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Dissertations / Theses on the topic 'Patient narrative'
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Hulslander, T. A. "Narratives of Aging and Patient Activation." Antioch University / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1454576308.
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Tong, Yao S. M. Massachusetts Institute of Technology. "Narrative as an aid for the doctor-patient relationship in China." Thesis, Massachusetts Institute of Technology, 2017. http://hdl.handle.net/1721.1/113548.
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Thesis: Massachusetts Institute of Technology, Department of Comparative Media Studies/Writing, 2017."September 2017." Cataloged from PDF version of thesis.
Includes bibliographical references (pages 93-97).
In recent years, the incidence of violence against Chinese doctors has increased dramatically, with the scale, frequency and viciousness of attacks shocking the world. The challenging doctor-patient relationship remains a complicated issue with no single cause. When the tension intensifies, some news media tend to blame the doctors, using misleading narratives to create sensationalism, thereby aggravating the antagonism between the society and medical professionals. Much scholarship has focused on exploring the social, economic, political, legal, and medical aspects of the doctor- patient relationship. In contrast, little research has been done to interrogate the media's role in contributing to the tension. Additionally, although most studies are concerned with proposing suggestions, no study has posed an intervention to combat the twisted depictions of doctors and to abate the worsening doctor-patient tension. To this end, this thesis examines the role of the media to provide an explanatory analysis of its influence on the doctor-patient relationship, and then leverages on the power of narrative to offer an intervention as an aid to the current doctor-patient tension. User feedback has been collected and analyzed to measure the effectiveness of this project. The aim of this intervention is to help promote perspective taking, increase awareness, and foster understanding toward medical professionals in China.
by Yao Tong.
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Patterson, Spencer D. "Putting on White Coats: Professional Socialization of Medical Students Through Narrative Pedagogy in Standardized Patient Labs." Ohio University / OhioLINK, 2012. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1339729044.
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Hale, Nicholas David. "A narrative theory of patient centrality : the impact of nurses on the interface between carers' and patients' experience." Thesis, King's College London (University of London), 2005. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.422650.
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Davis, Kayla. "On Experiencing Illness in the Western Biomedical World: A Push for more Comprehensive Healthcare in America." Digital Commons @ East Tennessee State University, 2018. https://dc.etsu.edu/honors/460.
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The purpose of this thesis is to identify common themes presented in several illness narratives with specific attention paid to the relationship between patients and their physicians and patients and their families. Only illness narratives written in America and Western Europe were used for this thesis so the topic could be narrowed to the experience within the western biomedical field. While most research on illness narratives focuses on defining illness and illustrating the importance of introspective work, this thesis identifies patterns in a way that can shape the future treatment of chronically ill patients. This thesis also allows me to creatively explore a personal illness narrative, reinforcing these themes and contributing to the discussion of what physicians and families can do to make the illness experience more bearable for the patient.
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Nasr, Nasrin. "Outcome from total hip replacement : from standardised measures to patient-focused narrative-based assessment." Thesis, Sheffield Hallam University, 2007. http://shura.shu.ac.uk/20767/.
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The dynamic construct of quality of life (QoL) and evidence of the response shift phenomenon in longitudinal studies can lead to biased and incomplete evaluation of change over time. This study examines the current approach to measurement of QoL, particularly the validity of measures routinely used in health care, using three different types of standardised measurements in association with narrative interviews of patients following total hip replacement: To explore the outcome from patients' perspectives by obtaining highly individualised data and encouraging them to identify domains of concern in their lives. To compare patients' expectations of outcome with their measured functional ability on the standardised measures. To establish whether there is a relationship between patients' expectations and characteristics and perceived QoL prior to surgery. To determine how well standardised generic measures fulfil patients' particular needs by comparing data obtained using them with individualised data. Narrative interviews were conducted with 25 participants, nine of whom participated in follow-up interviews. Different aspects of their lives, such as values, feelings, job, attitudes and relationships, were explored and analysed using content analysis and narrative analysis. The findings from content analysis were categorised into two major components, themes related to life dimensions and coping-related themes. Core concepts related to life dimensions were collated to develop an instrument representing participants' perspective of hip condition. Performance analysis of narrative showed that understanding of an experience relies on the structure of narrative rather than the content. Participants used different coping strategies not to get rid of pain and physical limitations but to alleviate the damaging effects of hip-related problems, supporting the notion of re-interpretation of life experiences through employing psychological mechanisms. The main recommendations are that (a) health outcomes should be evaluated through models of communication and (b) individualised, qualitative methods be used to generate further understanding of the impact of response shift on self-report measures.
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Reeher, Jennifer M. "“The Despair of the Physician”: Centering Patient Narrative through the Writings of Charlotte Perkins Gilman." Ohio University / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1523435451243392.
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Digan, John. "Are the counselling skills nurses learn in training apparent in their everyday interactions with patients and carers?" Thesis, University of Manchester, 2014. https://www.research.manchester.ac.uk/portal/en/theses/are-the-counselling-skills-nurses-learn-in-training-apparent-in-their-everyday-interactions-with-patients-and-carers(e0c2fba5-d651-4c44-b509-55433538d2df).html.
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This research evaluates whether nurses working in general hospital settings utilise the counselling skills they are taught during their initial nurse training when they practice as qualified nurses. A narrative enquiry methodology was used to gather stories about everyday nurse patient interactions from eight nurses working in a variety of general hospital settings. The stories were tape recorded and transcribed before being subjected to qualitative descriptive analysis, a variant of content analysis, which yielded a number of themes. The analytical process incorporated the use of a hermeneutic circle to reinforce the reliability of the analysis and three types of skill were identified within the narratives. The narratives suggest that nurses do use counselling skills regularly when interacting with patients and carers, in particular the skills of information giving and empathy. These skills are inter-related in nursing practice and their usage stems from the personal experiences of the nurses involved rather than any training received prior to their qualifying as registered practitioners. While the sample size is relatively small the findings might suggest there could be some worth in further research to determine the relational skills possessed by those wishing to enter nurse training. This type of investigation has a resonance with current calls for reform of nurse education and might allow for training in the area of interpersonal skills to become more personalised. Ethical permissions were obtained from NRES, the Ethics committee of the United Lincolnshire Hospitals Trust and the University of Manchester.
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Wytiaz, Victoria. "Physician-as-patient literature: Introducing and fostering a culture of empathy in medicine." Master's thesis, Temple University Libraries, 2017. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/449267.
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Urban BioethicsM.A.
The physician-patient dichotomy is reinforced continuously in medical education and medical practice. The physician possesses knowledge that will be used to help the patient in some way. However, as human beings, physicians are subject to the illnesses and diseases that affect their patients. Physicians moved by this role-reversal may feel compelled to record their experiences, leading to an accumulation of “physician-as-patient literature.” Five examples of “physician-as-patient” literature illustrate five fundamental lessons that can be adapted by physicians: relating to patient vulnerability, fostering hope for patients, mobilizing support systems, recognizing physical consequences of disease, and appreciating patient quality of life. By generalizing these individual stories, it is not necessary for physicians to experience the exact disease or illness they treat. Rather, they can draw from their unique life experiences to practice empathy. The concept of empathetic medicine can be introduced in medical school training by integrating empathy education into scientific curriculum. Current practitioners can benefit from narrative exercises, reflection and physician self-disclosure in efforts to promote empathy. Medical practice requires solid relationships between human beings, physicians and patients. This basic principle is further emphasized in “physician-as-patient” literature and concerted efforts by institutions and individual physicians can lead to a foundation for a culture of empathy.
Temple University--Theses
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Brooks, Helen. "Patient perceptions, experiences and expectations of recovery and prognosis in long-term conditions." Thesis, University of Manchester, 2013. https://www.research.manchester.ac.uk/portal/en/theses/patient-perceptions-experiences-and-expectations-of-recovery-and-prognosis-in-longterm-conditions(ffd083bc-ad64-4fc3-9d22-9050aef29cb4).html.
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Background: Whilst the experience of chronic physical conditions is well documented and has been recognised as relevant for health policy and practice little is known about notions of recovery and prognosis from the point of view of those with long-term physical health conditions. The extent to which people consider the future outcomes of their conditions is relevant to health policy which seeks to engage people in shared decision making, care plans, and self-management. This gap in knowledge about lay perceptions of recovery and prognosis becomes more pronounced when compared with literature from the mental health field in which recovery is one of the dominant foci, is comparatively well researched and in recent years has fed into policy and management approaches.Aims: The aim of the thesis is to explore perceptions of recovery and prognosis with people with long-term physical health conditions and to compare these with perspectives on recovery and prognosis apparent in the mental health field.Methodology: Using qualitative methods, a two phased approach to data collection and analysis was undertaken. Phase 1 used secondary data analysis with two existing datasets to examine whether notions of recovery and prognosis were implicit in narratives about the experience of illness. Phase 2 built on the findings from phase 1 and utilised longitudinal, primary data collection in the form of narrative interviews undertaken at two time points (baseline and 12 month follow-up). The analysis in both phases involved a cross case thematic analysis to look for commonalities and differences across individuals. Data from phase 2 were also subject to a narrative emplotment of individual stories which were used to capture the longitudinal changes in patient perspectives over time.Results: There were similarities with findings from the mental health field (recovery as a complex, nonlinear journey, the input from friends and family, notions of burden and the impact of condition on sense of self). However, there were nuanced differences in relation to physical health conditions which related to expectations about mortality, the experience of time, the extent to which narratives were future oriented and the experience of stigma. The dual focus on mental and physical health recovery proved useful for understanding those experiences of multiple morbidities. The results were used to develop a model of recovery narratives based on two dimensions (expectations and responsibility) which gave rise to four typologies of narratives. The aim of this model was to further highlight and summarise the themes arising from the data analysis.Discussion: The results of this study highlight the importance of understanding notions of recovery and prognosis in order to better understand the experience of illness and self-management. The thesis challenges the blanket use of health promotion strategies for those with and without chronic health conditions and supports a shift in policy focus from improved choice and autonomy to what Mol (2009) refers to as ‘enhanced care’.
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Stenhouse, Rosemary Clare. "Unfulfilled expectations : a narrative study of individuals' experiences of being a patient on an acute psychiatric inpatient ward in Scotland." Thesis, University of Edinburgh, 2009. http://hdl.handle.net/1842/4071.
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This study examines people’s experiences of being a patient on an acute psychiatric inpatient ward in Scotland. Within the existing research base few studies focus on the patient’s experience of acute psychiatric inpatient care, and none of these is set in Scotland. Those that do, indicate that the patient experience of acute psychiatric inpatient care is often negative. The theoretical perspective of this study conceptualises experience as represented in narrative form, thus the data take the form of narratives. Thirteen participants were recruited through the acute ward. Each participant participated in two unstructured interviews focussed on gathering narratives of their experience. Data analysis was holistic, guided by Gee’s (1991) socio-linguistic theories. This holistic analysis culminated in the presentation of each participant’s narrative in poetic form. From the holistic analysis I identified three themes - help, safety and power - that were evident in the analyses of all participants’ interviews. The theme of help represents participants’ expectations that they will receive help on the ward, and their experiences of trying to get this help. Safety represents participants’ expectations pertaining to the ward’s function in keeping them safe, their experience of threat and strategies to keep safe. The theme of power represents participants’ experiences of power relations within the acute ward. I conclude that participants’ experiences of being a patient on the ward are characterised by feelings of frustration, concerns about safety, and the perceived need to focus on self-presentation as they attempt to reach their desired goal of discharge.
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Bartell, Joanna. "When Maps Ignore the Territory: An Examination of Gendered Language in Cancer Patient Literature." Scholar Commons, 2016. http://scholarcommons.usf.edu/etd/6178.
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Cancer patients report having a high need for cancer information. Several studies show that the majority of patients surveyed report preferring information from the American Cancer Society (ACS). Ranging up to 129 pages, the ACS’ Detailed Guides (DG) are widely distributed throughout the United States, and offer patients an authoritative guide to help patients navigate the difficult terrain of the cancer journey. This dissertation examines the ACS’ cervical, endometrial, ovarian, penile, prostate, testicular, and vaginal cancer guides. Through a rhetorical analysis of the 7 guides, it was shown that the ACS DGs in question foster gendered narratives that strictly limit the type, range, and quality of information offered to cancer patients. These limitations and their resulting exclusions pose serious risks of misinformation and isolation among vulnerable patient populations with high information needs. Three recommendations are offered to help mitigate the issues identified within the ACS DGs, to improve the quality of information offered in the DGs, and to subsequently help improve patient quality of life.
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Friis, Kirsten Leigh. "The influence of the therapist's activities on clients' subject positioning in relation to gender in narrative couples therapy." Thesis, Rhodes University, 2014. http://hdl.handle.net/10962/d1013050.
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Narrative Therapy draws on an understanding of how discourse acts to construct, reproduce and deconstruct power relationships. Therapy is focussed on collaborating with clients in a process of re-authoring their self-stories by critically evaluating the positions made available to them in relation to dominant discourses. Whilst there is a large body of theoretical knowledge on post-structuralism and psychotherapy, very few discourse analyses of psychotherapy sessions have been published. Thus, though post-structuralist therapeutic approaches are theoretically well supported, there is an identified gap in the literature on the therapeutic processes that occur within practice. This research aims to further explore these therapeutic processes, focussing specifically on subject positioning with relation to gender in Narrative Couple Therapy, and the influence of the therapist thereupon. It is based on the analysis of a video of a Michael White Narrative Couple Therapy session, "The Best of Friends." Using discourse analysis as a methodological approach, the analysis seeks first to identify talk that signifies discourses of gender difference, and then to explore how the subjects (therapist and clients) are positioned in relation to these discourses. The analysis focuses on the therapist's activities to investigate the influence of his interactions with the partners on how they are positioned or position themselves within stories of gender difference. The analysis shows that, by working reflexively, transparently and collaboratively with the partners, the therapist assists to render power, restrictive discourses, and alternate positions visible to the clients. The therapist resists being drawn into dominant therapy discourses of expert and patient, and instead continuously recognises the knowledges and expertise that the clients bring to the therapy context. He then works closely with the clients to thicken alternative representations of self.
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West, Charles K. "An investigation of second-person narratives: the positioning of "you" in a therapy relationship." Diss., Virginia Tech, 1994. http://hdl.handle.net/10919/45323.
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The purpose of this project was to study the second-person narrative tools used by one particular therapist-client pair in an on-going therapy relationship. One male therapist and one male client were each individually interviewed on five occasions. The first interview with each of them focused on their views of what it means to be a therapist, client, and in therapy. The next three individual interviews involved reviewing previously recorded therapy sessions, and asking the co-researchers (the therapist and client) to respond as if they were the other person in the therapy relationship. The final interview focused on their views of the research process and all the participants.
Using an instructional account informed by social constructionist language, the metaphor of narrative, and the decentering of the possessive "I" for the more relationally-oriented "you," I organized the data of the interviews into second-person narratives that seemed to be used by the client and therapist. One of the primary narratives the client used to make sense of the therapist was that the therapist was an "augmenter of the client’s processes." The client seemed to primarily position the researcher as someone doing "research, not therapy." Some of the narratives the therapist used to position the client included "someone needing to vent emotions," "carrier of labels and stories," "employer," and "seeker of options." One of the tools the therapist used to position the researcher was as a nontraditional "Supervisor."
Some narratives seemed to fit into broad categories such as "self-as-same" and "self-as-different." However, the more salient understandings that seemed to develop out of this study have been derived from the co-researchers’ perceptions of how this project became a part of the therapy relationship and, therefore, what might be said about how therapy is usually conducted. More specifically, the process of this study invited reflection on how the therapy conversation has been traditionally divided into two conversations, a therapy conversation and a supervision conversation. I propose there are some benefits in viewing these usually separated conversations as parts of one conversation.Ph. D.
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Lê, Thi Thu Hang. "Exploration des facteurs relationnels propres aux médecins qui influencent sur la prise en charge du patient douloureux chronique." Mémoire, Université de Sherbrooke, 2017. http://hdl.handle.net/11143/10640.
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Contexte : La chronicité de la maladie est difficile, autant pour le soigné que pour le soignant. Malgré de nombreux travaux et recherches (réalisés principalement chez le soigné), la douleur chronique reste un fléau. Il est suggéré qu’une approche centrée sur la personne soit la meilleure pour aider ces patients. Il serait donc possible que la façon dont le médecin adapte sa clinique face au patient ait une influence. En regard de la douleur chronique, sa prise en charge difficile peut mener le soignant à ressentir de l’impuissance. Quelles stratégies utilise le soignant lorsque la pharmacopée est insuffisante ? S’il est répandu que les engagements spirituels des patients permettent d’attribuer un sens aux expériences de la douleur, peu de choses sont connues du côté des médecins. But : La présente étude explore les facteurs influençant la prise en charge par les médecins du patient douloureux chronique afin de comprendre comment leurs caractéristiques identitaires, spirituelles et relationnelles orientent leur approche de soins. Méthodes : Un dispositif de théorisation ancrée en recherche qualitative a été retenu. Le cadre conceptuel élaboré repose sur deux concepts clés : celui de l’identité narrative selon Ricœur et celui du temps selon Tillich. Les participants furent recrutés selon un échantillonnage de convenance. Des entrevues individuelles semi-structurées ont été conduites auprès de sept médecins de diverses spécialités, confrontés aux difficultés de prise en charge en contexte de douleur chronique. La moitié des participants ont été interviewés une seconde fois afin d’approfondir le thème de l’identité, et ce, jusqu’à saturation des données. Les transcriptions sont analysées selon la méthode de codification Strauss et Corbin. Résultats : Si le facteur temps était théoriquement connu de par la littérature sur la maladie douloureuse chronique, la collecte et l’analyse des données en a favorisé son émergence en tant que concept, révélant ainsi son importance implicite cruciale au sein de la relation thérapeutique. Notre approche, cadre à la fois théologique et inspirée de l’anthropologie philosophique, a permis d’identifier la reconnaissance en tant que processus émergent des données pour expliquer le cheminement de l’identité du médecin – professionnelle et personnelle – en contexte clinique de douleur chronique. Bien que non recherchée de façon explicite, la reconnaissance par le médecin (et indirectement par le douloureux chronique) apparaît comme source de motivation et d’énergie insoupçonnée afin d’entretenir une relation de qualité. La particularité du mot reconnaissance de se décliner en différents termes polysémiques a permis d’élaborer le processus de la re-connaissance vers la re-co-naissance mutuelle qui est ici proposé comme cadre explicatif de l’évolution de l’identité du médecin en contexte clinique relationnel de prise en charge du douloureux chronique. Le médecin doit ainsi se définir à nouveau en tant que thérapeute en vue de ne pas vivre l’échec. Conclusion : La compétence relationnelle acquise, ajoutée à sa compétence professionnelle, permet au médecin d’enrichir ses connaissances (savoir et expérience), mais aussi de cheminer, au fil du temps, avec son patient douloureux chronique, passant d’une re-connaissance (identitaire et spirituelle) à une re-co-Naissance mutuelle et dynamique dans la relation en contexte de douleur chronique. Les différentes perspectives pour les cliniciens et soignants s’occupant de ces patients sont discutées.Abstract : Background: Chronic pain is difficult, both for the patient and the caregiver. Even though many studies and researches have been conducted (mostly with patients), chronic pain remains. It is suggested that a person-centered approach is the best way to help these patients. However, little is known about how physicians adapt their practice to their powerlessness when faced with chronic pain patient. Which strategies are to be used when the pharmacopoeia is insufficient? Though it is known that religious and spiritual commitments may allow patients to give meaning to their pain, little is known about how physicians deal with these commitments. Purpose: This study explores the factors influencing how physicians take charge of chronic pain patients to understand how their identity, their spirituality and their relationship shape their care approach. Methods: Within a qualitative research design in grounded theory, the conceptual framework developed is based on the two key concepts: the narrative identity by Ricœur and the concept of time by Tillich. Participants were recruited using a convenience sampling. Semi-structured individual interviews were conducted with seven physicians in various specialties dealing with the difficulties of chronic pain management. Four of them were interviewed a second time to further investigate the subjet, until data saturation. The transcripts were analyzed by Strauss and Corbin’s method of codification. Results: If the time factor was theoretically known from the literature on chronic pain, continuous and simultaneous data collecting and analyzing has brought its emergence as concept (axial coding), revealing thereby its implicit crucial importance within the therapeutic relationship. Our approach, inspired from both theological and philosophical anthropology‘s frames, have allowed us to identify “recognition” as an emerging process to explain the flow scheme of the physician’s professional and personal identity when faced with chronic pain. Although not researched explicitly, mutual recognition between patient and physician is a source of motivation to improve the quality of the relationship. The process of recognition to mutual re-co-birth (“re-co-naissance” in French) is proposed here as an explanatory framework for the development of the physician’s identity in the clinical context of chronic pain patient care. The French word “reconnaissance” (recognition) thus can be broken down into “re-co-naissance” (re-co-birth), the co-rebirth of a relationship to define oneself anew as a therapist and to not experience failure. Conclusions: The new acquired confidence and competence between physician and the patient, in addition to actual professional skills, enables the concerned physician not only to enrich his knowledge but also to make progress in time, along with his chronic pain patients, moving from professional identity to spiritual recognition and to a dynamic relationship of mutal re-birth and re-acknowledge (“re-co-naissance”), so that he no longer experiences medical failure. Various perspectives for clinicians and caregivers will be further discussed.
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Monteiro, Denise Espiúca. "A comunicação na prática homeopática: como a racionalidade homeopática se expressa na comunicação entre médico e paciente?" Universidade do Estado do Rio de Janeiro, 2015. http://www.bdtd.uerj.br/tde_busca/arquivo.php?codArquivo=9211.
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Coordenação de Aperfeiçoamento de Pessoal de Nível SuperiorNo atual contexto da prática médica no Brasil, observa-se o predomínio de uma comunicação de caráter informativo, normativo e com pouca ênfase na promoção da autonomia dos pacientes, secundarizando o diálogo e a compreensão do paciente sobre o processo saúde-doença-cuidado. Esse tipo de prática baseia-se fortemente no Modelo Biomédico, que enfoca prioritariamente a doença e as lesões orgânicas, o que em muitas situações colabora para a medicalização, a (super)especialização e fragmentação do cuidado, comprometendo a qualidade da relação médico-paciente e a resolutividade das ações de saúde. Em contrapartida, uma prática médica centrada no paciente e que valorize a compreensão de sua interpretação da saúde-doença favorece a construção da integralidade do cuidado e a maior efetividade das ações. A presente pesquisa exploratória, predominantemente qualitativa com componente quantitativo investiga as práticas comunicacionais na relação médico-paciente na consulta homeopática, pautada pelo paradigma Vitalista. Nessa especialidade médica oferecida desde 1988 pelo Sistema Único de Saúde, e desde 2006, integrante da Polícia Nacional de Práticas Integrativas e Complementares do Ministério da Saúde, compreender múltiplas dimensões da existência e adoecer humanos demanda competência narrativa para a prática de sua semiologia, baseada na escuta atenta e implicada dos contextos biopatográficos, valorizadora dos sentidos atribuídos às vivências pelos sujeitos. Foram gravadas oito consultas de primeira vez realizadas num ambulatório-escola por médicos experientes, transcritas e submetidas à Análise de Conteúdo, que permitiram analisar como os fundamentos da racionalidade homeopática podem contribuir para a produção compartilhada de sentidos. Os resultados estão organizados nas categorias: Tomada de Turnos e Controle de Tópicos, Concepção de Saúde-Doença-Cuidado, Itinerários Terapêuticos, Ethos científico e Ethos do Mundo da Vida, Capacidade empática (atitudes de apoio, legitimação e polidez) e O Papel do Médico. Observa-se que a comunicação que estabelecida nesse tipo de prática em saúde avança na construção da integralidade da atenção e pode contribuir para a maior resolutividade do cuidado em saúde na medida em que minimiza a dicotomia entre mental e somático, individual e social.
The predominance of informative and normative communication is observed in the current context of medical practice in Brazil. This practice relies on Biomedical Model focus on disease and organ damage, with little emphasis on dialogue and understanding of the patient on the health-illness care, which in many cases contributes to the social medicalization, the medical specialization and fragmentation of care, negatively affecting the quality of the doctor-patient relationship on promoting patient autonomy and the solving of health actions. In contrast, a patient-centered medical practice that enhances understanding of their interpretation of health-disease favors a holistic care and a greater effectiveness of actions. This exploratory research, predominantly qualitative with quantitative component investigates the communicative practices in the doctor-patient relationship in homeopathic consultation, is guided by vitalist paradigm. Looking broadly at the patient and the illness, homeopathic practice provides the means to understand the personal connections between patient and physician to improve the effectiveness of their work. This medical specialty offered since 1988 by SUS, and since 2006, included in PNPIC, requires narrative competence to practice their semiotics. Eight inquiries were first recorded performed in a clinic-school by experienced doctors, transcribed and submitted to content analysis, allowing to analyze how the foundations of homeopathic rationality can contribute to the health care. The results are organized into categories shifts: Topics Control, Health-Disease-Cares Concept, Therapeutic Itineraries, Scientific Ethos and Life Ethos, Empathic Capacity (attitudes of support, legitimacy and politeness) and The Role of the Physician. It is observed that the communication established in this type of health practice advances in the construction of an integral care and can contribute to the better resolution of care in that it minimizes the dichotomy between mental and somatic, individual and social.
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Persson, Hanna, and Sofie Vikström. "Att vårdas enligt tvångslagstiftning vid en psykiatrisk avdelning : En litteraturstudie av patienters upplevelser." Thesis, Umeå universitet, Institutionen för omvårdnad, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-89925.
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Bakgrund: Vid psykisk sjukdom kan behov av heldygnsvård uppstå för att den enskilde personen inte skall utgöra någon fara för sig eller för tredje part. Vården kan vara av nytta trots att personen i fråga inte ger medgivande till vård, vilket medför ett etiskt dilemma för vårdpersonalen. Syfte: Att belysa patienters upplevelse av att vårdas enligt tvångslagstiftning vid en psykiatrisk avdelning. Metod: En litteraturstudie har genomförts som omfattar 11 kvalitativa vetenskapliga artiklar. Resultat: Resultatet visar att patienterna antingen upplevde att inläggningen varit till nytta eller till skada och att flertalet patienter upplevde en bristande autonomi och en känsla av minskat människovärde. Slutsats: Slutsatsen är att patienternas syn på inläggningen beror på dennes upplevelse av bevarad autonomi och möjlighet till delaktighet. Personal som har ett förhållningssätt som främjar detta, främjar också att patienten upplever den tvångslagstiftade vården som nödvändig. Detta förtydligar vikten av att i vården arbeta personcenterat och med ett förhållningssätt som främjar patientens autonomi och delaktighet.Background: When a person is mentally ill, they might need hospitalisation against their ill, to protect them from themselves or to third parties. The care may be beneficial even though the person does not give consent to treatment, resulting in an ethical dilemma for caregivers. Aim: To elucidate patients' experiences of being cared for under a compulsory admission at a psychiatric ward. Method: A literature review has been carried out covering 11 qualitative research articles. Results: The results show that patients either feel that the admission was beneficial or detrimental, and that most patients experience a lack of autonomy and a sense of diminished human dignity. Conclusion: It is concluded that patients' views on the admission depends on his or hers experience of preserved autonomy and the opportunity to participate. Staff who have an attitude that promotes this, also encourages the patient to experience the compulsory care as necessary. This clarifies the importance of working personcentered with an approach that promotes patient autonomy and participation.
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Rosén, Aksel, and David Hjertberg. "Personcentrerad vård under LPT : En kvalitativ intervjustudie." Thesis, Linnéuniversitetet, Institutionen för hälso- och vårdvetenskap (HV), 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:lnu:diva-104636.
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Bakgrund: Patienters delaktighet i sin vård ses idag som en självklarhet i Sverige och personcentrerad vård (PCV) är ett verktyg för att öka delaktigheten. Genom att lyssna till patientens berättelse, sträva efter ett jämbördigt partnerskap och dokumentera det som framkommer får sjuksköterskan möjlighet att med patienten skapa en hållbar och långsiktig effekt av vården. Inom tvångsvården enligt Lagen om psykiatrisk tvångsvård (LPT) ges sjukvården rätten och skyldigheten att vårda patienten mot deras vilja när det anses vara befogat för att skydda patientens liv och hälsa. Enligt LPT är syftet med tvångsvården att förmå patienten till att ta emot vården som erbjuds frivilligt. Syfte: Syftet med denna studie är att undersöka erfarenheter hos sjuksköterskor i psykiatrisk vård av att arbeta med PCV med patienter som vårdas enligt LPT. Metod: Studien har genomförts med en kvalitativ semistrukturerad intervju. Detta har sedan analyserats med en kvalitativ innehållsanalys. Resultat: Studiens resultat uppvisar erfarenheter av att främja patientberättelsen men även hinder för denna. Det framkommer även erfarenheter av partnerskap som bedrivs under LPT. Partnerskapet främjas till stor del av sjuksköterskans bemötande. Till sist framkommer erfarenheter av dokumentationens betydelse för PCV som bedrivs enligt LPT. Slutsats: Utifrån den fakta som läggs fram rörande PCV och LPT i bakgrunden är dessa två begrepp relativt komplicerade att förena. I resultatet av denna studie kan det konstateras att delaktighet kan främjas PVC i vård som bedrivs enligt LPT, som i sin tur främja delaktighet. Förhållandet mellan begreppen PCV och delaktighet blir i det närmsta cirkulärt där de stödjer varandra och skapar uppbyggande symbios Kliniska implikationer: Baserat på resultatet framkommer en tilltro till att PCV kan vara positiv i bemärkelsen att det skapas ökad delaktighet mellan patient och sjuksköterska i vård som bedrivs enligt LPT.Background: Patients' participation in their care is today seen as a matter of course in Sweden and person-centred care (PCV) is a tool to increase participation. By listening to the patient's story, striving for an equal partnership and documenting what emerges, the nurse has the opportunity to create a sustainable and long-term effect of care with the patient. In coercive care under the Compulsory Psychiatric Care Act (LPT), healthcare is given the right and obligation to care for the patient against their will when this is considered justified to protect the patient's life and health. According to LPT, the purpose of coercive care is to induce the patient to receive the care offered voluntarily. Aim: The aim of this study is to investigate the experiences of nurses in psychiatric care of working with PCV with patients being cared for according to LPT. Method: The study has been conducted with a qualitative semi-structured interview. This has then been analyzed with a qualitative content analysis. Results: The results of the study show experiences in promoting the patient's story but also obstacles to it. There is also experience of partnerships conducted under LPT. This partnership is largely promoted by the nurse's treatment. Finally, experience of the importance of documentation for PCVs carried out under LPT emerges. Conclusion: Based on the facts presented regarding PCV and LPT in the background, these two concepts are relatively complex to reconcile. In the results of this study, it can be concluded that participation can be promoted PVC in care conducted according to the LPT, which in turn promotes participation. The relationship between the concepts of PCV and participation becomes almost circular where they support each other and create constructive symbiosis. Clinical implications: Based on the results, there is a belief that PCV can be positive in the sense that increased participation between patient and nurse is created in care conducted according to LPT.
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Löfgren, Karolina, Susanna Sjöberg, and Linnea Neugebauer. "Vietnamese nursing students` perception of person-centered care. : A Minor Field Study in Vietnam." Thesis, Hälsohögskolan, Jönköping University, HHJ, Avd. för omvårdnad, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-48700.
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Summary Background: Person-centred care is a concept which aims to achieve quality in health care. Person-centred care is about taking the patient's own story into account and creating a partnership between all involved parties. Aim: Exploring nursing students` perception of person-centred care in Vietnam. Method: This study is a qualitative study with a semistructured interview guide. It has a deductive approach with a directed content analysis. Twelve nursing students were interviewed in this study. Result: The result showed that communication, nurses' knowledge, mutual respect, cooperation and family’s experienced knowledge about the patient were identified as important parts of the participants perceptions about person-centred care in Vietnam. Challenges such as time constraints and misunderstandings were shown to be a repeating problem. Conclusion: The nursing students' perception about implementing person-centred care in Vietnam is positive, but there are challenges in applying this in practice. The number of patients related to the number of nurses is uneven, which may lead to problems in Vietnam regarding person-centered care.
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Ketheeswaran, Nivethitha. "In Another's Voice: Making Sense of Reproductive Health as Women of Color." Scholar Commons, 2019. https://scholarcommons.usf.edu/etd/7828.
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The goals of this project are twofold. The first goal is to articulate my sense making of reproductive health for Women of color in the United States as a postcolonial condition; one that I trace back to the logics of elimination of settler colonialism (Wolfe, 2006) and frame as maintained through the colonial institutions, or racial projects (Omi & Winant, 2015), of the Prison Industrial Complex, the welfare system, and the health care system which create and perpetuate dominant cultural narratives of “the welfare queen”, “the negligent Black mother”, and “the wily patient”. I show how these narratives colonize the minds of health care providers and contribute to the current stratification of health care.
My second goal with this project is to show how postcolonial interpretive ethnography can be used as a narrative medicine educational intervention for providers. Currently, Narrative Medicine asks providers to read themselves, their patients, and their interactions as literature to emphasize the personal and interpersonal tensions that are often lost in the fast paced biomedical world (Charon, 2001). With this project I aim to expand the field of Narrative Medicine to consider the ways patient-provider interactions are postcolonial, and how analyses of these interactions can be a method of decolonization. I do so by analyzing three interpretive ethnographic narratives that I have created which story my interactions with three Women of color: Tiffany, Rose, and Jane. I then analyze each of these interactions for colonizing and decolonizing sense making.
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Batikhy, Nejma. "Étude narrative et éthique de la personne âgée hospitalisée : la chute, l'alitement, et la toilette." Thesis, Paris Est, 2018. http://www.theses.fr/2018PESC2184/document.
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À partir de la chute physique d'un patient, qui survient dans un service hospitalier, nous nous interrogeons sur les actions soignantes, qui vampirisées par la prévention, et par les soins codifiés, techniques, mettent ce moment entre parenthèse. Et pourtant, il nous semble que ce moment condense à lui seul l'existence. L'asymétrie ici est criante entre le soignant debout et le patient au sol ; autour de cet incident, qu'est la chute, le soin peut prendre tout son sens. Cette situation serait comme une mi-parabole de la relation soignant - soigné. Nous souhaitons aborder la chute, le vécu du patient, celui du soignant, de la position administrative, et ce qu’elle peut susciter dans un service. Le lien entre les soins infirmiers et la chute physique est ici bien concret, mais nous servira de tremplin pour élargir sur une autre Chute. Notre cheminement est de partir d’une situation concrète, et de faire focus sur certains aspects : le silence soudain lorsque les soignants entendent le bruit de la chute, sans réellement savoir que c’est d’une chute dont il s’agit, le temps passé au sol et dans la solitude, et peut-être la crainte du patient, les efforts physiques et du patient et du soignant pour la mise au lit, la gêne, la honte souvent de celui qui est tombé… en rythmant ce travail avec des témoignages de soignants et patients. La bibliographie présentée traite de l’hôpital- prison (Foucault), lorsqu’il s’agit de contentionner la personne sous prétexte de sécurité, sur l’Événement (Hannah Arendt et Derrida) pour approfondir ce terme clef 'Evénement' par les cellules qualité des institutions hospitalières : « événement indésirable » pour la chute d’un patient … qui est événement révélateur : la chute est ce moment où l'on perd son éminence parce qu'une vérité est révélée, au lieu de rester cachée à l'intérieur de soi. Cette éminence était donc fausse ? Ou bien pourrait-elle être, à l'inverse, révélée dans cette chute ?The initial question came to my mind when I saw a patient fall physically in a hospital ward. This sighting made me wonder about the nurses’ pursuant actions, who over-laden by strict prevention rules, coded medical acts and techniques, put this particular moment on hold. And yet, it seems that this very instant alone summarizes the essence of our existence. Asymmetry here is striking: the nurse standing and the patient lying on de floor. In that case i.e. the fall, care becomes meaningful. This could create a half-parabolic situation in the caregiver-patient relationship. I am going to broach the phenomenon of fall, examine the patient’s and the carer’s life experiences, administrative rules and how these rules impact a ward’s activities. The link between nursing care and physical fall is very concrete here, but it will also serve a springboard for an opening onto another fall. My unfolding is set as follows : Start out from a concrete situation, focus on some aspects e.g. the nurses’ hush after hearing the noise of the fall trying to find out what made that noise; the length of time past, the solitude while lying on the floor, the fear the patient may have, physical efforts on both sides, to get the patient back in bed; the feeling of embarrassment and the shame the fallen ones often have. Eventually, I punctuate this work by evoking both patients’ and nurses’ accounts and testimonies in the subject. The bibliography presented in this paper is about subjects such as hospital, prison (Foucault) when it comes to restraining the patient on the account of security. Furthermore, event (Hannah Arendt and Derrida) in order to examine the key term EVENT in more detail by the quality cells of hospital institutions: “Undesired/Unwanted fall” to refer to a patient’s fall. It is a revealing event insofar as the fall causes the person to lose his/her eminence due to an unveiled truth impeding him/her to stay hidden inside his/herself. Has this eminence been false then ? Or, conversely, could that fall reveal it ?
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Berglund, Helena. "Personcentrerad vård för ökad delaktighet : Ett förbättringsarbete av patientdelaktighet på en kirurgisk vårdavdelning." Thesis, Hälsohögskolan, Jönköping University, HHJ. Kvalitetsförbättring och ledarskap inom hälsa och välfärd, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-49711.
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Bakgrund: Det finns idag tydliga signaler om att hälso- och sjukvården ska ge en personcentrerad vård till samhällets individer. Det finns även en önskan att öka möjligheten för patienten att vara delaktig i sin vård. En personcentrerad vård kan ge möjlighet för patienten att bli medskapare och inte enbart mottagare av vård. Syftet: Förbättringsarbetets syfte var att öka patientens möjlighet till delaktighet genom att implementera patientberättelse och hälsoplan. Studiens syfte är att synliggöra medarbetarnas erfarenheter av att arbeta med patientberättelsen och hälsoplanen samt patientdelaktighet i vården. Metod: Förbättringsarbetet genomfördes med stöd av Nolans förbättringsmodell samt kartläggning av enheten utfördes med hjälp av 5P. De idéer som testades var införande av patientberättelse och dokumenterad hälsoplan. Datainsamling till studien gjordes med intervjuer av sex medarbetare som analyserats med kvalitativ innehållsanalys. Resultat: Andelen patienter som angav att de var delaktiga i den utsträckning de önskar i vården på avdelningen, ökade från 77% till 95% vilket kan ses som ett positiv effekt på patientdelaktighet. I den kvalitativa innehållsanalysen identifierades tre kategorier: patientens vård, kommunikation samt organisationen och arbetssätt, där både möjligheter och hinder kunde ses. Slutsats: Personcentrerad vård ökar möjligheten för patienten att vara delaktig i sin vård på en akutkirurgisk vårdavdelning.Background: There are clear signals that health care should provide person-centered care for the citizens. There is also a wish to increase the possibility for the patient to be involved in their care. The person-centered care can provide an opportunity for the patient to become co-creators and not only recipients of care. Purpose: The purpose of the improvement work was to increase the patient's opportunity for participation by implementing patient narrative and care plan. The purpose of the study is to make visible the employees' experience of working with the patient narrative and care plan to create patient participation. Method: The improvement work was implemented with the support of Nolan's improvement model and 5P was used to assess the unit. The ideas tested were the introduction of a patient narrative and a documented care plan. Data collection for the study was conducted with interviews of six employees and analyzed with qualitative content analysis. Results: The proportion of patients who felt that they had participated in the decisions regarding their care/treatment on the ward to the extent they wanted, increased from 77% to 95%, that can be seen as a positive effect on patient participation. The qualitative content analysis of interviews with employees was identified in three categories: the patient's care, knowledge/communication and organization/working methods where both facilitators and barriers could be seen. Conclusion: Person-centered care increases the possibility for the patient to participate in their care in an emergency surgical ward.
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Elsoukhova-Lord, Irina. "La temporalité dans la logogenèse narrative : perspective de rapprochement à travers l'étude linguistique de deux romans : "The English patient" de Michael Ondaatje et "Starik" de Iouri Trifonov." Brest, 2006. http://www.theses.fr/2006BRES1009.
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Au coeur du présent travail se trouve un intérêt profond pour les mécanismes de création du sens et du texte, à savoir la logogenèse. Les recherches menées s'inscrivent dans une optique empirique comparatiste et aboutissent à la construction d'un cadre analytique " sur mesure ". Le rapprochement de deux textes narratifs dans leur langue originale, anglais et russe, s'effectue à travers le prisme de la sémiotique temporelle. En termes plus concrets, il s'agit de décomposer la notion de temporalité narrative en unités linguistiques et textuelles discrètes et de leur faire subir une analyse quantitative et qualitative afin de mettre en valeur les choix langagiers récurrents dans la construction de l'espace temprel narratif. Ainsi émergent diverses tendances sémantiques et textuelles. Elles révèlent le design sémiotique caractéristique à chaque texte et montrent la façon dont une oeuvre fictive rend son message et sa fonction légitimes dans le contexte global de cultureThis empirical study investigates meaning-making mechanisms in language by identifying and contrasting recurrent lexicogrammatical and textual patterns in two narrative texts (one written in English, the other written in Russian). Temporal semiotics provides a solid basis for this comparison given that the narrative genre is considered to be a truly pan-cultural phenomenon and ‘setting in time' is a genre-specific feature. A framework based on the principles of Systemic Functional Linguistics accounts further for the non-parallel nature of the corpus from a methodological perspective. Consistencies observed in the selection of linguistic features which contribute to the construal. Of temporal narrative space bring to light semantic tendencies specific to the semiotic design. Of each novel as well as demonstrate how a work of fiction legitimates its message and its function within a broader context of culture
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Hellström, Olle. "Patienten som person : om mening och dialog i allmänmedicinsk praktik." Doctoral thesis, Umeå universitet, Socialmedicin, 1999. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-96897.
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Shann, Steve. "Mating with the world : on the nature of story-telling in psychotherapy /." View thesis View thesis, 2000. http://library.uws.edu.au/adt-NUWS/public/adt-NUWS20030429.131118/index.html.
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Lippa, Katherine Domjan. "Cognition of Shared Decision Making: The Case of Multiple Sclerosis." Wright State University / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=wright1463576554.
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Dehghan, Azad. "Mining patient journeys from healthcare narratives." Thesis, University of Manchester, 2015. https://www.research.manchester.ac.uk/portal/en/theses/mining-patient-journeys-from-healthcare-narratives(69ebfa6d-764a-4dfe-bbf8-6aab1905a6f3).html.
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The aim of the thesis is to investigate the feasibility of using text mining methods to reconstruct patient journeys from unstructured clinical narratives. A novel method to extract and represent patient journeys is proposed and evaluated in this thesis. A composition of methods were designed, developed and evaluated to this end; which included health-related concept extraction, temporal information extraction, and concept clustering and automated work-flow generation. A suite of methods to extract clinical information from healthcare narratives were proposed and evaluated in order to enable chronological ordering of clinical concepts. Specifically, we proposed and evaluated a data-driven method to identify key clinical events (i.e., medical problems, treatments, and tests) using a sequence labelling algorithm, CRF, with a combination of lexical and syntactic features, and a rule-based post-processing method including label correction, boundary adjustment and false positive filter. The method was evaluated as part of the 2012 i2b2 challengeand achieved a state-of-the-art performance with a strict and lenient micro F1-measure of 83.45% and 91.13% respectively. A method to extract temporal expressions using a hybrid knowledge- (dictionary and rules) and data-driven (CRF) has been proposed and evaluated. The method demonstrated the state-of-the-art performance at the 2012 i2b2 challenge: F1-measure of 90.48% and accuracy of 70.44% for identification and normalisation respectively. For temporal ordering of events we proposed and evaluated a knowledge-driven method, with a F1-measure of 62.96% (considering the reduced temporal graph) or 70.22% for extraction of temporal links. The method developed consisted of initial rule-based identification and classification components which utilised contextual lexico-syntactic cues for inter-sentence links, string similarity for co-reference links, and subsequently a temporal closure component to calculate transitive relations of the extracted links. In a case study of survivors of childhood central nervous system tumours (medulloblastoma), qualitative evaluation showed that we were able to capture specific trends part of patient journeys. An overall quantitative evaluation score (average precision and recall) of 94-100% for individual and 97% for aggregated patient journeys were also achieved. Hence, indicating that text mining methods can be used to identify, extract and temporally organise key clinical concepts that make up a patient’s journey. We also presented an analyses of healthcare narratives, specifically exploring the content of clinical and patient narratives by using methods developed to extract patient journeys. We found that health-related quality of life concepts are more common in patient narrative, while clinical concepts (e.g., medical problems, treatments, tests) are more prevalent in clinical narratives. In addition, while both aggregated sets of narratives contain all investigated concepts; clinical narratives contain, proportionally, more health-related quality of life concepts than clinical concepts found in patient narratives. These results demonstrate that automated concept extraction, in particular health-related quality of life, as part of standard clinical practice is feasible. The proposed method presented herein demonstrated that text mining methods can be efficiently used to identify, extract and temporally organise key clinical concepts that make up a patient’s journey in a healthcare system. Automated reconstruction of patient journeys can potentially be of value for clinical practitioners and researchers, to aid large scale analyses of implemented care pathways, and subsequently help monitor, compare, develop and adjust clinical guidelines both in the areas of chronic diseases where there is plenty of data and rare conditions where potentially there are no established guidelines.
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Koo, Chiu-yee Christy. "Narrative production of Cantonese aphasic patients." Click to view the E-thesis via HKUTO, 2002. http://sunzi.lib.hku.hk/hkuto/record/B36208292.
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Thesis (B.Sc)--University of Hong Kong, 2002."A dissertation submitted in partial fulfilment of the requirements for the Bachelor of Science (Speech and Hearing Sciences), The University of Hong Kong, May 10, 2002." Also available in print.
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Whitman, Birgit. "Breast cancer : patient narratives and treatment methods." Thesis, University of Glasgow, 2004. http://theses.gla.ac.uk/2969/.
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This thesis concentrates on the treatment of women with breast cancer in the 19th and 20th century. It analyses written published patient narratives linking them with clinical developments. Medical history holds a rich source of information providing the view of the clinician. This includes case reports and case series from one surgeon or one hospital for the earlier period of the study and has progressed to the double blind randomised controlled trial that dominates comparative research today. There is an imbalance in the material available for the analysis of patients’ perceptions of their treatment. The patient view is not represented well in the history of medicine. This thesis attempts to provide a more complete assessment of the developments in breast cancer treatment by including the patient’s view. Three narratives provide an insight into the perception of women who were treated with breast cancer prior to the introduction of anaesthesia and infection control. The novelist, Fanny Burney (1752-1840), underwent a mastectomy in 1811. In a letter to her sister she wrote about her experience providing details of her diagnosis and treatment. In comparison, Emily Gosse (1806-1857) refused a mastectomy for her breast cancer and sought alternative treatment with caustics. Her husband, Phillip Gosse and friend, Anna Shipton, wrote narratives about Emily’s suffering. A third narrative provides the view of a woman with breast cancer who received no treatment and died of metastatic breast cancer; Zelie Martin died in 1877. These narratives were linked to a case report by Lorenz Heister (1683-1758). Heister described the procedure for amputation of the breast in detail. His method prevailed until new scientific developments in surgery such as anaesthesia and infection control improved the short-term survival of patients and enabled surgeons to operate sooner with a greater attention to detail.
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Blickem, Christian C. "Stroke stories : the potential of patient narratives for enhancing patient-centred care." Thesis, University of East Anglia, 2008. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.443093.
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Walkup, Katie Lynn. "Constructing Health Narratives: Patient Feedback in Online Communities." Scholar Commons, 2017. http://scholarcommons.usf.edu/etd/6634.
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This project examines user-generated health narratives through corpus analysis of 246 reviews posted on Midwestern Hospital’s Yelp page. Understanding how different stakeholders act and interact within online health communities models a shift in new conceptions of health, and provides evidence of health ecologies’ ability to determine patient perceptions of care. Documents produced by users in these health communities represent health narratives comprised of a user’s health experience, that user’s treatment perceptions, and the community’s perceptions of the user’s experience. Author uses corpus methods to interpret user trace data and rhetorical moves embedded in health narratives. Findings suggest that users who interact with the Yelp community produce different health narratives than less engaged users. Understanding how different stakeholders act and interact within online health communities models a shift in new conceptions of health, and provides evidence of health ecologies’ ability to determine patient perceptions of care.
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Keane, Kathleen Marie. "Older Adult Narrative of the Experience of Cardiac Surgery." Thesis, Boston College, 2015. http://hdl.handle.net/2345/bc-ir:104362.
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Thesis advisor: Dorothy A. JonesCardiac surgery is frequently performed as a surgical intervention within the United States; but there is little known about how the older adult (70 years of age or greater) experiences cardiac surgery and recovery over time. This qualitative research study utilized narrative methodology to interview 13 older adults to inform understanding of the older adult's cardiac surgical experience. The purpose of this study was to describe the story of the older adult both coming to surgery (preoperative period) and during the transitional time of the acute recovery period following cardiac surgery (up to 8 weeks after cardiac surgery). The primary research question asked was "What stories do older adults tell of their experience of cardiac surgery from the preoperative period through the first 2 months postoperatively?" Using narrative analysis of participant discourse, consisting of both structural (re-storying of narrative content) and thematic analysis of interview content, there emerged an overarching story of older adult experience of cardiac surgery which can be described thematically as: Moving toward healing: engaged in and appreciating life while conscious of time passing amidst the primacy and struggle of the symptom experience. Knowledge gained from this study can help to broaden the understanding of the experience and the trajectory of older adult recovery after cardiac surgery, and also serves to inform nursing education and practice models, nursing interventions, instrument development and innovative models of care designed to support the perioperative care of older adults
Thesis (PhD) — Boston College, 2015
Submitted to: Boston College. Connell School of Nursing
Discipline: Nursing
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Yau, Wing-kit Vicky. "Representing illness patients, monsters, and microbes /." Click to view the E-thesis via HKUTO, 2007. http://sunzi.lib.hku.hk/hkuto/record/B3786726X.
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Holmes, Beverley. """Me on-line"": narrative identities of people with arthritis /." Burnaby B.C. : Simon Fraser University, 2005. http://ir.lib.sfu.ca/handle/1892/2099.
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Yau, Wing-kit Vicky, and 邱穎潔. "Representing illness: patients, monsters, andmicrobes." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2007. http://hub.hku.hk/bib/B3786726X.
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Stanley, B. Liahnna. "Communicating Health: A Thematic Narrative Analysis Among Methadone Patients." Scholar Commons, 2019. https://scholarcommons.usf.edu/etd/7953.
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This study seeks to understand and document how people recovering from opioid addiction communicate about health and identity in the context of a methadone clinic. This project emerges in response to the rising incidence of opioid addiction and overdose death in the U.S. and suggests there is an urgent theoretical and practical calling for bringing forth the stories of people experiencing addiction and recovery. Guided by the structure-centered approach (SCA) to health communication, this study employs a thematic narrative analysis through interviews with 4 methadone maintenance treatment (MMT) patients about the meanings of health, recovery, and identity. With respect to how methadone patients communicate about health and identity, study findings reveal three key themes, which I distinguish as: 1) health as normalcy; 2) health as lack of resources; and 3) recovering the self, (be)longing, and health citizenship. It is through an understanding of these themes that this project contributes, in several meaningful ways, to research and praxis on health communication in addiction treatment spaces. Limitations of research design and considerations for future research projects on health and addiction are provided.
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Högberg, Maria, and Therese Ydreborg. "Sjuksköterskans upplevelse av att vara patient : en narrativ analys." Thesis, Högskolan i Borås, Akademin för vård, arbetsliv och välfärd, 2015. http://urn.kb.se/resolve?urn=urn:nbn:se:hb:diva-332.
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Detta är ett examensarbete med narrativ ansats vilken bygger på en självbiografi där en sjuksköterska beskriver sin upplevelse av att vara patient och en bok där fem sjuksköterskor blivit intervjuade om sina upplevelser av att vara patienter. Syftet med examensarbetet var att ta reda på hur sjuksköterskan upplever det att vara patient. För att kunna förstå sjuksköterskans syn och upplevelser beskrivs i avsnittet bakgrund begreppen förförståelse, caritas och caring samt en redogörelse för vad sjuksköterskans profession innebär. Analysen resulterade i tre huvudkategorier med tillhörande underkategorier vilka presenteras i resultatet. De är följande: Upplevelsen av bemötandet, Det vårdande mötet, Erfarenheter av kommunikation och Att känna sig särbehandlad. Vidare Omvårdnadshandlingars betydelse, Vikten av de små tingen, Närvarande omvårdnad, När omvårdnaden brister i ansvar och engagemang och Hur tiden påverkar patientupplevelsen och slutligen Förförståelsens påverkan, Att ha kunskap inom vårdvetenskap och medicin, Upplevelsen av dubbla roller. Patienterna upplevde att det var viktigt hur information gavs och att kommunikationen fungerade väl. Människor är olika och därför är det viktigt att individanpassa både vård och information. ”De små tingen” i vardagen har stor betydelse och det är viktigt att vårdpersonal svarar an på patientens behov. Diskussionen fördjupar områden som personcentrerad vård samt hur brister i omvårdnaden kan leda till destruktiv vårdkultur.
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Tsope, Lindiwe. "A narrative study of patients’ illness experiences on antiretroviral treatment." Thesis, Rhodes University, 2018. http://hdl.handle.net/10962/63032.
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Eight female respondents, who have publicly disclosed their HIV-positive status on social media, were involved in a semi-structured in-depth interview process. Using the theoretical frameworks of symbolic interactionism and social constructionism, the study explores the effects of antiretroviral treatment on patients’ illness experiences, looking at the personal and social symbolisms and meanings attached to taking antiretrovirals. The study revealed a positive and inspirational aspect of living with HIV/AIDS and especially consuming antiretroviral therapy. It became evident that the knowledge participants had of antiretrovirals before consuming them was misguided and based more on false ‘general knowledge’ among laypersons than actual medical fact. Moreover, the study revealed that there is a social reconstruction of narratives that has taken place in each participant’s life due to consuming antiretrovirals. Publicly disclosing their statuses has also proved to have both negative and positive consequences for the individuals and for society at large. While there is a consensus that participants’ illness experiences are directly affected by antiretroviral treatment, each participant’s narrative is different, yet positive.
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Adame, Alexandra Lynne. "Recovered voices, recovered lives a narrative analysis of psychiatric survivors' experiences of recovery /." Oxford, Ohio : Miami University, 2006. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=miami1152813614.
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Strydom, Munro. "Kanker- en niekankerpasiënte se belewenis van die luistergroeptegniek / M. Strydom." Thesis, North-West University, 2006. http://hdl.handle.net/10394/1277.
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The aim with this research was to determine how cancer patients (the inner group) and
non-cancer patients (the listening group) experience the listening group technique. A
qualitative research design was utilised.
The reasons for undertaking this research were the following:
Experience has indicated that the listening group technique may be an effective
method to help individuals discover alternative life stories besides the dominant
stories that direct their lives. Some authors have expressed the need for therapists
to do research on the listening group technique to ascertain its effectiveness as a
therapeutic approach.
The reason for focusing specifically on cancer patients is the high incidence of
cancer and the accompanying medical and psychological effects it has for the
individual. Psychological interventions appear to have positive results for cancer
patients.
The project was announced to cancer patients and their supporters, as well as in the
postgraduate Psychology classes. Six cancer patients, five supporters and ten students
participated on a voluntarily basis - twelve as members of the inner group (cancer patients
and supporters) and nine as members of the listening group. Eight members of the inner
group were female and four were male. Their ages varied from twenty - two to sixty - two.
The listening group consisted of six female and three male students, of whom seven were
honours students and two were masters students. Their ages varied from twenty - one to
twenty - two.
The study leader and the researcher acted as facilitators during the sessions. The process
covered five evenings. After the introductory session, the first two sessions were held in
the first week, while the last two sessions took place during the subsequent two weeks.
Each session lasted approximately two hours.
The way the participants experienced the technique was determined by means of semi-structured
interviews. The following five themes came to the fore on analysing the data:
other perspectives that developed and growth that took place during sessions, it was a
learning experience, the participants' experience of the process, the participants'
experience of the procedures and application of the technique, and suggestions that the
participants made. The results indicated that the listening group technique can be applied
to obtain beneficial outcomes for the participants. It can, inter aha, help them to develop
new perspectives about their personal dilemmas and stimulate personal growth.Thesis (M.A. (Clinical Psychology))--North-West University, Potchefstroom Campus, 2007.
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Conde, Mónica Jacinto. "The effects of proving information to patients in emergency room on psychological and physical outcomes." Master's thesis, Instituto Superior de Psicologia Aplicada, 2008. http://hdl.handle.net/10400.12/439.
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Dissertação de mestrado em Psicologia da SaúdeA Urgência é um serviço que envolve sentimentos negativos e tudo é inesperado. O objectivo deste estudo foi compreender os efeitos psicológicos e físicos da intervenção psicológica nos utentes do Serviço de Urgência. A amostra incluiu 72 utentes (36 em cada grupo) do Centro Hospitalar de Lisboa Ocidental, E.P.E. com lesões moderadas, seleccionados por amostragem não aleatória acidental. As variáveis demográficas incluíram idade, género, estado civil, nível de educação, grau das lesões, patologias e se os utentes queriam a informação. As variáveis estudadas foram ansiedade, percepção de controlo, percepção de certeza, frequência cardíaca e pressão arterial. Os resultados demonstram que a intervenção teve um efeito significativo nas variáveis, observando-se uma diminuição da ansiedade e um aumento da percepção de controlo e de percepção de certeza nos utentes submetidos à intervenção. Por outro lado, verificaram-se diferenças estatisticamente significativas nas avaliações biomédicas. A conclusão deste estudo centra-se no facto de uma intervenção psicológica poder ter um efeito psicológico e físico significativo no utente. Este estudo contribui para a demonstração do efeito muito importante que uma intervenção simples e pouco dispendiosa pode ter nos cuidados de saúde.
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Drottz, Sandra. "Psykiatrisjuksköterskors erfarenheter av vårdande samtal med patienter som har substansmissbruk : En kvalitativ intervjustudie." Thesis, Högskolan Väst, Avdelningen för omvårdnad - avancerad nivå, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:hv:diva-16885.
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Bakgrund: Substansmissbruk är ett globalt problem och leder till negativa konsekvenser både för personen och samhället. Antal patienter som vårdats för substansmissbruk inom hälso- och sjukvården i Sverige har ökat de senaste åren. Tidigare forskning visar att substansmissbruk kan grundas i och leda till lidande. Psykiatrisjuksköterskor ger ofta omvårdnad till patienter som har substansmissbruk. Kommunikation mellan psykiatrisjuksköterska och patient sker vanligen via samtal. Forskning har visat att vårdande samtal kan lindra lidande. Syfte: Studiens syfte var att beskriva psykiatrisjuksköterskors erfarenheter av vårdande samtal med patienter som har ett substansmissbruk. Metod: Semistrukturerade narrativa intervjuer via telefon utfördes med elva psykiatrisjuksköterskor. Data analyserades med kvalitativ innehållsanalys. Resultat: Analysen mynnade ut i elva subkategorier och fyra kategorier. Kategorierna var drogfrihet som ambition, följsam närvaro, genuin människokärlek och att möta och lindra lidandets olika skepnader. Slutsats: Vårdande samtal kan ha potential att lindra patientens lidande samt tillfrisknande från substansmissbruk. Psykiatrisjuksköterskan behöver ha ett professionellt och personcentrerat förhållningssätt. Det vårdande samtalet beskrivs vara ett samtal mellan två människor vilket för psykiatrisjuksköterskan innebär utmaning i balans mellan närhet och distans till patienten.Background: Substance abuse is a global problem that leads to negative consequences both for the person and for society. Healthcare in Sweden has the last couple of years taken care ofan increasing number of patients with substance abuse. Research shows that substance abuse can both lead to and caused suffering. Psychiatric nurses often give nursing care to patients who have substance abuse. Communication between the psychiatric nurse and the patient is often done by conversation. Research has shown that caring conversations can alleviate suffering. Aim: The aim of the study was to describe psychiatric nurses’ experiences of caring conversations with patients who have substance abuse. Method: Semi-structured narrative interviews were conducted by phone with eleven psychiatric nurses. Data is analyzed according to qualitative content analysis. Results: The analysis resulted in eleven subcategories and four categories. The categories were drug freedom as ambition, compliant presence, genuine human love and to meet and alleviate the various forms of suffering. Conclusion: Caring conversations can have the potential to alleviate the patient's suffering as well as recovery from substance abuse. The psychiatric nurse needs to have a professional and person-centered approach. The caring conversation is described as a conversation between two people, which for the psychiatric nurse means a challenge in balancing closeness and distance to the patient.
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Waller, Dylan Ellingson. "Therapy and the Nontraditional Transgender Narrative." PDXScholar, 2015. https://pdxscholar.library.pdx.edu/open_access_etds/2336.
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The history of transgender identity is inextricable from the mental health industry. Since the late 1970's transgender people have required permission from mental health professionals to make medical modifications to their sex characteristics. During the time of this research, it was difficult for transgender individuals to receive the hormones or surgeries they desire without first being diagnosed with Gender Identity Disorder (GID).
This study applies labeling theory to the label of GID. Labeling theory poses that if an individual is labeled with a mental illness, they will either reject or accept the label. Acceptance of the mentally ill label will cause the individual to adopt characteristics expected of the label.
The intent of this study is to examine the relationship between mental health therapy and the formation of transgender identities. Utilizing labeling theory, it analyzes whether or not transgender participants of this study accepted or rejected the mental illness label of GID. It was originally posed that if transgender individuals accepted the label of GID, they would experience a shift in their gender identity.
However, the overwhelming majority of the twelve participants interviewed rejected the label of GID. Even though most participants rejected the GID label, many still saw a shift in gender identity while attending therapy. This thesis proposes that there may be a link between a transgender person’s reason for entering therapy and identity shift. Those who felt obligated to go to therapy for the sole reason of gaining permission to change their sex characteristics saw no change in identity. However, those who wanted help in exploring their gender with a therapist saw identity changes while in therapy.
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Auer, Deborah. "The experience of female patients seeking elective rhinoplasty surgery : a narrative inquiry." Thesis, Middlesex University, 2018. http://eprints.mdx.ac.uk/25906/.
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The aim of this research is to understand what motivates patients to have an elective rhinoplasty, taking into consideration any societal, familial, cultural and intrapersonal influences. The research question explored how, if at all, surgery impacts women's embodied sense of themselves and if there is a way of providing psychological support to this patient group. Four female patients were interviewed preoperatively and postoperatively using a narrative inquiry approach. The research offers a detailed qualitative contribution in a field that is predominantly quantitatively studied. The research explored the nuances of why female patients want to have rhinoplasty surgery. The narratives of the patients showed that the motivation to have surgery is based on external and internal factors. The external factors revealed the following: society's acceptance of cosmetic surgery, the influence of the media, the experience of the consultation and how risk is understood. The internal factors were influenced by the patients' experience of the death of significant family members, a need to separate from patriarchal and matriarchal family members, feelings of body shame, a fear of negative evaluation from others, and objectification of their body in preparation for surgery. Following surgery, a psychological shift was discussed by each patient; this indicates that cosmetic surgery does indeed have a psychological impact. The implication for practice is that clinicians need to have a better understanding of the motivation of this patient group to be able to offer the appropriate psychological support. Awareness also needs to be raised with surgeons, to help them better understand how the surgery they perform can have a psychological impact. This research showed that patients proceeding with cosmetic surgery could benefit from having specialised psychological support preoperatively and postoperatively. This would contribute to more realistic expectations for surgery and, hopefully, a better outcome for both patient and surgeon.
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Loftus, Stephen Francis. "Language in clinical reasoning learning and using the language of collective clinical decision making /." Faculty of Health Sciences, School of Physiotherapy, University of Sydney, 2006. http://hdl.handle.net/2123/1165.
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Doctor of PhilosophyThe aim of the research presented in this thesis was to come to a deeper understanding of clinical decision making from within the interpretive paradigm. The project draws on ideas from a number of schools of thought which have the common emphasis that the interpretive use of language is at the core of all human activity. This research project studied settings where health professionals and medical students engage in clinical decision making in groups. Settings included medical students participating in problem-based learning tutorials and a team of health professionals working in a multidisciplinary clinic. An underlying assumption of this project was that in such group settings, where health professionals are required to articulate their clinical reasoning for each other, the individuals involved are likely to have insights that could reveal the nature of clinical decision making. Another important assumption of this research is that human activities, such as clinical reasoning, take place in cultural contexts, are mediated by language and other symbol systems, and can be best understood when investigated in their historical development. Data were gathered by interviews of medical students and health professionals working in the two settings, and by non-participant observation. Data analysis and interpretation revealed that clinical decision making is primarily a social and linguistic skill, acquired by participating in communities of practice called health professions. These communities of practice have their own subculture including the language game called clinical decision making which includes an interpretive repertoire of specific language tools and skills. New participants to the profession must come to embody these skills under the guidance of more capable members of the profession, and do so by working through many cases. The interpretive repertoire that health professionals need to master includes skills with words, categories, metaphors, heuristics, narratives, rituals, rhetoric, and hermeneutics. All these skills need to be coordinated, both in constructing a diagnosis and management plan and in communicating clinical decisions to other people, in a manner that can be judged as intelligible, legitimate, persuasive, and carrying the moral authority for subsequent action.
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Gates, Rose A. "Narrative shifts : patients' stories of cancer and the experiences of telling their stories /." Connect to full text via ProQuest. IP filtered, 2006.
Find full textAbstract:
Thesis (Ph.D. in Nursing) -- University of Colorado, 2006.Typescript. Includes bibliographical references (leaves 278-301). Free to UCDHSC affiliates. Online version available via ProQuest Digital Dissertations;
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Agresti, Albert A. "Effects of mode of presentation on head injured patients' recall of narrative information /." The Ohio State University, 1986. http://rave.ohiolink.edu/etdc/view?acc_num=osu1487266691094183.
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Kosny, Agnieszka Arlette. "Examining the doctor-patient relationship : knowledge, vulnerability, and power in women's health care narratives /." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape10/PQDD_0004/MQ42404.pdf.
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Bodin, Erika, and Hanna Dyvik. "Psykiska vårdbehov hos intensivvårdspatienten -en utmaning för vårdpersonalen att bemöta och tillgodose. : - En narrativ syntes av kvalitativa artiklar." Thesis, Uppsala universitet, Anestesiologi och intensivvård, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-352331.
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Bakgrund: En patient som vårdas på en intensivvårdsavdelning befinner sig i en särskilt utsatt situation då patienten är allvarligt sjuk eller skadad. Patienterna har och upplever vårdbehov som vårdpersonalens uppgift är att identifiera och tillgodose. Att inte ha förmåga att förmedla sina vårdbehov gör patienterna sårbara och vårdbehoven som patienten värdesätter kan inte tillgodoses. Syfte: Syftet med studien var att sammanställa vilka vårdbehov patienter som vårdades på en intensivvårdsavdelning upplevt och undersöka om vårdbehoven tillgodosågs under vårdtiden. Metod: En kvalitativ litteraturöversikt med deskriptiv design baserades på 21 vetenskapliga artiklar som sedan sammanställdes till en narrativ syntes. Resultat: Resultatet visar att patienterna under sin intensivvårdstid upplevde både psykiska och fysiska behov. Patienterna uttryckte ett stort behov av mänsklig kontakt och anhöriga tillgodosåg främst det behovet. Att inte kunna uttrycka sig verbalt var ett stort hinder för patienterna som uttryckte ett behov av att göra sig förstådd och att få information om sin situation. En icke fungerande kommunikation mellan patienterna och vårdpersonalen var den största anledningen till att vårdbehoven inte tillgodosågs. Slutsats: Trots tidigare forskning, teorier, värdegrunder, kompetensbeskrivningar och lagar som beskriver vikten av att vårda patientens psykiska hälsa genom ett personcentrerad och ett etiskt förhållningssätt frångår vårdpersonalen ofta detta inom intensivvård. Vårdpersonal behöver bli bättre på att identifiera och tillgodose dessa psykiska behov. Det finns ett behov av att fördjupa specialistutbildningen för intensivvårdssjuksköterskor där det psykologiska patientperspektivet får en större del.Background: A patient being treated in an intensive care unit is in a particularly vulnerable situation when the patient is often seriously ill or injured. Patients experience care needs that is the healthcare staff's task is to identify and supply. Being unable to convey their care needs makes the patients vulnerable and the care needs that the patient values can not be met by healthcare staff. Aim: The aim of the study was to compile the care needs of patients who were treated in an intensive care unit and to investigate whether care needs were met during the care period. Method:A qualitative literature review with descriptive design based on 21 scientific articles, then compiled into a narrative synthesis. Result: The result shows that during the intensive care period, patients experienced psychological and physical needs. Patients expressed a great need for human contact wich their relatives mainly addressed. Being unable to express yourself verbally was a major obstacle for patients who expressed a need to understand and to get information about their situation. Non-functioning communication between patients and healthcare staff was the main reason why care needs were not met. Conclusion: Despite prior research, theories, values, skill descriptions and laws describing the importance of caring for the psychological needs of the patient through an individual and ethical approach, the healthcare staff often abandon this in intensive care. Healthcare professionals need to be better at identifying and meeting these psychological needs. There is a need to deepen specialist education for intensive care nurses, where the psychological patient perspective gets a greater part.
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King, Katharine E. "Writing the breast cancer journey : illness narratives from an Internet forum /." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp03/MQ54928.pdf.
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