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1.
Medicine (Baltimore) ; 98(36): e16692, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490361

RESUMO

OBJECTIVES: To ascertain bereavement practices offered by hospitals and medical practitioners (MPs), factors that influence the likelihood of MPs' involvement in funeral attendance, the benefits and barriers to attendance to a patient's funeral as perceived by MPs and the rate of attendance to patients' funeral by MPs. DESIGN: MEDLINE (Ovid), Embase, PubMed, and Google Scholar were searched with a systematic search structure for randomized controlled trials, comparative observational studies, case series, cross-sectional studies, editorials, and letters. The search was limited to English only. The study was registered with Prospero (Registration Number: CRD42018095368). RESULTS: A total of 381 articles were identified with 46 articles meeting the inclusion criteria. Of the 46, 16 were editorials and 12 were letters. Eighteen were cross-sectional studies conducted in the United States, Canada, Australia, Israel, and Ireland. Year of publication ranged from 1990 to 2017. Of these, 12 were quantitative, 3 were qualitative, and 3 were mixed-method studies. Two of the cross-sectional studies involved family members of deceased patients while others involved MPs. Bereavement practices offered by hospitals included memorial services, letters, and services provided by bereavement coordinators. Bereavement practices employed by MPs included answering or making phone calls, attending family meetings, and sending condolence letters. MPs' attendance at a patient's funeral was influenced by MPs' gender, age years of experience the medical specialty. Perceived benefits of MPs' attendance at a patient's funeral included providing support to the family, extending the professional relationship, illustrating respect to the patient and the family, resolving guilt and personal growth. Barriers to the attendance included a lack of time, blurring of professional boundaries, personal discomfort with death, emotional arousal, and discouragement by colleagues. General practice had an attendance rate of 71%. Attendance rates for palliative care, oncology, and psychiatrists ranged from 63% to 81%, 7.1% to 67%, and 15% to 67%, respectively. Intensivists had an attendance rate of 22%. CONCLUSION: Several bereavement practices are provided by hospitals and MPs. Funeral attendance is an uncommon bereavement practice. MPs' attitudes toward attending a patient's funeral are understudied in many specialties. Patient factors that influence MPs' participation in bereavement practices are poorly understood.


Assuntos
Atitude do Pessoal de Saúde , Luto , Rituais Fúnebres , Profissionalismo/normas , Fatores Etários , Estudos Transversais , Emoções , Feminino , Humanos , Masculino , Relações Profissional-Paciente , Fatores Sexuais , Fatores de Tempo
2.
BMJ ; 366: l4912, 2019 08 23.
Artigo em Inglês | MEDLINE | ID: mdl-31444168

RESUMO

The studyFeatherstone K, Northcott A, Harden J, et al. Refusal and resistance to care by people living with dementia being cared for within acute hospital wards: an ethnographic study. Health Serv Deliv Res 2019;7.This study was funded by the National Institute for Health Research Health Services and Delivery Research Programme (project number 13/10/80).To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000779/understanding-dementia-care-in-hospitals.


Assuntos
Demência/enfermagem , Demência/psicologia , Hospitalização , Cooperação do Paciente , Inglaterra , Humanos , Relações Profissional-Paciente , Medicina Estatal/normas , País de Gales
3.
Rev. enferm. UFSM ; 9: 14, jul. 15, 2019.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-1009366

RESUMO

"\"\\\"[{\\\\\\\"text\\\\\\\": \\\\\\\"Objetivo: conhecer a percepção das adolescentes acerca das relações interpessoais estabelecidas com os\\\\\\\\r\\\\\\\\nprofissionais de um Centro Obstétrico. Método: estudo qualitativo exploratório descritivo. Foram entrevistadas 62 adolescentes que tiveram filho em um Hospital Universitário do sul do Brasil. Os dados foram analisados por meio da Análise de Conteúdo, buscou-se visualizar os diferentes papéis profissionais descritos por Peplau. Resultados: o relacionamento interpessoal estabelecido com interação baseada no respeito, cordialidade, paciência, solicitude, presença constante, disposição para responder aos questionamentos e ações para transmitir tranquilidade e calma são aspectos satisfatórios. Porém, o distanciamento, desinformação, desrespeito e hostilidade também despontaram. O surgimento de elementos negativos parece estar ligado às posturas pessoais dos profissionais. Considerações Finais: o relacionamento interpessoal não é compreendido como parte fundamental da assistência ao parto, deixando de ser explorado em sua plenitude enquanto parte do cuidado, permanecendo em segundo plano e compartimentalizando a assistência ao parto.\\\\\\\", \\\\\\\"_i\\\\\\\": \\\\\\\"pt\\\\\\\"}, {\\\\\\\"text\\\\\\\": \\\\\\\"Aim: to know the perception of the adolescents about the interpersonal relations established with the\\\\\\\\r\\\\\\\\nprofessionals of an Obstetric Center. Method: descriptive exploratory qualitative study. Sixty-two teenagers who had a child in a University Hospital in southern Brazil were interviewed. The data were analyzed through Content Analysis, and we sought to visualize the different professional roles described by Peplau. Results: the interpersonal relationship established with interaction based on respect, cordiality, patience, solicitude, constant presence, willingness to respond to questions, and actions to convey tranquility and calm are satisfactory aspects. However, detachment, disinformation, disrespect and hostility also emerged. The emergence of negative elements seems to be linked to the personal postures of professionals. Final Considerations: interpersonal relationships are not understood as a fundamental part of childbirth care, and are no longer fully explored as part of care, remaining in the background and compartmentalizing childbirth care.\\\\\\\", \\\\\\\"_i\\\\\\\": \\\\\\\"en\\\\\\\"}, {\\\\\\\"text\\\\\\\": \\\\\\\"Objetivo: conocer la percepción de las adolescentes sobre las relaciones interpersonales establecidas\\\\\\\\r\\\\\\\\ncon los profesionales de un Centro Obstétrico. Método: estudio cualitativo, exploratorio, descriptivo. Fueron entrevistadas 62 adolescentes que tuvieron hijo en un Hospital Universitario del sur de Brasil. Los datos fueron analizados por medio de análisis de contenido, con el cual se buscó visualizar los diferentes papeles profesionales descriptos por Peplau. Resultados: la relación interpersonal basada en el respeto, cordialidad, paciencia, solicitud, presencia constante, disposición para responder a los cuestionamientos y acciones para transmitir tranquilidad y calma son aspectos satisfactorios. Pero, el distanciamiento, desinformación, falta de respeto y hostilidad también fueron identificados. El surgimiento de esos elementos negativos puede estar relacionado a las posturas personales. Consideraciones finales: la relación interpersonal no es entendida como fundamental en la asistencia al parto, deja de ser explotada en su plenitud, como parte del cuidado, permanece en segundo plan y segmenta la asistencia al parto.\\\\\\\", \\\\\\\"_i\\\\\\\": \\\\\\\"es\\\\\\\"}]\\\"\""


Assuntos
Humanos , Relações Profissional-Paciente , Adolescente , Enfermagem , Parto Humanizado
4.
Rev. pesqui. cuid. fundam. (Online) ; 11(4): 900-907, jul.-set. 2019. tab
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1005715

RESUMO

Objetivo: Descrever o perfil sociodemográfico e clínico de idosos usuários crônicos de omeprazol. Método: Trata-se de um estudo transversal com usuários com idade superior a 60 anos, que retiraram o omeprazol na Farmácia Pública de Panambi/RS. Resultados: Participaram da pesquisa sessenta idosos, com idade média de 67,90 ±5,6 anos. Duas interações graves foram identificadas envolvendo citalopram e clopidogrel. Observou-se a presença nas prescrições de medicamentos que tem a sua absorção alterada pelo uso concomitante com o omeprazol como captopril (25%) e enalapril (16,7%). Conclusão: Dessa forma, evidenciou-se uma população suscetível a riscos que necessita de acompanhamento farmacêutico


Objective: To describe the sociodemographic and clinical profile of elderly chronic omeprazole users. Method: This is a cross-sectional study. Patients aged 60, from the Public Pharmacy of the city of Panambi / RS. Results: A total of 60 elderly chronic omeprazole users participated in the study with an average of 67.90 ± 5.6 years of age. Two serious interactions were identified involving citalopram and clopidogrel. There was the presence in the prescription of drugs that have their absorption altered by concomitant use of omeprazole as captopril (25%) and enalapril (16.7%). Conclusion: Thus, we highlight that there is a population susceptible to risks that needs pharmaceutical monitoring


Objetivo: Describir el perfil sociodemográfico y clínico de los ancianos usuarios crónicos de omeprazol. Método: Es un estudio transversal descriptivo cuantitativo. Participaron en el estudio pacientes con edad igual o mayor de 60 años, usuarios crónicos de omeprazol, y que acudieron al medicamento en la Farmacia Publica de la cuidad de Panambi/RS. Resultados: Participaron de la investigación 60 ancianos 51,7% del sexo femenino, con edad media de 67,90 ±5,6 años, 81,7% relataran alguna comorbilidad, siendo la más prevalente la hipertensión arterial sistémica (61,7%). Los medicamentos que actúan en el tracto alimentar y metabólico fueron los más frecuentes. Se identificaron dos graves interacciones relacionado al citalopram (8,4%) y clopidogrel (1,7%). Se observó en las prescripciones la presencia de medicamentos cuya absorción es alterada por el uso concomitante con el omeprazol, como el captopril (25%) y enalapril (16,7%). Conclusión: De esta forma, se ha evidenciado una populación susceptible a los riesgos y que necesita de acompañamiento farmacéutico


Assuntos
Humanos , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Omeprazol/efeitos adversos , Omeprazol/uso terapêutico , Saúde do Idoso , Interações de Medicamentos , Relações Profissional-Paciente , Antiulcerosos
5.
BMC Health Serv Res ; 19(1): 389, 2019 Jun 14.
Artigo em Inglês | MEDLINE | ID: mdl-31200705

RESUMO

BACKGROUND: The quality of the care relationship between a client and a professional is important in long-term care, as most clients depend on support for a lengthy period. The three largest client groups who receive long-term care in the Netherlands are older adults who are physically or mentally frail, people with mental health problems and people with intellectual disabilities. There is little clarity about how generic and variable the determinants of the quality of care relationships are across these client groups. The aim of this study is to explore and compare the determinants of the quality of care relationships in these three client groups in long-term care. METHODS: This participatory study involving clients as co-researchers was held in three healthcare organizations, each providing long-term care to one client group. The research was conducted by three teams consisting of researchers and co-researchers. We interviewed clients individually and professionals in focus groups. The focus was on care relationships with professionals where there is weekly recurring contact for at least 3 months. Clients and professionals were selected using a convenience sample. The interviews were coded in open, axial and selective coding. The outcomes were compared between the client groups. RESULTS: The study sample consisted of 30 clients and 29 professionals. Determinants were categorized into four levels: client, professional, between client and professional, and context. The findings show that the majority of the determinants apply to the care relationships within all three client groups. At the professional level, eleven generic determinants were found. Eight determinants emerged at the client level of which two were found in two client groups only. At the level between a client and a professional, six determinants were found of which one applied to mental healthcare and disability care only. Five determinants were found at the contextual level of which two were specific for two client groups. CONCLUSIONS: The study yielded a variety of determinants that came to the fore in all three client groups in long-term care. This suggests that including a homogenous client group from a single care setting is not necessary when studying the quality of long-term care relationships.


Assuntos
Assistência de Longa Duração/normas , Qualidade da Assistência à Saúde , Idoso , Comunicação , Feminino , Idoso Fragilizado , Humanos , Masculino , Países Baixos , Satisfação do Paciente , Autonomia Pessoal , Relações Profissional-Paciente , Respeito
7.
Rev Infirm ; 68(252): 30-31, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31208596

RESUMO

The hospital is a healthcare setting in which staff often manage acute health situations. Patients, families and healthcare professionals constantly interact, often against a background of emergencies and anxiety. In such contexts, communication plays an important role in establishing a compassionate relationship. Does humour have a place in this relationship? If so, in what form and what are the benefits for the teams and the patients?


Assuntos
Corpo Clínico Hospitalar/psicologia , Relações Profissional-Família , Relações Profissional-Paciente , Senso de Humor e Humor como Assunto , Ansiedade , Comunicação , Cuidados Críticos/psicologia , Empatia , Humanos
8.
Soins ; 64(836): 29-32, 2019 Jun.
Artigo em Francês | MEDLINE | ID: mdl-31208579

RESUMO

In the transcultural approach, emphasis is placed on cultural countertransference in order to account for caregivers' implicit and explicit reactions with regard to patients and their history. As language is a constitutive element of culture, linguistic countertransference must be granted a place, in care, research and teaching.


Assuntos
Cuidadores/psicologia , Contratransferência (Psicologia) , Linguagem , Relações Profissional-Paciente , Humanos
9.
Soins ; 64(836): 33-36, 2019 Jun.
Artigo em Francês | MEDLINE | ID: mdl-31208580

RESUMO

Supporting teenagers in search of ideality sometimes requires accepting and understanding the movements present in the process of Islamist radicalisation. It is therefore necessary to understand the implicit dimension to this notion of radicalisation and what it arouses in each of us. For caregivers with a North African immigrant background, it is a question of implementing their countertransference in order to guarantee unconditional acceptance, and to establish a bond to deliver better care.


Assuntos
Cuidadores/psicologia , Emigrantes e Imigrantes/psicologia , Islamismo/psicologia , Relações Profissional-Paciente , Terrorismo/psicologia , Adolescente , África do Norte/etnologia , Cuidadores/estatística & dados numéricos , Contratransferência (Psicologia) , Emigrantes e Imigrantes/estatística & dados numéricos , Humanos , Identificação Social
10.
Eur J Oncol Nurs ; 40: 71-77, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31229209

RESUMO

PURPOSE: The purpose of the study was to explore experiences of older people with cancer in ascertaining the attributes of a person-centred approach in sustaining hope and enabling human flourishing. This was a qualitative study comparing patients and professional experiences and perceptions of care across to ward settings. METHODS: Methods involved 10 semi-structured interviews conducted with patients and focus groups (n = 6) and 10 semi-structured interviews with health professionals. Three dissemination focus groups (n = 14) were also carried out with professionals to allow further analysis of the data. RESULTS: Two main themes were identified, including 'Emotional adaptations of hope: wants and expectations' and 'Hope through belittling their illness'. Findings highlight the way hope is conveyed and the emphasis' accorded to issues such as societal perceptions, knowledge, expectations of care, life stage, relationships, identity, and emotions. Findings also reinforce the importance of maintaining hope, recognising the different ways hope is used, and enabling patients to flourish. CONCLUSION: This study highlights how hope is facilitated through the interaction between patients and professionals and that the relational interactive stance. This current study establishes that hope seemed to be temporal, contextual and dynamic in nature, involving an ongoing process. Helping older people with cancer to understand their illness considering the situation of lives and experiences is essential to address expectations and wants.


Assuntos
Esperança , Unidades Hospitalares/estatística & dados numéricos , Neoplasias/psicologia , Relações Profissional-Paciente , Idoso , Idoso de 80 Anos ou mais , Emoções , Feminino , Grupos Focais , Humanos , Masculino , Neoplasias/terapia , Pesquisa Qualitativa
11.
Stud Health Technol Inform ; 260: 17-24, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31118314

RESUMO

Children are rarely affected by medical emergencies. The experience of doctors or paramedics with child emergencies is correspondingly poor. The anatomical features and individual calculations make such an emergency much more error-prone than a comparable adult emergency. Particularly in dose calculations, critical errors occur time and again. Since these calculations are based on the child's weight, which is preclinically often derived from the size of the child, the number of errors can be minimized with an assistance service that performs all calculations based on the size. Technically, it is possible to detect the size with a depth camera, which is occasionally installed in smartphones or head-mounted displays. In order to investigate to what extent these cameras provide precise results, a study with 33 children was carried out. The children were measured with both an emergency ruler and an augmented reality app with associated smartphone with depth camera. The result is that the depth camera does not provide significantly different results than an emergency ruler. This allows further research, e.g. the automatic recognition of patients with the help of machine learning or usability studies, to be tackled.


Assuntos
Emergências , Aprendizado de Máquina , Smartphone , Adulto , Peso Corporal , Criança , Humanos , Relações Profissional-Paciente , Interface Usuário-Computador
13.
BMC Public Health ; 19(1): 600, 2019 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-31101099

RESUMO

BACKGROUND: Kamrangirchar and Hazaribagh are the largest slum areas in Dhaka, Bangladesh. In 2013, Médecins Sans Frontières initiated an urban healthcare programme in these areas providing services for factory workers and responding to the sexual and reproductive health needs of young women. Little in-depth information is available on perceptions of health and health seeking behaviour in this population. We aimed to provide a better understanding of community perceptions toward health and health care in order to inform programme strategies. METHODS: In-depth interviews were conducted with women (n = 13); factory workers (n = 14); and key informants (n = 13). Participants were selected using purposive maximum variation sampling and voluntarily consented to take part. Topic guides steered participant-led interviews, which were audio-recorded, translated and transcribed from Bangla into English. By comparing cases, we identified emerging themes, patterns and relationships in the data. NVivo11© was used to sort and code the data. RESULTS: Emerging themes indicated that in Kamrangirchar and Hazaribagh, health is seen as an asset necessary for work and, thus, for survival. Residents navigate a highly fragmented health system looking for 'quick fixes' to avoid time off work, with the local pharmacy deemed 'good enough' for 'common' health issues. Health care seeking for 'serious' conditions is characterised by uncertainty, confusion, and unsatisfactory results. Decisions are made communally and shaped by collective perceptions of quality care. People with limited socio-economic capital have few options for care. 'Quality care' is perceived as comprehensive care 'under one roof,' including predictive biomedical diagnostics and effective medication, delivered through a trusting relationship with the care provider. CONCLUSIONS: Health seeking behaviour of slum dwellers of Kamrangirchar and Hazaribagh is based on competing priorities, where quick and effective care is key, focussed on the ability to work and generate income. This takes place in a fragmented healthcare system characterised by mistrust of providers, and where navigation is informed by word-of-mouth experiences of peers. Improving health in this context demands a comprehensive and integrated approach to health care delivery, with an emphasis on rapid diagnosis, effective treatment and referral, and improved trust in care providers. Health education must be developed in collaboration with the community to identify knowledge gaps, support decision-making, and be channelled through existing networks. Further research should consider the effectiveness of interventions aiming to improve the practice of pharmacists.


Assuntos
Atitude Frente a Saúde , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Pobreza/psicologia , Trabalho/psicologia , Adulto , Bangladesh , Tomada de Decisões , Assistência à Saúde , Feminino , Humanos , Pessoa de Meia-Idade , Áreas de Pobreza , Relações Profissional-Paciente , Pesquisa Qualitativa , Confiança
14.
BMC Health Serv Res ; 19(1): 279, 2019 May 02.
Artigo em Inglês | MEDLINE | ID: mdl-31046748

RESUMO

BACKGROUND: In Malawi, as in many low-and middle-income countries, health facility committees (HFCs) are involved in the governance of health services. Little is known about the approaches they use and the challenges they face. This study explores how HFCs monitor the quality of health services and how they demand accountability of health workers for their performance. METHODS: Documentary analysis and key informant interviews (7) were complemented by interviews with purposefully selected HFC members (22) and health workers (40) regarding their experiences with HFCs. Data analysis was guided by a coding scheme informed by social accountability concepts complemented by inductive analysis to identify participants' perceptions and meanings of processes of social accountability facilitated by HFCs. RESULTS: The results suggest that HFCs address poor health worker performance (such as absenteeism, poor treatments and informal payments), and report severe misconduct to health authorities. The informal and constructive approach that most HFCs use is shaped by formal definitions and common expectations of the role of HFCs in service delivery as well as resource constraints. The primary function of social accountability through HFCs appears to be co-production: the management of social relations around the health facility and the promotion of a minimum level of access and quality of services. CONCLUSIONS: Policymakers and HFC support programs should take into account the broad task description of HFCs and integrate social accountability approaches in existing quality of care programs. The study also underscores the need to clarify accountability arrangements and linkages with upward accountability approaches in the system.


Assuntos
Comitês Consultivos , Assistência à Saúde/organização & administração , Administração de Instituições de Saúde , Pessoal de Saúde , Relações Profissional-Paciente , Responsabilidade Social , Países em Desenvolvimento , Recursos em Saúde , Administração de Serviços de Saúde , Humanos , Malaui , Atenção Primária à Saúde/organização & administração
16.
Nursing (Säo Paulo) ; 22(252): 2882-2886, maio.2019.
Artigo em Português | LILACS, BDENF - Enfermagem | ID: biblio-998987

RESUMO

Objetivos: Desvelar o significado de conforto na perspectiva dos familiares de pacientes internados em unidade de terapia intensiva (UTI) e conhecer os principais motivos do desconforto vivenciado por eles. Método: Estudo qualiquantitativo em que foram entrevistados 60 familiares de pacientes internados em UTI, no período de julho a setembro de 2015. O referencial metodológico utilizado foi o discurso do sujeito coletivo. Resultados: Conforto, na perspectiva dos familiares, tem um significado plural que engloba comunicação efetiva, flexibilização de visitas, apoio psicológico e direito de permanência na unidade. Por outro lado, os motivos de desconforto são inúmeros e refletem uma prática de saúde pouco humanizada e atrelada às dificuldades financeiras. Conclusão: O conforto dos familiares está ligado ao acolhimento e à humanização da assistência em UTI. Embora a participação da família na recuperação do paciente seja fundamental, ainda se evidencia descompasso entre políticas e práticas no país em relação a essa questão.(AU)


Objectives: Unveil the meaning of comfort from the perspective of the relatives of patients hospitalized at an Intensive Care Unit (ICU) and to discover the mean motives for discomfort they experience. Method: Qualitative and quantitative study in which 60 relatives of ICU patients were interviewed in the interior of São Paulo, Brazil, between July and September 2015. The methodological framework used was the Collective Subject Discourse. Results: According to the relatives, comfort has a plural meaning that involves effective communication, easing of visits, psychological support and the right to remain at the unit. On the other hand, there are countless sources of discomfort, reflecting a hardly humanized practice, linked to financial difficulties. Conclusion: The relatives' comfort is linked to the humanization of ICU care and to welcoming. Although the family's participation in the patient's recovery is fundamental, a mismatch between policies and practices continues to exist in the country.(AU)


Objetivos: Revelar el significado de confort según los familiares de pacientes internados en Unidad de Terapia Intensiva (UTI) y conocer los principales motivos de incomodidad que viven. Método: Estudio cuali y cuantitativo en que fueron entrevistados 60 familiares de pacientes internados en UCI del interior de São Paulo, Brasil, entre julio y septiembre 2015. El referencial metodológico fue el Discurso del Sujeto Colectivo. Resultados: Confort, según los familiares, es un significado plural que abarca la comunicación efectiva, flexibilización de visitas, apoyo psicológico y derecho de permanencia en la unidad. Por otra parte, los motivos de incomodidad son numerosos y reflejan una práctica poco humanizada y vinculada a dificultades financieras. Conclusión: El Confort de los familiares está vinculado a la humanización de la atención en UCI y al acogimiento. Aunque la participación de la familia en la recuperación del paciente sea fundamental, continua un desajuste entre políticas y prácticas en el país.(AU)


Assuntos
Humanos , Relações Profissional-Paciente , Cuidados Críticos , Acolhimento , Unidades de Terapia Intensiva , Enfermagem Familiar
17.
Monaldi Arch Chest Dis ; 89(1)2019 Mar 20.
Artigo em Inglês | MEDLINE | ID: mdl-30968660

RESUMO

Heart failure (HF) is a life-limiting condition, associated with high morbidity. End-stage, known as advanced heart failure (AHF), is more common among the elderly. HF patients' disease trajectory is more variable and unpredictable than the trajectory for most oncologic illnesses. Despite a growing armamentarium of resources the management of AHF patients can be complex. Advances in medical therapy have dramatically improved the quality of life and survival of patients with end-stage HF. The majority of studies reveal lack of knowledge of HF among elderly patients. Mechanical circulatory support can provide bridge-to-transplantation therapy in eligible patients or destination therapy in those ineligible for heart transplantation like the majority of elderly patients with HF. The palliative care stage, considered as treatment basically aimed at controlling symptoms, may last a long time in some patients and should not simply be regarded as the final phase. Studies show that patients with AHF may have a poor understanding of their condition and its outcome and, therefore, guidelines recommend health care professionals to have an open communication with patients and their families about the AHF trajectory, including discussing their preferences for future care, acknowleding the risk of a sudden death, and the possibility of deactivation of devices (i.e. implantable defibrillators) in the end-of-life. This contribution is an attempt to have a brief overview of strategies for the management of HF terminal stage in elderly.


Assuntos
Insuficiência Cardíaca/terapia , Cuidados Paliativos/métodos , Qualidade de Vida , Fatores Etários , Idoso , Comunicação , Insuficiência Cardíaca/fisiopatologia , Transplante de Coração/métodos , Humanos , Guias de Prática Clínica como Assunto , Relações Profissional-Paciente
18.
Sex Reprod Healthc ; 19: 24-30, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30928131

RESUMO

OBJECTIVE: Fear of childbirth is a well-known problem affecting women's wellbeing and health. The prevalence of intense fear varies across countries from 4.8 to 14.8%. During the past 25 years in Sweden women with intense fear of childbirth have been offered counselling at specialised clinics staffed by midwives. Although the counselling demonstrates positive results, the training, education, supervision and organisation differ between clinics. It is still unclear which approaches and practices are the most beneficial. The aim was to explore and describe the counselling of women with intense fear of childbirth from the viewpoint of midwives who provide counselling in specialised fear of childbirth clinics in one region of Sweden. METHODS: A qualitative study of 13 midwives using focus group interviews and inductive content analysis. RESULTS: The midwives' counselling of women with intense fear of childbirth is described as 'striving to create a safe place for exploring fear of childbirth', comprising the following categories: Providing a reliable relationship; Investigating previous and present fears; and A strong dedication to the women. CONCLUSION: Although there are no guidelines for the counselling the midwives described similar frameworks. Some approaches were general, while others were specific and related to the individual woman's parity. The midwives achieved professional and personal development through counselling experiences. The findings add to the existing literature on counselling and can be used to inform the development of midwife-led interventions for women with intense fear of childbirth and previous traumatic births, as well as for the formal education of midwives.


Assuntos
Aconselhamento Diretivo/métodos , Medo/psicologia , Tocologia/métodos , Parto/psicologia , Aconselhamento Diretivo/organização & administração , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Tocologia/educação , Planejamento de Assistência ao Paciente , Educação de Pacientes como Assunto , Relações Profissional-Paciente , Pesquisa Qualitativa , Confiança
19.
Sex Reprod Healthc ; 19: 36-41, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30928133

RESUMO

OBJECTIVE: This study aimed to explore women's experiences related to recovery from obstetric anal sphincter muscle injuries (OASIS) one year after childbirth. METHOD: This is a qualitative study based on written responses from 625 women approximately one year after childbirth in which OASIS occurred. Data was obtained from a questionnaire distributed by the national Perineal Laceration Register (PLR) in Sweden. Inductive qualitative content analysis was applied for analysis. RESULTS: The theme "Struggling to settle with a damaged body" indicated that the first year after OASIS involved a struggle to settle to and accept living with a changed and sometimes still-wounded body. Many participants described problems related to a non-functional sexual life, physical and psychological problems that left them feeling used and broken, and increased worries for their future health and pregnancies. However, some women had adjusted to their situation, had moved on with their lives, and felt recovered and strong. Encountering a supportive and helpful health care professional was emphasized as vital for recovery after OASIS. CONCLUSION: This study provides important insights on how women experience their recovery approximately one year after having had OASIS at childbirth, wherein many women still struggled to settle into their damaged bodies. Clear pathways are needed within health care organizations to appropriate health care services that address both physical and psychological health problems of women with prolonged recovery after OASIS.


Assuntos
Canal Anal/lesões , Lacerações/psicologia , Complicações do Trabalho de Parto/psicologia , Parto , Períneo/lesões , Comportamento Sexual , Adulto , Relações Familiares , Feminino , Humanos , Lacerações/complicações , Dor/etiologia , Gravidez , Relações Profissional-Paciente , Pesquisa Qualitativa , Autoimagem , Inquéritos e Questionários , Suécia , Fatores de Tempo , Adulto Jovem
20.
Bull World Health Organ ; 97(4): 296-305, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30940987

RESUMO

Home-based records have been used in both low- and high-income countries to improve maternal and child health. Traditionally, these were mostly stand-alone records that supported a single maternal and child health-related programme, such as the child vaccination card or growth chart. Recently, an increasing number of countries are using integrated home-based records to support all or part of maternal and child health-related programmes, as in the maternal and child health handbook. Policy-makers' expectations of home-based records are often unrealistic and important functions of the records remain underused, leading to loss of confidence in the process, and to wasted resources and opportunities for care. We need to examine the gaps between the functions of the records and the extent to which users of records (pregnant women, mothers, caregivers and health-care workers) are knowledgeable and skilful enough to make those expected functions happen. Three key functions, with increasing levels of complexity, may be planned in home-based records: (i) data recording and storage; (ii) behaviour change communication, and (iii) monitoring and referral. We define a function-capacity conceptual framework for home-based records showing how increasing number and complexity of functions in a home-based record requires greater capacity among its users. The type and functions of an optimal home-based record should be strategically selected in accordance not only with demands of the health system, but also the capacities of the record users.


Assuntos
Assistência à Saúde/métodos , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/psicologia , Registros de Saúde Pessoal , Serviços de Saúde Materno-Infantil , Relações Profissional-Paciente , Saúde da Criança , Alfabetização em Saúde , Habitação , Humanos , Educação de Pacientes como Assunto , Organização Mundial da Saúde
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