-planning and preventative, rather than episodic and reactive. Despite the breadth of support for such approaches, in reality they are not routinely adopted. Multiple Sclerosis (MS) is a heterogeneous neurodegenerative long term condition, which is unpredictable with limited treatments available. Such uncertainty and complexity position MS as an interesting long term condition to explore decisional and information needs. This doctoral research comprises of three methods stages. Firstly, two systematic reviews assessing the effectiveness of personalised care planning for people with long-term conditions and people with MS were carried out. Secondly, 22 in-depth semi-structured qualitative interviews were carried out with people with MS across the UK to explore experiences of decision making and interactions with healthcare professionals. Purposive sampling was carried out and data saturation determined sample size. A modified grounded theory approach was used and thematic analysis of interview data was carried out. Lastly, a series of structured qualitative interviews were carried out with 6 consultant neurologists. This stage was iterative in that problematic areas identified during analysis of interview data from stage 2 were presented to neurologists in infographic form to further examine issues raised. Framework analysis was carried out on neurologist interview data to examine their interpretations and potential solutions. Although there appears to be some evidence demonstrating that personalised care planning is effective for people with long term conditions, such favourable effects were not demonstrated in the context of MS. Based on the findings from the systematic reviews it is unclear whether personalised care planning is effective for people with MS and there is a clear gap in the literature examining this. Findings from the interview stages suggest there are key areas which are lacking in terms of information and decisional support. Such areas included the type and amount of information around the time of diagnosis, support when choosing disease modifying drugs and discussions about approaches outside mainstream medicine. Findings from neurologist interview data corroborated those from MS interview data, but through examination of issues raised it also highlighted some of the complexities and challenges of involving patients and enacting shared decision making in reality. This research identified key areas that require improvement for people with MS in terms of provision of the information and decisional support. Although in theory personalised care planning and shared decision making are positioned as best practice, in reality it is unclear whether they are effective or appropriate for people with MS. The way in which such approaches are enacted are complex and require careful consideration. Potential barriers and pitfalls identified within this study suggest a lack of clarity in how to respond to challenges and further investigation into how patient involvement is enacted is needed.

Background: This research explores whether rural Community Maternity Units (CMUs) contribute to NHS Scotland’s Quality Ambitions of safe, effective and person centred care. Currently there is no available recent evidence regarding the quality of this particular model of care in a rural setting. This research makes an important contribution given that most women are encouraged to access local maternity services. Design: An exploratory case study was used with a hermeneutic phenomenological approach to the qualitative data collection and analysis. Quantitiative data were collected and analysed to provide descriptive statistics. Methods: The study was conducted in three phases. In phase one a retrospective medical records review was undertaken to provide quantitative data on the care provided. Phase two was an observation of team meetings, interviews with staff and focus groups with stakeholders in roles aligned to the provision of care at the CMUs. In phase three observations of clinical encounters and interviews with women informed by aide memoire diaries were used. Findings: Maternity services provided by the CMU teams achieved a consistently high standard of safety and effectiveness when measured against national guidelines, standards and other evidence. The stakeholders appreciated the ability within these small teams to provide local, accessible services to women with effective support when required from tertiary services. The women valued person centred and relationship based continuity of antenatal carer, provided by compassionate named midwives, but were disappointed by the discontinuity when complications occurred. Conclusions: The CMUs’ physical position within the community, smallness of scale and the midwifery team’s ethos of normality within a socially based but medically inclusive service facilitated local access for most women to maternity care. This service provision addressed NHS Scotland’s Healthcare Quality Strategy of improving health and reducing inequalities for the people of Scotland. The role of the named midwife was key to providing high quality care by maintaining connections across contextual boundaries for women experiencing normal and complicated pregnancies. This research provides an original contribution to the study of rural maternity service provision in Scotland to help inform future sustainability and service development of rural CMUs.

ARAÚJO, Iago Cavalcante. Peter Schmid e a Abordagem Centrada na Pessoa: uma aproximação à alteridade radical. 2015. 116f. – Dissertação (Mestrado) – Universidade Federal do Ceará, Programa de Pós-graduação em Psicologia, Fortaleza (CE), 2014. / Submitted by Márcia Araújo (marcia_m_bezerra@yahoo.com.br) on 2015-06-05T15:29:24Z No. of bitstreams: 1 2014_dis_icaraujo.pdf: 1035970 bytes, checksum: 7a2baf5b3ee9043c0608ba563346d681 (MD5) / Approved for entry into archive by Márcia Araújo(marcia_m_bezerra@yahoo.com.br) on 2015-06-05T17:19:35Z (GMT) No. of bitstreams: 1 2014_dis_icaraujo.pdf: 1035970 bytes, checksum: 7a2baf5b3ee9043c0608ba563346d681 (MD5) / Made available in DSpace on 2015-06-05T17:19:35Z (GMT). No. of bitstreams: 1 2014_dis_icaraujo.pdf: 1035970 bytes, checksum: 7a2baf5b3ee9043c0608ba563346d681 (MD5) Previous issue date: 2014 / The Person Centred Approach (PCA), founded by Carl Rogers, can only be justified from a set of values and ethics and not only as an application of skills and knowledge. Furthermore, from studies of Figueiredo (1996), it is established the importance of ethos as a search for a place to the Other in the constitution of psychologies. In what refers to the place of the Other in the constitution of subjectivity, Freire (2002) investigates the place to alterity in several modern psychologies and states that in PCA, the place for Levinas’ radical alterity is vacant, as in other psychologies. The Other, as postulated by Levinas (2008 [1961]), is precedent and transcendent to the I; not being possible to totalize and understand it fully; it shows the dimension of the strange in the psychological experience. This Other is not so dear figure to psychologies as it appears to be. On the other hand, Peter Schmid (1999) conceives that ethics is the first issue to be considered when it comes to PCA, either its theory or its practice. Hence, the present paper aims to present the work of Peter Schmid to the Brazilian community of Rogerian approach. The perspective of this author is grounded in an important dialogue with the philosophies of dialogue and a vision of the human as radically a person, which offers another way to face the alterity in Rogerian theory and practice. Such change presents a fruitful approach to ethical philosophy of Emmanuel Levinas. A methodology for the study, we used an almost-in-method inspired by the philosophies of Levinas (2008 [1961]) and Derrida (2007), in which we seek, among other things, to put on display the polysemy of the studied speeches. We conclude that, despite the divergences among the prospect formulated by Schmid with Levinasian ethics, doing readings of the main concepts of the PCA, it shows a closer relationship with that one and a new way of dealing with the alterity within the framework of the Rogerian approach. With this work, we hope to foment a greater dialogue and production on the clinical and psychotherapeutic care of the person and the place offered to otherness in Rogerian psychology. / A Abordagem Centrada na Pessoa (ACP), fundada por Carl Rogers, só pode ser justificada a partir de um conjunto de valores e de uma ética e não somente como uma aplicação de técnicas e conhecimentos. Além disto, a partir dos estudos de Figueiredo (1996) fica estabelecida a importância do éthos como busca de um lugar para o Outro na constituição das psicologias. Naquilo que se refere ao Lugar do Outro na constituição da subjetividade, Freire (2002) investiga o lugar para a alteridade nas diversas psicologias modernas e afirma que, na ACP, o lugar para a alteridade radical levinasiana está vacante, assim como nas demais psicologias. O Outro, conforme postulado por Lévinas (2008 [1961]), é precedente e transcendente ao Eu; não sendo possível totalizá-lo e compreendê-lo inteiramente, ele apresenta a dimensão do estranho na experiência psicológica. Este Outro não é figura tão cara para as psicologias como aparenta ser. Por outro lado, Peter Schmid (1999) concebe que a ética é a primeira questão a ser pensada quando se trata da ACP, quer de sua teoria, quer de sua prática. Daí que este trabalho objetivou apresentar a obra de Peter Schmid à comunidade brasileira da abordagem rogeriana. A perspectiva deste autor está alicerçada em um diálogo importante com as filosofias do diálogo e uma visão do humano como radicalmente pessoa, o que oferece outra forma de encarar a alteridade na teoria e prática rogerianas. Tal mudança apresenta uma profícua aproximação com a filosofia ética de Emmanuel Lévinas. Como metodologia para o estudo, utilizou-se um quase-método inspirado nas filosofias de Lévinas (2008 [1961]) e Derrida (2008), em que buscamos, entre outras coisas, pôr à mostra a polissemia dos discursos estudados. Concluiu-se que, apesar da perspectiva formulada por Schmid apresentar divergências com a ética levinasiana, ao fazer releituras dos principais conceitos da ACP, ela apresenta uma maior aproximação com aquela e uma nova forma de lidar com a alteridade dentro do arcabouço da abordagem rogeriana. Espera-se, com este trabalho, fomentar um maior diálogo e produção acerca do cuidado clínico e psicoterapêutico com a pessoa e o lugar oferecido para a alteridade na psicologia rogeriana.

Introduction: Recent developments in the study of trauma responses have shown how some people may experience positive and life altering changes following traumatic life events which have been described as posttraumatic growth. Research is beginning to examine the role of trauma treatments in the facilitation of posttraumatic growth. Aim: This study sets out to explore participants’ experiences of posttraumatic growth during Eye Movement Desensitization and Reprocessing therapy, and the role of the therapeutic relationship in facilitating posttraumatic growth. Method: Semi-structured interviews were carried out with participants to examine their phenomenological experiences. Methodology: Interpretative Phenomenological Analysis was employed to consider emergent meanings and themes within a hermeneutic circle of interpretation. Participants: Seven participants were interviewed who had received Eye Movement Desensitization and Reprocessing therapy within National Health Service primary care psychological therapy services for posttraumatic stress disorder. Findings: Four superordinate themes emerged from the analysis of the participant accounts including: (i) Safe and secure; (ii) Taking back control; (iii) Reconstructing the self; and (iv) Journeying beyond trauma to the future. Conclusions: Person-centred conditions and client-therapist attachment were important elements of the therapeutic relationship which provided participants with the safety, trust, and relational depth necessary for the facilitation of experiences of posttraumatic growth during Eye Movement Desensitization and Reprocessing therapy. Implications: The findings emphasise the importance of a clinical focus on the quality of the therapeutic relationship as a facilitative therapeutic environment allowing affective-cognitive processing and the emergence of posttraumatic growth.

Bakgrund: 80% av de människor som dör varje år i Sverige antas ha varit i behov av palliativa vårdinsatser. För att patienterna ska kunna känna sig delaktiga i sin vård behöver de vara väl informerade om sitt tillstånd. Rapporter visar att inte alla palliativa patienter får ett brytpunktssamtal, vilket ökar risken att patienten inte känner sig delaktig i sin vård. Syfte: Att undersöka patienters upplevelse av delaktighet i sin vård i livets slutskede Metod: Designen är en litteraturöversikt. Datainsamling har skett genom sökningar i databaserna PubMed och CINAHL. Resultat: Resultatet baserades på 15 vetenskapliga artiklar och delades in i fyra kategorier: patientens behov av information, delat beslutsfattande, Patientens preferenser och upplevelse av en god död. De flesta patienter önskade information om sitt tillstånd men inte alla upplevde att de fick detta. Det varierade i hur mycket patienterna ville vara delaktiga i beslutsfattandet. Patienter som önskade delat beslutsfattande upplevde i mindre grad att deras önskningar blev mötta. Konklusion: För att säkerställa att patienterna känner sig delaktiga i sin vård i livets slutskede är det viktigt att se till den enskilda individens behov och anpassa vården utefter dessa, samt vara medveten om att detta kan ändra sig under vårdprocessen. / Background: 80% of the people that die every year in Sweden are believed to have benefited from palliative care. In order for patients to be involved in their care, they must be well informed about their condition. Reports show that not all palliative patients get a breakpoint conversation, which increases the risk that patients don’t feel involved in their care. Aim: To investigate patients’ experiences of participation in their end-of-life care Methods: The design is a literature review. Data collection has been done through searches in the databases PubMed and CINAHL. Results: The result was based on 15 scientific articles and were divided into four categories: patients’ need for information, shared decision-making, patients’ preferences, and experience of a good death. Most patients wanted information about their condition, but not everyone felt that they received it. It varied in how much patients wanted to be involved in the decision-making. Patients who wanted shared decision-making felt less that their wishes were met. Conclusions: To ensure that patients feel involved in their care, it is important to investigate the individual's needs and to adjust the care accordingly, as well as being aware that this may change over time.