Bakgrund: Patientlag, SFS 2014:821, infördes den 1 januari, 2015, i syfte att tydliggöra och stärka patientens ställning samt främja patientens integritet, självbestämmande och delaktighet inom hälso- och sjukvård. Vårdgivarens informationsplikt utökades och förtydligades gentemot patienten, vilket innebär att informationen ska vara av en kvalitet som optimerar patientens förutsättningar att utöva sitt självbestämmande och vara delaktig i sin egen vård. Syfte: Att undersöka huruvida kapitel tre och fem i patientlag, SFS 2014:821, följs och tillämpas i den kliniska verksamheten med syfte att främja patientens delaktighet och självbestämmande. Metod: Sex patienter rekryterades från en toraxkirurgisk avdelning på ett universitetssjukhus i Sverige. Intervjudeltagarna var elektiva, thoraxkirurgiska patienter vars ingrepp utfördes med extrakorporeal cirkulation. Ett bekvämlighetsurval gjordes där urvalsgruppen innefattade en kvinna och fem män. Intervjuerna genomfördes kvalitativt och semistrukturerat, på kirurgavdelningen, 1-2 dagar innan utskrivning. Data analyserades genom kvalitativ innehållsanalys, enligt Hällberg-Graneheim och Lundman (2004). Resultat: Vårdgivaren tillger information på ett överskådligt, respektfullt och hänsynstagande sätt i syfte att främja patientdelaktiget, integritet och autonomi. Även uppföljningar i informationsflödet görs för att minska risken för missförstånd. Majoriteten deltagare är tillfredsställda med informationen de fått i samband med vårdtillfället. Deltagarna har upplevt minskad oro och ökad trygghet till följd av god information. Avdelningen anses följa patientlagens föreskrifter i detta avseende. Slutsats: Patientlag, (2014:821), följs och tillämpas på kirurgavdelningen där studien utförts. Det påvisas starkt från insamlad data att vårdpersonalen aktivt arbetar med att involvera patienter i vården. Detta genom att hålla patienten välinformerad och bjuda in till delaktighet. / Background: The patient law, SFS 2014:821, was introduced in January the 1st of 2015, which has been developed to clarify and strengthen the position of patients and promote patient integrity, self-determination and participation in medical healthcare. The caregivers’ duty of giving information to the patients was clarified due to the introduction of the law. This means that the quality of the information should optimize the patient's ability to be self-determinated and involved in their care. Aim: To investigate whether chapter three and five in the patient law, SFS 2014:821, is followed and applied in the clinical practice with aim to promote patient involvement and self-determination. Method: Six patients were recruited from a thorax surgery ward at university hospital in Sweden. The participants were elective, thoracic surgical patients whose procedures were performed with extracorporeal circulation. A convenience sample was made where as the sample group included one woman and five men. The interviews were conducted qualitatively and semi- structured, on the surgical ward, 1-2 days before discharge. Data were analyzed by qualitative content analysis according to Hällberg-Graneheim & Lundman (2004). Findings: The caregiver provides information in a clear, respectful and considerate manner in purpose to promote patient participation, integrity and autonomy. Follow-ups were made to reduce the risk of misunderstandings. The majority of participants were satisfied with the information that was given during their care. They experienced reduced anxiety and increased sense of security due to good quality of information. The ward seems to follow regulations in regard to the new patient law. Conclusion: The patient law is followed in the surgical ward where the study was conducted. The collected data strongly indicated that the health staff was actively working to promote patients involvement in their health care. This by keeping the patient well informed and continuously invites patients to participate.

Orientadores: Ilka de Fátima Santana Ferreira Boin, Sebastião Araújo / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-15T23:52:43Z (GMT). No. of bitstreams: 1 Sasseron_AnaBeatriz_M.pdf: 872264 bytes, checksum: 6bc1e73ee6b6ee241a3baa5d4991e69f (MD5) Previous issue date: 2010 / Resumo: Antecedentes: A fisioterapia pré-operatória em cirurgia cardíaca (CC) visa amenizar a disfunção respiratória e prevenir ou tratar complicações pulmonares comuns no período pós-operatório (PO). Objetivos: Avaliar a influência da fisioterapia respiratória pré-operatória e a intensidade da dor pós-operatória referida em determinadas variáveis utilizadas para a mensuração da função respiratória em pacientes submetidos à CC eletiva com circulação extracorpórea (CEC). Desenho: Pesquisa prospectiva, de coorte longitudinal, por amostra de conveniência. Local: Hospital da Irmandade Santa Casa de Misericórdia de Araras. Período: Agosto a dezembro de 2007. Método: Foram estudados 35 pacientes. As variáveis que avaliaram a função respiratória: força muscular respiratória, volume corrente (VC), volume minuto (VM), frequência respiratória (FR) e capacidade vital (CV) foram obtidas nos momentos: pré-operatório (PRE-OP) e PO (1°, 3° e 5°PO). A dor PO referida foi correlacionada com a disfunção respiratória. Baseado na mediana do número de sessões de fisioterapia PRE-OP realizadas, os pacientes foram divididos em Grupo 1 (pacientes que realizaram menor número de sessões) e Grupo 2 (pacientes que realizaram maior número de sessões). Os pacientes seguiram a rotina de atendimento fisioterapêutico local no PO. Resultados: Quinze pacientes compuseram o Grupo 1 (= 6 sessões) e 20 o Grupo 2 (= 8 sessões). As comparações das variáveis categóricas medidas no PRE-OP entre os grupos (idade, peso, altura, índice de massa corpórea e tempo de CEC), além das variáveis que avaliaram a função respiratória antes da CC não apresentaram diferenças significantes, evidenciando homogeneidade da amostra. Entretanto, a variável tempo total de cirurgia (média±desvio padrão) foi maior no grupo 2 (238,2±55,1 minutos versus 197,7±55,8 minutos no grupo 1, p=0,045). Houve predomínio de sujeitos do sexo masculino (73,3% no grupo 1 e 60,0% no grupo 2) e ex-tabagistas (73,3% no grupo 1 e 50,0% no grupo 2), predominando a cirurgia de revascularização do miocárdio (66,7% no grupo 1 e 70,0% no grupo 2). Em todas as variáveis da função respiratória estudadas, os valores obtidos no período PO foram menores em relação aos do PRE-OP em ambos os grupos e permaneceram abaixo até o 5°PO, com exceção do VM. Não houve diferença estatisticamente significante no comportamento das variáveis entre os grupos em relação aos tempos, com exceção do VC, que apresentou aumento significante (p = 0,029) entre os momentos 1º PO e 5º PO e 3º PO e 5º PO apenas para o grupo 2. Quanto maior foi a dor PO referida, maior foi a FR e menores foram os valores de VM e CV. O tempo de internação hospitalar foi similar entre os grupos. Conclusões: O número de sessões de fisioterapia PRE-OP não teve influência na evolução da função respiratória no PO de CC. A intensidade da dor pós-operatória referida influenciou de forma significante o aumento da FR e a diminuição do VM e da CV / Abstract: Background: Preoperative physiotherapy in cardiac surgery (CS) aims to minimize respiratory dysfunction and prevent or treat pulmonary complications common in postoperative period (PO). Purpose: To evaluate the influence of preoperative respiratory physiotherapy and the intensity of postoperative referred pain in certain variables of respiratory function measurements in patients undergoing elective CS with cardiopulmonary bypass (CPB). Design: Prospective and longitudinal cohort with a convenience sample. Setting: Hospital of the Santa Casa de Misericórdia de Araras. Period: August to december of 2007. Method: Thirty-five patients were studied. Respiratory function variables [respiratory muscle strength, tidal volume (TV), minute volume (MV), respiratory rate (RR) and vital capacity (VC)] were obtained at preoperative period (PP) and postoperative moments (1st, 3rd e 5th PO). Referred postoperative pain was correlated with respiratory dysfunction. Based on median of the number of preoperative physiotherapy sessions performed, patients were allocated into two groups: Group 1 (patients with fewer sessions) and group 2 (more sessions). Patients followed the local routine for physiotherapy at PO. Results: Fifteen patients composed the group 1 (6 sessions) and 20 the group 2 (= 8 sessions). Categorical variables obtained at PP period and compared between the two groups (age, weight, height, body mass index and CPB time), as well variables for respiratory function measurements, had not statistical differences, showing homogeneity of the casuistic. However, time of surgery (meanstandard deviation) was higher in group 2 (238.2±55.1 minutes versus 197.7±55.8 minutes in group 1, p=0.045). Overall, there was a predominance of male subjects (73.3% in group 1 and 60% in group 2), ex-smokers (73.3% in group 1 and 50.0% in group 2) and coronary artery bypass grafting (66.7 % in group 1 and 70.0% in group 2). All variables obtained in PO had lower values than those of PP for both groups, and remained bellow until the 5th PO day, with exception of the MV. When PO moments were evaluated, there was no statistical difference for variables performance between groups regarding the moments, with the exception of TV that presented significant increase (p = 0.029) between 1st and 5th PO; and 3rd and 5th PO only for group 2. Higher referred pain was seen with higher RR and with lower values of MV and VC. Both groups had similar hospital length of stay. Conclusions: The number of preoperative physiotherapy sessions had no influence on the evolution of respiratory function at the PO in CS. The intensity of postoperative referred pain influenced significantly the increase of RR and the reduction of MV and VC / Mestrado / Cirurgia / Mestre em Ciências Médicas