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1.
Front Public Health ; 12: 1359790, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38841670

RESUMO

Introduction: Antimicrobial resistance (AMR) is a major public health threat. With the growing emphasis on patient-centred care/ shared decision making, it is important for healthcare professionals' (HCPs) who prescribe, dispense, administer and/or monitor antimicrobials to be adequately equipped to facilitate appropriate antimicrobial use. We systematically identified existing interventions which aim to improve HCPs interaction with patients and examined barriers and facilitators of appropriate the use of such interventions and appropriate antimicrobial use among both HCPs and patientsantimicrobial use while using these interventions. Methods: We searched MEDLINE, EMBASE, Web of Science, Google Scholar, and internet (via Google search engine). We included primary studies, published in English from 2010 to 2023 [PROSPERO (CRD42023395642)]. The protocol was preregistered with PROSPERO (CRD42023395642). We performed quality assessment using mixed methods appraisal tool. We applied narrative synthesis and used the COM-B (Capability, Opportunity, Motivation -Behaviour) as a theoretical framework for barriers and facilitators at HCP and patient levels. Results: Of 9,172 citations retrieved from database searches, From 4,979 citations remained after removal of duplicates. We included 59 studies spanning over 13 countries. Interventions often involved multiple components beyond HCPs' interaction with patients. From 24 studies reporting barriers and facilitators, we identified issues relating to capability (such as, knowledge/understanding about AMR, diagnostic uncertainties, awareness of interventions and forgetfulness); opportunity (such as, time constraint and intervention accessibility) and motivation (such as, patient's desire for antibiotics and fear of litigation). Conclusion: The findings of this review should be considered by intervention designers/adopters and policy makers to improve utilisation and effectiveness.


Assuntos
Pessoal de Saúde , Humanos , Pessoal de Saúde/psicologia , Pessoal de Saúde/estatística & dados numéricos , Relações Profissional-Paciente , Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana
2.
Psychodyn Psychiatry ; 52(2): 136-149, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38829224

RESUMO

This article explores the problems of the frequent loss, in the course of treatment, of the initial goals and motivation for treatment by both patient and therapist, and the connected lack of clarity of the real initial motivation for treatment on the part of both participants. It is strongly proposed that a true coincidence of at least one important initial motivational goal of patient and therapist is essential to assure the success of psychotherapy and that particular care is required to establish such agreement. On this basis, the goals of therapy may be expanded in the course of the therapist's experience, countertransference, and the patient's changing reality during treatment, and the existential and philosophical value systems of the therapist may play an important role in such widening of the therapist's expectations for the patient.


Assuntos
Motivação , Psicoterapia , Humanos , Memória , Relações Profissional-Paciente , Objetivos , Contratransferência
3.
Sante Publique ; 36(2): 57-67, 2024.
Artigo em Francês | MEDLINE | ID: mdl-38834525

RESUMO

INTRODUCTION: The caregiver-patient relationship has been the subject of numerous studies in the field of medicine, but has received little attention in the context of chiropractic care, particularly in France. PURPOSE OF THE RESEARCH: This ethnographic and sociological study aims to gain a better understanding of the characteristics of the chiropractic relationship in chiropractic care through the observation of consultations followed by interviews with both patients and caregivers. These observations were carried out in the Franco-European Chiropractic Institute’s two outpatient clinics and in three private practices. RESULTS: The data were collected between October 2022 and March 2023. Most of the patients treated their health as an asset to be preserved or even improved, and had a good knowledge of their body as a tool for work and/or sports performance. They turned to chiropractic care to find relief from their pain and a form of care combining technical and interpersonal skills. Chiropractic care is based on manual therapy, combined with a dimension of self-management by the patient. Follow-up of the exercises and advice given by chiropractors varies greatly from patient to patient, from diligent application to non-application, and with everything in between. CONCLUSION: Trust is the foundation of all care, and even more so in manual therapy, because of the way the hands act on the body. To establish a working alliance with the patient, the chiropractor has to adapt his or her professional ethos and accept compromises regarding the treatment plan envisaged. Cooperation between a patient and a chiropractor is based on trust, the negotiation of objectives, and the division of tasks between the two parties.


Assuntos
Quiroprática , Humanos , Feminino , Masculino , França , Adulto , Pessoa de Meia-Idade , Encaminhamento e Consulta , Relações Profissional-Paciente , Manipulação Quiroprática , Idoso , Adulto Jovem , Cuidadores
4.
Clin Psychol Psychother ; 31(3): e3016, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38859691

RESUMO

OBJECTIVE: This study examined therapists' dispositional empathy profiles and how they differ based on professional and personal characteristics. METHOD: A total of 376 clinicians was recruited for this study. Dispositional empathy was assessed with the Interpersonal Reactivity Index (IRI). Profiles were generated using latent profile analysis. Predictors of profiles were assessed with multiple self-report questionnaires measuring demographic and professional characteristics, romantic attachment styles, five-factor personality traits and vulnerable narcissism. RESULTS: A four-profile solution was retained with the following proportions: rational empathic (20%), disengaged/detached (10%), empathic immersion (35%) and insecure/self-absorbed (35%). Overall, few relationships were found regarding demographic and professional characteristics. In contrast, significant relationships were found between profile membership and personal characteristics, including avoidant and anxious attachment, agreeableness, conscientiousness, neuroticism, intellect/imagination and vulnerable narcissism. CONCLUSION: The findings show that differences in therapists' empathic dispositions are linked to personality dimensions. Implications for psychotherapy research, practice and training are discussed.


Assuntos
Empatia , Psicoterapeutas , Humanos , Masculino , Feminino , Adulto , Psicoterapeutas/psicologia , Psicoterapeutas/estatística & dados numéricos , Pessoa de Meia-Idade , Personalidade , Inquéritos e Questionários , Relações Profissional-Paciente , Narcisismo
5.
Addict Sci Clin Pract ; 19(1): 44, 2024 May 23.
Artigo em Inglês | MEDLINE | ID: mdl-38783382

RESUMO

BACKGROUND: Norway has a growing proportion of ageing opioid agonist treatment (OAT) patients, with 42% of the 8300 Norwegian OAT patients aged over 50 in 2022. This study aims to explore practitioners' views and experiences from treatment of ageing OAT patients. METHODS: Data were collected as a series of semi-structured interviews with treatment staff (roles interviewed: doctor, psychologist, social worker, nurse, and learning disability nurse). Participants were recruited from three OAT outpatient clinics, one with an urban catchment area and two with a mix of urban and rural. The interviews incorporated questions on patients' somatic and mental health, strengths and weaknesses of the service for this group, and patients' quality of life. RESULTS: Older patients were perceived to be more often stable in terms of substance use and housing situation, but also experiencing some key challenges in terms of cognitive impairment, loneliness and isolation, and comorbidities. Both the practitioner-patient relationship and healthcare interactions outside OAT had the potential to impact treatment quality positively or negatively depending on how they were managed. CONCLUSIONS: Treating older patients in a way that respects and enhances their dignity is important. We argue that this requires better services for those whose functioning is impacted by cognitive impairment/dementia, an age-informed treatment model for this patient group, along with urgent work to improve municipal-level services given practitioners describe them as unacceptable in certain areas.


Assuntos
Tratamento de Substituição de Opiáceos , Transtornos Relacionados ao Uso de Opioides , Qualidade de Vida , Humanos , Noruega , Pessoa de Meia-Idade , Masculino , Feminino , Tratamento de Substituição de Opiáceos/métodos , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Idoso , Atitude do Pessoal de Saúde , Entrevistas como Assunto , Disfunção Cognitiva/tratamento farmacológico , Comorbidade , Analgésicos Opioides/uso terapêutico , Solidão/psicologia , Relações Profissional-Paciente
6.
J Appl Res Intellect Disabil ; 37(4): e13245, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38770887

RESUMO

BACKGROUND: It can be challenging for support staff to develop meaningful moments of interaction with people with profound intellectual disabilities. Gathering information on observable behaviour characterising such meaningful moments is expected to be beneficial. METHOD: Three staff-client dyadic interactions were videotaped for 30 min. During reviewing the recording, staff members indicated which moments of interaction they experienced as meaningful. Per dyad, one meaningful moment was microanalytically coded via a developed coding system, and behaviourally described. RESULTS: The coding system reliably coded behaviour at the micro level. Exploratory results indicated that looking, movement and touching were most shown, and that staff displayed this behaviour more frequently than their clients. Both exhibited behaviours substantially more often during meaningful moments than at their onset. DISCUSSION: People with profound intellectual disabilities are more engaged during meaningful moments of interaction compared to at their onset. In daily practice, cultivating circumstances increasing their involvement is important.


Assuntos
Deficiência Intelectual , Relações Profissional-Paciente , Humanos , Adulto , Masculino , Feminino , Pessoa de Meia-Idade , Adulto Jovem
7.
BMC Pregnancy Childbirth ; 24(1): 402, 2024 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-38822258

RESUMO

BACKGROUND: The COVID-19 pandemic has challenged the provision of maternal care. The IMAgiNE EURO study investigates the Quality of Maternal and Newborn Care during the pandemic in over 20 countries, including Switzerland. AIM: This study aims to understand women's experiences of disrespect and abuse in Swiss health facilities during the COVID-19 pandemic. METHODS: Data were collected via an anonymous online survey on REDCap®. Women who gave birth between March 2020 and March 2022 and answered an open-ended question in the IMAgiNE EURO questionnaire were included in the study. A qualitative thematic analysis of the women's comments was conducted using the International Confederation of Midwives' RESPECT toolkit as a framework for analysis. FINDINGS: The data source for this study consisted of 199 comments provided by women in response to the open-ended question in the IMAgiNE EURO questionnaire. Analysis of these comments revealed clear patterns of disrespect and abuse in health facilities during the COVID-19 pandemic. These patterns include non-consensual care, with disregard for women's choices and birth preferences; undignified care, characterised by disrespectful attitudes and a lack of empathy from healthcare professionals; and feelings of abandonment and neglect, including denial of companionship during childbirth and separation from newborns. Insufficient organisational and human resources in health facilities were identified as contributing factors to disrespectful care. Empathic relationships with healthcare professionals were reported to be the cornerstone of positive experiences. DISCUSSION: Swiss healthcare facilities showed shortcomings related to disrespect and abuse in maternal care. The pandemic context may have brought new challenges that compromised certain aspects of respectful care. The COVID-19 crisis also acted as a magnifying glass, potentially revealing and exacerbating pre-existing gaps and structural weaknesses within the healthcare system, including understaffing. CONCLUSIONS: These findings should guide advocacy efforts, urging policy makers and health facilities to allocate adequate resources to ensure respectful and high-quality maternal care during pandemics and beyond.


Assuntos
COVID-19 , Serviços de Saúde Materna , Pesquisa Qualitativa , Humanos , COVID-19/psicologia , COVID-19/epidemiologia , Feminino , Suíça , Adulto , Gravidez , Inquéritos e Questionários , Serviços de Saúde Materna/normas , Atitude do Pessoal de Saúde , SARS-CoV-2 , Relações Profissional-Paciente , Respeito , Qualidade da Assistência à Saúde
8.
J Am Psychoanal Assoc ; 72(1): 85-107, 2024 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-38733264

RESUMO

In-person meeting offers psychologically usable material-signifiers that serve as day's residue-that cannot be duplicated or substituted for in remote ways of working. Questions of materiality, the history and specificity of location, and bodily proximity all are key aspects of the psychoanalytic frame, as Bleger's classic formulations attest. The COVID-19 pandemic has changed the choreography of engagement between analyst and patient: the ghostly dust in the frame enters the room. As Bleger says, with ghosts so rustled, nonprocess has a chance to become process. Two clinical examples highlight these points about materiality and in-person working. The final section of the paper extends Bleger's description to tackle the perplexing situation of patients who hesitate to return to the office. Issues of "ghosting," vanishing, disappearing are discussed, and linked to the constitutive absence that grounds any meaningfully structured presence. This constitutive absence is evoked by the prospect of the return to in-person analytic work. A final clinical example is used to illustrate this disturbing and irreducible fact about human interaction when two bodies are together in a room to discuss, over time, the life of one of the participants.


Assuntos
COVID-19 , Terapia Psicanalítica , Humanos , COVID-19/psicologia , SARS-CoV-2 , Relações Profissional-Paciente
9.
BMC Pregnancy Childbirth ; 24(1): 380, 2024 May 21.
Artigo em Inglês | MEDLINE | ID: mdl-38773395

RESUMO

BACKGROUND: Globally, disrespectful, and abusive childbirth practices negatively impact women's health, create barriers to accessing health facilities, and contribute to poor birth experiences and adverse outcomes for both mothers and newborns. However, the degree to which disrespectful maternity care is associated with complications during childbirth is poorly understood, particularly in Ethiopia. AIM: To determine the extent to which disrespectful maternity care is associated with maternal and neonatal-related complications in central Ethiopia. METHODS: A multicentre cross-sectional study was conducted in the West Shewa Zone of Oromia, Ethiopia. The sample size was determined using the single population proportion formula. Participants (n = 440) were selected with a simple random sampling technique using computer-generated random numbers. Data were collected through face-to-face interviews with a pretested questionnaire and were entered into Epidata and subsequently exported to STATA version 17 for the final analysis. Analyses included descriptive statistics and binary logistic regression, with a 95% confidence interval (CI) and an odds ratio (OR) of 0.05. Co-founders were controlled by adjusting for maternal sociodemographic characteristics. The primary exposure was disrespectful maternity care; the main outcomes were maternal and neonatal-related complications. RESULTS: Disrespectful maternity care was reported by 344 women (78.2%) [95% CI: 74-82]. Complications were recorded in one-third of mothers (33.4%) and neonates (30%). Disrespectful maternity care was significantly associated with maternal (AOR = 2.22, 95% CI: 1.29, 3.8) and neonatal-related complications (AOR = 2.78, 95% CI: 1.54, 5.04). CONCLUSION: The World Health Organization advocates respectful maternal care during facility-based childbirth to improve the quality of care and outcomes. However, the findings of this study indicated high mistreatment and abuse during childbirth in central Ethiopia and a significant association between such mistreatment and the occurrence of both maternal and neonatal complications during childbirth. Therefore, healthcare professionals ought to prioritise respectful maternity care to achieve improved birth outcomes and alleviate mistreatment and abuse within the healthcare sector.


Assuntos
Serviços de Saúde Materna , Humanos , Feminino , Etiópia , Estudos Transversais , Adulto , Gravidez , Serviços de Saúde Materna/normas , Adulto Jovem , Relações Profissional-Paciente , Parto/psicologia , Atitude do Pessoal de Saúde , Recém-Nascido , Parto Obstétrico/psicologia , Complicações do Trabalho de Parto/psicologia , Complicações do Trabalho de Parto/epidemiologia , Inquéritos e Questionários , Qualidade da Assistência à Saúde
10.
J Anal Psychol ; 69(3): 367-388, 2024 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-38726595

RESUMO

While Jung's notion of archetypes has had far-reaching universal appeal and significance, it remains less obvious how these ideas might benefit the analytic patient. In particular, the therapist and/or patient may struggle to hold the tension between the latter's personal neuroses and how transpersonal/archetypal elements inform his/her experience. While Jung strove to develop a treatment that dealt primarily with the archetypal/objective psyche, the personal psyche is arguably the medium through which the archetypes are experienced. I contend that the "discipline" of Jungian analysis evolved from a transposition of Jung's ideas around transpersonal, philosophical and religious themes (borne out of his own self-analysis), into a two-person psychotherapeutic process. Jung provides little description of his clinical encounters and the way in which he conducted his analyses leaving an uncertainty that has likely contributed to the divergence of approaches practised today by analytical psychologists. This article considers the implication of these divergences for contemporary Jungian practice and proposes a way of working in the Jungian spirit that maintains a connection to the symbolic realm while at the same time remaining focused on the complexities of personal and relational dynamics.


Alors que le concept jungien d'archétype a eu un attrait et une importance majeure et universelle, ce qui demeure moins évident est de savoir comment ces idées peuvent bénéficier au patient en analyse. En particulier, le thérapeute et/ou le patient peuvent peiner à contenir la tension entre les névroses personnelles du patient et la manière dont les éléments transpersonnels/archétypaux façonnent son expérience. Alors que Jung s'est efforcé de développer un traitement qui s'occupait essentiellement de la psyché objective/archétypale, c'est la psyché personnelle qui est probablement l'intermédiaire par lequel on fait l'expérience des archétypes. Je soutiens que la « discipline ¼ analyse jungienne est issue de la transposition des idées de Jung autour de thèmes transpersonnels, philosophiques et religieux (issus de sa propre auto­analyse), et qu'elle est progressivement devenue un processus psychothérapeutique impliquant deux personnes. Jung fournit peu de descriptions de ses rencontres cliniques et de la manière dont il conduisait ses analyses, ce qui laisse de l'incertitude. Ceci a probablement contribué au fait qu'il y a des divergences dans les approches utilisées aujourd'hui par les psychologues analytiques. Cet article examine les conséquences de ces divergences pour la pratique contemporaine de l'analyse jungienne. Il propose une manière de travailler dans l'esprit jungien c'est­à­dire en maintenant le lien avec le domaine symbolique, mais tout en restant concentré sur les complexités des dynamiques personnelles et relationnelles.


Aunque la noción de arquetipos de Jung ha tenido un atractivo y una relevancia extensa y universal, sigue siendo menos obvio cómo estas ideas pueden beneficiar al paciente analítico. En particular, el terapeuta y/o el paciente pueden tener dificultades para mantener la tensión entre las neurosis personales de este último y el modo en que los elementos transpersonales/arquetípicos informan su experiencia. Aunque Jung se esforzó por desarrollar un tratamiento que se ocupara principalmente de la psique arquetípica/objetiva, la psique personal es el medio a través del cual se experimentan los arquetipos. Sostengo que la "disciplina" del análisis Junguiano evolucionó a partir de una transposición de las ideas de Jung en torno a temas transpersonales, filosóficos y religiosos (surgidos de su propio análisis de sí mismo), en un proceso psicoterapéutico de dos personas. Jung brinda poca descripción de sus encuentros clínicos y de la forma en que llevó a cabo sus análisis, dejando una incerteza que probablemente ha contribuido a la divergencia de abordajes practicados en la actualidad por analistas Junguianos. Este artículo considera la implicancia de estas divergencias para la práctica Junguiana contemporánea y propone una manera de trabajar en el espíritu Junguiano que mantiene una conexión con la dimensión simbólica mientras que al mismo tiempo permanece centrado en las complejidades de las dinámicas personales y relacionales.


Assuntos
Teoria Junguiana , Terapia Psicanalítica , Humanos , Relações Profissional-Paciente , Angústia Psicológica
12.
BMC Pregnancy Childbirth ; 24(1): 359, 2024 May 14.
Artigo em Inglês | MEDLINE | ID: mdl-38745117

RESUMO

BACKGROUND: Respectful Maternal and Neonatal Care (RMNC) maintains and respects a pregnant person's dignity, privacy, informed choice, and confidentiality free from harm and mistreatment. It strives for a positive pregnancy and post-pregnancy care experiences for pregnant people and their families, avoiding any form of obstetric violence. Though RMNC is now widely accepted as a priority in obstetric care, there is a gap in resources and support tools for healthcare wproviders to clearly understand the issue and change long-established practices such as non-humanized caesarean sections. MSI Reproductive Choices (MSI) manages 31 maternities across 7 countries with a zero-tolerance approach towards disrespectful maternity care and obstetric violence. MSI developed and implemented a hybrid training package, which includes an online module and 1-day in-person workshop that allows healthcare providers to explore their beliefs and attitudes towards RMNC. It leverages methodologies used in Values-Clarification-Attitudes-Transformation (VCAT) workshops and behaviour change approaches. METHODS: The impact of this training intervention was measured from the healthcare providers' and patients' perspectives. Patient experience of (dis)respectful care was collected from a cross-sectional survey of antenatal and postnatal patients attending MSI maternities in Kenya and Tanzania before and following the RMNC training intervention. Healthcare providers completed pre- and post-workshop surveys at day 1, 90 and 180 to measure any changes in their knowledge, attitudes and perception of intended behaviours regarding RMNC. RESULTS: The results demonstrate that healthcare provider knowledge, attitudes and perceived RMNC practices can be improved with this training interventions. Patients also reported a more positive experience of their maternity care following the training. CONCLUSION: RMNC is a patient-centred care priority in all MSI maternities. The training bridges the gap in resources currently available to support changes in healthcare wproviders' attitudes and behaviours towards provision of RMNC. Ensuring health system infrastructure supports compassionate obstetric care represents only the first step towards ensuring RMNC. The results from the evaluation of this RMNC provider training intervention demonstrates how healthcare provider knowledge and attitudes may represent a bottleneck to ensuring RMNC that can be overcome using VCAT and behaviour change approaches.


Assuntos
Atitude do Pessoal de Saúde , Pessoal de Saúde , Respeito , Humanos , Quênia , Tanzânia , Feminino , Gravidez , Adulto , Estudos Transversais , Pessoal de Saúde/educação , Pessoal de Saúde/psicologia , Serviços de Saúde Materna/normas , Recém-Nascido , Relações Profissional-Paciente , Adulto Jovem
13.
PLoS One ; 19(5): e0295834, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38743763

RESUMO

The current demographic change means that young psychotherapists and older patients will increasingly come into contact. Unique for this constellation is the intergenerational therapeutic relationship, which forms the basis of psychotherapy, but has not yet been the focus of empirical research. This qualitative study provides preliminary insights into how older patients (aged over 65) experience and perceive the therapeutic relationship with young psychotherapists (aged in their mid-20s to mid-30s). We conducted semi-structured interviews with twelve older patients (8 women, 4 men) and analysed their data using the grounded theory approach. We found a connection between the type of transference a participant demonstrated and their biographical as well as social experiences, desires, and fantasies. Overall, a tendency to seek harmony was observed among the participants, which was reflected in their behaviour towards young psychotherapists: (a) conflict avoidance, (b) (fantasised) therapy discontinuation, (c) adaption/subordination, and (d) solidarity, support, and protection. Our findings demonstrated that various intergenerational transference phenomena, including the roles in which young therapists are perceived, are associated with certain particularities and challenges, such as the topic of sexuality. It can be valuable for young psychotherapists to become aware of a potential role reversal that may result in older patients trying to support them.


Assuntos
Psicoterapeutas , Psicoterapia , Humanos , Feminino , Masculino , Idoso , Adulto , Psicoterapeutas/psicologia , Psicoterapia/métodos , Relações Profissional-Paciente , Pesquisa Qualitativa
14.
BMC Pregnancy Childbirth ; 24(1): 370, 2024 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-38750412

RESUMO

OBJECTIVE: To ascertain and explore the views of women and their partners, giving birth in the Czech Republic, of the level of respectful or disrespectful care provided during pregnancy and early labour. DESIGN: Ethical approval was granted for a descriptive, online anonymous survey of 65 questions, with quantitative and qualitative responses. SETTING: The Czech Republic.The survey was completed by 8,767 women and 69 partners in 2018. MEASUREMENTS AND FINDINGS: Descriptive statistics and thematic analysis were used to present results. The majority of women were aged 26-35 years. Most had birthed in one of 93 hospitals, with 1.5% home births. Almost 40% never had an abdominal examination.in pregnancy. Quantitative data analysis revealed that less than half were given information on place of birth, or how to keep labour normal or non-interventionist. Almost 60% did not get information on positions for birth. Most (68%) commenced labour naturally, 25% had labour induced, 40% of them before term, and 7% had an elective caesarean section; 55% stated they had not been given any choice in the decision. Over half of those who had a membrane sweep said permission had not been sought. Half (54%) only had 'checking' visits from the midwife in labour. KEY CONCLUSIONS: Findings reveal a lack of information-giving, discussion and shared decision-making from healthcare professionals during pregnancy and early labour. Some practices were non-evidenced-based, and interventions were sometimes made without consent. IMPLICATIONS FOR PRACTICE: The examples of disrespectful care described in this study caused women distress during childbirth, which may result in an increased fear of childbirth or an increase in free-birthing.


Assuntos
Respeito , Humanos , Feminino , Gravidez , Adulto , República Tcheca , Inquéritos e Questionários , Trabalho de Parto/psicologia , Adulto Jovem , Relações Profissional-Paciente , Gestantes/psicologia , Parto Obstétrico/psicologia , Atitude do Pessoal de Saúde
15.
Scand J Pain ; 24(1)2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-38776518

RESUMO

OBJECTIVES: The aim of this study was to gain qualitative insight into cancer patients' experiences, explanations, and management strategies regarding their cancer-related pain (CP). METHODS: Seventeen patients with CP were interviewed using a semi-structured interview approach. Braun and Clarke's thematic analysis method was used to analyze the transcribed interviews. The patients all participated in cancer rehabilitation courses arranged by the research clinic at The Danish Knowledge Centre for Rehabilitation and Palliative Care. RESULTS: Three themes were identified: (1) Explaining CP: Patients found it difficult to explain how they experienced their pain. They lacked words, and they frequently used invasive metaphors such as "Pain feels like a heart attack" (2). Strategies and barriers to the management of CP: Initiatives provided by healthcare professionals (HCPs) were perceived as insufficient, and the patients missed guidance in both pharmacological and non-pharmacological approaches to pain management. Several saw medicine as unnatural for their body, and they focused on side effects and the medicine affecting their quality of life. (3) Responsibility for managing CP: A lack of responsiveness from the HCPs and taking on responsibility for pain management were experienced by several of the patients. The patients expressed uncertainty about whom to contact for help with the management of their CP. CONCLUSION: The patients' difficulties in explaining, understanding, and communicating their pain and pain management contributed to insufficient pain management. They were also uncertain about who had the responsibility to help them to achieve pain relief. These results share the evidence drawn from studies on patients with chronic non-cancer pain. This qualitative study highlights the need for having more focus on a common language and shared understanding between patients and HCPs. It also underpins the importance of HCPs to assume their responsibility to help patients manage their pain conditions.


Assuntos
Dor do Câncer , Manejo da Dor , Pesquisa Qualitativa , Humanos , Feminino , Masculino , Dor do Câncer/terapia , Dor do Câncer/psicologia , Pessoa de Meia-Idade , Manejo da Dor/métodos , Idoso , Adulto , Comunicação , Neoplasias/complicações , Neoplasias/psicologia , Dinamarca , Relações Profissional-Paciente
16.
J Int AIDS Soc ; 27(5): e26258, 2024 May.
Artigo em Inglês | MEDLINE | ID: mdl-38740547

RESUMO

INTRODUCTION: Person-centred care (PCC) has been recognized as a critical element in delivering quality and responsive health services. The patient-provider relationship, conceptualized at the core of PCC in multiple models, remains largely unexamined in HIV care. We conducted a systematic review to better understand the types of PCC interventions implemented to improve patient-provider interactions and how these interventions have improved HIV care continuum outcomes and person-reported outcomes (PROs) among people living with HIV in low- and middle-income countries. METHODS: We searched databases, conference proceedings and conducted manual targeted searches to identify randomized trials and observational studies published up to January 2023. The PCC search terms were guided by the Integrative Model of Patient-Centeredness by Scholl. We included person-centred interventions aiming to enhance the patient-provider interactions. We included HIV care continuum outcomes and PROs. RESULTS: We included 28 unique studies: 18 (64.3%) were quantitative, eight (28.6.%) were mixed methods and two (7.1%) were qualitative. Within PCC patient-provider interventions, we inductively identified five categories of PCC interventions: (1) providing friendly and welcoming services; (2) patient empowerment and improved communication skills (e.g. supporting patient-led skills such as health literacy and approaches when communicating with a provider); (3) improved individualized counselling and patient-centred communication (e.g. supporting provider skills such as training on motivational interviewing); (4) audit and feedback; and (5) provider sensitisation to patient experiences and identities. Among the included studies with a comparison arm and effect size reported, 62.5% reported a significant positive effect of the intervention on at least one HIV care continuum outcome, and 100% reported a positive effect of the intervention on at least one of the included PROs. DISCUSSION: Among published HIV PCC interventions, there is heterogeneity in the components of PCC addressed, the actors involved and the expected outcomes. While results are also heterogeneous across clinical and PROs, there is more evidence for significant improvement in PROs. Further research is necessary to better understand the clinical implications of PCC, with fewer studies measuring linkage or long-term retention or viral suppression. CONCLUSIONS: Improved understanding of PCC domains, mechanisms and consistency of measurement will advance PCC research and implementation.


Assuntos
Países em Desenvolvimento , Infecções por HIV , Assistência Centrada no Paciente , Humanos , Infecções por HIV/terapia , Infecções por HIV/psicologia , Assistência Centrada no Paciente/métodos , Continuidade da Assistência ao Paciente , Relações Profissional-Paciente
17.
Harm Reduct J ; 21(1): 97, 2024 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-38760824

RESUMO

BACKGROUND: Structural harm reduction is an approach to care for people who use drugs (PWUD) that incorporates services and resources (e.g., naloxone, sterile syringes). As conceptualized in our previous research, harm reduction is also "relational," encompassing a patient-provider relationship that is non-judgmental and respectful of patients' autonomy. Little is known about health care workers' (HCW) knowledge or attitudes towards harm reduction beyond structural strategies, whose availability and legality vary across geographical settings. To operationalize how relational harm reduction is both characterized and employed in HIV care settings, where nearly half of patients have a diagnosed substance use disorder, we qualitatively explored HCWs' knowledge of and use of harm reduction via individual in-depth interviews. METHODS: Our study sample included three HIV clinics, one in Birmingham, Alabama (AL) and two in Pittsburgh, Pennsylvania (PA). We conducted individual interviews with n = 23 health care workers via Zoom, using a semi-structured interview guide to probe for questions around health care workers' attitudes towards and experiences with providing care to PWH who use drugs and their knowledge of and attitudes towards relational and structural harm reduction. Data was analyzed in Dedoose using thematic analysis. RESULTS: Qualitative analyses revealed two primary themes, Continuum of Relational Harm Reduction in Practice and Limited Harm Reduction Training. Nearly all HCWs (n = 19, 83%) described a patient interaction or expressed a sentiment that corresponded with the principles of relational harm reduction. Yet, over half of participants (n = 14, 61%) used language to describe PWH who use drugs that was stigmatizing or described an interaction that was antithetical to the principles of relational harm reduction. Five HCWs, all from Birmingham, were unaware of the term 'harm reduction.' Few HCWs had any harm reduction training, with most learning about harm reduction from webinars/conferences or on the job. CONCLUSION: Our findings suggest that relational harm reduction in HIV care settings is practiced along a continuum, and that a range of behaviors exist even within individual HCWs (e.g., used stigmatizing terms such as "addict" but also described patient interactions that reflected patients' autonomy). Given that harm reduction is typically described as a structural approach, a broader definition of harm reduction that is not dependent on policy-dependent resources is needed.


Assuntos
Atitude do Pessoal de Saúde , Infecções por HIV , Redução do Dano , Pessoal de Saúde , Atenção Primária à Saúde , Humanos , Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Feminino , Masculino , Pessoal de Saúde/psicologia , Adulto , Pessoa de Meia-Idade , Pesquisa Qualitativa , Relações Profissional-Paciente , Conhecimentos, Atitudes e Prática em Saúde
18.
Z Psychosom Med Psychother ; 70(1): 77-93, 2024 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-38598707

RESUMO

Does the therapeutic style differ in age-homogeneous and age-heterogeneous therapeutic dyads? BACKGROUND AND AIMS: Differences between age-homogeneous and age-heterogeneous therapeutic dyads have rarely been the subject of research.The present study aimed to investigate differences in therapeutic style (Healing and Stressful Involvement). METHOD: A sample of 527 questionnaires completed by therapists of different ages was available. Therapy style was compared between two patient groups (under 40 and over 65 years old) and three therapist groups (25-39, 40-59, ≥ 60). RESULTS: The results show in particular more stress experienced by younger therapists in the treatment of older patients, while older therapists report less stress.There were no or fewer differences in the treatment of younger patients.The regression-analytical results show that the experience of stress in the therapy of older people is associated with a greater fear of old age. CONCLUSION: Finally, some conclusions are discussed with regard to training and supervision of therapists in the treatment of older people.


Assuntos
Medo , Psicoterapia , Humanos , Idoso , Psicoterapia/métodos , Inquéritos e Questionários , Relações Profissional-Paciente
19.
J Clin Psychol ; 80(7): 1698-1710, 2024 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-38588045

RESUMO

OBJECTIVES: The therapist-facilitative interpersonal skills (FIS) has shown to predict therapy outcomes, demonstrating that high FIS therapists are more effective than low FIS therapists. There is a need for more insight into the variability in strengths and weaknesses in therapist skills. This study investigates whether a revised and extended FIS-scoring leads to more differentiation in measuring therapists' interpersonal skills. Furthermore, we explorative examine whether subgroups of therapists can be distinguished in terms of differences in their interpersonal responses. METHOD: Using secondary data analysis, 93 therapists were exposed to seven FIS-clips. Responses of therapists using the original and the extended FIS scoring were rated. RESULTS: Three factors were found on the extended FIS scoring distinguishing supportive, expressive, and persuasive interpersonal responses of therapists. A latent profile analysis enlightened the presence of six subgroups of therapists. CONCLUSION: Using the revised and extended FIS-scoring contributes to our understanding of the role of interpersonal skills in the therapeutic setting by unraveling the question what works for whom.


Assuntos
Relações Profissional-Paciente , Habilidades Sociais , Humanos , Adulto , Feminino , Masculino , Pessoa de Meia-Idade , Relações Interpessoais , Psicoterapia/métodos , Psicoterapia/normas , Psicoterapeutas , Adulto Jovem
20.
Curr Opin Support Palliat Care ; 18(2): 86-91, 2024 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-38652458

RESUMO

PURPOSE OF REVIEW: Adolescents with haematological malignancies within adult services, in the UK from 16 years old, have unique needs and require developmentally targeted services and approaches to care delivery. High-risk intensive treatments are common for this cohort and a better understanding of what individualised supportive and palliative care means in this context is required. RECENT FINDINGS: Being known and understood as an emerging adult, with particular recognition of developmental stage, is an essential component of quality measures and underpins the adolescent, and caregiver, experience when faced with an uncertain or poor cancer prognosis (UPCP). Healthcare professionals (HCPs) can experience increased emotional labour and feelings of professional inadequacy when caring for adolescents with UPCP. Therapeutic alliance improves HCPs understanding of optimum individualised care by improving communication and supported decision making. Access to training and support for HCPs is required to address the emotional impact of therapeutic alliance with teenage/adolescent and young adults (T/AYAs) with advanced cancer. SUMMARY: Investment in therapeutic alliance, alongside robust support mechanisms and targeted training, can improve the skills, confidence and wellbeing for HCPs, and can also ensure optimum individualised care for T/AYAs with UPCP. Evidence for optimum care for adolescents with advanced cancer is relatively scarce, especially for younger T/AYAs (16-24) in the UK who sit within adult services. Further evaluation of the impact of current UK expertise, services and programs are needed to inform future development.


Assuntos
Neoplasias Hematológicas , Cuidados Paliativos , Assistência Terminal , Humanos , Cuidados Paliativos/organização & administração , Adolescente , Adulto Jovem , Neoplasias Hematológicas/terapia , Neoplasias Hematológicas/psicologia , Assistência Terminal/organização & administração , Assistência Terminal/psicologia , Reino Unido , Comunicação , Tomada de Decisões , Pessoal de Saúde/psicologia , Pessoal de Saúde/organização & administração , Relações Profissional-Paciente , Prognóstico
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