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1.
Rev. enferm. UERJ ; 28: e47321, jan.-dez. 2020.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1116094

RESUMO

Objetivo: analisar a produção científica nacional e internacional, buscando as interfaces existentes entre os princípios bioéticos e os cuidados em saúde prestados ao fim da vida às pessoas idosas. Método: revisão integrativa, cuja busca ocorreu entre outubro e novembro de 2019 nas bases de dados Medline via Pubmed, Lilacs e Scopus com os descritores: "Palliative Care", "Aged" e "Bioethics" de 2014-2019. Resultados: a partir dos artigos selecionados, emergiram as seguintes categorias: condutas terapêuticas frente aos cuidados ao fim da vida; tomada de decisão nos cuidados ao fim da vida; e desafios nos cuidados ao fim da vida. Conclusão: destaca-se a relevância dos profissionais manterem o compromisso com a pessoa idosa e sua família de forma a considerar suas subjetividades e preferências e os instrumentalizar para que os cuidados sejam pautados em princípios bioéticos, para assim proporcionar um processo de morte e de morrer com dignidade.


Objective: to examine the Brazilian and international scientific production for connections between bioethical principles and the health care provided to older adults at the end of their lives. Method: between October and November 2019 this integrative review searched the Medline (Pubmed), Lilacs, and Scopus databases using the descriptors: "Palliative Care", "Aged", and "Bioethics" for the period 2014-2019. Results: the following categories emerged from the selected articles: therapeutic conducted with regard to end-of-life care; decision making on end-of-life care; and challenges in end-of-life care. Conclusion: of particular importance is for health professionals to uphold their commitment to older adults and their families, consider their subjectivities and preferences, and empower and equip them so that care is guided by bioethical principles in order to assure a dignified process of dying and death.


Objetivo: examinar la producción científica brasileña e internacional en busca de conexiones entre los principios bioéticos y la atención médica brindada a los adultos mayores al final de sus vidas. Método: entre octubre y noviembre de 2019, esta revisión integradora buscó en las bases de datos Medline (Pubmed), Lilacs y Scopus utilizando los descriptores: "Cuidados paliativos", "Envejecido" y "Bioética" para el período 2014-2019. Resultados: las siguientes categorías surgieron de los artículos seleccionados: terapéutico realizado con respecto a la atención al final de la vida; toma de decisiones sobre la atención al final de la vida; y desafíos en la atención al final de la vida. Conclusión: es de particular importancia que los profesionales de la salud mantengan su compromiso con los adultos mayores y sus familias, consideren sus subjetividades y preferencias, y los empoderen y equipen para que la atención se guíe por principios bioéticos para asegurar un proceso digno de muerte y muerte.


Assuntos
Humanos , Idoso , Idoso de 80 Anos ou mais , Atitude do Pessoal de Saúde , Cuidados Paliativos na Terminalidade da Vida/ética , Temas Bioéticos , Pessoalidade , Morte , Relações Profissional-Família/ética , Relações Profissional-Paciente/ética , Atitude Frente a Morte , Valor da Vida
3.
Yakugaku Zasshi ; 140(10): 1275-1284, 2020.
Artigo em Japonês | MEDLINE | ID: mdl-32999206

RESUMO

In April 2018, as part of their fifth-year pre-clinical education curriculum, pharmacy students at Setsunan University attended a lecture presented by hepatitis B patients and their lawyer entitled "Lecture by Hepatitis B Patients". This lecture was intended to help the students to understand the circumstances and difficulties encountered by hepatitis B patients on a daily basis. For this study, we conducted questionnaire surveys of the pharmacy students before and after the lecture. The survey items pertained to students' knowledge about hepatitis B (e.g., its spread and infection possibility in daily life). Students' responses before and after the lecture varied depending on the survey topic. Hepatitis B knowledge acquired by the students in their junior year increased after the lecture; moreover, attitudes to hepatitis B patients and understanding of the difficulties and prejudice that they experienced showed a significant change. For example, responses to the items, "Feel sympathy for patients suffering from discrimination and prejudice" and "Hard to work…" were much more sympathetic after the lecture; additionally, students were less likely to "Fear infection when near patients" and more likely "… to associate with patients". Thus, the "Lecture by Hepatitis B Patients" had a significant impact on the pharmacy students' perceptions of these patients, allowing them to cultivate greater empathy. From an educational standpoint, it is of the utmost importance for pharmacy/medical students to develop their humanity as members of healthcare teams. Educational real-world experiences, such as the "Lecture by Hepatitis B Patients", provide opportunities for this development.


Assuntos
Atividades Cotidianas , Educação em Farmácia/métodos , Empatia , Hepatite B/psicologia , Participação do Paciente/métodos , Pacientes/psicologia , Aprendizagem Baseada em Problemas/métodos , Relações Profissional-Paciente , Estudantes de Farmácia/psicologia , Atitude Frente a Saúde , Currículo , Humanos , Conhecimento , Inquéritos e Questionários
4.
Annu Int Conf IEEE Eng Med Biol Soc ; 2020: 1512-1515, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-33018278

RESUMO

The patient-clinician relationship is known to significantly affect the pain experience, as empathy, mutual trust and therapeutic alliance can significantly modulate pain perception and influence clinical therapy outcomes. The aim of the present study was to use an EEG hyperscanning setup to identify brain and behavioral mechanisms supporting the patient-clinician relationship while this clinical dyad is engaged in a therapeutic interaction. Our previous study applied fMRI hyperscanning to investigate whether brain concordance is linked with analgesia experienced by a patient while undergoing treatment by the clinician. In this current hyperscanning project we investigated similar outcomes for the patient-clinician dyad exploiting the high temporal resolution of EEG and the possibility to acquire the signals while patients and clinicians were present in the same room and engaged in a face-to-face interaction under an experimentally-controlled therapeutic context. Advanced source localization methods allowed for integration of spatial and spectral information in order to assess brain correlates of therapeutic alliance and pain perception in different clinical interaction contexts. Preliminary results showed that both behavioral and brain responses across the patient-clinician dyad were significantly affected by the interaction style.Clinical Relevance- The context of a clinical intervention can significantly impact the treatment of chronic pain. Effective therapeutic alliance, based on empathy, mutual trust, and warmth can improve treatment adherence and clinical outcomes. A deeper scientific understanding of the brain and behavioral mechanisms underlying an optimal patient-clinician interaction may lead to improved quality of clinical care and physician training, as well as better understanding of the social aspects of the biopsychosocial model mediating analgesia in chronic pain patients.


Assuntos
Encéfalo , Dor Crônica , Manejo da Dor , Relações Profissional-Paciente , Encéfalo/fisiologia , Humanos , Imagem por Ressonância Magnética , Percepção da Dor
7.
Soins ; 65(845): 10-13, 2020 May.
Artigo em Francês | MEDLINE | ID: mdl-32862956

RESUMO

There is a close link between care and communication. The purpose of the study is to evaluate therapeutic communication when bed washing patients, which dependent patients may experience as an aggressive treatment. Improved comfort, improved serenity, less intense pain, lower pulse and blood pressure have been observed in patients looked after by caregivers practising therapeutic communication.


Assuntos
Banhos , Cuidadores/psicologia , Comunicação , Relações Profissional-Paciente , Humanos , Resultado do Tratamento
8.
Rech Soins Infirm ; (141): 70-77, 2020 06.
Artigo em Francês | MEDLINE | ID: mdl-32988193

RESUMO

Patient education prior to discharge from hospital is a practice developed under the name of "discharge education" (DE) in the Anglo-Saxon countries. This new form of patient education targets acute and sometimes chronic patients and concerns all hospital specialties ; it aims to facilitate the transition "hospitalhome" and avoid early readmissions. In this article we want to outline a framework of indications and effects of DE, starting from an analysis of the international literature, and identify its quality criteria in order to forecast the conditions of its application to our context. A scoping review allowed us to examine 43 scientific studies specifically related to the description, analysis and evaluation of discharge education, as well as some recommendations. Almost half of the studies are published in Nursing Science journals. DE is an intense and short educational intervention (30 minutes to an hour) delivered mainly in acute situations. Paediatrics has the largest number of publications together with post-operative care. In most studies, DE is effective in improving clinical and psychosocial parameters, reducing early admissions, increasing skills and patient compliance. To achieve its goals, DE must be structured and include systematic follow up. Focused on the patient's needs and his learning ability, it uses a specific interactive pedagogy to which caregivers must be trained. The analysis of the international research leaves no doubt about the positive contributions of DE. It would be important for caregivers and policymakers to look at it as an opportunity to improve the quality of care and to humanize it.


Assuntos
Alta do Paciente , Educação de Pacientes como Assunto , Cuidadores/psicologia , Humanos , Relações Profissional-Paciente , Qualidade da Assistência à Saúde
10.
BMC Public Health ; 20(1): 1337, 2020 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-32878612

RESUMO

BACKGROUND: People who are houseless (also referred to as homeless) perceive high stigma in healthcare settings, and face disproportionate disparities in morbidity and mortality versus people who are housed. Medical students and the training institutions they are a part of play important roles in advocating for the needs of this community. The objective of this study was to understand perceptions of how medical students and institutions can meet needs of the self-identified needs of the houseless community. METHODS: Between February and May 2018, medical students conducted mixed-methods surveys with semi-structured qualitative interview guides at two community-based organizations that serve people who are houseless in Portland, Oregon. Medical students approach guests at both locations to ascertain interest in participating in the study. Qualitative data were analyzed using thematic analysis rooted in an inductive process. RESULTS: We enrolled 38 participants in this study. Most participants were male (73.7%), white (78.9%), and had been houseless for over a year at the time of interview (65.8%). Qualitative themes describe care experiences among people with mental health and substance use disorders, and roles for medical students and health-care institutions. Specifically, people who are houseless want medical students to 1) listen to and believe them, 2) work to destigmatize houselessness, 3) engage in diverse clinical experiences, and 4) advocate for change at the institutional level. Participants asked healthcare institutions to use their power to change laws that criminalize substance use and houselessness, and build healthcare systems that take better care of people with addiction and mental health conditions. CONCLUSIONS: Medical students, and the institutions they are a part of, should seek to reduce stigma against people who are houseless in medical systems. Additionally, institutions should change their approaches to healthcare delivery and advocacy to better support the health of people who are houseless.


Assuntos
Assistência à Saúde , Pessoas em Situação de Rua , Transtornos Mentais , Defesa do Paciente , Relações Profissional-Paciente , Estigma Social , Estudantes de Medicina , Adulto , Atitude Frente a Saúde , Comportamento Aditivo , Feminino , Necessidades e Demandas de Serviços de Saúde , Pessoas em Situação de Rua/psicologia , Habitação , Humanos , Masculino , Transtornos Mentais/complicações , Saúde Mental , Pessoa de Meia-Idade , Oregon , Saúde da População , Pesquisa Qualitativa , Mudança Social , Apoio Social , Transtornos Relacionados ao Uso de Substâncias/complicações , Inquéritos e Questionários
11.
Soins Pediatr Pueric ; 41(315): 17-19, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32951690

RESUMO

The representation that parents have of their child has an impact on their child's future. Similarly, what the therapist understands of his patient has an impact on the therapeutic process. Through the presentation of clinical situations put into perspective with theoretical elements, it is possible to propose a model of understanding of these effects via the concept of anticipatory illusion.


Assuntos
Antecipação Psicológica , Desenvolvimento Infantil , Ilusões/psicologia , Criança , Humanos , Modelos Psicológicos , Pais/psicologia , Relações Profissional-Paciente
12.
Orv Hetil ; 161(32): 1322-1330, 2020 08.
Artigo em Húngaro | MEDLINE | ID: mdl-32750020

RESUMO

International migration is a current and growing phenomenon, which has become an increasingly critical issue in Europe since 2013 and this has posed new challenges to the healthcare systems of the European Union (EU). The need for 'culturally competent' healthcare systems that can adapt and respond to the needs of a changing population while taking into account cultural, religious, linguistic and gender diversity, has become more and more an agenda across Europe. Nowadays, it is widely accepted that inequalities in health conditions are mainly due to socio-economic factors, and disparities are particularly evident among certain ethnic and cultural minority groups. Additionally, minorities often face difficulties during their attempts in accessing healthcare, including linguistic and cultural barriers. These barriers are primarily manifested in communication and other interactions between the patient and the healthcare provider. Communication difficulties and misunderstandings may lead to frustration and prejudice among caregivers and also to a lack of cooperation from patients, and consequently, may contribute to poorer health outcomes. Therefore, in order to ensure the highest quality of care for migrants, ethnic or other minority populations in our increasingly diverse societies, it is of crucial importance to overcome the difficulties arising from linguistic, cultural and religious differences. To achieve these goals, an important step is the development of intercultural competences within the healthcare system. Our paper discusses the concept, content and opportunities for the development of intercultural competence in clinical and healthcare settings. Orv Hetil. 2020; 161(32): 1322-1330.


Assuntos
Barreiras de Comunicação , Competência Cultural , Assistência à Saúde Culturalmente Competente , Assistência à Saúde/métodos , Pessoal de Saúde/psicologia , Disparidades em Assistência à Saúde , Relações Profissional-Paciente , Qualidade da Assistência à Saúde , Comunicação , Diversidade Cultural , Europa (Continente) , Humanos , Hungria , Grupos Minoritários , Multilinguismo , Migrantes
13.
PLoS One ; 15(8): e0236706, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32760146

RESUMO

INTRODUCTION: Due to provider shortages, it is probable that non-Latinx health care providers (HCPs) will treat Latinx patients. Because of this discrepancy, both providers and patients are likely to experience barriers and cultural differences during medical encounters. This article discusses select cultural factors and behaviors such as language, communication styles, and health care practices of Latinx families through the lens of their non-Latinx HCPs. The purpose of this study was to examine how non-Latinx HCPs perceive and describe certain behaviors they observe during healthcare visits with Latinx patients and families, and to illustrate how those behaviors can alternatively be interpreted as representing Latinx cultural norms. METHODS: This qualitative study used a template coding approach to examine narrative interviews conducted with 18 non-Latinx HCPs to report how they described interactions with and the behaviors of their Latinx patients. Template codes were based on well-established Latinx cultural norms (e.g., familismo, respeto, personalismo, simpatía, confianza). RESULTS: Many HCP descriptions of Latinx patient behaviors were coded into the Latinx cultural values categories (familismo, personalismo, simpatía, respeto, and confianza) by the research team. Results suggest that HCPs were not aware of how several of their patients' behaviors may be culturally grounded, and that cultural differences between HCPs and their Latinx patients may exist. DISCUSSION: Understanding how Latinx-specific cultural norms may be exhibited by Latinx patients and their families during healthcare encounters has potential to improve providers' understanding of patient behavior, helping to promote culturally congruent care for Latinxs.


Assuntos
Assistência à Saúde/normas , Comportamentos Relacionados com a Saúde/etnologia , Pessoal de Saúde/psicologia , Hispano-Americanos/psicologia , Pesquisa Qualitativa , Adulto , Família , Feminino , Equidade em Saúde , Humanos , Renda , Masculino , Relações Profissional-Paciente
14.
PLoS One ; 15(8): e0236995, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32785245

RESUMO

Blended therapy is a new approach combining advantages of face-to-face psychotherapy and Internet- and mobile-based interventions. Acceptance is a fundamental precondition for its implementation. The aim of this study was to assess 1) the acceptance of psychotherapists towards blended therapy, 2) the effectiveness of an acceptance facilitating intervention (AFI) on psychotherapists' acceptance towards blended therapy and 3) to identify potential effect moderators. Psychotherapists (N = 284) were randomly assigned to a control (CG) or an intervention group (IG). The IG received a short video showing an example of blended therapy, the CG an attention placebo video. Both groups received a reliable online questionnaire assessing acceptance, effort expectancy, performance expectancy, facilitating conditions, social influence and internet anxiety. Between group differences were examined using t-tests and Mann-Whitney tests. Exploratory analysis was conducted to identify moderators. Psychotherapists in CG showed mixed baseline acceptance towards blended therapy (low = 40%, moderate = 33%, high = 27%). IG showed significantly higher acceptance compared to CG (d = .27, pone-sided = .029; low = 24%, moderate = 47%, high = 30%). Bootstrapped confidence intervals were overlapping. Performance expectancy (d = .35), effort expectancy (d = .44) and facilitating conditions (d = .28) were significantly increased (p < .05). No effects on social influence and internet anxiety were found (p>.05). Exploratory analysis indicated psychodynamic oriented psychotherapists profiting particularly from the AFI. Blended therapy is a promising approach to improve healthcare. Psychotherapists show mixed acceptance, which might be improvable by AFIs, particularly in subpopulations of initially rather skeptical psychotherapists. Forthcoming studies should extend the present study by shifting focus from attitudes to the impact of different forms of AFIs on uptake.


Assuntos
Psicoterapia/métodos , Telemedicina/métodos , Adulto , Feminino , Alemanha , Humanos , Masculino , Transtornos Mentais/terapia , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde , Relações Profissional-Paciente , Psicoterapia/educação , Psicoterapia Psicodinâmica/métodos , Distribuição Aleatória , Inquéritos e Questionários , Gravação em Vídeo
16.
N C Med J ; 81(4): 242-248, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32641457

RESUMO

Advance care planning (ACP) is associated with benefits for seriously ill patients, caregivers, and clinicians. As ACP usage expands, there should be greater emphasis on supporting an ongoing communication process among patients, families, and clinicians, as well as removing barriers for advance directive document completion and retrieval.


Assuntos
Planejamento Antecipado de Cuidados/organização & administração , Objetivos , Diretivas Antecipadas , Cuidadores/psicologia , Comunicação , Humanos , North Carolina , Relações Profissional-Família , Relações Profissional-Paciente
17.
Z Gastroenterol ; 58(7): 642-644, 2020 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-32659826

RESUMO

"Klug entscheiden" addresses the problem of over- and undersupply in medicine. Following the American model "Choosing wisely" an interdisciplinary team of all internal medicine societies develops evidence-based recommendations to improve the quality of indications. In contrast to guidelines, the initiative does not provide comprehensive medical recommendations, but focuses on problems that are particularly relevant to health care. In addition, it is intended to promote communication between doctors and patients, but also the national debate on the responsible and sensible use of medical resources.


Assuntos
Assistência à Saúde/normas , Medicina Interna/organização & administração , Relações Profissional-Paciente , Sociedades Médicas/normas , Comunicação , Humanos
18.
Med Care ; 58(8): 744-748, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32692141

RESUMO

INTRODUCTION: Cancer patients' experience of care is an important component of quality that has not previously been used for comparing performance. We administered a new patient experience survey to cancer patients receiving outpatient chemotherapy treatment. We examined its measures for sensitivity to adjustment for case-mix and response tendency (level of general optimism/pessimism) and reliability for making performance comparisons between practices. METHODS: We surveyed 2304 cancer patients who received chemotherapy at 23 medical oncology practices in Southeastern Pennsylvania, receiving 715 responses (response rate 31%; 14 practices had 10 or more responses). We aggregated patient responses to calculate practice-level scores on 5 predefined composites: Affective Communication, Shared Decision-Making, Patient Self-Management, Exchanging Information, and Access. We then ranked the practices on each composite before and after adjustment for standard case-mix variables and supplemental adjustment for response tendency (measured via the Life Orientation Test-Revised). We calculated the reliability of practice scores on each composite using hierarchical linear models and calculated minimum sample sizes necessary to achieve reliabilities exceeding 0.7. RESULTS: After adjusting responses for case-mix and converting to a 0-100 scale, composite scores ranged from 77 for the Patient Self-Management composite to 92 for the Access composite. Adjustment for response tendency had an impact on practice rankings only for the Shared Decision-Making composite. The number of responses necessary to create reliable practice-level measurements ranged from 17 (Access composite) to 96 (Affective Communication composite). CONCLUSIONS: Patient experiences at oncology practices can be measured reliably using reasonable sample sizes. Standard case-mix adjustment is adequate for making comparisons on most composites.


Assuntos
Institutos de Câncer/normas , Satisfação do Paciente , Qualidade da Assistência à Saúde/normas , Inquéritos e Questionários/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Institutos de Câncer/estatística & dados numéricos , Tomada de Decisão Compartilhada , Feminino , Acesso aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pennsylvania , Relações Profissional-Paciente , Qualidade da Assistência à Saúde/estatística & dados numéricos , Reprodutibilidade dos Testes , Inquéritos e Questionários/estatística & dados numéricos , Estados Unidos
19.
Soins Psychiatr ; 41(327): 16-18, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32718455

RESUMO

Dance therapy favours self-expression. The body is the focal point for the dance therapist, although accessing the body can be a sensitive matter, involving as it does the patient's intimacy. The professional must be able to decipher body language and take it into account, in order to lead the patient towards possible pathways. Here, perceptions, feelings or emotions are the keys to successful therapy.


Assuntos
Terapia pela Arte/métodos , Terapia através da Dança , Emoções , Humanos , Cinésica , Relações Profissional-Paciente
20.
Soins Psychiatr ; 41(327): 35-38, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32718461

RESUMO

Patients with psychosis are known to dislike change or being hurried. Their relationship with time must therefore be taken into account, all the more so given that today's society leads us to believe that immediate satisfaction takes priority. Constant switching and addiction upset the stability which supports these patients with difficulty. The case of a patient visited at home shows that the team's decision to adapt to that one time will favour her subjectivation and the consolidation of her equilibrium.


Assuntos
Visita Domiciliar , Relações Profissional-Paciente , Transtornos Psicóticos/terapia , Feminino , Humanos , Transtornos Psicóticos/psicologia , Fatores de Tempo
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