Submitted by Verena Bastos (verena@uefs.br) on 2015-08-03T22:03:06Z No. of bitstreams: 1 Disserta??o Ohana_Adapta?ao Transcultural_2014.pdf: 3891838 bytes, checksum: 45c10adb41af0ffa470f22fbfd1bd06a (MD5) / Made available in DSpace on 2015-08-03T22:03:06Z (GMT). No. of bitstreams: 1 Disserta??o Ohana_Adapta?ao Transcultural_2014.pdf: 3891838 bytes, checksum: 45c10adb41af0ffa470f22fbfd1bd06a (MD5) Previous issue date: 2014-03-19 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / Introduction: the PAJ inventory study the path of young love, from the perspective of analyzing the relationship between violent events and relationships with family, friends and lovers. This th?me has mobilized researchers in different social contexts, regions and countries, considering the violence`s impact. Researchers in this area requires the use of validated instruments, with multidimensional approach, regardless of source context, based on the experience of literature. Objective: submit the inventory PAJ "Parcour Amoreux des Jeunes" to the cross-cultural adaptation and validation of content. Methodology: protocol steps recommended were the ones that follow: (1) translation and back-translation - translation and back-translation - the translation was attended by two Brazilian researchers , skilled in French , and later , two young native Canadian researchers fluent in Portuguese, ending Pilot II version . (2) Analisys by the Expert Committee - ten professionals from different backgrounds participated (researchers in validation , adolescence and violence) , who analyzed individually , the clarity and equivalence for each question according to the characteristics of clarity (1) It is not clear , (2) It is a little unclear , (3) almost everything is clear , (4) it is clear and I have no doubt , and equivalence : (1) not equivalent , (2) Partially equivalent; " (3) equivalent . After analysis , the percentages of clarity and equivalence and Content Validity Index / general question for IVC were calculated, obtaining Pilot III version , (3) Pre -test - Pilot III was assessed by a sample of 36 young people , 14-24 years old, both genders , with the same characteristics as the target of the later stages (psychometric analysis and application to the target population) population. In the pre -test interpretive questions were analyzed , in order to obtain cultural, conceptual, semantic and idiomatic equivalence, improving, thus, the instrument comprehension. After analysis of experts and young people , proportions relative to clarity and equivalence and Content Validity Index ( CVI ) were calculated , considering as appropriate issues with grades 3 and 4 for clarity, with value above 0.78 , according literature recommendations. Results: in general, the inventory PAJ had adequate content validity (0.97), considering the recommended limit value for adequacy (0.78). All sections of the instrument showed good performance (adequacy to clarity and equivalence), except the first section (general information, sociodemographic questions the cultural context of young parents' ethnicity, education, language spoken, among others) whose items and issues experienced cross-cultural adaptation and adjustment to match the Brazilian reality. Conclusions: PAJ showed suitable validity of content. The stages of cultural adaptation, and validation of content of instrument becomes appropriate for the procedures that follow - steps of reliability assessment (psychometrics) and applicability to the youth population in the brazilian context. / Introdu??o: o invent?rio PAJ busca estudar o percurso amoroso de jovens, na perspectiva de analisar a rela??o entre os eventos violentos e relacionamentos com familiares, amigos e amores. Esse tema tem mobilizado estudiosos, nos distintos contextos sociais, regi?es e pa?ses, considerando o impacto da viol?ncia Pesquisar nesta ?rea requer a utiliza??o de instrumentos validados, com abordagem multidimensional, independente do contexto de origem, tendo como base a experi?ncia da literatura. Objetivo: submeter o invent?rio PAJ ?Parcours Amourex des Jeunes?, ? adapta??o transcultural e ? valida??o de conte?do, para utiliza??o em contexto nacional. Metodologia: foram obedecidas etapas protocolares recomendadas: : (1) Tradu??o e Retrotradu??o ? para tradu??o participaram dois pesquisadores brasileiros, habilitados na lingua francesa, obtendo duas vers?es em protugu?s; na retradu??o, dois novos pesquisadores nativos do Canad? com flu?ncia no portugu?s, finalizando vers?o Piloto II. (2) An?lise por Comit? de Especialistas ? participaram dez profissionais de diferentes forma??es, pesquisadores nas ?reas de (valida??o, adolesc?ncia e viol?ncia), os quais analisaram, individualmente, o grau de clareza e de equival?ncia para cada quest?o, segundo as caracter?sticas de clareza (1) N?o est? claro; (2) Est? um pouco claro; (3) Est? quase tudo claro; (4) Est? claro e n?o tenho d?vidas; e de equival?ncia: (1) N?o equivalente; (2) Pouco equivalente; ?(3) Equivalente. Ap?s an?lise, foram calculadas as porcentagens de clareza e de equival?ncia e o Indice de Validade de Conte?do/IVC geral por quest?o, obtendo-se vers?o Piloto III; (3) Pr?-teste ? o Piloto III foi avaliado por uma amostra de 36 jovens, de 14 a 24 anos, ambos os sexos, com as mesmas caracter?sticas da popula??o alvo das etapas posteriores (an?lise psicom?trica e aplicabilidade na popula??o alvo). No pr?-teste foram analisadas quest?es de ordem interpretativa, visando obter equival?ncias cultural, conceitual, sem?ntica, idiom?tica, na perspectiva de aprimorar a compreens?o do instrumento. Ap?s an?lise dos especialistas e dos jovens, foram calculadas propor??es relativas ao grau de clareza e equival?ncia e o ?ndice de Validade de Conte?do (IVC), considerando como adequadas quest?es com graus 3 e 4, para clareza, com valor acima de 0,78, segundo recomenda??es da literatura. Resultados: de maneira geral, o invent?rio PAJ apresentou adequada validade de conte?do (0,97), considerando o valor limite para adequa??o recomendado (0,78).Todas as se??es do instrumento apresentaram bom desempenho (adequa??o para clareza e equival?ncia), exceto a primeira se??o (informa??es gerais, quest?es sociodemogr?ficas do contexto cultural do jovem, etnia dos pais, escolaridade, l?ngua mais falada, entre outros aspectos) cujos itens e quest?es sofreram a adapta??o transcultural e adequa??o para corresponder ? realidade brasileira. Conclus?es: o PAJ mostrou adequada validade de conte?do. Os est?gios de adapta??o cultural e valida??o de conte?do torna o instrumento apropriado para os procedimentos que se seguem - medidas de avalia??o da confiabilidade (psicometria) e aplicabilidade para a popula??o jovem no contexto brasileiro.

Increased demand for culturally sensitive healthcare services suggests that interprofessional beginning healthcare students need to gain the necessary cultural competency skills to be successful in delivering positive health outcomes for diverse patients. Bandura's theory of observational learning, Mezirow's theory of transformative learning, and Purnell's and Paulanka's model of cultural competence informed the framework for this research. The purpose of this quasi-experimental quantitative study was to determine the relationship between mode of instruction (observing role models in videotaped role-play simulation) and increased transcultural self-efficacy in cultural competence instruction. A convenience sample of 196 students enrolled in an interprofessional education (IPE) course was randomly assigned at the time of course enrollment to either control or experiment course sections. Pretest and posttest data were collected anonymously through paper-and-pencil administration of the Transcultural Self-Efficacy Tool-Multidisciplinary Healthcare Provider (TSET-MHP). Paired-samples t test showed that students in the intervention group had statistically higher (p < .05) posttest scores in perceived transcultural self-efficacy after observation of standardized patient actors in a videotaped role-play simulation than did students in the control group. These results support the use of videotaped role-play simulation for cultural competence instruction as a means to achieve improved patient care within the culturally diverse population in the healthcare system.

With an increasing migrant population there is a growing need to organize interpreting practices in healthcare in order to deliver equitable high-quality care. This thesis focuses on healthcare institutions’ organization of interpreting services. The aim of the study was to explore interpreting practices in a healthcare context by comparing two different healthcare areas – elderly and emergency healthcare. The study aimed to highlight the impact of the organizational and institutional context. This study was designed as an explorative and descriptive qualitative study including 79 healthcare professionals with experience of interpreting practices recruited via purposeful sampling in elderly and emergency healthcare. Data were collected through individual and focus-group interviews and analysed with inductive qualitative content analysis. The main findings show that the processes and structures around interpreting practices were complex and mainly linked to individual and interpersonal levels and, to a limited extent, to the institutional level. On the institutional level the Public Procurement Act was the only formal policy to follow. On individual and interpersonal level interpreting practices were structured by self-established informal workplace routines developed by the professional groups. The norms and routines used was determined by access to interpreters, time aspects, characteristics of the care given, health conditions and the person’s problem, expectations and requests from the person and also from healthcare professionals. There were wishes for improvement, with better flexibility in access to professional interpreters, training for users and interpreters, and also better technical solutions and equipment. In conclusion, the use of interpreters was rooted in the organizational environment of interpreting practice, including the availability of laws, policy and guidelines, and closely related to individuals’ language skills, cultural values and social factors. The use of professional interpreters was based on the nature of care in context and access to interpreters and determined by health professionals’ estimation of the person’s current health status in order to deliver fast and individualized care based on humanistic values. Thus, it is important to consider organizational framework and cultural awareness when formulating interpreting practices adapted to the context, and formal guidelines in order to achieve the aim of personcentered and equal health care.

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This thesis 'The Symphony of Care' consists of four studies focusing on care relationships between patients and professional caregivers. Care relationships are central to the health process and a fundamental element in caregiving. The term care relationship is widely used in caring science but lacks a clear definition, which can create misunderstanding and can constitute an obstacle when attempting to optimize care relationships. The aim of this thesis is to describe the phenomenon of care relationships in order to add to the body of knowledge in caring science.The main research questions are: • What is a care relationship within the caring science field? • How can a care relationship be optimized to improve its caring function, in order to promote health? The ontological foundation of this thesis is caring science. Phenomenology and Lifeworld theory are used as its epistemological bases. Reflective Lifeworld Research is used as a methodological approach. The four studies were conducted in different contexts and cultures- the first two empirical studies were performed in China and the remaining two, a metasynthesis and a secondary analysis, were carried out in a Swedish context. The results show that care relationships are temporary intentional relationships between a person who needs help and a helper. The purpose of this relationship is to support the patient in his/her dynamic health process, which is unique for each person in different times and contexts. Care relationships are fragile because the patient is vulnerable and the demand on the helper is great. It is an inter-human relationship between equals, which can at the same time be an asymmetric relationship due to the professionalism with the caregiver and the vulnerability with the patient. A care relationship is not independent, but is affected by internal factors such as the two individuals' lifeworlds and external factors such as health policies, organization, economics, health culture and environment. To optimize the effectiveness of caring, the relationship and its surrounding need to be in harmony. The view of care relationships should be broadened to include the external resources in order to optimize their caring potential.

Bakgrund: Barnhälsovården spelar en betydelsefull roll i det svenska folkhälsoarbetet. En femtedel av de inskrivna barnen har minst en förälder som är född utanför Sverige. Majoriteten av BVC-sköterskorna upplever arbetet med invandrarfamiljerna som stimulerande men anger också att svårigheter förekommer. Syftet: var att belysa faktorer som påverkar BVC-sköterskans transkulturella vårdrelationer med invandrarfamiljer i Barnhälsovården. Metod: Studien genomfördes som en allmän litteraturstudie och baserades på elva vetenskapliga artiklar som kvalitetsgranskades och analyserades. Resultatet redovisades i olika tre teman. Resultat: Faktorer som påverkade den transkulturella vårdrelationen i Barnhälsovården var BVC-sköterskans förmåga att kommunicera, bemötandet och förhållningssättet samt den kulturella kompetensen. Diskussion: Kommunikationssvårigheterna påverkade möjligheterna att skapa trygghet och förtroende i den transkulturella vårdrelationen. BVC-sköterskans bemötande och förhållningssätt hade betydelse inte bara för utgången av hälsovårdsarbetet utan även för invandrarfamiljens inställning till integration. Kulturell kompetens påverkade BVC-sköterskans möjligheter att se varje invandrarfamilj individuellt snarare än som en representant för sin kulturgrupp. Slutsats: För att möjliggöra en förtroendefull och trygg transkulturell vårdrelation i Barnhälsovården ställs inte bara krav på BVC-sköterskans skicklighet i att finna bra vägar för kommunikation, utan även på förmågan att praktiskt kunna omsätta sin kulturella kompetens samt insikt om betydelsen av att ge ett vänligt, empatiskt och individuellt bemötande åt invandrarfamiljen. / Background: The primary child health care services (PCHC services) plays an important part in the Swedish public health work. One fifth of the enrolled children have at least one parent born outside of Sweden. The majority of the PCHC nurses finds the interaction with the immigrant families stimulating but also recognizes difficulties. The aim: was to illuminate factors that influence the PCHC nurse's transcultural caring relationship with immigrant families in PCHC services. Method: The study was conducted as a literature review and based upon eleven scientific articles which were quality assessed and analyzed. The result was reported in three different themes. Result: Factors affecting the transcultural caring relationship in the PCHC services were the PCHC nurse's ability to communicate, the reception and approach and the cultural competence. Discussion: Communication difficulties affected the possibilities to create trust and confidence in the transcultural caring relationship. The PCHC nurse's reception and approach had implications not only for the outcome of the health care work but also for the immigrant family's attitude towards integration. Cultural competence affected the PCHC nurse's possibilities to see each immigrant family individually rather than as a representative of their cultural group. Conclusion: To enable a safe and trusting transcultural caring relationship in the PCHC services it’s necessary that the PCHC nurse has good communication skills, is able to use and incorporate cultural competence and understands the importance of providing a friendly, empathetic and individual approach to the immigrant family.

Given the increased number of children from racialized groups requiring foster care and the decreasing number of foster parents from racialized groups, transcultural foster placements are on the rise. Addressing racial and cultural diversity within the context of transcultural foster care placements is one of the most pressing dilemmas of contemporary child protection practice, in Canada. In this qualitative exploratory study, the perspectives of regular non-kinship foster parents groups in Nova Scotia and British Columbia, Canada, who provide foster care to children and youth from racialized groups, were explored through open-ended structured interviews. Participants consisted of nine foster parents, between the ages of 30 and over 60 years old, who were asked to share their experiences regarding transcultural foster care placements. The results of this study indicated foster parents were culturally receptive and ‘fostering cultural development’ in their homes as well as their respective communities.

Sammenfatning Baggrund og formål: Apopleksisygdommen er ansvarlig for flest tilfælde af invalidering blandt voksne i eget hjem. I Danmark alene lever godt 50.000 mennesker med følgerne efter apopleksi. En følge kan være reduceret evne til at kommunikere, afasi. Forebyggelse kan reducere antallet af nye tilfælde og følgerne efter sygdommen. Livskvalitet ved kronisk sygdom har voksende bevågenhed. Rehabilitering medvirker til at patienten kan blive fysisk, psykisk og socialt fungerende på et niveau, men sygdommens indvirken på oplevelsen af helbredsrelateret livskvalitet er i Danmark ikke undersøgt med sygdomsspecifikke instrumenter. Patienter med afasi udelukkes som regel fra undersøgelser, der kræver intakt tale og forståelse. Afhandlingens overordnede mål er at tilvejebringe et instrument, som kan anvendes til at måle helbredsrelateret livskvalitet efter apopleksi inkl. afasi. Metode og materiale: Afhandlingen har en kvantitativ tilgang. Et nordamerikansk instrument, Stroke Specific Quality of Life Scale, version 2.0, SSQOL © (copyright Linda S. Williams), er blevet oversat og kulturelt bearbejdet til dansk i overensstemmelse med anerkendt systematik i studie I. Instrumentet dækker med 49 items 12 domæner med fysisk, socialt og mentalt fokus samt 13 items, der dækker en vurdering af domænerne og livskvaliteten sammenlignet med før apopleksien. Instrumentets psykometriske egenskaber er blevet testet ved hjælp af tre studiepopulationer rekrutteret dels retrospektivt, dels konsekutivt. I studie II blev reliabilitet og validitet undersøgt, og i studie III responsivitet og sensitivitet. Afprøvningerne er foretaget med referenceformularer som eksterne kriterier i form af etablerede generiske skalaer. I studie IV er afprøvet en proxy-version tiltænkt patienter, som er ude af stand til selv at udfylde skemaet eller som ikke er i stand til at kommunikere tilstrækkeligt. Afprøvningen blev udført af en nærtstående udpeget af patienten. I studie V blev en gruppe let ramte patienter beskrevet, og variabler med betydningsfuld sammenhæng med oplevelsen af forringet helbredsrelateret livskvalitet blev undersøgt. Data er blevet testet ved hjælp af gennemsnit og standarddeviationer, median og range, proportioner, korrelationer og logistisk regression. Resultater: Den danske version af SSQOL, SSQOL-DK, har god face- og indholdsvaliditet. Det udfyldes på 10-20 minutter. Stabilitet, undersøgt med test-retest metode, viste korrelationer i området rs 0.65-0.99. Intern konsistens undersøgt med Cronbach’s alfa viste værdier i områderne 0.81-0.94 i studie II, 0.75-0.96 i studie III og 0.64-0.87 i studie V. Der blev set en ceiling effekt, 24-52%, men beskeden floor effekt. Begrebsvaliditet viste moderat delte varianser med de eksterne kriterier, r2 0.03-0.62. Konvergent validitet var (r) &gt; 0.40 med undtagelse af et enkelt item. SSQOL-DK var i stand til at klassificere retning af ændring i livskvalitet over tid i overensstemmelse med eksterne kriterier i 43-58 % af tilfældene. Proxy-versionen viste god overensstemmelse mellem patient- og proxy data. I en gruppe af let ramte patienter med apopleksi og transcerebral iskæmi, TCI, et år efter sygdommen vurderede 57 % deres livskvalitet som uændret i forhold til før apopleksien. Det mandlige køn (OR 3.77), erhvervsaktivitet (OR 2.84), og lavere scores på domænerne Mood og Work ved tre måneder var covariater, som var signifikant relateret til sandsynligheden for at vurdere livskvaliteten forringet efter sygdommen. Konklusion: Der foreligger nu et dansksproget instrument, SSQOL-DK, som har demonstreret tilfredsstillende reliabilitet og validitet, og som kan anvendes på gruppeniveau til dansktalende patienter med let til moderat apopleksi. Apopleksipatienten med større kommunikationsproblemer har dog stadig begrænsede muligheder med dette instrument, idet de foreliggende resultater fra proxy-afprøvningen fordrer yderligere undersøgelse af datas validitet / Abstract Background and aim: Stroke is most frequently the cause of adult disability. In Denmark more than 50.000 people suffer from the sequels of stroke. One of them may be aphasia, i.e. reduced ability to communicate. Primary and secondary prevention may reduce the incidence and the severity of stroke. The interest in quality of life with a chronic disease is increasing. Rehabilitation efforts are targeted for physical, mental and social function but the impact on health related quality of life after stroke has not been studied with stroke specific instruments. Aphasic patients are normally excluded from studies where communicative skills are required. The aim of this thesis is to develop an instrument suitable for measuring health related quality of life after stroke. Methods and material: The design of the thesis is quantitative. In study I Stroke Specific Quality of Life Scale, version 2.0, SSQOL © (copyright Linda S. Williams), an American instrument recently developed, was translated and culturally adapted to Danish according to established guidelines. With 49 items SSQOL covers 12 domains comprising physical and mental issues. Thirteen items covers an appraisal of each domain compared to pre stroke status and overall quality of life. Psychometric properties was examined by studying three samples of stroke survivors. Study II and III examined reliability, validity and responsiveness. Established generic scales were used as external criteria. Study IV tested a proxy-version meant for stroke patients with language impairment or patients who are unable to fill in a questionnaire. The patients chose the proxies. Study V provided health related quality of life in a group of mildly affected patients after stroke or transient ischemic attack, TIA. Significant covariates with deteriorated health related quality of life were studied. Data were analyzed with mean and standard deviations, median and range, proportions correlations and logistic regression. Results: The Danish version of SSQOL, SSQOL-DK, showed good face- and content validity. It can be completed in less than 25 minutes. Test-retest showed correlations rs 0.65-0.99. Internal consistency showed Cronbach’s alpha from 0.81-0.94 in study II, 0.75-0.96 in study III and 0.64-0.87 in study V. Ceiling effect was 24-52%, floor-effect was modest. Construct validity showed shared variance with external criteria, r2 0.03-0.62. Convergent validity showed (r) &gt;0.40 for 48 out of 49 items. SSQOL-DK classified direction of change in over all quality of life concordantly from 43-58% with external criteria. The agreement between patient- and proxy data was good. Fifty seven (57) percent of mildly affected patients after stroke or TIA rated their overall quality of life unchanged one year after stroke compared to pre stroke status. In the regression model male sex OR 3.77), working outside home (OR 2.84), and less than 5.00 (maximum score) on the domains Mood and Work/productivity at three months were significant predictors for rating over all quality of life deteriorated at 12 months. Conclusion: The SSQOL-DK has demonstrated satisfactory reliability and validity and can be used on group level measuring health related quality of life among Danish survivors after mild to moderate stroke and TIA. Stroke survivors with severe communication problems are still limited as validity of the proxy data should be further tested

INTRODUKTION Sverige tar emot en stor andel flyktingar och flera kommer till glesbygd. Ett bra mottagande är avgörande för flyktingarnas hälsa. De har rätt till hälsoundersökning, akut sjukvård samt sjukvård som inte kan vänta. Kulturella skillnader innebär utmaningar för vården och distriktssköterskorna som möter flyktingarna. SYFTE Syftet med studien var att undersöka distriktssköterskors upplevelser av faktorer som påverkar mötet med flyktingar på hälsocentraler utan specifik flyktingmottagning i glesbygd. METOD Studien genomfördes med kvalitativ design. Åtta distriktssköterskor med erfarenhet av flyktingmottagande i glesbygd valdes ut och intervjuades. Semistrukturerade intervjuer genomfördes och insamlad data analyserades med kvalitativ innehållsanalys. RESULTAT Ett bra bemötande är viktigt när flyktingar söker vård samt tilltro till flyktingarna när de söker vård som inte kan anstå. Bedömningar av vad som är vård som inte kan vänta har beskrivits som svåra. Kännedom om kulturer har beskrivits som önskvärt. Att prioritera hälsosamtalen har betonats som viktigt. Uppdraget kring flyktingmottagning är tydligt, men resurser saknas och kunskapsutveckling var önskvärd. Positiv utveckling i arbetet med flyktingar i glesbygd har setts och tron är att antalet kommer att öka. Relationerna upplevs mer personliga i glesbygd. KONKLUSION I glesbygd upplevs mötet mer personligt och distriktssköterskorna vill utvecklas och arbeta gränsöverskridande. Flyktingarna har förtroende för vårdpersonalen vilket möjliggör att integration främjas om distriktssköterskan ser det som sitt ansvar och ges resurser. Behovet av kunskap i transkulturell omvårdnad är högst aktuellt och för att tillgodose detta efterfrågas möjligheter till eftertanke och utbyte av erfarenheter. / INTRODUCION Sweden receives a large number of refugees and many of them come to the rural area. A good reception is crucial for the health of the refugees who are entitled to a health assessment, emergency care and care that cannot wait. Cultural differences imply challenges for the health care and primary health care nurses who meet the refugees. OBJECTIVE The aim of this study was to investigate the factors that affect the experience of primary health care nurses meeting with refugees at community health centers without specific care refugee centers in rural areas. METHOD The study was performed with a qualitative design. Eight primary health care nurses with experiences working with refugees in rural areas were sampled and interviewed. Data was collected from semi structured interviews and analyzed using qualitative content analysis. RESULTS A good attitude is important when refugees seek care, and to credence the refugees when they seek health care that cannot wait. Assessments to characterize 'what is care that cannot wait' described as difficult. The knowledge of cultures was expressed as desirable. Prioritizing health assessments were emphasized as important. The assignment in refugee reception is clear, but there is a lack of resources and the wish for knowledge was expressed. Positive development in working with refugees exists and the number of refugees is believed to increase in rural areas. The relationships are perceived more personal in rural areas. CONCLUSION In rural areas, the meeting felt more personal and primary health care nurses wish to develop and operate transboundary. The refugees have confidence in the nursing staff which enables integration and could be promoted by the primary health care nurses if they saw this as their responsibility and were provided proper resources. Knowledge of trans-cultural nursing is needed today in health care and to develop that it demands the opportunity for reflection and exchange of experiences.