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4.
BMC Palliat Care ; 18(1): 59, 2019 Jul 17.
Artigo em Inglês | MEDLINE | ID: mdl-31315678

RESUMO

BACKGROUND: Gender disparities of specific symptoms and problems have frequently been observed in palliative care patients, but research rarely focused on the range of problems and needs affected by gender. METHODS: We conducted semi-structured interviews with patients and healthcare professionals (HCPs) of a hospital-based palliative care unit to examine gender effects on patients' problems and needs based on systematically gathered qualitative data. Content analysis was used to identify emerging themes with data coded using MAXQDA. RESULTS: Ten patients (5 female, 5 male) and 17 HCPs (12 female, 5 male) were interviewed. Seven categories of gender-specific problems and needs emerged: "physical symptoms, care and body image", "psychological symptoms and emotional response", "interaction with the palliative care team", "use of professional supportive measures", "activation of informal social networks", "decision-making", and "preservation of autonomy and identity". Both patients and HCPs felt that female patients adopt more expressive coping strategies, have stronger need for communication with and support of HCPs, and activate an extended social network for support and decision-making. Further, both groups thought that male patients mainly rely on social support from partners, have higher expectations to be cared for at home, and have higher need for preservation of autonomy. CONCLUSION: Gender relevantly impacts patients' problems and needs during palliative care. Therefore, gender-sensitive palliative care that acknowledges the patient's individual situation and respective ramifications are required.


Assuntos
Pessoal de Saúde/psicologia , Fatores Sexuais , Adaptação Psicológica , Adulto , Idoso , Feminino , Alemanha , Acesso aos Serviços de Saúde , Humanos , Entrevistas como Assunto/métodos , Masculino , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Cuidados Paliativos/métodos , Cuidados Paliativos/psicologia , Cuidados Paliativos/normas , Pesquisa Qualitativa , Apoio Social , Inquéritos e Questionários
5.
Isr J Health Policy Res ; 8(1): 58, 2019 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-31266531

RESUMO

BACKGROUND: Organizational language practice and policy are not neutral elements but reflect social and political power relations. The micro-level of working groups is subject to the influence of political conflicts and power relations at the macro-level. In conflict zones in particular, these involve complex considerations. Consequently, the present research sought to examine tensions arising from the language spoken among mixed Jewish-Arab teams in Israeli public hospitals. METHODS: In-depth interviews were conducted during 2016-2017, with 50 Jewish and Arab healthcare practitioners - 10 managers, 20 physicians, and 20 nurses - employed in 11 public hospitals in Israel. RESULTS: Our interviews with healthcare practitioners revealed that speaking Arabic in the presence of the patient (not with the patient) may evoke negative feelings and resentment among both Jewish patients and colleagues. Moreover, conflicting attitudes may come into play when Arab practitioners speak Arabic among themselves. Two contexts of language use in Israeli public hospitals can be noticed: the language used in the presence of the patient; and the language used among the practitioners when no patient is present. The former involves the principles of cultural and linguistic competency, and is therefore governed by clear guidelines and procedures. The latter echoes the tensions between the two ethno-national groups in Israel, Jews and Arabs, and is not regulated by a clear policy formulated by the Ministry of Health or by the hospitals' managements. CONCLUSIONS: Our analysis of language practice and policy as a multi-leveled phenomenon, where the micro-level of everyday interactions is influenced by the macro-level of political life, indicates a need for meso-level policy, led by the Ministry of Health. A policy of linguistic competency should be publicized and enforced to ensure that in the presence of the patient, practitioners speak a language s/he understands. This policy should also stipulate that among mixed teams of healthcare professionals every language is permissible, while the language spoken in a particular context should be understood by everyone present.


Assuntos
Barreiras de Comunicação , Pessoal de Saúde/psicologia , Política de Saúde/tendências , Comunicação Interdisciplinar , Adulto , Assistência à Saúde Culturalmente Competente/normas , Assistência à Saúde Culturalmente Competente/tendências , Feminino , Pessoal de Saúde/estatística & dados numéricos , Humanos , Entrevistas como Assunto/métodos , Israel , Masculino , Pesquisa Qualitativa
6.
BMC Palliat Care ; 18(1): 54, 2019 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-31288816

RESUMO

BACKGROUND: Early start of palliative care improves the quality of life of eligible patients and their relatives. However, in hospital, patients who could benefit from palliative care are often not identified timely. The aim of this study is to assess how hospital-based nurses and physicians define the palliative phase, how they identify the palliative phase and what difficulties they face. METHODS: Semi-structured interviews were held with ten nurses and 18 physicians working at seven hospitals in the Netherlands. Data was analysed using thematic analysis. RESULTS: Nurses and physicians feel insecure about how to define the palliative phase and differentiate between an acute and extended phase. Great variation existed in what life expectancy is attributed to each phase. A variety of ways to identify the palliative phase were described: 1) Prognostication. 2) Treatment trade-off. 3) Assessment of patients' preferences and needs. 4) Interprofessional collaboration. Professionals base prognostication on their experience but also search for clinical indicators. When benefits of treatment no longer outweigh the negatives, this was considered an, albeit late, identification point. To start a conversation on a patients' palliative care needs was found to be difficult. Therefore, some respondents wait for patients to vocalize preferences themselves. Many professionals rely on interprofessional collaboration for identification, however uncertainty exist about responsibilities. Difficulties in identification occurred because of variance in definitions, unpredictability of non-oncological diseases, focus on treatment and difficulties in communication and collaboration. CONCLUSION: These results provide insight into the challenges and difficulties hospital-based professionals experience in timely identification of patients with palliative care needs.


Assuntos
Recursos Humanos de Enfermagem no Hospital/psicologia , Cuidados Paliativos/normas , Médicos/psicologia , Adulto , Atitude do Pessoal de Saúde , Feminino , Humanos , Entrevistas como Assunto/métodos , Masculino , Pessoa de Meia-Idade , Países Baixos , Recursos Humanos de Enfermagem no Hospital/estatística & dados numéricos , Cuidados Paliativos/tendências , Médicos/estatística & dados numéricos , Pesquisa Qualitativa , Qualidade de Vida/psicologia
7.
BMC Palliat Care ; 18(1): 53, 2019 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-31288821

RESUMO

BACKGROUND: Parkinson's disease (PD) is a chronic and neurodegenerative disease associated with a wide variety of symptoms. The risk of complications increases with progression of the disease. These complications have a tremendous impact on the quality of life of people with PD. The aim of this study was to examine health care professionals' experiences of potential barriers and facilitators in providing palliative care for people with PD in the Netherlands. METHODS: This was a qualitative descriptive study. The data were collected from 10 individual in-depth interviews and three focus groups (n = 29) with health care professionals. Health care professionals were selected based on a positive answer to the question: "In the past 2 years, did you treat or support a person with PD who subsequently died?" The data were analyzed by thematic text analysis. RESULTS: Health care professionals supported the development of a palliative care system for PD but needed to better understand the essence of palliative care. In daily practice, they struggled to identify persons' needs due to interfering PD-specific symptoms such as cognitive decline and communication deficits. Timely addressing the personal preferences for providing palliative care was identified as an important facilitator. Health care professionals acknowledged being aware of their lack of knowledge and of their little competence in managing complex PD. Findings indicate a perceived lack of care continuity, fragmentation of services, time pressure and information discontinuity. CONCLUSIONS: Health care professionals experienced several facilitators and barriers to the provision of palliative care to people with PD. There is a need to improve the knowledge on complex PD and the continuity of information, as well as optimize coordination and deliver care based on a persons' preferences. Additional training can help to become more knowledgeable and confident.


Assuntos
Pessoal de Saúde/psicologia , Doença de Parkinson/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Atitude do Pessoal de Saúde , Feminino , Grupos Focais/métodos , Pessoal de Saúde/estatística & dados numéricos , Humanos , Entrevistas como Assunto/métodos , Acontecimentos que Mudam a Vida , Masculino , Pessoa de Meia-Idade , Países Baixos , Cuidados Paliativos/métodos , Cuidados Paliativos/normas , Doença de Parkinson/fisiopatologia , Pesquisa Qualitativa
8.
Medicina (Kaunas) ; 55(7)2019 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-31277309

RESUMO

Background and objectives: The inadequate knowledge of complementary and alternative medicine (CAM) among health professionals may put their clients at risk because clients would then find information about CAM from unreliable sources. Clinical psychologists (CPs), as health professionals, also have the opportunity to provide psychoeducation on the latest scientific CAM research for their clients. The current study aimed to explore knowledge and educational needs regarding CAM among CPs in Indonesia because previous studies on exploring CAM knowledge and educational needs regarding CAM were primarily conducted in Western countries. Materials and Methods: Data were collected through semi-structured face-to-face interviews with 43 CPs in public health centers (PHCs) in Indonesia. Most interviews were conducted at the PHCs where the participants worked and lasted for 55 minutes on average. The interview recordings were transcribed and were analyzed using deductive thematic analysis. Results: Five main themes emerged within participants' responses regarding CAM knowledge and educational needs. First (CAM understanding), participants' responses ranged from those with little or no prior knowledge of CAM treatments and uses, to those with much greater familiarity. Second (source of knowledge), participants' access ranged widely in terms of references, from popular to scientific literature. Third (why is it important?), participants identified CAM as an essential part of Indonesian culture and considered it therefore crucial to have this cultural knowledge. Fourth (the challenges and what is needed?), the challenges for improving participants' knowledge came from personal and institutional levels. Fifth (what and how to learn?), participants advised that only CAM treatments that fit in brief psychotherapy sessions should be introduced in professional training. Conclusions: This qualitative study discovered that CAM was neither well-known nor understood widely. Participants advised that professional associations and health institutions should work together in enhancing knowledge of CAM and incorporating CAM education into psychology education.


Assuntos
Terapias Complementares/métodos , Competência Profissional/normas , Psicologia/normas , Terapias Complementares/tendências , Humanos , Indonésia , Entrevistas como Assunto/métodos , Determinação de Necessidades de Cuidados de Saúde , Competência Profissional/estatística & dados numéricos , Psicologia/estatística & dados numéricos , Pesquisa Qualitativa , Inquéritos e Questionários
9.
Nurse Educ Pract ; 38: 120-125, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31260879

RESUMO

Knowing the patient has been identified in research as important in nursing practice. It's a central phenomenon used by nurses in decision-making to provide good and safe qualitative individualized care. The aim of this study was to describe what strategies nursing students' use to 'know the patient'. Interviews with ten nursing students were analysed using a qualitative content analysis. Four themes emerge: Prepare oneself before the first meeting; Creating relationship; Dare to be open and near; Doing the best for the patient, with a main theme: To engage with and care for the unique person. The results show that the nursing students prepare themselves by reading journals, asking staff members for information and research current diseases and medications before the first meeting with the patient. They also think through how to behave and to be present in the encounter and to create a good relationship with the patient which can only be done by spending time together. They are open-minded while listening to the patient to get to know the unique person behind the façade of the patient. This study indicates that knowing the patient is important to nursing students, or else they cannot provide good quality of care for the patients nor be satisfied in their work as nurses. The students also emphasize that if they are not able to get to know the patient, it's better for someone else to take over the responsibility of care for the patient.


Assuntos
Relações Enfermeiro-Paciente , Estudantes de Enfermagem/psicologia , Adulto , Comunicação , Bacharelado em Enfermagem/métodos , Feminino , Humanos , Relações Interpessoais , Entrevistas como Assunto/métodos , Masculino , Pesquisa Qualitativa
10.
MCN Am J Matern Child Nurs ; 44(4): 228-233, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31261300

RESUMO

PURPOSE: The purpose of this study was to explore experiences of women currently with or at high risk for developing postpartum depression (PPD) who were participating in a postpartum support group facilitated by mental health providers. STUDY DESIGN AND METHODS: Using a qualitative design, women ≥18 years of age, who had given birth within the past 2 years, and who were currently attending, or had attended the PPD support group within the past year were invited to participate. The women provided demographic data and participated in a semistructured face-to-face interview. Data were analyzed using qualitative content analysis. RESULTS: Seven women between 27 and 38 years of age participated. Most were married and college educated. At time of the interviews, participants were between 5 months and 2 years postpartum and all reported taking antidepressant medications for their symptoms. Qualitative content analysis revealed three overall themes: attendance, impact, and medication adherence, with associated subthemes. CLINICAL IMPLICATIONS: Women attending a PPD support group facilitated by mental health providers felt supported, were more likely to disclose their symptoms to other women in the same situation, and were able to share their feelings without fear of judgment. Having concerns about antidepressant medication addressed at each meeting promoted medication adherence. Nurses working with childbearing women should be aware of community support services available for women at risk for developing PPD.


Assuntos
Depressão Pós-Parto/diagnóstico , Mães/psicologia , Grupos de Autoajuda , Adulto , Depressão Pós-Parto/epidemiologia , Feminino , Pessoal de Saúde , Humanos , Entrevistas como Assunto/métodos , Serviços de Saúde Mental , Mães/estatística & dados numéricos , Pesquisa Qualitativa , Fatores de Risco , Apoio Social
11.
Rev Bras Enferm ; 72(3): 707-714, 2019 Jun 27.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31269136

RESUMO

OBJECTIVE: to analyze patient safety incidents identified by caregivers of hospitalized children. METHOD: a qualitative, exploratory-descriptive study was carried out with 40 caregivers of children hospitalized in three hospital institutions in the city of Porto Alegre, Rio Grande do Sul State, Brazil, from April to December 2016. Semi-structured, recorded and transcribed interviews were carried out in their entirety, submitted to a thematic analysis using the NVivo 11.0 software. RESULTS: reports related to falls, infant feeding, patient/caregiver identification, medication process, communication, hand hygiene and hygiene of the hospital environment, spread of diseases, relations between caregivers and professionals and care processes/procedures were all cited. FINAL CONSIDERATIONS: communication and the relations among caregivers and professionals are the main contributory factors for patient safety incidents, interfering with the quality of care. The participation of caregivers and engagement in child care may be strategies to be developed to promote a safety culture.


Assuntos
Cuidadores/psicologia , Segurança do Paciente/normas , Brasil , Criança , Criança Hospitalizada/psicologia , Pré-Escolar , Hospitalização , Humanos , Entrevistas como Assunto/métodos , Pesquisa Qualitativa , Gestão de Riscos/métodos , Gestão de Riscos/tendências , Gestão da Segurança/métodos
12.
Rehabil Nurs ; 44(4): 221-229, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31265440

RESUMO

PURPOSE: The aim of the study was to assess the feasibility, safety, and preliminary estimates of effectiveness of Tai Chi on functional outcomes in stroke survivors. DESIGN: A mixed-method study with a single-group repeated-measure design and in-depth interviews. METHODS: Fourteen stroke survivors with hemiplegia were recruited to participate in a Tai Chi program, twice weekly for 12 months. Outcomes included physical function, self-efficacy, and activity of daily living measured at 3-month intervals for 12 months. FINDINGS: Ten participants (mean age, 68.5 years) completed all assessments with significantly improved balance (χ = 14.08, p = .007), flexibility (χ = 11.70, p = .020), and self-efficacy (χ = 21.84, p < .001) over 12 months. Qualitative results highlighted the positive impact on physical improvement, psychological well-being, social support, and improved confidence in performing activities of daily living. CONCLUSION: An adapted Tai Chi program was safe, feasible, and well received in community-dwelling stroke survivors. CLINICAL RELEVANCE: The Tai Chi-based rehabilitation program shows promise for improving function and balance outcomes related to fall prevention in stroke survivors.


Assuntos
Reabilitação do Acidente Vascular Cerebral/normas , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/terapia , Tai Ji/métodos , Atividades Cotidianas , Idoso , Feminino , Humanos , Entrevistas como Assunto/métodos , Masculino , Pessoa de Meia-Idade , Autoeficácia , Reabilitação do Acidente Vascular Cerebral/métodos , Resultado do Tratamento
13.
Rev. Ciênc. Plur ; 5(1): 34-51, jun. 2019. ilus
Artigo em Português | LILACS, BBO - Odontologia | ID: biblio-1007338

RESUMO

Introdução:A assistência desumanizada no parto pode originar informações negativas que são transmitidas entre as gerações, acarretandoem representações sociais. Dessa forma,representações sociais do parto normal por parte do profissional enfermeiro, um dos protagonistas da assistência à saúde da mulher na atenção básica, são importante objeto de estudo, a partir do entendimento que estes profissionais constroem nas realidades em que vivem.Objetivo:Identificar as representações sociais de enfermeiras da atenção básica sobre parto normal.Método:Estudo descritivo, exploratório, qualitativo, realizado com 12 enfermeiras, responsáveis por Equipes de Saúde da Família e que tinham mais de 01 ano de experiência na atenção básica no município de Caruaru/PE, nordeste do Brasil. Foram realizadas entrevistas semi-estruturadas, guiadaspela questão norteadora: Fale-me sobre parto normal. As falas foram submetidas à análise de conteúdo temática proposta por Bardin e interpretadas à luz dos constructos da Teoria das Representações Sociais.Resultados:A partir da análise das falas, emergiram quatro categorias temáticas: Lei da vida, Desejo e negação do parto normal, Insegurança, Imposição para mulheres de baixa renda.Conclusões:As representações que emergiram das falas das enfermeiras apresentam o parto normal como um evento natural, permeado pelo auxílio divino, trazendo o desejo em vivenciá-lo. Entretanto, este fato não é suficiente para que haja uma escolha por este tipo de parto, devido a outros fatores,como a insegurança presente em diferentes momentos e aspectos, bem como a compreensão de que o parto normal é imposto nos serviços públicos de saúde. Dessa forma, compreender as representações sociais do parto normal, pela perspectiva da enfermagem atuante na atenção básica, propicia um olhar sob a educação em saúde no pré-natal, onde são reelaborados os conhecimentos que envolvem este evento (AU).


Introduction:Dehumanized careat birth may give rise to negative information that is transmitted between generations, giving rise to social representations. Thus, these social representations of normal childbirth by the nurse practitioner, one of the protagonists of the assistance to women's health in basic care, are an important object of study, based on the understanding that these professionals construct in the realities in which they live.Objective:To identify the social representations of primary care nurses on normal delivery.Methods:A descriptive, exploratory, qualitative study was carried out with 12 nurses, who were responsible for Family Health Teams and who had more than 01 years of experience in basic care in the city of Caruaru / PE, northeastern Brazil. Semi-structuredinterviews were conducted, guided by the guiding question: Tell me about normal delivery. The speeches were submitted to the analysis of thematic content proposed by Bardin and interpreted in the light of the constructs of Theory of Social Representations. Results:Based on the analysis of the speeches, four thematic categories emerged: Law of life, Desire and denial of normal birth, Insecurity, Imposition for low income women. Conclusions:The representations that emerged from the nurses' statements present normal childbirth as a natural event, permeated by divine help, bringing the desire to experience it. However, this fact is not enough to make a choice for this type of delivery, due to other factors such as the insecurity present at different times andaspects, as well as the understanding that normal delivery is imposed in public health services. In this way, understanding the social representations of normal childbirth, from the perspective of nursing acting in basic care, provides a perspective on prenatal health education, where the knowledge that involves this event is re-elaborated (AU).


Assuntos
Humanos , Adulto , Pessoa de Meia-Idade , Atenção Primária à Saúde , Estratégia Saúde da Família , Parto Normal , Enfermeiros , Brasil , Entrevistas como Assunto/métodos , Pesquisa Qualitativa
14.
Nurse Educ Pract ; 38: 34-39, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31176241

RESUMO

There is no consensus regarding the required education content and competence needed for professionals working in the emergency medical services and only a few countries in Europe staff ambulances with registered nurses. This study aimed to identify common core content in Swedish, Finnish and Belgian university curricula in the education on advanced level for registered nurses in ambulance care and to describe the teachers' perception of the necessary content for the profession as a registered nurse in ambulance care. A deductive research design was used. Three Universities, one from each country; Sweden, Finland and Belgium, participated. Data was generated from curricula and interviews with teachers and analyzed with different approaches of qualitative content analysis. The results showed commonness with respect to core content; the emphasis was mainly on medical knowledge but the content concerning contextual subjects differed between the three universities. The teachers, however, aimed for the students' to acquire a broad competence in clinical reasoning by implementing theory into practice, as well as developing the students' personal aptitude and instilling a scientific awareness. The results suggest that it is possible to create a common curriculum for training of RNs for working in ambulance care.


Assuntos
Currículo/normas , Serviços Médicos de Emergência/métodos , Ambulâncias , Bélgica , Currículo/tendências , Finlândia , Humanos , Entrevistas como Assunto/métodos , Pesquisa Qualitativa , Suécia
15.
Midwifery ; 76: 110-117, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31195219

RESUMO

OBJECTIVES: The research team aimed to understand women's lived experiences during pregnancies with poor prognosis following prenatal detection of Fetal Growth Restriction at the limits of viability (FGRLV). METHODS: Qualitative interviews with six women who had attended a specialist service following a prenatal diagnosis of FGRLV were conducted. The interview data were analysed using interpretative phenomenological analysis. FINDINGS: Three superordinate themes alongside thirteen subthemes were identified. Theme 1 described 'a fine line between supportive and unhelpful' care experiences. A second theme of 'understanding the situation and decisions to be made' described how women faced many uncertainties. The final theme of 'parental responsibility' reflected how women imagined their futures to have been, exploring their embodied parental role and connection to their unborn or young child. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Women highlighted the importance of maternal healthcare teams providing clear information and reassurance to them. They also reported that prior experiences were important to them in influencing their perception of that pregnancy. Furthermore, women reflected on their desperation for a positive outcome. Understanding these factors can enable maternal healthcare teams to facilitate informed decision-making and provide individualised emotional support for women. Our findings will enable maternal care teams to better support women in similar clinical situations.


Assuntos
Retardo do Crescimento Fetal/psicologia , Viabilidade Fetal , Gestantes/psicologia , Adulto , Feminino , Humanos , Entrevistas como Assunto/métodos , Acontecimentos que Mudam a Vida , Gravidez , Pesquisa Qualitativa , Medicina Estatal , Reino Unido
16.
Compr Child Adolesc Nurs ; 42(sup1): 226-233, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31192711

RESUMO

This study aims to explore mothers' experiences in caring for overweight children under five years of age. This study used a descriptive phenomenology approach, with in-depth interviews with ten mothers who had overweight children under five years of age (2-5 years) selected by purposive sampling. The data was then analyzed using thematic analysis based on Collaizi's approach. This study produced eight themes illustrating that mothers were not only unaware of the children's overweight condition, but even felt more pleased to have overweight kids. This caused mothers not to give the optimum effort in limiting their children's food intake. The low awareness mothers had towards their children's overweight condition indicated the need for an intervention program that focuses on overweight children under five years of age to empower the family and increase family awareness in managing obesity early.


Assuntos
Relações Mãe-Filho , Mães/psicologia , Obesidade Pediátrica/complicações , Adulto , Índice de Massa Corporal , Pré-Escolar , Empatia , Feminino , Humanos , Indonésia , Entrevistas como Assunto/métodos , Masculino , Pessoa de Meia-Idade , Mães/estatística & dados numéricos , Obesidade Pediátrica/psicologia , Pesquisa Qualitativa
17.
Compr Child Adolesc Nurs ; 42(sup1): 234-244, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31192714

RESUMO

This study aimed to explore Bugis culture related to feeding practice in children age 0-23 months. The study used a qualitative research method with an ethnographic study approach. Observations and focused group discussions were conducted on 22 caregivers, while in-depth interviews were conducted with a customary leader, two cadres, and a village mindwife. Data analysis applied a thematic analysis with an ethnonursing approach. This study resulted in three themes: giving sweet food, choosing a qualified person to give the first bribe, and delayed feeding of animal-sourced food (ASF) before the age of one year. These results affirm that culture is one of the most influential aspects of feeding children. The culture embraced by parents and society can affect the nutritional intake of children, especially during the first 1000 days of life.


Assuntos
Antropologia Cultural/métodos , Comportamento Alimentar/psicologia , Mães/psicologia , Adulto , Antropologia Cultural/tendências , Cuidadores/psicologia , Feminino , Grupos Focais/métodos , Humanos , Indonésia , Lactente , Recém-Nascido , Entrevistas como Assunto/métodos , Masculino , Pessoa de Meia-Idade , Relações Mãe-Filho , Pesquisa Qualitativa
18.
Work ; 63(2): 269-282, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31156208

RESUMO

BACKGROUND: While investigation of physicians' work experience is often limited to issues of satisfaction or burnout, a broader view of their experiences is lacking. OBJECTIVE: To explore professional experiences, we asked Japanese physicians (N = 18, 12 men and 6 women) of a general hospital to react to so-called "narrative facilitators". METHODS: The narrative facilitators - inspired by clinical psychology, visual sociology and purpose-designed techniques - oriented physicians' narratives towards clinical practise, relationship with peers and context. Transcribed interviews were subject to thematic analysis. RESULTS: The thematic analysis of participants' narratives revealed a lonely physician with a tough job, torn between the ideal of patient-centred care and a clinical reality, which limits these aspirations. Patients emerged as anxious and burdensome consumers of medicine. Feeling neither supported by peers nor the institution, physicians also perceived the society as somewhat negligent, delegating its problem to medicine. Communication difficulties, with patients and peers, and the absence of joyful aspects of the profession constituted fundamental elements of their narratives. CONCLUSIONS: Comprehensive investigation of physicians' lived professional experience could become a key to conceive ways to support them.


Assuntos
Narração , Médicos/psicologia , Adulto , Atitude do Pessoal de Saúde , Feminino , Humanos , Entrevistas como Assunto/métodos , Japão , Masculino , Pesquisa Qualitativa , Trabalho/psicologia
19.
JMIR Mhealth Uhealth ; 7(6): e13162, 2019 06 04.
Artigo em Inglês | MEDLINE | ID: mdl-31165717

RESUMO

BACKGROUND: Homeless smokers want to quit smoking but face numerous barriers to doing so, including pervasive smoking among peers and a lack of social support for quitting. An SMS (short message service) text messaging intervention could address these challenges by providing virtual daily support for homeless smokers who are trying to quit but coping with multiple triggers to smoke. OBJECTIVE: This study aimed to assess whether a free SMS text messaging program, added to evidence-based pharmacotherapy and counseling, improved smoking abstinence among homeless adult smokers. METHODS: From October 2015 to June 2016, we conducted an 8-week pilot randomized controlled trial (RCT) of nicotine patch therapy and weekly in-person counseling with (n=25) or without (n=25) SmokefreeTXT, a free SMS text messaging service administered by the National Cancer Institute (NCI) at Boston Health Care for the Homeless Program. All participants were provided with a mobile phone and a 2-month prepaid voice and text plan at no cost. SmokefreeTXT enrollees were sent 1 to 5 automated SMS text messages daily for up to 8 weeks and could receive on-demand tips for managing cravings, mood symptoms, and smoking lapses. The primary outcome was smoking abstinence, defined as an exhaled carbon monoxide count of <8 parts per million, assessed 14 times over 8 weeks of follow-up, and analyzed using repeated-measures logistic regression with generalized estimating equations. Other outcomes were use of SmokefreeTXT, assessed by data obtained from NCI; perceptions of SmokefreeTXT, assessed by surveys and qualitative interviews; and mobile phone retention, assessed by self-report. RESULTS: Of the SmokefreeTXT arm participants (n=25), 88% (22) enrolled in the program, but only 56% (14) had confirmed enrollment for ≥2 weeks. Among 2-week enrollees, the median response rate to interactive messages from SmokefreeTXT was 2.1% (interquartile range 0-10.5%). Across all time points, smoking abstinence did not differ significantly between SmokefreeTXT and control arm participants (odds ratio 0.92, 95% CI 0.30-2.84). Of SmokefreeTXT enrollees who completed exit surveys (n=15), two-thirds were very or extremely satisfied with the program. However, qualitative interviews (n=14) revealed that many participants preferred in-person intervention formats over phone-based, found the SMS text messages impersonal and robotic, and felt that the messages were too frequent and repetitive. Only 40% (10/25) of SmokefreeTXT arm participants retained their study-supplied mobile phone for the 8-week duration of the trial, with phone theft being common. Storing and charging phones were cited as challenges. CONCLUSIONS: SmokefreeTXT, added to nicotine patch therapy and in-person counseling, did not significantly improve smoking abstinence in this 8-week pilot RCT for homeless smokers. SMS text messaging interventions for this population should be better tuned to the unique circumstances of homelessness and coupled with efforts to promote mobile phone retention over time. TRIAL REGISTRATION: ClinicalTrials.gov NCT02565381; https://clinicaltrials.gov/ct2/show/NCT02565381 (Archived by WebCite at http://www.webcitation.org/78PLpDptZ).


Assuntos
Fumantes/psicologia , Abandono do Hábito de Fumar/métodos , Mensagem de Texto/normas , Adulto , Boston , Feminino , Pessoas em Situação de Rua/psicologia , Pessoas em Situação de Rua/estatística & dados numéricos , Humanos , Entrevistas como Assunto/métodos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Pesquisa Qualitativa , Fumantes/estatística & dados numéricos , Abandono do Hábito de Fumar/psicologia , Abandono do Hábito de Fumar/estatística & dados numéricos , Inquéritos e Questionários , Mensagem de Texto/instrumentação , Mensagem de Texto/estatística & dados numéricos
20.
Nurs Adm Q ; 43(3): 222-229, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31162341

RESUMO

Little is known about how hospital-based nurse managers use electronic health records (EHR) to monitor nurse-sensitive quality measures, or about how they learn to do so. This article describes the role of nurse managers in quality monitoring, their experience in using the EHR to monitor nurse-sensitive quality measures, and their related training. A convenience sample of nurse managers and directors (n = 28) was recruited to participate in semistructured interviews. The resulting data were analyzed, using content analysis. This study revealed 3 components of the nurse manager's quality-monitoring role: monitoring documentation, monitoring practice, and performing investigations. Facilitators for accessing EHR information included ease of navigation, timeliness and accessibility of reports, and usefulness of EHR tools. Participants described a range of formal and informal approaches to learning how to access information for quality monitoring in general and for the EHR specifically. The findings provide direction for further exploration of the EHR structures and processes needed to support nurse managers' information needs and quality-monitoring training.


Assuntos
Registros Eletrônicos de Saúde/normas , Enfermeiras Administradoras/psicologia , Indicadores de Qualidade em Assistência à Saúde/estatística & dados numéricos , Adulto , Feminino , Humanos , Entrevistas como Assunto/métodos , Invenções/tendências , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa
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