Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / No atual contexto da prática médica no Brasil, observa-se o predomínio de uma comunicação de caráter informativo, normativo e com pouca ênfase na promoção da autonomia dos pacientes, secundarizando o diálogo e a compreensão do paciente sobre o processo saúde-doença-cuidado. Esse tipo de prática baseia-se fortemente no Modelo Biomédico, que enfoca prioritariamente a doença e as lesões orgânicas, o que em muitas situações colabora para a medicalização, a (super)especialização e fragmentação do cuidado, comprometendo a qualidade da relação médico-paciente e a resolutividade das ações de saúde. Em contrapartida, uma prática médica centrada no paciente e que valorize a compreensão de sua interpretação da saúde-doença favorece a construção da integralidade do cuidado e a maior efetividade das ações. A presente pesquisa exploratória, predominantemente qualitativa com componente quantitativo investiga as práticas comunicacionais na relação médico-paciente na consulta homeopática, pautada pelo paradigma Vitalista. Nessa especialidade médica oferecida desde 1988 pelo Sistema Único de Saúde, e desde 2006, integrante da Polícia Nacional de Práticas Integrativas e Complementares do Ministério da Saúde, compreender múltiplas dimensões da existência e adoecer humanos demanda competência narrativa para a prática de sua semiologia, baseada na escuta atenta e implicada dos contextos biopatográficos, valorizadora dos sentidos atribuídos às vivências pelos sujeitos. Foram gravadas oito consultas de primeira vez realizadas num ambulatório-escola por médicos experientes, transcritas e submetidas à Análise de Conteúdo, que permitiram analisar como os fundamentos da racionalidade homeopática podem contribuir para a produção compartilhada de sentidos. Os resultados estão organizados nas categorias: Tomada de Turnos e Controle de Tópicos, Concepção de Saúde-Doença-Cuidado, Itinerários Terapêuticos, Ethos científico e Ethos do Mundo da Vida, Capacidade empática (atitudes de apoio, legitimação e polidez) e O Papel do Médico. Observa-se que a comunicação que estabelecida nesse tipo de prática em saúde avança na construção da integralidade da atenção e pode contribuir para a maior resolutividade do cuidado em saúde na medida em que minimiza a dicotomia entre mental e somático, individual e social. / The predominance of informative and normative communication is observed in the current context of medical practice in Brazil. This practice relies on Biomedical Model focus on disease and organ damage, with little emphasis on dialogue and understanding of the patient on the health-illness care, which in many cases contributes to the social medicalization, the medical specialization and fragmentation of care, negatively affecting the quality of the doctor-patient relationship on promoting patient autonomy and the solving of health actions. In contrast, a patient-centered medical practice that enhances understanding of their interpretation of health-disease favors a holistic care and a greater effectiveness of actions. This exploratory research, predominantly qualitative with quantitative component investigates the communicative practices in the doctor-patient relationship in homeopathic consultation, is guided by vitalist paradigm. Looking broadly at the patient and the illness, homeopathic practice provides the means to understand the personal connections between patient and physician to improve the effectiveness of their work. This medical specialty offered since 1988 by SUS, and since 2006, included in PNPIC, requires narrative competence to practice their semiotics. Eight inquiries were first recorded performed in a clinic-school by experienced doctors, transcribed and submitted to content analysis, allowing to analyze how the foundations of homeopathic rationality can contribute to the health care. The results are organized into categories shifts: Topics Control, Health-Disease-Cares Concept, Therapeutic Itineraries, Scientific Ethos and Life Ethos, Empathic Capacity (attitudes of support, legitimacy and politeness) and The Role of the Physician. It is observed that the communication established in this type of health practice advances in the construction of an integral care and can contribute to the better resolution of care in that it minimizes the dichotomy between mental and somatic, individual and social.

Bakgrund Antalet diagnostiserade cancerfall ökar i Sverige. Sjukdomen ställer höga krav på hälso- och sjukvården, inte minst gällande kommunikation eftersom patienter med en sådan diagnos är mycket sårbara och påverkas existentiellt. Syftet var att undersöka hur patienter med cancer ser på kommunikationen med läkare. Ett bisyfte var att undersöka hur patienter med cancer ser på sin egen kommunikation med läkare. Metod Med en allmän, beskrivande litteraturöversikt med kvalitativ ansats inkluderades tio originalartiklar efter utförd kvalitetsgranskning. Resultat Patienter uppskattar när läkare är tillgängliga och kommunicerar ärligt, engagerat och med empati, använder en lugn och reflekterande kommunikationsstil och visar hopp om att kunna behandla dem. De uppskattar även när läkare etablerar en god relation och ser patienten som person. De uppskattar inte när läkare använder sig av envägskommunikation med avsaknad empati eller förhindrar patientdeltagande. Inte heller när läkare är otydliga, ger för mycket information eller visar brist på tid. Patienter ser även hinder och möjligheter hos sig själva i kommunikationen med läkare. Patienter ser möjligheter till god kommunikation med läkare när de själva känner ansvar och behov att ta kontroll. Patienter hindras då de störs av sina egna känslor och tankar och har brist på specifik kunskap. Vissa patienter ser det som en möjlighet att få träffa en och samma läkare vid varje sjukhusbesök, medan andra ser det som ett hinder. Slutsats Läkare, men även övrig sjukvårdspersonal, kan dra nytta att veta vad patienter uppskattar och inte uppskattar i sin kommunikation med patienter och ger utrymme för utveckling inom området. / Background The number of diagnosed cancer cases is increasing in Sweden. The disease poses high demands on the healthcare, not least communication, because patients with such diagnoses are very vulnerable and affected existentially. The purpose was to investigate how patients with cancer look at communication with physicians. A second purpose was to investigate how patients with cancer look at their own communication with physicians. Method With a general, descriptive literature review with qualitative approach, ten original articles were included after quality review. Results Patients appreciate when physicians are available and communicate honestly, engaging and empathizing, using a calm and reflective communication style and showing hope to be able to treat them. They also appreciate when physicians establish a good relationship and sees the patient as a person. They do not appreciate when physicians use one-way communication with lack of empathy or prevent patient participation. Neither when physicians are unclear, give too much information or show lack of time. Furthermore, patients see opportunities for themselves to communicate well with physicians when they feel responsibility and the need to take control. Patients are obstructed when they are disturbed by their own feelings and thoughts and lack specific knowledge. Some patients see it as an opportunity to meet one and the same doctor at each hospital visit, while others see it as an obstacle. Conclusion Physicians, but also other healthcare professionals, can benefit from knowing what patientes appreciate and do not appreciate in their communication with patients and provide space for development in the area.

INTRODUCTION: While mobile device use by physicians increases, there is an increased risk that errors committed while using mobile devices can lead to harm. This mixed-method study evaluates the effects of screen size on clinical users’ perceptions of medical application usability and safety when interfacing to critical patient information. In this research, two mobile devices are examined: iPhone® and the iPad®. METHOD: Eleven physicians and one nurse practitioner participated in a chart-review simulation using an app that was an end-point to an electronic health record. Screen-recording, video-recording and a think-aloud protocol were used to gather data during the simulation. Additionally, participants completed Likert-based questionnaires and engaged in semi-structured interviews. RESULTS: A total of 105 usability, usefulness and safety problems were recorded and analysed. A strong preference was found for the larger screen when reviewing patient data due to the large quantity of data and the increased display size. The smaller device was preferred due to the devices portability when participants needed to remain informed when they were away from the point of care. CONCLUSION: There is an association between screen size and the perceived safety of the handheld device. The iPad was perceived to be safer to use in clinical practice. Participants preferred the iPad® because of the larger size, not because they thought it was safer or easier to use. The iPhone® was preferred for its portability and its usefulness was perceived to increase with greater distance from the point of care. / Graduate

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / No atual contexto da prática médica no Brasil, observa-se o predomínio de uma comunicação de caráter informativo, normativo e com pouca ênfase na promoção da autonomia dos pacientes, secundarizando o diálogo e a compreensão do paciente sobre o processo saúde-doença-cuidado. Esse tipo de prática baseia-se fortemente no Modelo Biomédico, que enfoca prioritariamente a doença e as lesões orgânicas, o que em muitas situações colabora para a medicalização, a (super)especialização e fragmentação do cuidado, comprometendo a qualidade da relação médico-paciente e a resolutividade das ações de saúde. Em contrapartida, uma prática médica centrada no paciente e que valorize a compreensão de sua interpretação da saúde-doença favorece a construção da integralidade do cuidado e a maior efetividade das ações. A presente pesquisa exploratória, predominantemente qualitativa com componente quantitativo investiga as práticas comunicacionais na relação médico-paciente na consulta homeopática, pautada pelo paradigma Vitalista. Nessa especialidade médica oferecida desde 1988 pelo Sistema Único de Saúde, e desde 2006, integrante da Polícia Nacional de Práticas Integrativas e Complementares do Ministério da Saúde, compreender múltiplas dimensões da existência e adoecer humanos demanda competência narrativa para a prática de sua semiologia, baseada na escuta atenta e implicada dos contextos biopatográficos, valorizadora dos sentidos atribuídos às vivências pelos sujeitos. Foram gravadas oito consultas de primeira vez realizadas num ambulatório-escola por médicos experientes, transcritas e submetidas à Análise de Conteúdo, que permitiram analisar como os fundamentos da racionalidade homeopática podem contribuir para a produção compartilhada de sentidos. Os resultados estão organizados nas categorias: Tomada de Turnos e Controle de Tópicos, Concepção de Saúde-Doença-Cuidado, Itinerários Terapêuticos, Ethos científico e Ethos do Mundo da Vida, Capacidade empática (atitudes de apoio, legitimação e polidez) e O Papel do Médico. Observa-se que a comunicação que estabelecida nesse tipo de prática em saúde avança na construção da integralidade da atenção e pode contribuir para a maior resolutividade do cuidado em saúde na medida em que minimiza a dicotomia entre mental e somático, individual e social. / The predominance of informative and normative communication is observed in the current context of medical practice in Brazil. This practice relies on Biomedical Model focus on disease and organ damage, with little emphasis on dialogue and understanding of the patient on the health-illness care, which in many cases contributes to the social medicalization, the medical specialization and fragmentation of care, negatively affecting the quality of the doctor-patient relationship on promoting patient autonomy and the solving of health actions. In contrast, a patient-centered medical practice that enhances understanding of their interpretation of health-disease favors a holistic care and a greater effectiveness of actions. This exploratory research, predominantly qualitative with quantitative component investigates the communicative practices in the doctor-patient relationship in homeopathic consultation, is guided by vitalist paradigm. Looking broadly at the patient and the illness, homeopathic practice provides the means to understand the personal connections between patient and physician to improve the effectiveness of their work. This medical specialty offered since 1988 by SUS, and since 2006, included in PNPIC, requires narrative competence to practice their semiotics. Eight inquiries were first recorded performed in a clinic-school by experienced doctors, transcribed and submitted to content analysis, allowing to analyze how the foundations of homeopathic rationality can contribute to the health care. The results are organized into categories shifts: Topics Control, Health-Disease-Cares Concept, Therapeutic Itineraries, Scientific Ethos and Life Ethos, Empathic Capacity (attitudes of support, legitimacy and politeness) and The Role of the Physician. It is observed that the communication established in this type of health practice advances in the construction of an integral care and can contribute to the better resolution of care in that it minimizes the dichotomy between mental and somatic, individual and social.

Cooperation of nurses and physicians from the perspective of nursing management Master's thesis was focused on the cooperation of nurses and physicians from the perspective of nursing management. Nursing care and nursing management has an irreplaceable role in health care. The world of medicine, nursing care and health care is an extremely complex organizational system, which is not surely represented only by physicians and nurses, but these, however, are still the dominant persons on the scene. The first objective of this thesis was to make a survey of cooperation between nurses and physicians during the nursing process in the care of patients from the perspective of nursing management in departments of surgery and internal medicine. The second objective was to identify problem areas in cooperation between nurses and physicians from the perspective of nursing management in departments of surgery and internal medicine, and the third objective was to find out the way the nursing management tackles problem situations in cooperation between nurses and physicians in departments of surgery and internal medicine. To meet these objectives four research questions were stated: 1. In what areas do nurses and physicians cooperate during the nursing process while providing care for patients from the perspective of nursing management in their respective departments? 2. How do nurses assess and perceive cooperation with physicians from the perspective of nursing management in their respective departments? 3. Are there problem areas in cooperation of nurses and physicians from the perspective of nursing management in their respective departments? 4. How does nursing management tackle problem situations in cooperation between nurses and physicians in their respective departments? The research was conducted in the hospital, where I was given information under the condition of anonymity of the respondents interviewed. The responders were chief nurses and senior staff nurses working in departments of surgery and internal medicine. The investigation conducted is a qualitative research. Interviews with the structure of questions to non-standardized interviews were conducted with the respondents according to question structures of the non-standardized interview. Subsequently, transcripts of interviews and data categorization in tables according to the Ritchie and Spencer´s framework analysis were made. The survey suggests the following conclusions. Nurses and physicians cooperate within the nursing process in providing care for patients from the perspective of nursing management in departments of surgery and internal medicine at the stage of problem solving. Nurses appreciate cooperation with physicians on the basis of mutual respect, but they still feel the prevailing dominance of physicians. From the perspective of nursing management there are problematic areas in cooperation between nurses and physicians. Nursing management tackles problem situation in cooperation between nurses and physicians by seeking common solutions. It will be possible to provide the health care facilities, where the research was conducted, with the outcomes of the research. Thinking about the possible improvement in mutual cooperation as early as during physicians´ and nurses´ studies, to introduce various measures to improve cooperation between nurses and physicians by organizing joint seminars and cultural events could lead to meeting the purpose. It is necessary to raise physicians´ awareness of nursing process and to carry out further research on this topic.

Objetivo: avaliar o grau de empatia dos estudantes de medicina e suas mudanças durante o curso médico de uma Faculdade na cidade de São Paulo, Brasil. Método: Estudo descritivo, comparativo e transversal. Amostra não aleatória de 296 alunos. O estudo foi conduzido de Setembro até Dezembro de 2013. A avaliação da empatia foi realizada usando a escala de empatia médica de Jefferson (JSPE) na versão para estudantes de medicina, e a escala multidimensional de reatividade interpessoal de Davis (EMRI) na versão validade e adaptada no Brasil. Ambas escalas foram aplicadas simultaneamente a cada aluno. A JSPE contém 20 itens que são respondidos de acordo com a variante de escala de Likert de sete pontos (Concordo = 7 / Discordo = 1) .Esta escala avalia atributos cognitivos da empatia. A EMRI contém 21 itens que são respondidos de acordo com a escala de Likert de cinco pontos ( Descreve-me muito bem = 5 / Não me descreve muito bem = 1). Esta escala avalia tanto componentes cognitivos quanto afetivos da empatia. Os alunos foram divididos em três grupos de acordo com o ano da graduação: o grupo básico (1º e 2º ano), grupo clínico (3º e 4º ano ) e o grupo do internato (5 º e 6 º ano), e foram comparados os escores de empatia entre os três grupos. Resultados: Ao aplicar JSPE não houve uma diferença significativa quando comparado o escore entre os 3 grupos. Por outro lado ao aplicar a EMRI foi identificado um escore de empatia significativamente menor no grupo do internato quando avaliado o componente afetivo (p < 0,01). Tanto na JSPE quanto na EMRI, as mulheres obtiveram os melhores escores de empatia (p < 0,01) quando comparada aos homens. Os alunos que pretendiam seguir especialidade clínica obtiveram escore de empatia maior quando comparada com especialidade cirúrgica utilizando tanto a JSPE (p=0,05) quanto a EMRI (p < 0,01). Conclusões: O nível de empatia pode mudar e, neste caso, a dimensão afetiva é a mais afetada durante o curso médico. A identificação desta erosão afetiva mostra a necessidade de elaborar estratégias educacionais efetivas que possam contribuir para uma boa formação do futuro profissional médico / Purpose: This study was designed to examine changes in medical students\' empathy during medical school in São Paulo, Brazil. Method: Descriptive, comparative and cross-sectional study. Not randomized sample of 296 students. The study was conducted from September to December 2013. The empathy evaluation was performed using the Jefferson Scale of Physician Empathy (JSPE), version for medical students, and the Davis\'s multidimensional Interpersonal Reactivity Index (EMRI), both of then being applied simultaneously to each student. The JSPE contains 20 items that are answered according to the scale of Likert variant of seven points (7= completely in agreement / 1= completely in disagreement). It is important to emphasize that this scale assesses cognitive attributes of empathy. The EMRI contains 21 items that are answered according to the scale of Likert variant of five ponts (5= describe me very well /1= not describe me very well). This scale assesses cognitive and affective attributes of empathy. The students were divided into three groups, according to the year of professional career: the Basic Group (1st and 2 nd year), the Clinical Group (3rd and 4th year) and the Clerkship group (5th and 6th year). The score of empathy between the three groups was compared. Results: The JSPE scores were similar among the students from the Basic, Clinical and Clerkship groups (p=0.53). On the other hand, the affective dimension of EMRI revealed a significantly lower score in the Clerkship Group (p < 0.01). Women obtained better scores for empathy compared to men, in both scales (p < 0,01). Students who intended to follow clinical careers had higher empathy scores when compared to those who intended to follow surgical careers so when applied to JSPE (p = 0.05) as the EMRI (p < 0.01). Conclusions: The level of empathy can change and in this case, the affective dimension is most affected during medical school. The identification of affective erosion support the need to develop effective educational strategies that contribute to a good training medical professional future

Atualmente, os profissionais da saúde não vêm sendo preparados para lidar com as dificuldades inerentes à morte e o morrer, no entanto, observa-se que, dentre eles, é o médico que vivencia mais negativamente essa realidade, em detrimento das intervenções psicossociais. A literatura aponta que, crenças e práticas religiosas são importantes na vida de muitos pacientes que procuram assistência, entretanto, muitos médicos e demais profissionais da equipe ainda estão incertos sobre a melhor maneira para abordar questões espirituais e religiosas. Esta pesquisa teve a intenção de compreender a vivência de religiosidade de médicos oncologistas no cuidado com o paciente oncológico. Optou-se pela modalidade de pesquisa qualitativa, na perspectiva da Fenomenologia Ontológica- Hermenêutica de Martin Heidegger, para a compreensão das situações vivenciadas. Foram realizadas entrevistas com oito médicos oncologistas, após a assinatura do consentimento livre e informado. As entrevistas foram gravadas e transcritas na íntegra, seguida de uma leitura ampla. Posteriormente, verificadas as convergências e divergências dos relatos, emergiram as categorias de análise. A análise interpretativa desvelou que os médicos têm uma abertura para a compreensão da dimensão religiosa do paciente, no entanto, a fazem com muita dificuldade e ambigüidade quanto às condutas a serem tomadas. Mostram-se sensíveis a uma nova postura médica que precisa de bases seguras para se solidificar, porém encontra-se em momento inicial, na construção de um novo paradigma, que transita entre o cuidar autêntico e o inautêntico. Revelaram a compreensão da importância de Deus, como facilitador ao enfrentamento da facticidade introduzida pelo adoecer e, paralelamente, relataram que, também buscam e confortam-se em sua relação com a espiritualidade e o transcendente. Diante do desamparo sentido pela angústia, na proximidade da fronteira vida-morte, emergem os modos de existir destes cuidadores, na medida em que deparam-se com a finitude humana. Alguns continuam agregados aos rituais religiosos, como missas, velórios e práticas de rezas como forma de elaboração do luto que vivenciam cotidianamente, assim, conservam a dimensão pública do evento morte. Outros mostram-se em uma postura mais contemplativa diante de um Deus interno, cultivando a religiosidade em seu mundo próprio, sem freqüentarem rituais. Acolheram a necessidade do paciente ser-com-o-divino, nos diversos momentos, ao longo do tratamento. Embora, alguns médicos não se sintam confortáveis, ponderando o valor científico das práticas, não há oposição. Tendo em vista que o cuidado permeia toda e qualquer ação humana, segundo a ontologia de Heidegger, podemos vislumbrar, a partir dos resultados desta pesquisa, filosofias educacionais que envolvam os modos de ser-com e suas implicações para o cuidado e o existir autêntico na relação do médico com a religiosidade. (CAPES). / Nowadays, the health professionals have not been prepared to deal with the difficulties inherent to death and dying, however, it is noticeable that, among them, it is the physician who experiences more negatively this reality, for he is the focus of the patients and their relatives. Literature points out that beliefs and religious practices are important the lives of many patients who look for assistance, however, many doctors and other professionals of the staff are still wrong about the best way of approaching spiritual and religious issues. This research had the aim of comprehending the experience of religiosity of oncologist physicians in the caring of the oncologic patient. We opted for the qualitative research, through the perspective of Martin Heideggers Ontological-Hermeneutic Phenomenology, to understand the situations experienced. We interviewed eight oncologist physicians, after the signature of the informed and free consent. The interviews were recorded and transcribed entirely, followed by a broad reading. After the convergences and divergences of the reports were verified, the categories of analysis emerged. The interpretative analysis unveiled that the physicians have an opening for the comprehension of the patients religious dimension, however, they do it with much difficulty and ambiguity in relation to the actions to be taken. It is a new medical posture that needs safe foundations to solidify, but it is in an initial moment, in the construction of a new paradigm that oscillates between the authentic and non-authentic treating. The Physicians revealed the importance of God as a facilitator to the coping with the adversity of sickening and alongside they reported that they also search for and comfort themselves with their relation with spirituality and the transcendental. In the situation of helplessness caused by anguish, in the proximity to death, these care takers existing forms emerge: some continue attached to religious rituals, such as masses, funerals and praying practices as a way of elaborating the grief that they experience daily, so as to keep the public dimension of the death event. Others show themselves in a more contemplative posture before an inner God, cultivating the religiosity in their own world, without attending rituals. The physicians incorporated the patients necessity of being-with-the-divine, in the various moments along the treatment. Although some physicians do not feel comfortable, considering the scientific value of the practices, there is no opposition. Seen that the care permeates all and every human action, according to Heideggers ontology, we can discern educational philosophies that involve the results of this research and the being-with ways and their implications for the caring and the authentic existing in the relationships between physicians and religiosity (CAPES).

Bakgrund: Dödshjälp är ett debatterat ämne som berör sjuksköterskans arbetsuppgifter. Flera länder och stater har legaliserat dödshjälp. Dödshjälp kan ses som ett sätt att respektera patientens önskemål, att lindra lidande och bevara värdighet. Det kan även ställas mot vårdpersonalens egen autonomi eller ICN:s etiska kod som menar att sjukvårdens uppgift är att lindra och bota sjukdom och inte skada patienten. Vårdpersonal beskriver svårigheter i att hantera situationer där dessa komponenter på olika sätt ställs emot varandra. Syfte: Syftet var att belysa sjuksköterskans erfarenheter upplevelser och faktorer som kan påverka upplevelser av att arbeta med personer som önskar eller kommer att genomgå dödshjälp. Metod: En litteraturöversikt i enlighet med Friberg genomfördes. Resultatet byggde på tio originalartiklar som togs fram genom systematisk sökning. Analysen genomfördes genom tematisering och färgkodning.   Resultat: Arbetet med dödshjälp upplevdes olika beroende på vilken typ av dödshjälp som genomfördes, patientens och anhörigas upplevelser, deltagandet i beslutsfattandet, etiska koder och lagar som gällde samt sjuksköterskornas egna värderingar och erfarenheter. Detta ledde till både positiva och negativa upplevelser för sjuksköterskan. Dessa upplevelser kunde också hanteras genom formellt eller informellt stöd, vilket i sin tur bidrog till sjuksköterskans upplevelser. Diskussion: Resultatet diskuteras utefter Travelbees teori om den mellanmänskliga relationen och hur vårdandet utan roller kan bidra till en bättre vård, men även påverka sjuksköterskans upplevelser av vården. Dessutom diskuteras om hur sjuksköterskans egna värderingar och erfarenheter påverkar upplevelserna i vården. / Background: Euthanasia is a debated subject that concerns nurses’ duties. Several countries and states have legalized euthanasia. Euthanasia can be seen as a way of respecting patients wishes, relieving suffering and preserving dignity. However, it can also be considered against healthcare personnels own autonomy or ICN ethical code, which means that the health care task is to alleviate and cure and not harm the patient. Healthcare professionals describe difficulties in dealing with situations where these components differ in a variety of ways. Aim: The aim of the study was to highlight nurses’ experiences and factors that may affect experiences of working with people who want or will undergo euthanasia.  Method: A literature review according to Friberg was conducted. The result is based on ten original articles that were obtained through systematic search. The analysis was conducted by thematization and color-coding. Results: Workning with assistens in death was experienced differently depending on the type of euthanasia that was carried out, the experiences of patients and relatives, participation in decision making, ethical codes and laws, as well as nurses’ own values and experiences. This led to both positive and negative experiences for the nurse. These experiences could also be managed through formal or informal support, which in turn contributed to nurses’ experiences. Discussion: The discussion is based on Travelbees theory of interpersonal relationships and how care without rolls can contribute to better care, but also affect nurses’ experiences of care. In addition, there is discussion about how nurses own values ​​and understandings affect experiences in health care.

La communication est au centre de la relation soignant-soigné en médecine. Si la littérature dans ce domaine est abondante, il reste aujourd’hui de nombreuses questions relatives à l'efficacité des formations des médecins à la communication en termes d'acquisition et de transfert de compétences. Ce travail de thèse a étudié ces questions au travers de quatre objectifs: l'évaluation de l'acquisition de compétences communicationnelles dans un contexte hautement émotionnel, l'évaluation du transfert de compétences communicationnelles dans la pratique clinique, l'évaluation de l'impact de l'acquisition et du transfert de compétences communicationnelles sur l'état émotionnel du patient, et l'évaluation de l'impact de l'acquisition et du transfert de compétences communicationnelles sur l'état émotionnel du patient et de son proche. Des programmes de formation à la communication ont donc été testés empiriquement. Les résultats de ces études montrent qu'un programme de formation à la communication permet l'acquisition de compétences communicationnelles centrées sur le patient ainsi que le transfert de ces compétences en situations cliniques. De plus, ce transfert de compétences est perçu par les patients. Ces études montrent néanmoins qu'un programme de formation à la communication n'a d'impact ni sur l'évolution de l'anxiété des patients lors de consultations médicales impliquant un patient seul ni sur l'évolution de l'anxiété des patients et de leurs proches lors de consultations médicales impliquant un patient accompagné par un proche. Ces résultats soulignent l'importance de proposer dès aujourd'hui ce type de formations dans les curriculums des médecins mais aussi de continuer à améliorer l'optimisation de ces formations à la relation soignant-soigné. /Communication is at the center of the doctor-patient relationship in medicine. Although literature is abundant in this area, there are now many questions about the effectiveness of communication training for physicians in terms of acquisition and transfer of skills. This thesis has addressed these issues through four objectives: the assessment of communication skills in a highly emotional context, the assessment of transfer of communication skills in clinical practice, the assessment of the impact of acquisition and transfer of communication skills on the patient's emotional state, and the assessment of the impact of acquisition and transfer of communication skills on the patient's and its relative's emotional state. Two communication skills training programs have been tested empirically. Results of these programs show that a training program allows the acquisition of patient-centred communication skills and the transfer of these skills in clinical practice. Moreover, this transfer of skills is perceived by patients. Results of the studies included in this thesis show however that a communication skills training program has no impact on the evolution of patient anxiety following medical consultation or on the evolution of patient and relative anxiety following medical consultation when patient was accompanied by a relative. These results underscore the importance of including this type of training in the curricula of doctors but also to further study the optimisation of such training program to doctor-patient relationship. / Doctorat en Sciences Psychologiques et de l'éducation / info:eu-repo/semantics/nonPublished

The purpose of this phenomenological study was to describe how professional educators make sense of their role in helping novice practitioners make meaning from authentic clinical practice. Simultaneously studying a clinical educator from teacher and graduate medical education, and subsequently setting their stories side by side, speaks to the interest both professions have in learning from the other. Both clinical educators were Board certified in their respective area of practice. In-depth phenomenological interviewing was used as the study’s methodology, and the professional formation construct served as the study’s conceptual framework. Data corroborate findings in the literature that there is a lack of consensus about what the clinical educator role entails. Participants showed alignment with the professional formation conceptual framework and demonstrated that the clinical educator role is multifaceted, complex, and made up of more than discrete functions. Their capacity to support professional formation comes from their ownership of a special mix of cognitive and behavioral processes, professional knowledge, and personal attributes. Given both professions’ interest in and ongoing efforts to improve clinical education, the study can help both continue their work toward understanding the clinical educator role and ensuring that people selected for the role are chosen through thoughtful methods and provided with clinical-educator-specific professional development throughout the professional lifespan.