Los pacientes que acuden a un centro sanitario esperan ser atendidos no solo por un buen médico, sino también por un médico bueno. Las aptitudes y las actitudes son claves para una atención médica de ...calidad y calidez. Los médicos del siglo XXI tienen unos conocimientos, capacidades y tecnologías a su alcance, impensables hace unas décadas. Estos avances científico-tecnológicos están influyendo en la misma relación médico-paciente. El historiador de la medicina y bioeticista Diego Gracia, ya advertía que en el último tercio del siglo veinte, la forma de relacionarse los médicos y los enfermos había cambiado más que en los veinticinco siglos anteriores. ¿Están los médicos y los pacientes preparados para los nuevos retos del futuro? Desde la educación médica ¿Se puede aportar a los futuros médicos una formación a la altura de los retos que implica el nuevo escenario de la sanidad? ¿Puede adquirir el estudiante de medicina durante su formación las actitudes necesarias para desarrollar una medicina centrada en el paciente? ¿Es posible preservar esos buenos niveles de empatía que lleva consigo el alumnado que ingresa en las Facultades de Medicina? Estos y otros interrogantes se plantean en las páginas de este libro, que pretende ser un material para la reflexión y el incentivo de actitudes más humanizadas en la práctica de la relación médico-paciente. Hemos intentado poner en diálogo a distintos especialistas que creen posible acompasar el desarrollo científico-técnico a la rehumanización del trato al paciente. Los pacientes del presente siglo tampoco son los mismos; el cambio del modelo paternalista al autonomista ha favorecido un sujeto menos pasivo, más empoderado, que reclama una toma compartida de decisiones. Pacientes y médicos están hoy en diálogo pues, la buena o mala relación, depende de los distintos actores implicados en la misma.
Antecedentes/Objetivo: Este estudio analiza las propiedades psicométricas del cuestionario Shared Decision-Making (SDM-Q-9) en pacientes con cáncer resecado, no metastásico y elegibles para ...quimioterapia adyuvante. Método: Estudio multicéntrico, prospectivo, transversal en el que se reclutaron 568 pacientes que respondieron al SDM-Q-9 después de visitar a su oncólogo quien, a su vez, completó el SDM-Q-versión médico. Se estudiaron la fiabilidad, la estructura factorial análisis factorial exploratorio (EFA), análisis factorial confirmatorio (CFA) y la validez convergente de las puntuaciones del SDMQ-9. Resultados: La escala SDM-Q-9 mostró una estructura factorial clara, compatible con un factor general fuerte y replicable, y un factor de grupo secundario. La puntuación del factor general mostró una buena fiabilidad en términos de coeficiente omega: 0,90. La asociación entre la percepción del médico y del paciente en la SDM fue débil y no logró alcanzar significación estadística. Los hombres y los pacientes mayores de 60 años mostraron mayor satisfacción con la toma de decisiones compartidas con el oncólogo. Conclusiones: El cuestionario SDM-Q-9 puede ayudar en la evaluación de la toma de decisiones compartidas desde la perspectiva de los pacientes con cáncer y como indicador del grado de calidad y satisfacción en la relación médico-paciente.
Communication represents the core of psychotherapy. The dynamic interaction between verbal and non-verbal components during patient-therapist exchanges, indeed, promotes the co-construction of ...meanings bringing about change within a process of reciprocal influence of participants. Our paper aims to illustrate the building of a new observational instrument of the therapeutic discourse, the Communicative Modes Analysis System in Psychotherapy (CMASP), and its reliability study from Mixed Methods framework. The CMASP is a single classification system analyzing the communication features within therapeutic exchanges. Born to overcome the limits of traditional psychotherapy research which considers verbal and non-verbal dimensions of communication as in polar opposition, the CMASP building was based on the performative function derived from the Speech Act Theory. We used this function as a comprehensive theorization to interpret the communication components in psychotherapy as an integrated and interacting system. In fact, the instrument detects and classifies, at the overall and dimension level, the verbal and extra-linguistic components of psychotherapeutic communication implemented by the therapist and patients in the form of communicative modes. From the observational methodology framework, it was built an instrument able to record and analyze verbal, vocal and interruption behaviors by combining elements of qualitative and quantitative research approaches. The sample consisted of 30 psychotherapy audio recordings and verbatim transcripts of psychotherapy sessions (for a total of 8327 speaking turns). Four main dimensions were elaborated (Verbal Mode-Structural Form, Verbal Mode-Communicative Intent, Vocal Mode, and Interruption Mode) according to the agency role of communication components. The instrument is a field format combined with category systems. For each dimension, we built a category system that is exhaustive and mutually exclusive. From all dimensions, we have a total of 33 categories. Intra-and inter-judge reliability among four independent judges was computed on a total of 503 speaking turns coded through Cohen's κ and Krippendorff's canonical agreement coefficients (Cc), respectively. The CMASP showed high intra-and inter-judge agreement at the global, dimensional, and categorical level providing researchers and professionals with a single and flexible classification system, able to give multiple and concurrent information about the psychotherapy process.
În domeniul sănătății au fost elaborate și validate numeroase scale de măsurare având aplicabilitate la evaluarea stării de sănătate, a bunăstării psihologice și a calității vieții în legătură cu ...sănătatea. În scopul selectării unei anumite scale de măsurare sau în scopul dezvoltării de noi scale (instrumente) de măsurare este necesară o abordare coerentă care să includă criterii de evaluare, proceduri și tehnici de evaluare. Pe baza analizei literaturii de specialitate în domeniu, autorii au prezentat un set de criterii de evaluare a scalelor de măsurare și au propus o metodologie pentru dezvoltarea și validarea scalelor în domeniul sănătății. Metodologia cuprinde cinci etape: conceptualizare, dezvoltarea măsurilor, specificarea modelului, evaluarea și rafinarea scalei, validarea scalei. Criteriile de evaluare și metodologia furnizează un cadru general ce poate fi utilizat în cercetarea academică și cercetările clinice pentru realizarea studiilor empirice referitoare la dezvoltarea și validarea scalelor de măsurare.
Purpose
To examine how evidence about the therapeutic alliance gleaned from participatory action project affected the level of this alliance and the degree of empathy of psychiatric nurses.
Design ...and Methods
Quasi‐experimental study in two psychiatric units. In one group, evidence‐based practices that affected the therapeutic alliance were implemented; in the comparison group, there was no such intervention.
Findings
The nurses from the intervention group improved their degree of empathy and factors such as agreement on objectives and tasks with the patient.
Practice Implications
The results confirm the possibility of measuring and improving the therapeutic relationship in psychiatric care.
Purpose: to examine how evidence about the therapeutic alliance gleaned from participatory action project affected the level of this alliance and the degree of empathy of psychiatric nurses. Design ...and methods: quasi-experimental study in two psychiatric units. In one group, evidence-based practices that affected the therapeutic alliance were implemented; in the comparison group, there was no such intervention. Findings: the nurses from the intervention group improved their degree of empathy and factors such as agreement on objectives and tasks with the patient. Practice implications: the results confirm the possibility of measuring and improving the therapeutic relationship in psychiatric care.
The relationship between healthcare professionals and patients in the Spanish health sector has undergone dramatic change. One aspect of this is that the use of informed consent has become a key ...factor in the delivery of adequate healthcare. But although a certain period of time has already passed since informed consent started to be used, in Spain there is still doubt about how adequately informed consent is being used.
Purpose: to study the significance of 'therapeutic relationship' between nurses and patients within the context of a psychiatric hospital. Method: narrative literature review. Content analysis. ...Findings: the significance of the therapeutic relationship is quite similar for both nurses and patients in psychiatric hospital units. Nevertheless, several factors may separate the two positions: the time available for the relationship, the negative perceptions on the part of both parties, and the insecurity of the setting. Practice implications: increased knowledge and understanding of the significance of the therapeutic relationship from the perspective of nurses and patients would allow the strengthening of areas of mutual interest.
Hi ha dos grups de verbs psicològics pronominals catalans que regeixen un sintagma preposicional
(interessar-se {per/en}, penedir-se de) i que es diferencien dels verbs psicològics ergatius ...pronominals
(emocionar-se, emmurriar-se). Les característiques semàntiques del subjecte experimentador d’aquests
predicats són compatibles amb un pacient i, alhora, amb un agent que actua com una causa interna
iniciadora de la seva pròpia experiència psicològica. Proposo que participen en oracions amb una
estructura inacusativa agentiva, amb un subjecte experimentador legitimat com a argument intern que
ocupa la posició d’argument extern de forma derivada. Són oracions que expressen voluntarietat en
l’experimentador i alguns d’aquests verbs presenten un alternant de caràcter emotiu que els permet
participar en una alternança emotiva/volitiva.
There are two groups of Catalan pronominal psychological verbs that govern a prepositional phrase
(interessar-se per/en ‘take an interest in’, penedir-se de ‘regret’) which differ from pronominal ergative
psychological verbs (emocionar-se ‘get excited’, emmurriar-se ‘get angry’). The semantic characteristics
of the experiencer subject of these predicates are compatible with a patient and, at the same time,
with an agent that acts as an internal cause initiating its own psychological experience. I propose they
take part in sentences with an agentive unaccusative structure, with an experiencer subject licensed
as an internal argument that occupies the position of an external argument in a derivative way. These
sentences express willingness in the experiencer and some of the verbs have an emotional alternant that
allows them to take part in an emotional/volitional alternation.
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