Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 27.970
Filtrar
1.
Prax Kinderpsychol Kinderpsychiatr ; 69(1): 60-81, 2020 Jan.
Artículo en Alemán | MEDLINE | ID: mdl-31918648

RESUMEN

Alliance Ruptures in the Psychotherapy of Adolescents with Borderline Personality Pathology: Risk or Benefit? Adolescents with subthreshold or full-blown borderline personality disorders (borderline personality pathology (BPP)) are characterized by a pronounced instability in their self-image and their interpersonal relationships. The building of a stable therapeutic relationship is considerably challenged in patients with BPP. The concept of alliance ruptures and resolutions assumes that the resolution of ongoing relationship difficulties contributes to therapeutic change. Resolutions are strategies of the therapist to address ruptures, to explore their meaning with the patient and to enhance the therapeutic collaboration between the patient and the therapist. This article illustrates the use and benefits of alliance ruptures and resolutions among adolescents with BPP treated with the manualized treatment concept Adolescent Identity Treatment (AIT). Ten patients were treated with AIT. Three out of ten patients dropped out of treatment prematurely. A total of 187 therapy sessions were analyzed using the Rupture and Resolution Rating System (3RS; Eubanks, Lubitz, Muran, Safran, 2018). Alliance ruptures and resolutions are illustrated in session transcripts of a qualitative case vignette. Quantitative analyses show that alliance ruptures occur frequently over the complete treatment course in good outcome patients. However, frequent alliance ruptures at the beginning of treatment represent a risk for premature treatment termination. The concept of alliance ruptures and resolutions may help to improve the ongoing therapeutic alliance in the treatment of adolescents with BPP.


Asunto(s)
Trastorno de Personalidad Limítrofe , Psicoterapia , Adolescente , Trastorno de Personalidad Limítrofe/psicología , Trastorno de Personalidad Limítrofe/cirugía , Humanos , Relaciones Interpersonales , Relaciones Profesional-Paciente , Autoimagen , Conducta Social
2.
Artículo en Inglés, Portugués | LILACS, BDENF - Enfermería | ID: biblio-1048327

RESUMEN

Objetivo: descrever ações executadas pelo acompanhante junto à parturiente, conforme informações recebidas no pré-natal. Método: estudo qualitativo, descritivo, exploratório, com 21 acompanhantes, com o uso de um questionário semiestruturado. No processamento de análise dos dados, foi utilizado o software Iramuteq. Resultados: emergiram duas classes: 1. A informação no pré-natal sobre o direito do acompanhante e 2. A participação do acompanhante junto à parturiente e as ações executadas. Conclusão: a informação referente ao direito do acompanhante e ações a serem desenvolvidas por eles no processo de parto foram poucas ou nenhuma durante o pré-natal e as ações realizadas por eles foram provenientes de conhecimento adquirido por meio de busca individual ou recebido no momento da internação


Objective: to describe actions taken by the companion of the parturient, according the information received in prenatal care. Method: qualitative, descriptive, exploratory study with 21 companions, with the use of a semi-structured questionnaire. In the data analysis processing, Iramuteq software was used. Results: the two categories that emerged: 1. The information in the prenatal about your rights to the parturient companion 2. The participation of the parturient companion and the actions taken. Conclusion: observed that the information concerning the right of the companion and actions to be undertaken by them on labor process, were little or no during prenatal care, and the actions performed by them came from knowledge acquired through individual search or received at the time of hospitalization


Objetivo: describir acciones ejecutadas por el acompañante junto a la parturienta, conforme informaciones recibidas en el prenatal. Método: estudio cualitativo, descriptivo, exploratorio, con 21 acompañantes, con el uso de un cuestionario semiestructurado. En el procesamiento de análisis de los datos, se utilizó el software Iramuteq. Resultados: emergieron dos clases: 1. La información en el prenatal sobre el derecho del acompañante y 2. La participación del acompañante junto a la parturienta y las acciones ejecutadas. Conclusión: la información referente al derecho del acompañante y acciones a ser desarrolladas por ellos en el proceso de parto y parto fueron pocas o ninguna durante el prenatal y las acciones realizadas por ellos, fueron provenientes de conocimiento adquiridos por medio de búsqueda individual o recibidas en el momento de la internación


Asunto(s)
Humanos , Masculino , Femenino , Embarazo , Adulto , Persona de Mediana Edad , Atención Prenatal , Parto Humanizado , Chaperones Médicos/tendencias , Relaciones Profesional-Familia , Relaciones Profesional-Paciente , Trabajo de Parto , Parto , Investigación Cualitativa , Humanización de la Atención , Acogimiento
3.
J Oncol Pharm Pract ; 26(1): 13-22, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30832554

RESUMEN

PURPOSE: To describe the outcomes of a pharmacist-led multi-center, collaborative patient education and proactive adverse event management program in a community-based oncology setting. METHODS: Patients with EGFR mutation-positive (EGFRm+) non-small cell lung cancer, newly prescribed with oral afatinib, and monitored as part of the Florida Cancer Specialists patient management program, were included in a retrospective, observational analysis. During follow-up, data were collected on adverse event frequency, and changes in afatinib dosing. Data analyses were descriptive and exploratory in nature. RESULTS: The mean age of the 123 patients included in the analysis was 69 years, and 78% were female. At the time of the analysis, 3 patients had discontinued before receiving treatment, 89 patients had discontinued afatinib treatment, and 31 patients were continuing to receive afatinib treatment. The most common afatinib-related adverse events were diarrhea (85%), rash/skin reactions (58%), stomatitis/mucositis (19%), and paronychia (16%). Overall, 13% of patients discontinued due to afatinib-related adverse events. The median duration of treatment was 4 months in patients who discontinued due to adverse events, 6 months in those who discontinued for other reasons, and 18 months in those who were continuing to receive therapy. Afatinib dose-reductions were more frequent in patients continuing treatment versus those who discontinued due to adverse events (77% vs. 42%, respectively). CONCLUSIONS: Findings suggest that adverse events in patients with EGFRm + non-small cell lung cancer receiving afatinib can be successfully managed in a community-based, real-world setting with the help of collaborative pharmacist-led patient education, adverse event monitoring, and continuous support.


Asunto(s)
Afatinib/efectos adversos , Antineoplásicos/efectos adversos , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Neoplasias Pulmonares/tratamiento farmacológico , Educación del Paciente como Asunto/tendencias , Farmacéuticos/tendencias , Adulto , Anciano , Anciano de 80 o más Años , Carcinoma de Pulmón de Células no Pequeñas/diagnóstico , Carcinoma de Pulmón de Células no Pequeñas/genética , Servicios Comunitarios de Farmacia/tendencias , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/diagnóstico , Efectos Colaterales y Reacciones Adversas Relacionados con Medicamentos/terapia , Receptores ErbB/genética , Femenino , Humanos , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/genética , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto/métodos , Relaciones Profesional-Paciente , Estudios Retrospectivos
4.
Am J Clin Hypn ; 62(1-2): 12-30, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31265365

RESUMEN

To build bridges between hypnosis and contemporary psychoanalysis, this article addresses how hypnosis, when used in psychotherapy, facilitates curative action through its relational essence. The author's extensive experience with hypnosis, psychotherapy, and psychoanalysis orient the narrative toward the unconscious patient-therapist interaction, with particular attention paid to the ethics of the inherent hypnotic seduction. Whether used primarily in relief-oriented ways or geared toward more transformative therapeutic aims, powerful unconscious factors are in play for both patient and therapist and are explicated to illustrate the interactive and frequently unformulated, intersubjective factors that facilitate effective, psychotherapeutic hypnosis. Consequently, therapists attuned to such intersubjective dynamics can make use of their own internal mental activities to understand a patient's current state of mind and level of developmental functioning, and thereby subsequently formulate mutative interventions. For instance, because hypnotizability reflects the ability to play in imaginative space, the regression promoted in hypnotherapy may activate both an illusion of omnipotence and its optimal disillusionment through the relational context. This requires going beyond more traditional, procedural ways of bifurcating hypnotic interventions as being either direct or indirect and instead further distinguish hypnotic interventions in accordance with their maternal and paternal relational dimensions. Arguably, then, the skillful hypnotherapist needs to maintain a coupling interplay between the maternal, maximally receptive and the paternal, more active modes of functioning within hypnotic play space.


Asunto(s)
Hipnosis , Teoría Psicoanalítica , Humanos , Hipnosis/ética , Imaginación , Relaciones Profesional-Paciente/ética , Psicoanálisis , Alianza Terapéutica
5.
Am J Clin Hypn ; 62(1-2): 74-94, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31265367

RESUMEN

This article explores five interwoven principles about relationship that impact on attentional focus as it relates to the practice of clinical hypnosis. It first reviews how relationship is an irreducible feature of life that greatly predates the arrival of human beings. Second, it describes brain structures that, from an evolutionary perspective, appeared relatively recently, and the neuropsychological abilities those structures confer on human relationships. Third, it links those social brain structures to trance, an inborn response to novelty that is an important feature of our adaptive learning capacity. It further suggests that narrative is a multilevel concept that is deeply embodied and constitutes the sorbate from which hypnotic interactions can draw their rich impact. Finally, the article posits that hypnosis represents a skill set through which attuned clinicians engage in co-creative dances with clients, where the choreography of their interaction attends and responds to spontaneously arising and/or deliberately seeded opportunities for adaptive change. Reconstructed descriptions of interactions with clients are provided to illustrate the application of the principles presented.


Asunto(s)
Encéfalo/fisiología , Hipnosis , Humanos , Relaciones Profesional-Paciente , Alianza Terapéutica
6.
Am J Clin Hypn ; 62(1-2): 118-137, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31265368

RESUMEN

Over the years, the field of hypnosis has often given more attention to the state and procedural factors of hypnosis than the relational ones. In an attempt to address this imbalance, the 60th annual meeting of the American Society of Clinical Hypnosis (ASCH) had as its theme "Hypnosis and the Treatment Relationship." A centerpiece of this meeting was a collegial discussion among a panel of psychologists with expertise in relational hypnotherapy. The panel addressed several pertinent questions: (1) What are the healing qualities of relationship in psychotherapy? (2) What makes hypnosis relational in nature? (3) How do relational factors of hypnosis resemble healthy attachment processes and recapitulate stalled developmental maturation? (4) How does relationally informed hypnotherapy influence and strengthen the relationship, process, and outcome of psychotherapy? This article summarizes the factors that led to the creation of this panel; provides an edited transcript of this panel discussion, along with additional commentary on several key points raised; and concludes with a summary of the main themes and recommendations for further clinical practice and study.


Asunto(s)
Hipnosis , Alianza Terapéutica , Humanos , Relaciones Profesional-Paciente , Psicoterapia
7.
Am J Clin Hypn ; 62(1-2): 31-59, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31265369

RESUMEN

This article develops the idea that hypnosis is an interactive phenomenon occurring in a relational matrix. A tripartite model for explicating this relational matrix is presented, which includes a discussion of transference, contemporary relationship factors, and the interaction of these to produce a sense of therapeutic alliance. These relationship factors are central to the therapeutic action of hypnosis as a vehicle to potentiate change and growth. The unique and specific contribution of each of these factors to the process of hypnotherapy and to therapeutic action is examined. Phenomenologically, this relational interaction is conceptualized as occurring in transitional space, shaped by processes of regression and attunement. From this perspective, the hypnotherapist is viewed as a kind of transitional object whose empathic presence contains and facilitates those interactive phenomena which evoke and balance the transferential and contemporary aspects of the relationship and which allow for uniquely evocative developmentally focused interventions in trance work. Several examples are presented from an ongoing case that demonstrate how these relational variables shape the hypnotherapeutic process and how they can be used for uncovering and self-examination, for structural maturation, for affect regulation, and for emerging ego mastery. The therapeutic action demonstrated relies on hypnotic interventions rooted in the various components of the relational matrix made possible by the clinician's awareness of and attunement to these and by hisor her informed and sensitive management of them and of his or her own intersubjectivity. Specific strategies are presented via these examples to effectively utilize this experience in the service of treatment goals.


Asunto(s)
Hipnosis , Encéfalo/fisiología , Humanos , Modelos Psicológicos , Relaciones Profesional-Paciente , Alianza Terapéutica
8.
Am J Clin Hypn ; 62(1-2): 95-117, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31265370

RESUMEN

This article explores how hypnotic strategies can be used within a polyvagal science framework to help create more secure attachment within the therapeutic relationship, as well as within the client in terms of ego-state relationships. Principles of safety and connection are emphasized, along with specific strategies to access the attachment circuits of the ventral vagal system, including the necessity of being present with the client without agenda. Uses of hypnosis related to safety and connection and methods to work with the center core self to facilitate empowerment, self-cohesion, and conflict-free experience are also reviewed. From an ego-state therapy perspective, a discussion of hypnosomatic approaches to connect with preverbal, nonverbal, and somatic aspects of self to accomplish developmental repair and facilitate secure attachment is also offered, along with case examples. A three-step model, which attempts to integrate polyvagal, somatic, and hypnotic approaches, is offered by the author to help structure corrective experiences for clients with trauma.


Asunto(s)
Ego , Hipnosis , Relaciones Profesional-Paciente , Encéfalo/fisiopatología , Humanos , Modelos Psicológicos , Apego a Objetos , Trastornos por Estrés Postraumático/fisiopatología , Trastornos por Estrés Postraumático/terapia , Alianza Terapéutica
9.
Am J Clin Hypn ; 62(1-2): 60-73, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31265372

RESUMEN

This article examines the spatial and social nature of human relationships with children and adolescents in clinical hypnosis. Beginning with the unique way in which the phenomenon of rapport is intrinsic to the therapeutic uses of hypnosis and is distinct among other therapies, the stage is set for the importance of relational hypnosis. Through the use of case vignettes that illustrate developmental imperatives, relationship factors influencing the clinical interaction are demonstrated in practice. These include transference and countertransference, safety, embodiment, novelty, creativity, respect, trust, equality, being with, loving responses, synchronicity, and empathy. Hypnotic relating exists in a framework through which absorption in play and imagination evokes the child's resources and suggestions are made. In this receptive stance the personalized suggestions lead to an environment for positive change.


Asunto(s)
Hipnosis , Imaginación , Adolescente , Niño , Desarrollo Infantil , Preescolar , Femenino , Humanos , Masculino , Relaciones Profesional-Paciente , Alianza Terapéutica
10.
Am J Clin Hypn ; 62(1-2): 138-158, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31265373

RESUMEN

It is unquestioned that reaching the hypnotic state is helped along by relational factors and that, conversely, relational experiences can be deepened through hypnosis. It is also true that deepening the experience of being in a relationship with another person is neither comfortable nor indicated for every patient or therapist. Most humans feel ambivalent about closeness. People vary in their desire for and their skill in sustaining mature intimacy. When we move along the continuum from rudimentary notions about relational factors in psychotherapy, such as rapport, to complex concepts, such as enactments, we move along a corresponding continuum of increasing need for specialized training, supervised experience, and personal therapy. The field of psychotherapy has been plagued from its inception by not knowing what to do with the tensions that emerge when two people listen to and look at each other. Avoiding relational factors may be a very human response to a very daunting matter.


Asunto(s)
Miedo , Relaciones Profesional-Paciente , Psicoterapia , Emociones , Miedo/psicología , Humanos , Hipnosis , Relaciones Interpersonales , Psicoanálisis , Alianza Terapéutica
11.
J Clin Nurs ; 29(1-2): 94-106, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31509294

RESUMEN

AIMS AND OBJECTIVES: To describe the experiences and wishes of lesbian and bisexual women concerning health care in Finland. BACKGROUND: Sexual orientation is a personal aspect of identity and also an important aspect of holistic health care. Lesbian and bisexual women have unmet health needs. The way that healthcare personnel encounter lesbian and bisexual women affects whether they disclose their sexual orientation. DESIGN: Qualitative inductive survey. METHODS: The research data for this study were collected in spring 2018 using an electronic survey (n = 22). The data were analysed using inductive content analysis. The research report has been checked using COREQ checklist, see Appendix S1. RESULTS: The research data were divided into two main domains: experiences and wishes. Women described health care as being heteronormative. They had both good and bad experiences, and their own poor experiences and those of others had a negative impact on their utilisation of healthcare services. Women had apprehensions about encountering stereotyping in health care and did not always disclose their orientation, even though recognising it would be integral to the provision of holistic health care. Lesbian and bisexual women wished that health care would refrain from heteronormativity, acknowledge issues that were important to them and engage with them without any prejudgement. They also wished healthcare environments would be improved to reflect an open acceptance of sexual minorities and also co-operate with sexual minority organisations. CONCLUSIONS: Women had conflicting experiences. Heteronormativity was seen as an obstacle for holistic health care. Women hoped health care would collaborate with the third sector. RELEVANCE TO CLINICAL PRACTICE: Sexual diversity should be acknowledged and better communicated to patients. Women hoped personnel would have the understanding to treat them in the same professional way as any other patients, but with expertise specific to their needs, for example in sexual health guidance.


Asunto(s)
Revelación , Satisfacción del Paciente , Relaciones Profesional-Paciente , Minorías Sexuales y de Género/psicología , Adulto , Actitud del Personal de Salud , Femenino , Finlandia , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Calidad de la Atención de Salud , Conducta Sexual/psicología , Esposos , Encuestas y Cuestionarios
12.
Z Psychosom Med Psychother ; 65(4): 372-383, 2019 Dec.
Artículo en Alemán | MEDLINE | ID: mdl-31801443

RESUMEN

Difficult situations in psychotherapy and how therapists deal with them Objectives: In theory and research, it is assumed that therapeutic competences are especially relevant in difficult situations. In the present study, we collected and categorized situations that psychotherapists subjectively evaluated as difficult. Additionally, we inspected therapists' reactions to these situations and considered correlations between situations and reactions. Methods: In an online-survey, 101 therapists described difficult situations and their corresponding reactions. The reports were analyzed by qualitative content analysis (Mayring 2015) and resulted in two category systems for the difficult situations and the reactions. Results: Difficult situations reached from everyday conflicts to extreme situations (e. g. threats). The most frequent difficult situations were in context of therapeutic frame, aspects of disorder, and critics, demands, accusations of patients. The most frequent reactions concerned therapeutic frame, external help and supportive interventions. We found significant correlations between difficult situations due to aspects of disorder and asking for external help. Conclusions: Although categories were sometimes difficult to isolate and few cognitive behavioral therapists participated, the collection of difficult situations can be of help for therapists and their training.


Asunto(s)
Terapia Cognitivo-Conductual , Relaciones Profesional-Paciente , Psicoterapia/educación , Psicoterapia/métodos , Humanos , Encuestas y Cuestionarios
13.
BMJ ; 367: l6099, 2019 Dec 16.
Artículo en Inglés | MEDLINE | ID: mdl-31843743
14.
Pathologe ; 40(Suppl 3): 347-349, 2019 Dec.
Artículo en Alemán | MEDLINE | ID: mdl-31705241

RESUMEN

The label cancer in itself leads to complex psychological reactions in patients that are closely related to previous experiences and self-image. A cancer diagnosis can lead to increased distress and subsequent mental comorbidity such as depression or anxiety disorders. The responsibility of the pathologist, as the person who first uses the label cancer, is high. The pathologist must be conscious and focus not only on the accuracy of the anatomical pathology, but also on the potential influences the wording may have on the mental health of the patient. The word "carcinoma" should only be used in the case of tumors with the respective biological behavior. The example of non-invasive follicular thyroid neoplasm with papillary-like nuclear features shows that changing a label can lead to an improvement in distress and quality of life.


Asunto(s)
Adaptación Psicológica , Salud Mental , Neoplasias/psicología , Estrés Psicológico , Humanos , Patólogos/psicología , Relaciones Profesional-Paciente , Psicooncología/métodos , Calidad de Vida
15.
Br J Nurs ; 28(21): 1380-1386, 2019 Nov 28.
Artículo en Inglés | MEDLINE | ID: mdl-31778332

RESUMEN

BACKGROUND: young-onset dementia (under age 65) varies in many respects to typical aged dementia. Health professionals are centrally involved in supporting individuals and families to cope with the unique challenges that young-onset dementia (YOD) brings. AIMS: this study aimed to explore professionals' perceptions of the key challenges faced by people living with YOD and their families, and how they provide support to this group. METHODS: qualitative interviews were conducted with nine health professionals from a range of health and social care contexts. Data were analysed using interpretative phenomenological analysis. FINDINGS: interviewees reported significant challenges in trying to enact support for people with YOD, and families. Particular challenges relate to delays in accessing timely diagnosis, and difficulty in accessing relevant, age-appropriate supports. Interviewees experienced ethical tensions working in this area; interviewees were keen to enact support for the person following diagnosis, but felt constrained by service options that were not relevant or readily accessible to the person, and in some instances, traditional dementia services added to, rather than lessened the stress experienced by those involved. CONCLUSION: dementia and health services should be cognisant of the unique challenges of YOD, and models of service provision should aim to respond accordingly. Nurses and other health professionals should be afforded the necessary structures to support people living with YOD. This relates to dedicated YOD models of care, specifically timely diagnosis, post-diagnosis support and community services that enhance personhood and resilience.


Asunto(s)
Actitud del Personal de Salud , Demencia/terapia , Ética Médica , Personal de Salud/psicología , Accesibilidad a los Servicios de Salud , Necesidades y Demandas de Servicios de Salud , Adaptación Psicológica , Edad de Inicio , Demencia/psicología , Familia/psicología , Humanos , Persona de Mediana Edad , Relaciones Profesional-Familia , Relaciones Profesional-Paciente , Investigación Cualitativa , Apoyo Social
16.
Rev. bioét. derecho ; (47): 93-107, nov. 2019.
Artículo en Español | IBECS | ID: ibc-184868

RESUMEN

Este artículo tiene como propósito reflexionar sobre la situación de estigma y discriminación que afecta a personas con VIH/SIDA. Esto constituye una vulneración a los derechos fundamentales de estas personas y una barrera en el avance hacia la eliminación de la enfermedad. Ya que estudios realizados en diferentes países dan cuenta que las personas en esta condición se sienten discriminadas por la sociedad, y por los profesionales de la salud. Este es uno de los aspectos que ha dificultado el acceso al tratamiento, su adhesión, y educación para el cambio de conducta en los grupos de riesgo


Aquest article té com a propòsit reflexionar sobre la situació d'estigma i discriminació que afecta a persones amb VIH/SIDA. Això constitueix una vulneració dels drets fonamentals d'aquestes persones i una barrera en l'avanç cap a l'eliminació de la malaltia. Estudis realitzats en diferents països exposen que les persones en aquesta condició se senten discriminades per la societat i pels professionals de la salut. Aquest és un dels aspectes que ha dificultat l'accés al tractament, l'adhesió al mateix, i educació per al canvi de conducta en el grups de risc


This article aims to reflect on the situation of stigma and discrimination affecting people with HIV/AIDS. This constitutes a violation of the fundamental rights of these people and a barrier to progress towards the elimination of the disease. Studies carried out in different countries show that people in this condition feel discriminated against by society and by health professionals. This is one of the aspects that has hindered access to treatment, adherence, and behaviour change education in at-risk groups


Asunto(s)
Humanos , Ageísmo/ética , Sexismo , Discriminación Social , Estigma Social , Grupos de Riesgo , Relaciones Profesional-Paciente/ética , Accesibilidad a los Servicios de Salud/legislación & jurisprudencia , Personal de Salud/ética , Síndrome de Inmunodeficiencia Adquirida/epidemiología , Seroprevalencia de VIH , Accesibilidad a los Servicios de Salud/ética , Derechos Humanos
17.
BMC Health Serv Res ; 19(1): 747, 2019 Oct 24.
Artículo en Inglés | MEDLINE | ID: mdl-31651307

RESUMEN

BACKGROUND: Pregnant women and newborns are at high risk for infectious diseases. Altered immunity status during pregnancy and challenges fully vaccinating newborns contribute to this medical reality. Maternal immunization is a strategy to protect pregnant women and their newborns. This study aimed to find out how patient-provider relationships affect maternal vaccine uptake, particularly in the context of a lower middle- income country where limited research in this area exists. METHODS: We conducted semi-structured, in-depth narrative interviews of both providers and pregnant women from four sites in Kenya: Siaya, Nairobi, Mombasa, and Marsabit. Interviews were conducted in either English or one of the local regional languages. RESULTS: We found that patient trust in health care providers (HCPs) is integral to vaccine acceptance among pregnant women in Kenya. The HCP-patient relationship is a fiduciary one, whereby the patients' trusts is primarily rooted in the provider's social position as a person who is highly educated in matters of health. Furthermore, patient health education and provider attitudes are crucial for reinstating and fostering that trust, especially in cases where trust was impeded by rumors, community myths and misperceptions, and religious and cultural factors. CONCLUSION: Patient trust in providers is a strong facilitator contributing to vaccine acceptance among pregnant women in Kenya. To maintain and increase immunization trust, providers have a critical role in cultivating a positive environment that allows for favorable interactions and patient health education. This includes educating providers on maternal immunizations and enhancing knowledge of effective risk communication tactics in clinical encounters.


Asunto(s)
Aceptación de la Atención de Salud/psicología , Complicaciones Infecciosas del Embarazo/prevención & control , Mujeres Embarazadas/psicología , Relaciones Profesional-Paciente , Confianza , Vacunas , Adolescente , Adulto , Actitud del Personal de Salud , Familia , Femenino , Personal de Salud/psicología , Humanos , Inmunización , Kenia , Defensa del Paciente , Educación del Paciente como Asunto , Embarazo , Atención Prenatal/estadística & datos numéricos , Vacunación , Adulto Joven
18.
BMC Health Serv Res ; 19(1): 750, 2019 Oct 25.
Artículo en Inglés | MEDLINE | ID: mdl-31653215

RESUMEN

BACKGROUND: Although healthcare providers are well placed to help smokers quit, implementation of smoking cessation care is still suboptimal. The Ask-Advise-Refer tasks are important aspects of smoking cessation care. We examined to which extent a large and diverse sample of healthcare providers expressed the intention to implement smoking cessation care and which barriers they encountered. We moreover examined to which extent the Ask-Advise-Refer tasks were implemented as intended, and which determinants (in interaction) influenced intentions and the implementation of Ask-Advise-Refer. METHODS: Cross-sectional survey among addiction specialists, anaesthesiologists, cardiologists, general practitioners, internists, neurologists, paediatricians, pulmonologists, ophthalmologists, surgeons, youth specialists, dental hygienists, dentists, and midwives (N = 883). Data were analysed using multivariate linear and logistic regression analyses and regression tree analyses. RESULTS: The Ask-Advice-Refer tasks were best implemented among general practitioners, pulmonologists, midwives, and addiction specialists. Overall we found a large discrepancy between asking patients about smoking status and advising smokers to quit. Participants mentioned lack of time, lack of training, lack of motivation to quit in patients, and smoking being a sensitive subject as barriers to smoking cessation care. Regression analyses showed that the most important determinants of intentions and implementation of Ask-Advise-Refer were profession, role identity, skills, guideline familiarity and collaboration agreements for smoking cessation care with primary care. Determinants interacted in explaining outcomes. CONCLUSIONS: There is much to be gained in smoking cessation care, given that implementation of Ask-Advise-Refer is still relatively low. In order to improve smoking cessation care, changes are needed at the level of the healthcare provider (i.e., facilitate role identity and skills) and the organization (i.e., facilitate collaboration agreements and guideline familiarity). Change efforts should be directed towards the specific barriers encountered by healthcare providers, the contexts that they work in, and the patients that they work with.


Asunto(s)
Personal de Salud/psicología , Relaciones Profesional-Paciente , Fumadores/psicología , Cese del Hábito de Fumar/psicología , Estudios Transversales , Femenino , Adhesión a Directriz , Encuestas de Atención de la Salud , Personal de Salud/estadística & datos numéricos , Humanos , Intención , Masculino , Países Bajos , Guías de Práctica Clínica como Asunto , Embarazo , Fumadores/estadística & datos numéricos
19.
BMC Neurol ; 19(1): 250, 2019 Oct 25.
Artículo en Inglés | MEDLINE | ID: mdl-31653233

RESUMEN

BACKGROUND: Progressive neurological diseases, such as multiple sclerosis, Parkinson's disease, Huntington's disease, significantly interfere with patients' lives, and those of their families. The aim of the research was to establish whether the extent of the information on patients' health conditions, and the way patients learn this information from doctors affect their adaptation to chronic and progressive diseases. METHODS: Qualitative methodology was used for a total of 52 participants (patients with progressive neurological diseases, their family members, and health and social workers). Data were collected using individual, in-depth interviews and focus groups. Analysis of data for interpretation, conceptualization, and re-integration was performed by open, axial, and selective coding. RESULTS: It was determined that adequate information about patients' health status, and the use of coping strategies are related to their adaptation to their disease, and consequently, to their quality of life. The participants often considered the extent of the information provided, and the way they were informed to be inadequate. Receiving the diagnosis, the progression of the disease, and the end of life were found to be the most burdensome. CONCLUSION: Our results show that Czech neurologist should develop better communication skills, particularly for informing patients with progressive neurological diseases. Open communication, emotional support, and support in selecting effective coping strategies can help patients adapt more readily to their disease, and improve their quality of life.


Asunto(s)
Adaptación Psicológica , Enfermedades Neurodegenerativas/psicología , Neurólogos , Relaciones Profesional-Paciente , Adulto , Familia/psicología , Femenino , Grupos Focales , Humanos , Masculino , Persona de Mediana Edad , Calidad de Vida/psicología
20.
J Couns Psychol ; 66(5): 639, 2019 10.
Artículo en Inglés | MEDLINE | ID: mdl-31580126

RESUMEN

Reports an error in "Investigating the impact of early alliance on predicting subjective change at posttreatment: An evidence-based souvenir of overlooked clinical perspectives" by Christoph Flückiger, Peter Hilpert, Simon B. Goldberg, Franz Caspar, Christine Wolfer, Judith Held and Andreea Vîsla (Journal of Counseling Psychology, Advanced Online Publication, Jan 31, 2019, np). In the article, a portion, +γ40ERit, was omitted in the Model 3 formula. The corrected formula is presented in the erratum. All versions of this article have been corrected. (The following abstract of the original article appeared in record 2019-05150-001.) Despite meta-analytic evidence showing that alliance is associated with posttreatment outcomes, several open questions still remain regarding this relation. First, we investigate whether (or not) the progressive aggregation of early alliance assessments increases the alliance-outcome relation across 2 distress and 4 subjective change measures. Second, we investigate whether the alliance-outcome relations using subjective change measures are independent from intake distress and early response. Third, we explore whether the progressive aggregation of the alliance on outcomes becomes particularly apparent between or within therapists again investigating these six outcome measures. Data were drawn from N = 430 patients treated by N = 151 therapists. Patient ratings of early alliance were assessed after Session 1 to 6. For outcome, 2 commonly used distress measures at intake and at posttreatment and 4 measures of retrospectively evaluated subjective change at posttreatment are integrated into a series of multilevel models. The proportion of variance in outcome predicted by alliance scores varied considerably depending on the number of alliance assessments which were aggregated, as well as on the type of outcome assessment (distress vs. subjective change measures) explaining up to 15% of outcome variance. Improvements in the strength of prediction with aggregated alliance assessments were most pronounced for subjective change measures for between-therapist components of the alliance. Examining associations with subjective change measures provides an additional, patient-centered perspective of the relation between early alliance and treatment outcomes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Asunto(s)
Medicina Basada en la Evidencia/tendencias , Relaciones Profesional-Paciente , Adulto , Medicina Basada en la Evidencia/métodos , Femenino , Predicción , Humanos , Masculino , Estudios Retrospectivos , Resultado del Tratamiento
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA