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3.
Vet Rec ; 189(1): 42, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34241886

RESUMO

This month, Debbie Martin discusses how a few simple adjustments to practice procedures can make veterinary care more accessible for neurodiverse clients.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Transtornos do Neurodesenvolvimento , Medicina Veterinária/organização & administração , Animais , Gatos , Humanos , Relações Profissional-Paciente
4.
Clin Interv Aging ; 16: 1315-1325, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34285476

RESUMO

Purpose: The purpose of this case series is to illustrate the complexity of considerations across health (physical and mental), ethical, human rights and practical domains when an older adult with chronic symptoms of mental illness refuses treatment for a serious medical comorbidity. A broad understanding of these considerations may assist health care professionals in navigating this challenging but common aspect of clinical practice. Case Presentation: Three detailed case reports are described. Participants were older adults with an acute presentation of a chronic mental illness, admitted to a specialized older persons mental health inpatient unit (OPMHU) in an Australian metropolitan hospital. Significant comorbid medical issues were detected or arose during the admission and the patient refused the recommended medical intervention. Data extracted from patients' medical records were analyzed and synthesized into detailed case reports using descriptive techniques. Each patient was assessed as lacking capacity for healthcare and treatment consent and did not have relatives or friends to assist with supported decision-making. Multifaceted aspects of decision-making and management are highlighted. Conclusion: There are multiple complex issues to consider when an older adult with chronic symptoms of mental illness refuses treatment for serious comorbid medical conditions. In addition to optimizing management of the underlying mental illness (which may be impairing capacity to make healthcare decisions), clinicians should adopt a role of advocacy for their patients in considering the potential impact of ageism and stigma on management plans and inequities in physical healthcare. Consultation with specialist medical teams should incorporate multifaceted considerations such as potentially inappropriate treatment and optimum setting of care. Equally important is reflective practice; considering whether treatment decisions may infringe upon human rights or cause trauma.


Assuntos
Pessoal de Saúde/psicologia , Transtornos Mentais/terapia , Relações Profissional-Paciente , Recusa do Paciente ao Tratamento , Idoso , Idoso de 80 Anos ou mais , Austrália , Doença Crônica , Feminino , Direitos Humanos , Humanos , Masculino , Competência Mental
5.
Reprod Health ; 18(1): 146, 2021 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-34229710

RESUMO

BACKGROUND: Women's satisfaction with childbirth experience is considered as one of the quality indicators of the maternity services across the world. However, there is no guideline for improving the experience of childbirth in Iran that is suitable for women with different cultural, economic, and social statuses. The aim of this study is to make recommendations for practice and propose a clinical guideline for improving the experience of women with vaginal births. METHODS/DESIGN: The study design was a mixed method study with a sequential explanatory approach consisting of three phases. The first phase of the study was a cross-sectional study to identify the predictors of traumatic vaginal childbirth experience among 800 primiparous women from Tabriz health centers who had vaginal birth. Data collection tools in this phase were Childbirth Experience Questionnaire (CEQ) and Support and Control in Birth (SCIB). Both tools were validated for Farsi language. The second phase was a qualitative study with 17 in-depth individual interviews among women who took part in the first phase to better understand their reasons that influenced their childbirth experience either positively or negatively. The third phase of the study was to develop recommendations for a proposed clinical guideline through a Delphi study where maternal health experts were selected and invited to take part in the panel. They first rated the proposed recommendations individually and provided written responses on their own agreement or disagreement with each statement in terms of its impact on childbirth experience, feasibility, acceptability, and cost-effectiveness. After three confirmation rounds, the final conscience was reached by the panel members. RESULTS: The results of the quantitative phase showed that the probability of negative experience of childbirth was increased when physical exercise was not implemented during pregnancy, lacking pain relief options, having fear of childbirth, lacking skin to skin contact with the newborn and being unable to initiate breastfeeding in the first hour after birth (P < 0.05). The analysis of qualitative data revealed 13 major theme categories which were related to women's sense of internal control, external control and support. In the third phase of the study, culturally appropriate recommendations were made and an evidence-based clinical guideline was proposed. The proposed guideline was based on the combination of the quantitative and qualitative phases, a review of the literature, and the opinions of Iranian experts using the Delphi technique. CONCLUSION: Given the high prevalence of negative childbirth experience among Iranian primiparous women, the present study may be of great interest for managers, leaders, policymakers, and care providers to improve the quality of the maternity services. However, further studies are required to translate the recommendations into practice and identify enablers and barriers during the implementation of the proposed guideline. To adopt the recommendations at national level, there is a need to further studies to assess the effectiveness of the proposed guideline within different communities across the region and the country.


Assuntos
Parto Obstétrico/psicologia , Parto/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Satisfação do Paciente , Mulheres/psicologia , Estudos Transversais , Parto Obstétrico/métodos , Feminino , Humanos , Recém-Nascido , Irã (Geográfico) , Parto/etnologia , Gravidez , Relações Profissional-Paciente , Pesquisa Qualitativa , Qualidade da Assistência à Saúde , Confiança
6.
J Anal Psychol ; 66(3): 463-483, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34231894

RESUMO

This paper explores the experience of working as a Jungian analyst through the various phases of the global COVID-19 pandemic, examining the importance of the physical containing space alongside the analyst's internal mind and how technology can both help and hinder understanding. A number of clinical vignettes illustrate the challenge of communicating over a distance, paying particular attention to the way countertransference phenomena can become re-attuned. Reference is made to mythology and symbols of hope, and consideration given to the meaning and purpose of the pandemic.


Assuntos
COVID-19 , Contratransferência , Distanciamento Físico , Relações Profissional-Paciente , Terapia Psicanalítica , Telemedicina , Adulto , Humanos , Teoria Junguiana
7.
J Anal Psychol ; 66(3): 534-545, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34231893

RESUMO

This paper explores the impact of the COVID-19 pandemic on my relationship with analysands and my inner world. I reflect on the role of the archetypal Self during times of existential anxiety that may lead to an experience of 'essential anxiety'. This term refers to a meeting by a fearful ego with an inward recognition of the Self, when faced with threat. The efforts to curb the spread of the pandemic changed our ways of life, while the virus itself threatened our existence in debilitating or outright destructive ways. But what also came into view, in sessions of analysis and supervision, was the creative instinct, and a celebration of life. The soul-to-soul relationship, and the connection with images of the archetypal Self, made the experience of existential anxiety at times an essential experience that facilitated psychological growth. I discuss some advantages of on-line Jungian analysis where, despite distance and partial view, the body still serves as container to hold important psychological material, conferring a sense of wholeness for analyst and analysand. The COVID-19 crisis is terrible and terrifying but it also provides an opportunity for self-regulation and individuation.


Assuntos
Ansiedade/psicologia , COVID-19 , Pessoal de Saúde/psicologia , Individuação , Relações Profissional-Paciente , Terapia Psicanalítica , Autocontrole , Adulto , Humanos , Teoria Junguiana , Suíça , Telemedicina
8.
J Anal Psychol ; 66(3): 546-560, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34231895

RESUMO

COVID-19 has upended the way analysts and psychotherapists practice. Many use the phone for their sessions, many are using video platforms, and many use a combination of the two. Work with adolescents is very challenging in this new modality because of the loss of in-person connection and immediate non-verbal cues. The public health restrictions put in place to manage COVID-19 spread are at odds with the adolescent tasks of adventuring, experimenting and gaining new experiences. In addition, increased anxieties about infection, contamination and invasion are often manifest and adolescents can regress in the face of them. Using seminal ideas from Bion, this article looks at two process examples from adolescent boys who struggled with parts of themselves that felt disturbing and unacceptable. The author discusses the clinical exchanges in detail and offers ideas about the difficulty of creating psychic space when working virtually.


Assuntos
Adaptação Psicológica , Comportamento do Adolescente/psicologia , COVID-19 , Relações Profissional-Paciente , Terapia Psicanalítica , Telemedicina , Adolescente , Humanos , Masculino
9.
J Anal Psychol ; 66(3): 443-462, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34231900

RESUMO

This paper explores how the deadly shadow of COVID-19 passing over the Earth constitutes a collective trauma that frequently opens up or 'triggers' un-remembered personal trauma, and it provides clinical examples of these intersections. The paper further explores how the human imagination, which we normally utilize to make meaning out of traumatic experience, can be hijacked by fear - leading to avoidance of suffering and to illusory formulations and alternative realities such as conspiracy theories. Alternatively, the imagination can be employed in more realistic and creative ways - leading through conscious suffering to healing and wholeness. Which path the imagination takes is shown to depend on the capacity of individuals to feel the full reality of the human condition in general and the exquisite vulnerability of our existence as fragile human beings at this moment in history. Ernest Becker's analysis of our 'denial of death' and his urgency to embrace our common human vulnerability is explored in relation to Jung's early tendency to deny the body. The author proposes that the more creative uses of the imagination, connected to a more humble and realistic apprehension of our common destiny, may be seen in the 'Black Lives Matter' movement that swept the world in the aftermath of the COVID-19 outbreak.


Assuntos
COVID-19 , Medo/psicologia , Imaginação , Ativismo Político , Terapia Psicanalítica , Trauma Psicológico/psicologia , Racismo , Adulto , Humanos , Relações Profissional-Paciente , Telemedicina
10.
J Anal Psychol ; 66(3): 506-516, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34231897

RESUMO

This paper attempts to read the psychological and emotional impact of the COVID-19 pandemic through the archetypal images contained in patients' dreams. In these dreams, symbols related to the power of nature and to extreme danger are paired with feelings of detachment that seem to point to a traumatic dissociation, due to the archetypal experience that erupts in familiar surroundings. Through the humanization of the ineffable experience, dissociation, which in the beginning of the pandemic showed in high levels of anxiety, panic attacks and depersonalization, can be transformed into the overview needed for the search for meaning. The container for this process of transformation is the analyst, the real, virtual or imagined one, and his or her ability to relate and feel.


Assuntos
COVID-19 , Sonhos , Relações Profissional-Paciente , Interpretação Psicanalítica , Terapia Psicanalítica , Processos Psicoterapêuticos , Adulto , Humanos
11.
J Anal Psychol ; 66(3): 379-398, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34231908

RESUMO

Most of the clinical experiences discussed in this article arose from monthly Zoom meetings at Rome's Italian Centre of Analytical Psychology (CIPA). We set up a discussion group in April 2020, one month after lockdown began in Italy, and these monthly online meetings continue to this day. All senior analysts and analysts-in-training at Rome's CIPA, whose backgrounds range from child and adolescent psychotherapy to adult psychotherapy and analysis, to sandplay therapy and medicine and psychiatry, have been participating in these meetings. The group discussions focus on the present time and its impact on us, as well as on our relationships with patients. By further developing these reflections during the lockdown in Italy (9 March - 3 May 2020), it is fair to ask whether a sense of unreality, depersonalization, or derealization has occurred, either in the therapist or patient, and if so, whether it is possible that therapists miss the human contact more than clients. We will mainly refer to clinical and personal experiences as our most precious guidelines.


Assuntos
COVID-19 , Narrativas Pessoais como Assunto , Distanciamento Físico , Relações Profissional-Paciente , Terapia Psicanalítica , Telemedicina , Adulto , Humanos , Pessoa de Meia-Idade , Cidade de Roma , Telecomunicações , Adulto Jovem
12.
Anthropol Med ; 28(2): 188-204, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34196238

RESUMO

'Medical iatrogenesis' was first defined by Illich as injuries 'done to patients by ineffective, unsafe, and erroneous treatments'. Following Lokumage's original usage of the term, this paper explores 'obstetric iatrogenesis' along a spectrum ranging from unintentional harm (UH) to overt disrespect, violence, and abuse (DVA), employing the acronym 'UHDVA' for this spectrum. This paper draws attention to the systemic maltreatment rooted in the technocratic model of birth, which includes UH normalized forms of mistreatment that childbearers and providers may not recognize as abusive. Equally, this paper assesses how obstetric iatrogenesis disproportionately impacts Black, Indigenous, and People of Color (BIPOC), contributing to worse perinatal outcomes for BIPOC childbearers. Much of the work on 'obstetric violence' that documents the most detrimental end of the UHDVA spectrum has focused on low-to-middle income countries in Latin America and the Caribbean. Based on a dataset of 62 interviews and on our personal observations, this paper shows that significant UHDVA also occurs in the high-income U.S., provide concrete examples, and suggest humanistic solutions.


Assuntos
Parto Obstétrico , Disparidades em Assistência à Saúde/etnologia , Doença Iatrogênica/etnologia , Serviços de Saúde Materna , Antropologia Médica , Feminino , Humanos , Gravidez , Relações Profissional-Paciente , Estados Unidos , Violência/etnologia
13.
J Prim Care Community Health ; 12: 21501327211031767, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34235997

RESUMO

INTRODUCTION: Central sensitization syndromes (CSS) comprise an overlapping group of clinical conditions with the core feature of "pain arising as a direct consequence of a lesion or disease affecting the somatosensory system." Patients with CSS are known to have challenging interactions with healthcare providers contributing to psychological distress and increased healthcare utilization. CSS symptom severity has been associated with psychologic comorbidities, but little is known about how symptom severity relates to provider interactions. METHODS: We performed a cross-sectional survey among patients with CSS in our primary care practices to examine the relationship between CSS symptom severity and experiences with doctors. RESULTS: A total of 775 respondents completed the survey (775/5000; 15.5%) with 72% reporting high CSS symptom severity. About 44% of respondents had a prior diagnosis of fibromyalgia, 72% had migraines, and 28% had IBS. Patients with high CSS symptom severity were more likely to report that doctor(s) had often/always told them that they don't need treatment when they feel like they do (OR = 3.6, 95% CI 1.9-7.5), that doctor(s) often/always don't understand them (OR = 3.1, 95% CI 1.9-5.4), and that doctor(s) often/always seem annoyed with them when compared with respondents with low-moderate CSS symptom severity (OR = 4.8, 95% CI 2.2-12.5). Patients with high CSS symptom severity were at greater than 5 times odds of reporting being told that their symptoms were "all in their head" when compared to patients with low-moderate symptom severity (OR = 5.4, 95% CI 3.3-9.0). CONCLUSION: Patients with CSS spectrum disorders experience frequent pain and decreased quality of life. A high degree of CSS symptom severity is associated with negative experiences with healthcare providers, which deters the establishment of a positive provider-patient relationship. Further research is needed to help understand symptom severity in CSS and harness the power of the therapeutic alliance as a treatment modality.


Assuntos
Sensibilização do Sistema Nervoso Central , Fibromialgia , Estudos Transversais , Humanos , Relações Profissional-Paciente , Qualidade de Vida
15.
Artigo em Inglês | MEDLINE | ID: mdl-34128913

RESUMO

INTRODUCTION: We evaluated the use of text messages to communicate information to patients whose surgeries were postponed because of the COVID-19 restriction on elective surgeries. Our hypothesis was that text messaging would be an effective way to convey updates. METHODS: In this observational study, 295 patients received text messaging alerts. Eligibility included patients who had their surgery postponed and had a cell phone that received text messages. Engagement rates were determined using embedded smart links. Patient survey responses were collected. RESULTS: A total of 3,032 texts were delivered. Engagement rates averaged 90%. Survey responses (n = 111) demonstrated that 98.2% of patients liked the text messages and 95.5% said that they felt more connected to their care team; 91.9% of patients agreed that the text updates helped them avoid calling the office. Patients with higher pain levels reported more frustration with their surgery delay (5.3 versus 2.8 on 1 to 10 scale, P value < 0.01). More frustrated patients wished they received more text messages (24.4% versus 4.6%, P value = 0.04) and found the content less helpful (8.2 versus 9.2 on 1 to 10 scale, P value = 0.01). CONCLUSION: Text messaging updates are an efficient way to communicate with patients during the COVID-19 pandemic.


Assuntos
COVID-19 , Comunicação , Administração da Prática Médica/organização & administração , Relações Profissional-Paciente , Envio de Mensagens de Texto , Idoso , COVID-19/epidemiologia , Procedimentos Cirúrgicos Eletivos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , SARS-CoV-2 , Tempo para o Tratamento
16.
Artigo em Inglês | MEDLINE | ID: mdl-34066381

RESUMO

Despite persistent disparities in maternity care outcomes, there are limited resources to guide clinical practice and clinician behavior to dismantle biased practices and beliefs, structural and institutional racism, and the policies that perpetuate racism. Focus groups and interviews were held in communities in the United States identified as having higher density of Black births. Focus group and interview themes and codes illuminated Black birthing individual's experience with labor and delivery in the hospital setting. Using an iterative process to refine and incorporate qualitative themes, we created a framework in close collaboration with birth equity stakeholders. This is an actionable, cyclical framework for training on anti-racist maternity care. The Cycle to Respectful Care acknowledges the development and perpetuation of biased healthcare delivery, while providing a solution for dismantling healthcare providers' socialization that results in biased and discriminatory care. The Cycle to Respectful Care is an actionable tool to liberate patients, by way of their healthcare providers, from biased practices and beliefs, structural and institutional racism, and the policies that perpetuate racism.


Assuntos
Serviços de Saúde Materna , Relações Profissional-Paciente , Feminino , Pessoal de Saúde , Humanos , Gravidez , Pesquisa Qualitativa , Respeito , Estados Unidos
17.
Clin Interv Aging ; 16: 1173-1184, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34188460

RESUMO

Purpose: To determine the effectiveness of rehabilitation nursing program interventions in patients with acute ischemic stroke. Patients and Methods: An assessment-blinded randomized controlled trial was conducted at a tertiary referral hospital in China. Eligible patients were stratified according to their weighted corticospinal tract lesion load and then randomly assigned to an experimental group (n = 121) or a control group (n = 103). The experimental group received rehabilitation nursing from well-trained, qualified nurses (30 minutes per session, two sessions per day for seven consecutive days). The control group received therapist-led rehabilitation with the same timing and frequency. Comparative analysis of the primary outcomes was performed to determine non-inferiority with a predetermined non-inferiority margin. The primary outcomes were the Motor Assessment Scale, Fugl-Meyer Assessment, and the Action Research Arm Test assessed at baseline and after seven days of treatment. The secondary outcomes were the modified Barthel Index, the National Institutes of Health Stroke Scale, and the modified Rankin Scale, evaluated before and after the intervention and at 4 and 12 weeks of follow-up. Results: Two hundred participants completed the trial. In both groups, all outcomes improved significantly after seven days and at follow-ups. The rehabilitation nursing program was non-inferior to therapist-led treatment with lower 95% confidence limits beyond the margins for primary outcomes (P < 0.001). Conclusion: Both treatments had comparable effects; however, no definite conclusion could be drawn. Adequately powered studies are required.


Assuntos
Isquemia Encefálica/enfermagem , AVC Isquêmico/enfermagem , Enfermagem em Reabilitação/métodos , Reabilitação do Acidente Vascular Cerebral/métodos , Idoso , China , Terapia por Exercício/enfermagem , Humanos , Masculino , Pessoa de Meia-Idade , Relações Profissional-Paciente , Acidente Vascular Cerebral/terapia , Resultado do Tratamento
18.
Comunidad (Barc., Internet) ; 23(1): 0-0, mar.-jun. 2021. tab, graf, ilus
Artigo em Espanhol | IBECS | ID: ibc-201955

RESUMO

Mejorar el estado de salud de la población general no es tarea fácil. Hacerlo en el caso de colectivos desfavorecidos es aún más complicado. Presentamos una intervención inédita de educación para la salud desarrollada en el Centro Penitenciario Araba/Álava mediante una estrategia de comunicación altamente eficaz y eficiente. Con acciones informativas sencillas, vehiculizadas por un canal de comunicación existente, se ha conseguido mejorar la adherencia a la medicación de la población reclusa. El Programa «Tu medicación te aporta un plus», desarrollado en un contexto de escasez de recursos y dirigido a un target de población con necesidades complejas, se ha retroalimentado a través de la participación de las personas reclusas y está plenamente implantado, con una trayectoria de más de 3 años. Detallamos su puesta en marcha y los resultados obtenidos, especialmente el impacto en la salud mental y calidad de vida de la población reclusa. Aportamos una estrategia de comunicación y educación en salud de bajo coste, que promueve el empoderamiento individual y colectivo, y es válido y aplicable tanto en el ámbito penitenciario como en otros contextos comunitarios: centros educativos, sociales y sanitarios. El objetivo del estudio es mejorar la salud y la calidad de vida de las personas reclusas a través de un programa de intervención adaptado a sus características y necesidades


Improving the health of the general population is not an easy task. In the case of disadvantaged groups it is even more complicated. We report an unprecedented health education intervention carried out at Araba/Álava Prison Centre by means of a highly effective and efficient communication strategy. With simple explanatory actions, conveyed by an existing communication channel, it was possible to improve the prison population's medication adherence. "Your medication gives you a plus" Programme, carried out against a backdrop of scarcity of resources and targeted at a population with complex needs, has been fed back through the participation of inmates and has been fully implemented over more than three years. We outline implementation of the programme and its results, especially the impact on mental health and quality of life of the prison population. We provide a low-cost health education and communication strategy, which promotes individual and group empowerment, and is valid and applicable both in the prison setting and in other community contexts: educational, social and health centres


Assuntos
Humanos , Masculino , Feminino , Prisioneiros/psicologia , Participação da Comunidade , Prisões/organização & administração , Comunicação em Saúde/métodos , Nível de Saúde , Educação em Saúde/métodos , Qualidade de Vida , Cooperação e Adesão ao Tratamento , Saúde Mental , Relações Profissional-Paciente , Inquéritos e Questionários , Sistemas de Medicação/organização & administração , Alfabetização/estatística & dados numéricos
19.
CMAJ Open ; 9(2): E570-E575, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34021015

RESUMO

BACKGROUND: Factors influencing the quality of end-of-life communication are relevant to improving end-of-life care. We assessed the quality of end-of-life communication and influencing factors in 2 intensive care unit (ICU) cohorts at high risk of death: patients living in nursing homes and those on extracorporeal membrane oxygenation (ECMO). METHODS: This retrospective cohort study included admissions to 4 ICUs in Winnipeg, Manitoba, from 2000 to 2017. We identified cohorts and influencing factors from the Winnipeg ICU database and by manual chart review. We assessed quality of end-of-life communication using 18 validated, binary quality indicators to calculate a weighted, scaled, composite score (range 0-100). We used median regression to identify factors associated with the composite score. RESULTS: The ECMO cohort (n = 109) was younger than the nursing home cohort (n = 230), with longer hospital stays and higher disease severity. Mean composite scores of end-of-life communication were extremely low in both cohorts (mean 48.5 [standard error of the mean (SEM) 1.7] for the nursing home cohort, 49.1 [SEM 2.5] for the ECMO cohort). Patient characteristics associated with higher median composite scores were older age (5.0 per decade, 95% confidence interval [CI] 2.1-7.8) and lower (worse) Glasgow Coma Scale (GCS) scores (1.8 per GCS point, 95% CI 0.5-3.2). The median composite score rose significantly over time (1.7 per year, 95% CI 0.5-2.8). INTERPRETATION: The quality of end-of-life communication in ICUs is poor, and factors associated with better prognosis are also associated with worse communication. Direct and early communication should occur with all patients in the ICU and their surrogates, not just those who are believed most likely to die.


Assuntos
Barreiras de Comunicação , Estado Terminal , Morte , Relações Profissional-Paciente/ética , Qualidade de Vida , Assistência Terminal , Revelação da Verdade/ética , Planejamento Antecipado de Cuidados/ética , Idoso , Canadá/epidemiologia , Estado Terminal/mortalidade , Estado Terminal/psicologia , Oxigenação por Membrana Extracorpórea/métodos , Oxigenação por Membrana Extracorpórea/mortalidade , Oxigenação por Membrana Extracorpórea/psicologia , Feminino , Humanos , Unidades de Terapia Intensiva/ética , Unidades de Terapia Intensiva/normas , Unidades de Terapia Intensiva/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Casas de Saúde/ética , Casas de Saúde/estatística & dados numéricos , Prognóstico , Qualidade da Assistência à Saúde/organização & administração , Qualidade da Assistência à Saúde/normas , Medição de Risco , Índice de Gravidade de Doença , Assistência Terminal/métodos , Assistência Terminal/psicologia
20.
BMC Pregnancy Childbirth ; 21(1): 349, 2021 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-33934698

RESUMO

BACKGROUND: Although there is growing recognition of the importance of person-centered maternity care, the needs and perspectives of pregnant adolescents are rarely considered. The purpose of this study was to compare the maternity care experiences of Mexican-origin adolescents in Guanajuato, Mexico and Fresno, California from both youth and healthcare provider perspectives. METHODS: Qualitative interviews and focus groups were conducted with a total of 89 respondents, including 74 pregnant and parenting adolescents as well as 15 providers between December 2016 and July 2017. Adolescents also completed a short demographic survey prior to participation. Transcripts in English and Spanish were coded and thematically analyzed using Dedoose software. Results were compared by location and between youth and providers. RESULTS: Four themes emerged regarding patient-provider interactions: the need for communication and clear explanations, respectful versus judgmental providers, engaging youth in decision-making, and a focus on the age of the youth and their partners. While youth had similar perspectives and priorities in both locations, youth in Mexico reported more negative healthcare experiences than youth in California. Perspectives varied between the youth and providers, with providers in both California and Mexico identifying several structural challenges in providing quality care to adolescents. In California, challenges to supporting immigrant Latina adolescents and their families included language and translation issues as well as barriers to care due to immigration status and documentation. In both locations, providers also mentioned high patient caseloads and their own concerns about the youth's life choices. CONCLUSION: Youth-centered care requires more effective and respectful patient-provider communication, where adolescents are engaged in their healthcare decision-making and delivery options. Changes in patient-provider interactions can help improve the maternity care experiences and outcomes of Latina adolescents. Healthcare systems and providers need to reconfigure their approaches to focus on the needs and priorities of adolescents.


Assuntos
Tomada de Decisões , Pessoal de Saúde/psicologia , Serviços de Saúde Materna , Mães/psicologia , Adolescente , Atitude do Pessoal de Saúde , California , Comunicação , Feminino , Grupos Focais , Hispano-Americanos/psicologia , Humanos , Entrevistas como Assunto , México , Gravidez , Relações Profissional-Paciente , Pesquisa Qualitativa , Respeito
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