Análise da autonomia de indivíduos internados em enfermarias cirúrgicas de um hospital universitário

Pós-graduação em Enfermagem (mestrado profissional) - FMB

Jornalistas que escrevem sobre saúde conhecem a Humanização do Atendimento?

No Brasil, iniciativas de Humanização no atendimento em saúde são identificadas desde os anos 1990, mas ganharam vulto por meio do Programa Nacional de Humanização da Assistência Hospitalar (PNHAH), ampliado pela Política Nacional de Humanização (PNH). O objetivo deste artigo é identificar a percepção sobre Humanização por parte de alguns jornalistas que escrevem sobre Saúde em importantes publicações paulistas, e no que se constitui, na opinião deles, um atendimento humanizado. A análise do material coletado foi feita segundo referenciais teóricos da Bioética, sob o enfoque de autores como Pellegrino e Thomasma (Ética das Virtudes e Beneficência) e Beauchamp e Childress (Principialismo). Resultados: Os pesquisados ainda associam a Humanização às primeiras iniciativas de Humanização, vinculadas a assistência ao parto e pré-natal, além do voluntariado, mas desconhecem a existência de uma política estruturada sobre o tema: nenhum sequer mencionou a PNH; consideram o médico como figura essencial à Humanização da assistência e que, portanto, deveria ser virtuoso; e desejam que o atendimento tenha caráter integral (holístico).

Bioethical Aspects Across Medicine: The Care of Cardiovascular Diseases in Brazil

Bioethics applied to medicine extrapolates the traditional medical concepts of non-maleficence (primum non nocere) and beneficence (bonum facere) and regards to justice, autonomy, equity, protection, compassion and humanization, not considering people just like patients, but understanding the complex existence of each single person. Worldwide, the morbidity and mortality indices regarding to diseases of heart and blood vessels became progressively grater. For countries in development, like Brazil, these numbers are even more expressive and this increase trend seems to be caused by wider exposition of population to some risk factors. This article broaches an intersection between bioethics and medicine, focusing the reality of cardiovascular diseases in Brazil and the necessity of doctors to base their behavior in bioethical paradigms.

Macht der Fürsorge? Moral und Macht im Kontext von Medizin und Pflege

Wer anderen Gutes tun möchte, benötigt die Möglichkeit, wirksam tätig zu werden. Dabei kann es um Wissen um Therapietechniken und -verfahren gehen, um die Kenntnis derjenigen, die man fragen oder konsultieren sollte, aber natürlich auch um finanzielle Mittel, um etwa Spezialisten, ihre Kompetenzen und technologischen Möglichkeiten nutzen zu können. Man kann diese kulturellen, sozialen und ökonomischen Ressourcen mit dem französischen Soziologen Pierre Bourdieu unter dem Begriff des Kapitals zusammenfassen: Kulturelles, soziales und ökonomisches Kapital bezeichnen dann jeweils einen spezifischen Typ von sozialer Gestaltungsmacht. Aber gerade im Gesundheitswesen ist die Frage nach Gestaltungsmacht heikel. Denn einerseits fühlt sich jemand, der unter einer akuten und vielleicht sogar schmerzhaften Krankheit leidet, oft ohnehin schon verletzlich, ohnmächtig und ausgeliefert, sodass die Frage nach der Macht hier unangebracht oder obsolet erscheint. Andererseits wirkt in einem Bereich, in dem es um Fürsorge (caring), um Wohltun (beneficence), Behandlung und Heilung geht, der Begriff der Macht, den wir oft genug mit Herrschaft und Gewalt verbinden, merkwürdig fehl am Platz. Klassisch wird die Frage nach der Macht im Bereich des Gesundheitswesens unter dem Etikett des Paternalismus verhandelt und vor allem auf das Verhältnis von Arzt und Patient bezogen, in dem dann das normative Benevolenzprinzip und das Prinzips des Respekts vor der Autonomie des Patienten oder der Patientin in Konflikt geraten können. Allerdings lässt sich fragen, ob diese Perspektive nicht eine Engführung darstellt. Denn oft sind nicht nur die unmittelbar kranken oder pflegebedürftigen Patienten und Patientinnen, sondern auch ihre Angehörigen betroffen – bei betagten Patienten ist das sogar die Regel. Zudem sorgt die zunehmende Bedeutung, Präsenz und nicht zuletzt Verwissenschaftlichung der Pflege für möglichen Konfliktstoff zwischen Pflegenden und Behandelnden. Und schliesslich führt der steigende ökonomische Druck zu Reibungsflächen zwischen den zu Effizienz und ökonomischer Nachhaltigkeit verpflichteten Verwaltenden und Behandelnden wie Pflegenden. Der Band, der Beiträge einer interdisziplinären Berner Tagung aufnimmt und durch zusätzliche Perspektiven ergänzt, geht der ‹Macht der Fürsorge› und ihrer Verteilung im Sechseck von Patienten und Patientinnen, Behandelnden, Pflegenden, Verwaltenden, Angehörigen und politisch Verant-wortlichen in ethischer Perspektive nach.

"I understood what she meant when she said '21st century medicine'": A qualitative analysis of patient responses for plans for colorectal cancer screening following a recommendation from their physician

Although physician recommendation has been significantly associated with colorectal cancer screening (CRCS), it still does not motivate all patients to get CRCS. Although improved physician recommendation for CRCS has been shown to increase patient CRCS screening, questions remain about what elements of that discussion may lead to screening. The objective of this study is to describe patients' perceptions and interpretations about their physician's recommendation for CRCS during their annual wellness exam. A subset of patients (n=51) participating in a supplement study of a behavioral intervention trial designed to increase CRCS completed a follow-up, open-ended interview two to four weeks after their annual wellness visit. Using qualitative methods, transcripts of these interviews were analyzed. Findings suggest that most patients would follow their physician's recommendation for CRCS despite not engaging in much discussion. Patients may refrain from CRCS discussion because of a commitment to CRCS, awareness of screening guidelines, and trust in physician's honesty and beneficence. Yet many patients left their wellness exams with questions, refraining because of future plans to consult with their physicians, perceived time constraints or a lack of a patient-physician relationship. If patients are leaving their wellness exams with unanswered questions, interventions should prepare physicians for patient reticence, teaching physicians how to assure patients that CRCS is a primary care activity where all questions and concerns, including cost and scheduling, may be resolved.^

Clinical Implications for Working with Gay Men A Self Psychological Treatment Approach.

Specific training for conducting psychotherapy with gay men is limited for psychologists, particularly when using a Self Psychology theoretical orientation (Robertson, 1996). In fact, psychologists often are faced with conflicting and contradictory points of view that mirror society's condemnation of homosexuality (Robertson, 1996). This paper is written from a self-psychological perspective to address the lack of a constructive body of literature that explains the unique treatment needs which impact gay men. Estimates of the prevalence of male homosexuality have generated considerable debate. A common assumption is that there are homosexual and non-homosexual men. However, scientists have long been aware that sexual responsiveness to others of the same sex, like most human traits, is continuously distributed in the population (Michaels, 1996). Still the presumption exists that such traits are stable within each man over time (Michaels, 1996). Conflating same-sex sexual experiences with a categorization of the man as homosexual is problematic, in that defining sexuality solely on the basis of experience excludes people who fantasize about sex with others of the same sex but never have sexual contact. Thus, most modern conceptions of sexual orientation consider personal identification, sexual behavior, and sexual fantasy (McWhirter, Sanders & Reinisch, 1990). Gay men's mental health can only be understood in the context of homosexuality throughout history, since religious and moral objections to sexual attraction between men have existed for centuries. Men who desired other men were regarded as sinful and depraved if not ill or abnormal, and same sex contacts were not distinguished from lewd behaviors (Weeks, 1989). Although most people, regardless of sexual orientation, have experienced some feelings of personal rejection, rarely do heterosexuals become targets for disapproval based on the nature of their attractions and behaviors relative to the same and to the other sex. For lesbians, bisexuals, and gay men, however, homosexuality becomes the focus of aspects of themselves that make them feel hated and hateful (Isay, 1989). While gay men and lesbians are often considered together because of the same-sex nature of their relationships and the similar issues that they may experience in their treatment within society, there are many issues where they might be best studied separately. Issues involving with health, parenthood, sexuality and perceived roles and status in society, for example, are often related more to gender than to any shared concept of a 'gay and lesbian community'. Many issues surrounding lesbians and lesbian culture will have more to do with women's issues, and some issues involving with gay men will have more to do with the gay male subculture and with masculinity. The author of this paper has limited experience in working with lesbian and bisexual individuals, and although it is likely that some of the concepts articulated in this paper could translate to working with lesbian and bisexual individuals, further research is indicated to examine the beneficence of utilizing a Self Psychological orientation in psychotherapy with lesbian women and bisexual individuals. This paper presents an overview of the literature including historical treatments of homosexuality, the history of Self Psychology, key principles in Self Psychology, research on Self Psychology, identity development models for gay men, and Self Psychological perspectives on identity development related to gay men. The literature review is followed by a section on treatment implications for psychologists seeking to treat gay men, including case vignettes based on work from my own practice. I have preserved the anonymity of clients by changing demographics, and rearranging and combining presenting issues and historical backgrounds among the case examples.

Addresses of John Hay.

I. Franklin in France.--II. Omar Khayyám.--III. Sir Walter Scott.--IV. Speeches before the American society in London.--V. A partnership in beneficence.--VI. Speech at the annual dinner of the Royal society.--VII. Speech at the annual dinner of the Literary fund.--VIII. Speech at the opening, by Miss Helen Hay, of the Robert Browning garden.--IX. International copyright.--X. American diplomacy.--XI. A festival of pece.--XII. William McKinley.--XIII. At the universities.--XIV. Commercial club dinner.--XV. New Orleans.--XVI. The Grand army of the republic.--XVII. President Roosevelt.--XVIII. Edmund Clarence Stedman.--XIX. Lincoln's faith.--XX. The press and modern progress.--XXI. Fifty years of the Republican party.--XXII. America's love of peace.--XXIII. Life in the White House in the time of Lincoln.--XXIV. Clarence King.

Borrowing from models of motor control to translate cognitive processes: Evidence for hypokinetic-hyperkinetic linguistic homologues?

In relation to motor control, the basal ganglia have been implicated in both the scaling and focusing of movement. Hypokinetic and hyperkinetic movement disorders manifest as a consequence of overshooting and undershooting GPi (globus pallidus internus) activity thresholds, respectively. Recently, models of motor control have been borrowed to translate cognitive processes relating to the overshooting and undershooting of GPi activity, including attention and executive function. Linguistic correlates, however, are yet to be extrapolated in sufficient detail. The aims of the present investigation were to: (1) characterise cognitive-linguistic processes within hypokinetic and hyperkinetic neural systems, as defined by motor disturbances; (2) investigate the impact of surgically-induced GPi lesions upon language abilities. Two Parkinsonian cases with opposing motor symptoms (akinetic versus dystonic/dyskinetic) served as experimental subjects in this research. Assessments were conducted both prior to as well as 3 and 12 months following bilateral posteroventral pallidotomy (PVP). Reliable changes in performance (i.e. both improvements and decrements) were typically restricted to tasks demanding complex linguistic operations across subjects. Hyperkinetic motor symptoms were associated with an initial overall improvement in complex language function as a consequence of bilateral PVP, which diminished over time, suggesting a decrescendo effect relative to surgical beneficence. In contrast, hypokinetic symptoms were associated with a more stable longitudinal linguistic profile, albeit defined by higher proportions of reliable decline versus improvement in postoperative assessment scores. The above findings endorsed the integration of the GPi within cognitive mechanisms involved in the arbitration of complex language functions. In relation to models of motor control, 'focusing' was postulated to represent the neural processes underpinning lexical-semantic manipulation, and 'scaling' the potential allocation of cognitive resources during the mediation of high-level linguistic tasks. (c) 2005 Elsevier Ltd. All rights reserved.

Pediatric Nurses’ Information and Applications Related To Ethical Codes

Background: Ethics is defined as the entirety of moral principles that form the basis of individuals’ behavior; it can also be defined as “moral theory” or “theoretical ethics”. Objectives: To determinate information and applications related to ethical codes of pediatric nurses. Patients and Methods: Participants were nurses attending the Neonatal Intensive Care Unit Nursing Course and the Pediatric Nursing Course conducted in Istanbul between September 2011 and December 2012. A total of nurses attending the courses at the specified dates and who agreed to participate in the study were included in the analysis. Data were collected through a questionnaire that we developed in accordance with current literature on nursing ethics. Results: 140 nurses participated in this study. Information and applications were related to ethical codes of nurses including four categories; autonomy, beneficence, nonmaleficence, justice. The principle of confidentiality/keeping secrets. Exactly 64.3% of nurses reported having heard of nursing ethical codes. The best-known ethical code was the principle of justice. Furthermore, while the rates were generally low, some nurses engaged in unethical practices such as patient discrimination and prioritizing acquaintances. Conclusions: We conclude that most nurses working in pediatric clinics act in compliance with ethical codes. We also found that the majority of nurses wanted to learn about ethical codes. For this reason, we recommended that nurses working in clinics and future nurses in training be informed of the appropriate ethical behavior and codes.