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Soins Psychiatr ; 41(329): 31-35, 2020.
Artigo em Francês | MEDLINE | ID: mdl-33129403


Mental health facilities, despite the evolution of recent decades, remain in part places in which patients are deprived of their liberty. For elderly people with mental health issues, spirituality and freedom of expression are even more legitimate. Religious tolerance is a challenge for caregivers, and a patient's request to practise their religion must be acknowledged. The provision of dedicated spaces and the presence of chaplains must favour the respect of cultural liberties.

Cuidadores , Transtornos Mentais , Relações Profissional-Paciente , Religião , Respeito , Idoso , Cuidadores/psicologia , Humanos , Transtornos Mentais/terapia , Espiritualidade
Rev Infirm ; 69(263): 46-47, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32993908


Respectful care of a deceased patient. In their daily practice, nurses continue to provide care to patients after death has occurred. They perform the laying out which marks the end of their care and is a gesture of respect by the nursing teams towards the deceased person. Beyond the technical aspects, all nurses are faced with their own humanity when they carry out this procedure. Nursing teams were sorely tested during the COVID-19 health crisis in this regard.

Atitude Frente a Morte , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/enfermagem , Enfermeiras e Enfermeiros/psicologia , Pneumonia Viral/mortalidade , Pneumonia Viral/enfermagem , Respeito , Betacoronavirus , Humanos , Pandemias
PLoS One ; 15(9): e0239207, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32960933


BACKGROUND: Improving health outcomes for Indigenous people by strengthening the cultural safety of care is a vital challenge for the health sector, both in Australia and internationally. Although Indigenous people have long requested to have Indigenous practitioners involved in their health care, many health services report difficulties with recruiting and retaining Indigenous staff. This article describes Indigenous workforce policies and strategies from two Australian health services, as well as cancer-service specific strategies. METHODS: Services were identified as part of a national study designed to identify and assess innovative services for Indigenous cancer patients and their families. In-depth interviews were conducted in a small number of identified services. The interviews from two services, which stood out as particularly high performing, were analysed through the lens of Indigenous health workforce. RESULTS: Twenty-four hospital staff (Indigenous and non-Indigenous), five Indigenous people with cancer and three family members shared their views and experiences. Eight themes were identified from the way that the two services supported their Indigenous workforce: strong executive leadership, a proactive employment strategy, the Indigenous Health Unit, the Indigenous Liaison Officer, multidisciplinary team inclusion, professional development, work environment and a culture of respect. Participants reported two positive outcomes resulting from the active implementation of the eight workforce themes: 'Improved Indigenous patient outcomes' and 'Improved staff outcomes'. CONCLUSIONS: These two cancer services and their affiliated hospitals show how positive patient outcomes and a strong Indigenous health workforce can be achieved when a health service has strong leadership, commits to an inclusive and enabling culture, facilitates two-way learning and develops specific support structures appropriate for Indigenous staff. It is hoped that the strategies captured in this study will be used by health services and cancer services to inform their own policies and programs to support building their Indigenous workforce.

Assistência à Saúde Culturalmente Competente , Pessoal de Saúde , Serviços de Saúde do Indígena , Grupo com Ancestrais Oceânicos , Respeito , Austrália/etnologia , Feminino , Humanos , Masculino , Inquéritos e Questionários
BMJ Open ; 10(8): e037466, 2020 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-32759247


OBJECTIVE: The COVID-19 pandemic has highlighted ongoing challenges to optimal supportive end-of-life care for adults living in long-term care (LTC) facilities. A supportive end-of-life care approach emphasises family involvement, optimal symptom control, multidisciplinary team collaboration and death and bereavement support services for residents and families. Community-based and palliative care specialist physicians who visit residents in LTC facilities play an important role in supportive end-of-life care. Yet, perspectives, experiences and perceptions of these physicians remain unknown. The objective of this study was to explore barriers and facilitators to optimal supportive end-of-life palliative care in LTC through the experiences and perceptions of community-based and palliative specialist physicians who visit LTC facilities. DESIGN: Qualitative study using semi-structured interviews, basic qualitative description and directed content analysis using the COM-B (capability, opportunity, motivation - behaviour) theoretical framework. SETTING: Residential long-term care. PARTICIPANTS: 23 physicians who visit LTC facilities from across Alberta, Canada, including both in urban and rural settings of whom 18 were community-based physicians and 5 were specialist palliative care physicians. RESULTS: Motivation barriers include families' lack of frailty knowledge, unrealistic expectations and emotional reactions to grief and uncertainty. Capability barriers include lack of symptom assessment tools, as well as palliative care knowledge, training and mentorship. Physical and social design barriers include lack of dedicated spaces for death and bereavement, inadequate staff, and mental health and spiritual services of insufficient scope for the population. CONCLUSION: Findings reveal that validating families' concerns, having appropriate symptom assessment tools, providing mentorship in palliative care and adapting the physical and social environment to support dying and grieving with dignity facilitates supportive, end-of-life care within LTC.

Infecções por Coronavirus/terapia , Assistência de Longa Duração , Cuidados Paliativos/normas , Pandemias , Médicos , Pneumonia Viral/terapia , Instituições de Cuidados Especializados de Enfermagem , Assistência Terminal/normas , Adulto , Idoso , Alberta , Atitude do Pessoal de Saúde , Betacoronavirus , Infecções por Coronavirus/virologia , Família , Feminino , Idoso Fragilizado , Fragilidade , Necessidades e Demandas de Serviços de Saúde , Cuidados Paliativos na Terminalidade da Vida , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/virologia , Pesquisa Qualitativa , Respeito , Especialização
Soins Gerontol ; 25(144): 29-31, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32792239


Caregivers are responsible for respecting the privacy of the elderly, who are more vulnerable. This requires an individual and collective professional reflection on the meaning of the practices. It is also about respecting the free choice of lifestyle by taking into account the needs of family caregivers.

Cuidadores/psicologia , Privacidade , Respeito , Idoso , Humanos
Soins Gerontol ; 25(144): 44-46, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32792242


The basic need for humanity in care is the first request of the elderly, because otherwise it threatens, or even undermines, their dignity at certain moments in the course of care being administered to them. In the emergency services, it is therefore necessary to fight against ageism and the lack of communication and information that affect the quality of care.

Serviços Médicos de Emergência , Respeito , Idoso , Humanos
PLoS One ; 15(7): e0220538, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32644991


BACKGROUND: Various aspects of disrespect and abusive maternity care have received scholarly attention because of frequent reports of the phenomenon in most healthcare facilities globally, especially in low- and middle-income countries. Experiences of disrespect and abuse during childbirth may dissuade women from returning for facility-based postpartum services, for antenatal care, and delivery for future pregnancies and births. Midwives' knowledge of respectful maternity care is critical in designing any interventive measures to address the menace of disrespect and abuse in maternity care. However, the perspectives of skilled providers on respectful maternal care have not been extensively studied. Therefore, the present study sought to explore the views of midwives on respectful maternity care at a teaching hospital in Kumasi, Ghana. METHODS: We employed an exploratory descriptive qualitative research design using an interpretative approach. Data were generated through individual in-depth interviews of fifteen midwives, which were audio-recorded and transcribed verbatim. Open Code 4.03 was used to manage and analyse the data. FINDINGS: The midwives demonstrated some degree of awareness of respectful maternity care that comprised of the following components: non-abusive care, consented care, confidential care, non-violation of childbearing women's basic human rights, and non-discriminatory care. However, midwives' support for disrespectful and abusive practices such as hitting, pinching, and implicitly blaming childbearing women for mistreatment suggests that midwives awareness of respectful maternity care is disconnected from its practice. CONCLUSION: In view of these findings, we recommend frequent in-service training for midwives and the institutionalization of regular supervision of intrapartum care services in the healthcare facility.

Atitude do Pessoal de Saúde , Serviços de Saúde Materna/normas , Tocologia , Adulto , Feminino , Gana , Humanos , Pessoa de Meia-Idade , Tocologia/educação , Qualidade da Assistência à Saúde , Respeito
PLoS One ; 15(7): e0235262, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32716927


OBJECTIVE: Public insurance (Medicaid) covered 42% of all U.S. births in 2018. This paper describes and analyzes the self-reported experiences of women with Medicaid versus commercial insurance relating to autonomy, control and respectful treatment in maternity care. METHODS: The sampling frame for the Listening to Mothers in California survey was drawn from 2016 California birth certificate files. The 30-minute survey had a 55% response rate. A secondary multivariable analysis of results from the survey included 2,318 women with commercial private insurance (1,087) or public (Medi-Cal) (1,231) coverage. Results were weighted and were representative of all births in 2016 in California. The multivariable analysis of variables related to maternal agency included engagement in decision making regarding interventions such as vaginal birth after cesarean and episiotomy, feeling pressured to have interventions and sense of fair treatment. We examined their relationship to insurance status adjusted for maternal age, race/ethnicity, education, nativity and attitude toward birth as well as type of prenatal provider, type of birth attendant and pregnancy complications. RESULTS: Women with Medi-Cal had a demographic profile distinct from those with commercial insurance. In multivariable analysis, women with Medi-Cal reported less control over their maternity care experience than women with commercial insurance, including less choice of prenatal provider (AOR 1.61 95%C.I. 1.20, 2.17), or a vaginal birth after cesarean (AOR 2.93 95%C.I. 1.49, 5.73). Mothers on Medi-Cal were also less likely to be consulted before experiencing an episiotomy (AOR 0.30 95%C.I. 0.09, 0.94). They were more likely to report feeling pressure to have a primary cesarean (AOR 2.54 95%C.I. 1.55, 4.16) and less likely to be encouraged by staff to make their own decisions (AOR 0.63 95%C.I. 0.47, 0.85). CONCLUSIONS: Childbearing women with public insurance in California clearly and consistently reported less opportunity to choose their care than women with private insurance. These inequities are a call to action for increased accountability and quality improvement relating to care of the many childbearing women with Medicaid coverage.

Disparidades em Assistência à Saúde/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Relações Profissional-Paciente , Respeito , Adulto , California , Feminino , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/economia , Humanos , Cobertura do Seguro/economia , Idade Materna , Serviços de Saúde Materna/economia , Medicaid/economia , Medicaid/estatística & dados numéricos , Gravidez , Autorrelato/estatística & dados numéricos , Fatores Socioeconômicos , Estados Unidos , Adulto Jovem
J Postgrad Med ; 66(3): 133-140, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32675449


Background: Respectful maternity care is a rightful expectation of women. However, disrespectful maternity care is prevalent in various settings. Therefore, a systematic review and meta-analysis were conducted to identify various forms of ill-treatment, determinants, and pooled prevalence of disrespectful maternity care in India. Methods: A systematic review was performed in various databases. After quality assessment, seven studies were included. Pooled prevalence was estimated using the inverse variance method and the random-effects model using Review Manager Software. Results: Individual study prevalence ranged from 20.9% to 100%. The overall pooled prevalence of disrespectful maternity care was 71.31% (95% CI 39.84-102.78). Pooled prevalence in community-based studies was 77.32% (95% CI 56.71-97.93), which was higher as compared to studies conducted in health facilities, this being 65.38% (95% CI 15.76-115.01). The highest reported form of ill-treatment was non-consent (49.84%), verbal abuse (25.75%) followed by threats (23.25%), physical abuse (16.96%), and discrimination (14.79%). Besides, other factors identified included lack of dignity, delivery by unqualified personnel, lack of privacy, demand for informal payments, and lack of basic infrastructure, hygiene, and sanitation. The determinants identified for disrespect and abuse were sociocultural factors including age, socioeconomic status, caste, parity, women autonomy, empowerment, comorbidities, and environmental factors including infrastructural issues, overcrowding, ill-equipped health facilities, supply constraints, and healthcare access. Conclusion: The high prevalence of disrespectful maternity care indicates an urgent need to improve maternity care in India by making it more respectful, dignified, and women-centered. Interventions, policies, and programs should be implemented that will protect the fundamental rights of women.

Atitude do Pessoal de Saúde , Parto Obstétrico/psicologia , Serviços de Saúde Materna/estatística & dados numéricos , Serviços de Saúde Materna/normas , Abuso Físico/estatística & dados numéricos , Relações Profissional-Paciente , Adulto , Parto Obstétrico/métodos , Feminino , Humanos , Índia , Parto , Gravidez , Qualidade da Assistência à Saúde , Respeito
Brain Nerve ; 72(7): 727-735, 2020 Jul.
Artigo em Japonês | MEDLINE | ID: mdl-32641569


The New Clinical Ethics of Dementia Care is dedicated to the dignity of physically frail and cognitively vulnerable individuals. To deliberate on the dignity of a person with dementia, it is important to focus on their autonomy in health care and daily life.

Demência , Ética Clínica , Respeito , Idoso , Demência/terapia , Idoso Fragilizado , Humanos , Pessoalidade
PLoS One ; 15(6): e0235339, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32589649


Menstrual blood is not just a physical substance; it is laden with symbolism and often powerfully stigmatised. It is important to understand local perceptions and attitudes towards menstrual blood, as well as the preferred practices of menstruating women, in order to design appropriate sanitation and solid waste systems to support menstruation. Failure to take account of socio-cultural factors can jeopardise the effectiveness of such infrastructure. This study, conducted in Blantyre, Malawi, is a qualitative socio-cultural examination of how women manage and view menstruation. Thirty nine interviews, conducted with individuals and with small groups of friends, were carried out with thirty one women using pit latrines, flush toilets, and urine-diverting dry toilets in early 2019. Menstruation in Blantyre was found to be shrouded in secrecy because it was viewed as 'dirty', and therefore remained concealed. There was widespread anxiety about menstrual blood being used in ufiti (witchcraft), which affected how women used and disposed of their menstrual absorbents. At the same time, menstrual blood was also viewed as a powerful healing substance with uses in traditional medicine. The type of infrastructure required by women to support their menstruation depended on the type of menstrual absorbent used. Those using reusable cloth generally preferred a private bathroom with discreet drainage, whilst those using disposable pads needed a discreet and convenient disposal system. Increased preference for disposable pads over reusable cloth (particularly for younger women in education or employment) suggested that menstrual waste profiles of urban areas may be changing. Understanding these changing needs will be crucial for planning effective, sustainable waste disposal and sanitation infrastructure.

Confidencialidade , Cultura , Produtos de Higiene Menstrual , Poder Psicológico , Gerenciamento de Resíduos , Adulto , Medo , Feminino , Humanos , Entrevistas como Assunto , Malaui , Menstruação/psicologia , Pessoa de Meia-Idade , Respeito , Adulto Jovem
Proc Natl Acad Sci U S A ; 117(27): 15546-15553, 2020 07 07.
Artigo em Inglês | MEDLINE | ID: mdl-32581121


How can governments and nonprofits design aid programs that afford dignity and facilitate beneficial outcomes for recipients? We conceptualize dignity as a state that manifests when the stigma associated with receiving aid is countered and recipients are empowered, both in culturally resonant ways. Yet materials from the largest cash transfer programs in Africa predominantly characterize recipients as needy and vulnerable. Three studies examined the causal effects of alternative aid narratives on cash transfer recipients and donors. In study 1, residents of low-income settlements in Nairobi, Kenya (N = 565) received cash-based aid accompanied by a randomly assigned narrative: the default deficit-focused "Poverty Alleviation" narrative, an "Individual Empowerment" narrative, or a "Community Empowerment" narrative. They then chose whether to spend time building business skills or watching leisure videos. Both empowerment narratives improved self-efficacy and anticipated social mobility, but only the "Community Empowerment" narrative significantly motivated recipients' choice to build skills and reduced stigma. Given the diverse settings in which aid is delivered, how can organizations quickly identify effective narratives in a context? We asked recipients to predict which narrative would best motivate skill-building in their community. In study 2, this "local forecasting" methodology outperformed participant evaluations and experimental pilots in accurately ranking treatments. Finally, study 3 confirmed that the narrative most effective for recipients did not undermine donors' willingness to contribute to the program. Together these studies show that responding to recipients' psychological and sociocultural realities in the design of aid can afford recipients dignity and help realize aid's potential.

Motivação , Pobreza/psicologia , Assistência Pública/ética , Respeito , Estigma Social , Adulto , Feminino , Previsões , Humanos , Quênia , Masculino , Narração , Pobreza/economia , Assistência Pública/economia , Assistência Pública/tendências
Acta bioeth ; 26(1): 61-72, mayo 2020. tab
Artigo em Espanhol | LILACS | ID: biblio-1114599


La dignidad del paciente puede verse afectada en el transcurso de la hospitalización por conductas observables de los profesionales. A pesar de su importancia, existen pocos instrumentos para evaluarla. Mediante un estudio transversal, descriptivo, analítico y cuantitativo, se evalúa la percepción de dignidad del paciente con el "Cuestionario de percepción de dignidad de paciente hospitalizado (CuPDPH)", en español y validado. La muestra estuvo formada por 148 hombres y 138 mujeres, con una media de edad de 62.82 (DE 4.05). No se detectó diferencias significativas en las puntuaciones y las variables sociodemográficas. Los resultados permiten identificar puntos fuertes y áreas de mejora en el cuidado y respeto a la dignidad de las personas hospitalizadas. Profundizar en el tema resulta una oportunidad en el camino hacia la excelencia profesional, defendiendo las competencias técnica y ética.

Dignity is a fundamental concept that can be modified during hospitalization by the behavior of professionals. Despite its importance, there are few instruments to evaluate it. A transversal, descriptive, analytical and quantitative study evaluates the patient's perception of dignity based on the "Cuestionario de percepción de dignidad de paciente hospitalizado (CuPDPH)" in Spanish and validated. The sample was composed of 148 men and 138 women with an average age of 62.82 (SD 4.05). No significant differences were found in the scores and sociodemographic variables. The results allow us to identify highlights and areas of improvement in the care and respect for the dignity of hospitalized persons. Going deeper into the topic is an opportunity, on the way to professional excellence, defending technical competence and ethical competence.

Resumo A dignidade do paciente pode ser afetada no transcurso da hospitalização por condutas observáveis dos profissionais. Apesar de sua importância, existem poucos instrumentos para avalia-la. Mediante um estudo transversal, descritivo, analítico e quantitativo, avalia-se a percepção da dignidade do paciente com o "Questionário de percepção da dignidade de paciente hospitalizado (CuPDPH, sigla em espanhol)", em espanhol e validado. A amostra foi constituída por 148 homens e 138 mulheres, com uma média de idade de 62,82 (DP 4,05). Não se detectaram diferenças significativas nas pontuações e nas variáveis sócio-demográficas. Os resultados permitem identificar pontos fortes e áreas de melhora no cuidado e respeito à dignidade das pessoas hospitalizadas. Aprofundarse no tema representa uma oportunidade no caminho à excelência profissional, defendendo as competências técnica e ética.

Humanos , Masculino , Feminino , Adolescente , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Adulto Jovem , Pessoalidade , Respeito , Pacientes Internados/psicologia , Percepção , Relações Profissional-Paciente , Estudos Transversais , Análise Multivariada , Inquéritos e Questionários , Satisfação do Paciente , Confidencialidade , Vulnerabilidade em Saúde , Hospitalização
Acta bioeth ; 26(1): 9-16, mayo 2020.
Artigo em Espanhol | LILACS | ID: biblio-1114593


Este artículo tiene por objetivo introducir la noción de "autorrespeto" en el marco de la discusión sobre la eutanasia. Para ello muestra brevemente, en primer lugar, dos rasgos que caracterizan gran parte de los debates morales contemporáneos sobre temas de ética aplicada, rasgos que permitirán explicar, con mayor claridad, la necesidad de ampliar las razones que permitan a las personas estar en condiciones de adelantar su muerte. En segundo término, se expone una de las primeras reflexiones de Platón acerca de la diferencia entre el mero hecho de estar vivos (to zen) y el vivir bien (to eu zen), y cuyos argumentos podemos trasladar en parte al debate sobre la eutanasia. Luego de discutir la idea de "persona", el artículo aborda finalmente la noción de "autorrespeto" como criterio para considerar la legitimidad moral de poner anticipadamente fin a nuestra vida.

This paper aims to introduce the notion of self-respect in the context of the discussion on euthanasia. First, I briefly show two features that characterize much of the contemporary moral debates on issues of applied ethics, features that will allow me to explain more clearly the discussion about euthanasia. Looking back at the history of Philosophy, in the second part, I will show how Plato offered one of the first reflections on the difference between the mere fact of being alive (to zen) and living well (to eu zen), and whose arguments we can use to discuss euthanasia. Third, I will examine what we understand by a person and how a particular comprehension of this notion will allow me to elaborate arguments in favour of euthanasia based on the idea of self-respect.

Este artigo tem por objetivo introduzir a noção de "auto-respeito" no contexto da discussão sobre eutanásia. Para isto, mostra brevemente, em primeiro lugar, dois aspectos que caracterizam grande parte dos debates morais contemporâneos sobre temas de ética aplicada, aspectos estes que permitirão explicar, com maior clareza, a necessidade de ampliar as razões que permitam às pessoas estarem em condições de adiantar sua morte. Em segundo lugar, expõe-se uma das primeiras reflexões de Platão acerca da diferença entre o mero fato de estar vivos (to zen) e o viver bem (to eu zen), e cujos argumentos podemos transferir em parte ao debate sobre a eutanásia. Depois de discutir a ideia de "pessoa", o artigo aborda finalmente a noção de "auto-respeito" como critério para considerar a legitimidade moral de por antecipadamente fim à nossa vida.

Eutanásia/ética , Suicídio Assistido/ética , Autonomia Pessoal , Valor da Vida , Respeito , Autoimagem