Dissertations / Theses: 'Patient self-determination'

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Wagner, Leanna. "A Policy Analysis of the Patient Self-Determination Act of 1990." Thesis, California State University, Long Beach, 2018. http://pqdtopen.proquest.com/#viewpdf?dispub=10784173.

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This is a policy analysis of the Patient Self-Determination Act of 1990 which aimed to improve access and education of Advance Health Care Directives (ADs). ADs are in the form of durable power of attorneys and living wills that communicate a patient’s decisions concerning life sustaining treatment. The policy has three objectives, first that health care staff are required to educate patients on ADs and to follow such documentation when treating patients. Second, the policy calls for the Federal Department of Health and Human Services (HHS) to educate the United States population on the benefits and need for ADs. Lastly, it required states to create and implement their own laws concerning end-of-life treatments and the use of ADs. This analysis focuses on the impact of the policy on patient self-determination, informed consent and quality-of-life.

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Victoria, Lindsey N. "A Feasibility Analysis of a Pilot Study Comparing Prenatal Genetic Service Delivery Outcomes Using the Self-Determination Theory." Scholar Commons, 2019. https://scholarcommons.usf.edu/etd/7982.

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Genetic counselors, along with the National Society of Genetic Counselors, desire evidence-based research and data assessing the value of genetic counseling in genetic service delivery. This pilot study was designed to gather data about genetic counseling outcomes as well as analyze the feasibility of a study looking at new genetic outcome measures in the prenatal setting. Implementation of the methods used for data collection were evaluated by analysis of the appropriateness, acceptability, feasibility, fidelity, and adoption of the research protocol at three sites. We found that there is a hierarchy between implementation outcomes and it may be necessary to satisfy one implementation outcome before the next one can be achieved. We also found that patient engagement is a key component to evaluating the success of methods used for data collection. These findings may be useful to individuals designing future research studies used to measure genetic counseling outcomes.

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Johansson, Beatrice, and Oskar Holmdahl. "Patienters upplevelser av psykiatrisk vård : Med fokus på tvångsvård." Thesis, Kristianstad University College, School of Health and Society, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:hkr:diva-6379.

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Bakgrund: Att vara inskriven enligt lagen om psykiatrisk tvångsvård, LPT, innebär att självbestämmandet tas ifrån en. Eftersom den nya lagen skapades för att skydda patienters integritet undersöker detta arbetet patienternas upplevelser av tvångsvård. Syfte: Syftet var att beskriva patienters erfarenheter av tvång med fokus på tvångsvård inom den psykiatriska vårdenheten. Metod: En litteraturstudie där sju vetenskapliga artiklar ingick. Systematisk granskning av artiklarna genomfördes. Resultat: Resultatet utgörs av tre kategorier: de som uppfattar tvång i störst utsträckning vilket var främst vita, högutbildade och kvinnor. Negativa erfarenheter av tvångsvård vilket inkluderade att ingen lyssnade eller tog en på allvar. Slutligen positiva erfarenheter av tvångsvård vilket bland annat innebar att ha någon att prata med och få viss kontroll över sin vård. Diskussion: Självbestämmande och kommunikation är viktiga faktorer som spelar en stor roll när det kommer till upplevelser av tvångsvård. Slutsats: Många faktorer spelar in vid upplevelser av tvångsvård och tvång. Både negativa och positiva upplevelser kom fram. Många problem hade kunnat undvikas om personalen hade pratat med patienterna och visat empati. Fler studier i ämnet behövs för att personalen ska kunna förstå patienterna och i slutändan ge en bättre vård.

Background: To be admitted according to the law of coercive measures in psychiatric care, LPT, one is stripped of one’s self-determination. Since the new law was created to protect patients' integrities, the aim of this study was to determine how patients' experienced coercive measures. Purpose: The aim was to describe patient´s experience of coercive measures with focus on psychiatric coercive care within a psychiatric care unit. Method: A literature review in which seven scientific articles were included. Systematic review of the articles was used. Results: Three categories were found: Those who experience coercive measure the most which was mainly white people, women and those with a high education. Negative experience of coercive measures which included not being listened to and taken serious. Finally positive experience which included having someone to talk to and being given some control over one’s own care. Discussion: Self determination and communication are key factors when it comes to experiences of coercive measures in psychiatric health care. Conclusion: There are many factors that correlated with experience of coercive measures and coercion. Both negative and positive experiences were mentioned. Many problems could have been avoided if only the staff had talked to the patients and showed empathy. More studies are needed to make the staff understand patients and ultimately give them better care.

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Olivera, Jacqueline, and Leyton Maureen Loyola. "Äldre personers upplevelser av utskrivningsprocessen från slutenvård till primärvård : en litteraturöversikt." Thesis, Ersta Sköndal Bräcke högskola, Institutionen för vårdvetenskap, 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:esh:diva-8619.

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Bakgrund: Utskrivningsprocessen har förändrats på grund av sjukvårdsreformer med mål att stärka patienters ställning och förkorta vårdtider inom sluten vård. Samtidigt som en åldrande befolkning med ökande multisjukhet och komplexa vårdbehov ställer höga krav på samverkan mellan berörda parter. Äldre patienters upplevelse av utskrivningsprocessen är av intresse för sjuksköterskor i rollen som samordnare av insatser under utskrivningsprocessen. Syfte: Syftet var att belysa äldre personers upplevelser av utskrivningsprocessen från slutenvård till primärvård. Metod: Efter en kvalitetsgranskning gjordes en litteraturöversikt enligt Fribergs metod på nio kvalitativa och tre kvantitativa studier ur databaserna CINAHL och PubMed. Resultat: Ur analysen identifierades fem teman under utskrivningsprocessen och var patienters: informationsbehov och vårdpersonalens betydelse, känsla av utsatthet, nöjdhet och tillfredställelse med vården, strategier och empowerment, samt anhörigas betydelse för patienterna. Slutsats: Äldre patienter upplevelser av utskrivningsprocessen var brist på delaktighet och samordning vilket gav upphov till känslor av oro, stress, förvirring och maktlöshet. Patienter upplevde en ojämlik tillgång till insatser, i synnerhet personer ≥ 80 år. Bristande kommunikation mellan vårdpersonal och patienter påverkar patienters upplevelse av utskrivningsprocessen negativt och orsakade vårdlidande.
Background: The hospital discharge process (DP) has changed due to healthcare reforms whose aim has been to promote the status (voice) of patients and to shorten hospital stays. At the same time as an ageing population with increased multimorbidity and complex care needs puts high demands for integrated care on the partners concerned. Elderly patients’ experiences of the hospital discharge process are of interest to nurses in their role as coordinators of integrated care during the discharge process. Aim: The aim was to highlight older persons’ experiences of the discharge process from inpatient to primary care. Method: Following a quality review, a literature review was conducted according to the method by Friberg on nine qualitative and three quantitative articles from the databases CINAHL and PubMed. Results: From the analysis five themes emerged during the DP and were patients’: need for information and the importance of care personnel, feeling of vulnerability, satisfaction with health care, strategies and empowerment as well as the importance of relatives for the patients. Conclusion: Older patients’ experiences of the DP were lacking in participation and integrated care which aroused feelings of concern, stress, confusion and powerless. Patients experienced an unequal access to care and support, especially persons ≥ 80 years. Lack of communication between care professionals and patients influence patients experience of the DP negatively and can lead to health care-induced suffering.

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Riahi, Löfdahl Fredrika. "” Ibland känner jag mig övergiven därför att personalen har så mycket andra människor att ta hand om”. : - En kvalitativ intervjustudie som presenterar några äldres åsikter om hur relationen till vårdare kan påverka äldre i deras vardag." Thesis, Stockholms universitet, Institutionen för socialt arbete - Socialhögskolan, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-113671.

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The purpose of this thesis is to examine the relationship between the elderly at a retirement home and their professional caretakers with focus on the perspective of the elderly. Chosen method, a qualitative interview analysis has been conducted to describe how the relationship affects the elderly in their everyday lives. The total amount of interviews were four. The relationship between the elderly and their professional caretakers has rarely been examined in previous research from an elder’s perspective. The results indicate that the elderly often are satisfied with the way the professional caretakers treat them. Factors that the elderly mentioned as problematic were that professional caretakers often acted stressed, and rushed through things which the elderly considered as problematic for their own well- being. Another feature was the asymmetric relationship with the professional caretakers which affected the elderly ́s belief in their own capability in managing their everyday lives. In cases where the elderly felt that the relationship was equal their capacity and their beliefs to their own capacity increased significantly which was an effect that was positive for the elderly ́s physical and mental health.

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Gibb, Winna. "Informed consent : a liberal perspective." Thesis, Queensland University of Technology, 1998.

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Lindberg, Jenny. "Withholding information from patients regarding do-not-resuscitate (DNR) decisions - a moral evaluation." Thesis, Umeå universitet, Institutionen för idé- och samhällsstudier, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-132334.

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Yu, Chen-An. "Motivation and physical activity among rheumatoid arthritis patients : a self-determination theory approach." Thesis, University of Birmingham, 2015. http://etheses.bham.ac.uk//id/eprint/6197/.

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Rheumatoid Arthritis (RA) is a chronic inflammatory disease that can negatively impact people both psychologically and physically. Health benefits of regular physical activity (PA) have been demonstrated for RA patients (Cooney et al., 2011), however people living with RA are more likely to be sedentary (Sokka et al., 2008; Yu et al., 2015). A Self-Determination Theory (SDT) based approach was adopted in this thesis. The validity and reliability of the Behavioural Regulation in Exercise Questionnaire-2 (BREQ-2) was tested (Chapter 2) within RA patients via a mixed method approach. In a second study (Chapter 3), hypothesised relationships based on SDT between autonomy support from the important other (s), basic psychological needs, motivation regulations and RA patients’ subjective vitality and self-reported PA was tested via structural equation modelling. Presumed mediation effects were also examined. As an incongruence between PA measurement has been found previously (Semanik et al., 2011), the agreement with self-reported PA and sedentary time (ST) were determined (Chapter 4) on both objective and subjective PA, then related to the VO2 max test. The next investigation (Chapter 5) assessed the associations between motivation regulations, objectively measured PA/ST and a key indicator of compromised mental health (i.e., depressive symptoms). Overall findings of this thesis were discussed in Chapter 6, and future research directions, practical implication and limitations proposed.

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Urias-Bodnar, Leslie Yaneth. "Effect of Self-Determination, Motivation, and Dispositional Optimism with Physical Therapy in Geriatric Patients." ScholarWorks, 2017. https://scholarworks.waldenu.edu/dissertations/4108.

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Older people are frequently faced with physical conditions that require treatment. A better understanding of the components of engagement relating to the outcomes of treatment was the focus of the study. The purpose of this quantitative study was to examine whether there was an association between the independent variables of optimism, pessimism, motivation, and self-determination and their impact on the dependent variable of achieving physical activity goals in 86 geriatric patients, ages 65 to 80 receiving physical therapy services. The theoretical framework of self-determination, motivation, optimism, and pessimism was assessed by using two self-report questionnaires, The Self-Determination Scale and The Revised Life Orientation Test, along with reviewing physical therapy evaluations, progress notes, and discharge summaries. It was found through the use of a multiple regression analysis that no significant difference in modified independence existed between those with low versus high optimism, pessimism, self-determination, and motivation; there was also no significant difference in the number of physical therapy goals achieved upon discharge. The findings of this study warrant further research on the connection between cognitive and physical abilities and the decline of health due to the aging process. The implication of social change is the need for continued research for clarification of what has been provided through previous research that high levels of optimism, self-determination, and motivation explain a positive outcome in the treatment, rehabilitation process, and achievement of goals versus the contradictory results demonstrated in this research study.

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Chang, Ling Patricia. "Development of Motivation to Exercise in Patients with Parkinson's Disease: An Application of Self Determination Theory." Diss., Temple University Libraries, 2012. http://cdm16002.contentdm.oclc.org/cdm/ref/collection/p245801coll10/id/172423.

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Educational Psychology
Ph.D.
A patient's response to receiving a diagnosis of a chronic progressive disease is critical, as is the approach to the intervention that the patient receives. Parkinson's disease (PD) exemplifies chronic disease with the additional complication of being progressively degenerative and therefore increasingly debilitating. Many of the patients with PD suffer from a decrease in motivation. While physical therapy and individual independent exercise may benefit these patients with PD, the lack of motivation to exercise often presents a significant barrier to this beneficial behavior. Self-determination Theory (SDT) has been used successfully in other health paradigms to improve motivation. Motivation is achieved by satisfying the three psychological needs of competence, autonomy and relatedness of the individual. Physical therapy intervention may facilitate motivation through the development of relatedness to the health care professional (HCP). The purpose of this study was to determine if SDT may be effectively applied to increase motivation in patients with PD, determine the factors that facilitate the motivation, and quantify the effect on the patient's quality of life. This study utilized a within subject design consisting of 8 weekly sessions. At screening, demographics and baseline assessments for cognitive impairment (SLUMS), severity of PD ( Hoehn and Yahr), quality of life (PDQ-8 a questionnaire validated for the PD patient), and evaluation of physical impairments (Tinetti gait and balance test and Timed Up and Go Test[TUG]) were collected. Each weekly session included motivational interviewing designed to implement SDT strategies promoting satisfaction of the three psychological needs. Additionally, at each weekly physical therapy session, additional physical assessments were completed as well as the SRQ-E, a Likert scale SDT questionnaire designed to determine the motivation to exercise (extrinsic regulation, introjected regulation, identified regulation and intrinsic motivation.). Ten patients were consented and enrolled in this study at a physician-owned clinic in the Philadelphia suburbs. All patients completed the 8-week study, with 6 of the patients opting to continue in physical therapy after the study. At baseline, patients exhibited mild to moderate impairment in physical activity as assessed by the Hoehn and Yahr average score of 2.9 (range 1-4). The average age of the patient was 68.4 (range 50-84) years with an average SLUMS score of 26.3 (range 20-30), indicating mild cognitive impairment. The data from the SRQ-E did not demonstrate significance for change in motivation. Both the Tinetti gait and balance test and the TUG average scores improved, with a change of 4.9, 1.8, and 7.1, respectively. The PDQ-8 average change improved 0.118, indicating improvement in the quality of life. Results from both the Tinetti and PDQ-8 demonstrated improvements that were statistically significant (p=.0007 and p=.008 respectively). Qualitative analysis of the motivational interviews showed the most common themes as a decrease in pain, increase in strength and function as well as independently initiating a novel exercise. Correlative analysis was inconclusive. While motivational interviewing is qualitative, a positive effect was indirectly assessed by the patient's self-reports of increased exercise and the development of relatedness to the HCP as evidenced by the patient's 100% completion rate of the study and 60% continuation on physical therapy. Further study is warranted to determine the factors that facilitated this improvement and evaluate the benefit of motivation in these patients with Parkinson's disease.
Temple University--Theses

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Phares, Pamela Lynn. "PREDICTORS OF READINESS TO INITIATE INSULIN THERAPY IN PATIENTS WITH TYPE 2 DIABETES WHEN ORAL MEDICATIONS FAIL TO CONTROL HYPERGLYCEMIA." UKnowledge, 2011. http://uknowledge.uky.edu/nursing_etds/1.

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Type 2 diabetes (T2DM) has reached epidemic levels worldwide during the past two decades. It affects nearly 26 million adults in the U.S. Advances in both the treatments for T2DM and guidelines for its optimal management are extensive. Despite these advances, barely half of type 2 diabetics achieve recommended glycemic targets. Specific Aims: The specific aims were to: Describe the available research on clinical inertia and interventions that have been implemented to reduce it. Analyze various behavioral theories that explain and predict self-care practices in diabetes in order to develop a conceptual model on which to base an investigation of predictors of readiness to initiate insulin therapy in type 2 diabetics. Determine predictors of readiness to initiate insulin therapy in patients with T2DM when oral medications fail to control hyperglycemia using the conceptual model based on Self-Determination Theory (SDT) as a framework. Results: A review of research articles published from 1990 to 2010 concluded that clinical inertia of primary care providers treating T2DM resulted in a majority of patients experiencing unnecessary chronic uncontrolled hyperglycemia. Behavioral theories were analyzed for their ability to predict self-care behaviors in type 2 diabetics. A conceptual model was developed based on the major constructs of SDT in order to guide the design of study to investigate predictors of readiness to begin insulin therapy in T2DM. Finally, a descriptive, correlational study was performed to determine readiness to initiate insulin therapy in patients with T2DM when oral medications fail to control hyperglycemia. Results of the study revealed that participants who had a friend or family using insulin were 5.5 times more likely to rate their readiness to initiate insulin as high than those who had neither (p=.020). In addition, those with greater negative beliefs and attitudes toward insulin therapy were more likely to rate their readiness to initiate insulin as low (p=.012). A majority (58%) of participants rated their readiness to begin insulin therapy as immediate if it would give them better control over their hyperglycemia. The study also confirmed findings from previous studies that clinical inertia was present in this setting.

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Sanchez, Dudley, and Lena Sennblad. "Sjuksköterskors syn på självbestämmande för patienter som vårdas under lagen om psykiatrisk tvångsvård." Thesis, Röda Korsets Högskola, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:rkh:diva-203.

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Bakgrund: Vård under lagen om psykiatrisk tvångsvård (LPT) innebär att patienters självbestämmande kan begränsas. Omvårdnad i samband med LPT är av komplex karaktär som bland annat innebär att sjuksköterskan skall respektera patientens självbestämmande och utföra tvångsåtgärder samtidigt. Syfte: Studiens syfte var att undersöka och beskriva sjuksköterskors syn på självbestämmande för patienter som vårdas under lagen om psykiatrisk tvångsvård. Metod: Halvstrukturerade intervjuer med tre sjuksköterskor verksamma inom psykiatrin genomfördes och en manifest innehållsanalys användes för att bearbeta data. Resultat: Tre huvudkategorier och nio underkategorier bildades. 1. Sjuksköterskors syn på självbestämmande: möjlighet till självbestämmande, begränsande faktorer och självbestämmande i förändring. 2. Sjuksköterskors arbete med självbestämmande: strukturerat, ostrukturerat och skapa förutsättningar. 3. Utförande av begränsningsåtgärder: motiv till beslut, beslutsfattande och tillvägagångssätt. Slutsats: Sjuksköterskorna i denna studie ansåg att självbestämmande för patienterna är en viktig del vid vård under LPT men att självbestämmande begränsas av flera faktorer. Sjuksköterskor arbetar aktivt och skapar förutsättningar för att patienten ska kunna använda sitt självbestämmande, även när det handlar om omvårdnadsåtgärder som begränsar patientens självbestämmande.
Background: Caring of patients' under the law on compulsory psychiatric care means that patients' self-determination may be limited. Nursing in conjunction with the compulsory psychiatric care is of a complex character, among other things; nurses should respect patients' self-determination and carry out coercive actions at the same time. Aim: The aim of this study was to explore and describe nurses' views on self-determination for patients who are cared under the law on compulsory psychiatric care. Method: Semi-structured interviews with three nurses working in psychiatry care were conducted and a manifest content analysis was done. Results: Three main categories and nine sub-categories were formed: 1. Nurses' views of self-determination: opportunity to self-determination, limiting factors and self-determination in transition. 2. Nurses' work with self-determination: structured, unstructured and to create opportunities. 3. Limit setting: reason for decisions, decision making and approach. Conclusion: Nurses' in this studie viewed that the patients' self-determination is an important part during compulsory psychiatric care but self-determination is limited by several factors. Nurses are actively working to create conditions for the patient to use their self-determination, even when the nurses have to use interventions that restrict patient self-determination.

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Payne, Liz. "Continuity of care and its effect on patients' motivation to initiate and maintain cardiac rehabilitation." Thesis, University of Bath, 2015. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.667738.

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Background: Despite national guidance and empirical support for its clinical and cost-effectiveness, cardiac rehabilitation (CR) is underused. Only 44% of patients go to CR, with angioplasty (Percutaneous Coronary Intervention; PCI) patients being least likely to attend (31% of 87,000). Aim: To investigate the relationship between ‘continuity of care’ and patients’ motivation towards CR, through the lens of self-determination theory, and develop a model to inform service design to increase CR uptake and adherence. Methods: A mixed methods approach was used. In Study 1, a theoretical model of continuity of care and motivational antecedents was tested with a cross-sectional sample of 107 PCI patients. To further explore interactions between continuity of care and motivation towards cardiac rehabilitation, a Critical Interpretive Synthesis of the extant literature was used in Study 2, and focus groups were carried out with patients and service providers in Study 3. Results: In Study 1, continuity of care positively predicted patients’ autonomous motivation towards CR, and this was partially mediated by autonomy support. Autonomy support was associated with CR attendance. In Studies 2 and 3, aspects of continuity of care with positive effects on attendance were identified. These included timely, appropriate information provision, relationships bridging CR phases and settings, and continuing management strategies incorporating trusting, warm staff-patient relationships, and positive encouragement and feedback about progress. The SDT constructs of autonomy support, need satisfaction, internalisation and quality of motivation helped to explain positive and negative influences of continuity on attendance. Conclusion: Continuity of care has a positive effect on patients’ motivation towards CR. The most enduring motivation comes from delivering continuity of care in an autonomy-supportive and competence-supportive way. Longitudinal research is needed to compare how need-supportive and need-thwarting aspects of continuity of care affect CR attendance and adherence, and whether these relationships are influenced by need satisfaction and need frustration.

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Almarwani, Abdulaziz Mofdy. "The Relationship Of Perceived Basic Psychological Needs For Health Behaviors And Medication Adherence In Saudi Arabian Patients With Coronary Artery Disease." University of Akron / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=akron1574420777367008.

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Davisson, Erica Ann. "Discharge planning for patients with heart failure: bedside nurses' motivation and decision-making through the lens of self-determination theory." Diss., University of Iowa, 2018. https://ir.uiowa.edu/etd/6561.

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Heart failure (HF) is a diagnosis associated with significant mortality, morbidity, and healthcare costs. One in four patients with HF have an unplanned readmission within 30 days of discharge. Few interventions that seek to decrease readmissions target the discharge planning process during the acute hospitalization or account for the contributions of bedside nurses. Bedside nurses’ decision-making and motivation surrounding discharge planning for frequently readmitted patients with HF has not been described. Therefore, the purpose of this interpretive descriptive study was to understand bedside nurses’ motivation and decision-making during discharge planning for adult patients with HF on a telemetry step-down unit within a large, Magnet-designated, Midwest hospital. In order to achieve the aims of this study, Self-Determination Theory (SDT) was used as the organizing structure. SDT is generally defined as the motivation to act based on the degree of 1) autonomy, 2) competence, and 3) relatedness felt by bedside nurses. Fifteen bedside nurses were interviewed. Coding was done using Nvivo and thematic analysis was completed. Two members of the research team reviewed the coding and a nurse consultant who was not interviewed reviewed the nurse researcher’s identification of themes related to the three domains of SDT: autonomy, competence, and relatedness. The major finding was that bedside nurses described high levels of motivation to do effective discharge planning despite many barriers, such as lack of physician-nurse communication and "surprise" discharges. The nurses reported being motivated when they had a broader knowledge of methods to deliver HF education (felt competent), had time to establish a personal connection with patients (relatedness), and did not feel rushed to complete HF discharge planning tasks. Autonomy did not emerge from nurses’ responses to the degree that competence and relatedness did, but when it did emerge, a strong sense of autonomy was apparent (acting out of personal choice). Findings of this study emphasized a need for effective HF discharge planning to be established as an important competency for bedside nurses and for interdisciplinary relationship-building between nurses, patients, and physicians to be factored into the organizational culture. The SDT framework provided a unique lens to better understand the decision-making and motivation that bedside nurses have toward HF discharge planning and how work conditions can facilitate or constrain their natural tendencies to deliver effective patient-centered care to patients with HF.

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Martinsdotter, Sofie, and Johanna Tykesson. "Rätten till självbestämmande - En empirisk studie om vårdtagares upplevelser." Thesis, Malmö högskola, Fakulteten för hälsa och samhälle (HS), 2013. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-26736.

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Syfte: Syftet med studien är att fånga vårdtagares upplevelser av självbestämmande.Bakgrund: Sverige har under de senaste åren dragit ner på platsernainom särskilt boende och istället satsat på hemtjänst och hemsjukvård. Enligtlag ska sjukvården värna om vårdtagarens självbestämmande oavsett var vårdenges. Metod: Semistrukturerade intervjuer genomfördes inom två olika distrikt isödra Sverige. Datamaterialet analyserades med hjälp av kvalitativ innehållanalys.Resultat: I studiens resultat framkom att vårdtagarna upplevde att de haft inflytandeunder den samordande vårdplaneringen och de flesta var nöjda medresultatet av besluten. Dock upplevde vårdtagarna att det ibland var svårt att påverkaden dagliga vården. Informanterna hade en önskan om att kunna påverkasovtiderna utefter behov och ha ökad tillgänglighet till extra hjälp vid behov. Detvar viktigt för vårdtagarna att ha samma personal och att det skulle finnas mer tidför hjälp.
Aim: The aim of this study is to capture home care patients’ experiences of selfdetermination.Background: In Sweden the number of residents in nursing homeshas decreased; the government has instead invested in home care services. Accordingto Swedish law, the health care system must preserve patients’ rights andself-determination, regardless to where the care is located. Method: Semistructuredinterviews were performed in two different districts in the south ofSweden. The data was analysed with qualitative content analysis. Result: Patientsreported that they experienced that their voices were heard during the care planningconference and were satisfied with the decisions that had been made. However,the patients experienced some difficulties influencing their daily care. Theinformants had a desire to be able to affect their sleep cycles based on their needsand wants, in addition to having an extended accessibility to extra care when required.It was important for the informants to have the same staff and get moretime for assistance.

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Kallos, Alexandra, and Marie Kandelberg. "Regelverk inom metadonprogram- hinder eller stöd för patienten? : En kvalitativ uppsats om patienters och vårdpersonals erfarenheter." Thesis, Ersta Sköndal högskola, Institutionen för socialt arbete, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:esh:diva-658.

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Souesme, Guillaume. "Soutien à l'autodétermination, personnalité et conséquences émotionnelles chez les patients hospitalisés en service de soins de suite et réadaptation : apport de la théorie de l'autodétermination." Thesis, Tours, 2018. http://www.theses.fr/2018TOUR2022/document.

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L’hospitalisation représente une étape de vie à laquelle doit faire face une grande majorité des personnes âgées. Cette expérience trop souvent accompagnée d’un déclin physique et psychologique marque pour beaucoup le début de la fin. Basé sur les fondements théoriques de la théorie de l’autodétermination (TAD), ce travail doctoral a deux objectifs. (1) Définir qualitativement le soutien à l’autodétermination dans les services de soins de suite et réadaptation (SSR). (2) Connaître l’impact des orientations de causalité́ des patients sur la perception de soutien ou de contrôle à l’autodétermination et les conséquences motivationnelles et émotionnelles associées. L’étude 1 a montré que les professionnels de santé mettaient en avant une image idéalisée de leur environnement de soins. Les patients (étude 2) ont indiqué de nombreuses contraintes qui atténuent l’effet de cette vision positive. L’étude 3 a démontré que les orientations de causalité du patient étaient une variable qui en interaction avec la perception de l’environnement, n’aboutissait pas aux mêmes conséquences motivationnelles et émotionnelles. De par le rôle déterminant octroyé par la TAD à la motivation, les professionnels de santé se doivent d’être capables de nourrir, entretenir et soutenir la motivation des patients. Une réflexion sur les recommandations pratiques et des axes de recherches futurs seront proposés
Hospitalization is a life stage that faces a large majority of older people. This experience is often accompanied by both physical and psychological declines and means, for most of older people the beginning of the end. Based on the self-determination theory (SDT), this doctoral dissertation has two objectives. (1) To qualitatively define an autonomy supportive environment in after-care and rehabilitation services (ACRS). (2) To know the impact of causality orientations on patients' perceptions of an autonomy supportive or controlled environment and the associated motivational and emotional consequences. Study 1 showed that healthcare professionals conveyed an idealized image of their work environment and the care they provide. Patients (study 2) indicated many constraints that mitigated the effect of this positive view of an autonomy supportive environment and reduced their ability to experience it. Study 3 demonstrated that patient's causality orientations were a variable which interacted with the perception of ACRS environment, did not induce the same motivational and emotional consequences. Thus, these studies contribute to the self-determination theory in the health setting by showing the determining role of patients’ motivation. It is therefore necessary for healthcare professionals to be able to feed, maintain and support patients’ motivation. In the light of the contribution of the self-determination theory, a reflection about practical recommendations and future lines of research will be proposed

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SHIH, CHAO-JUNG, and 施肇榮. "Patient Self-Determination Act, Taiwan, 2016." Thesis, 2016. http://ndltd.ncl.edu.tw/handle/vpab4y.

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碩士
銘傳大學
法律學系碩士在職專班
104
The purpose of this thesis is to explore the ethical and legal issues for the latest "Patient Self-determination Act" of Taiwan on it's draft bill, pre-legislative scrutiny, and after legislation. The first issue concerned during the entire process is the name of the Act in the draft article and it’s legislative purpose. It states " to respect the patient medical autonomy to protect their best interests." This will mislead that it is the recognition the right of patient-led approach to whatever medical treatment, even when patient’s condition is in critical and curable, instead of patient is claiming hospice right. Secondly, to respect patient autonomy through making pre-established medical decision (advance directives), the pre-established health care plan (advance care planning) and choosing health care agent (health care proxy). The purpose of appointing health care proxy is to see patient’s pre-established medical decisions be followed when the patient is unable to speak for himself/herself due to an illness. However, family bound is quite tight and the culture is very different in Taiwan. How to reduce patient’s choice against family member's conflict and disputes in the future is also important. The Act also states patients in certain condition or disease suffering from great and unbearable pain may have the right to refuse or to request the removal life-sustaining treatment. Great, unbearable-pain, is so ill-defined clinically, it will be a great challenge to the specialist medical association to devise criteria to follow, even though, the Act free physicians involved from administrative, criminal charges and civil torts. The legislative under the concept of patient autonomy, provides patient’s right to refuse or to request the removal life-sustaining treatment from terminally ill patient to non-terminally ill patient (vegetative, etc.).This article will explore the relevant provisions of the concept and its problems in law enforcement level in the future.

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SHIH, PO-YI, and 施柏儀. "Patient Self Determination Act-The Research on Autonomy of Patient." Thesis, 2019. http://ndltd.ncl.edu.tw/handle/73z5qw.

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碩士
國立雲林科技大學
科技法律研究所
107
With the rapid advancement of medical science and technology, many diseases that were once considered to be terminally ill can be cured nowdays. Even patients with immediate risk of death can maintain their last breath with advanced medical equipment.This kinds of patients are also called “technical life”. The change of relationship between the doctors and patients has promoted the rise of patient autonomy consciousness,also the conflict between human autonomy and the self-determination in human dignity has. Through the process of conflict between medical treatment, law, live and death, hospice right and patient autonomy,Taiwan enacted the Hospice Palliative Care Regulation Amendment first in 2000, and then the Patient Right to Autonomy Act were announced in January 2016 after Legislature passed the Third Reading at the end of 2015.The concept of Informed Consent,Death with Dignity, Patient autonomy rights will be strengthened in the regulations, and the right to self-determination of life will be gradually improved step by step. This thesis will firstly describe the legislative background, legislative reasons, amendment reason of the two Taiwan Acts about the patient autonomy and it will analyze the legislative negligence, explain the imperfect point or the application question.At the final,all the doubt leads to the subject of this thesis,the capacity of the patient autonomy. Learn from the mistakes of others. In this thesis,it also lists the foreign legislation and the relevant laws and regulations, which are used to take advantage of the fact that Taiwan has something to learn from, or that Taiwan does not be recommended to have. The final chapster,it will dicuss about the patient autonomy of the minor patient or the one who has no capacity. These two types of patients are technically removed by the legal provisions.Try to find a legal way and suggest if there have any other solution to make these two types of patients have their own autonomy and whether there are other methods to identify their capacity of patient autonomy.

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Feng, Yen-Lin, and 馮彥霖. "Good Death and Patient Right to Self-Determination." Thesis, 2019. http://ndltd.ncl.edu.tw/handle/47r2n3.

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碩士
國立臺灣大學
科際整合法律學研究所
107
Patient’s “Right to Good Death” draws a line balancing between patients'' right to life and right to autonomy. Through the literature analysis related to law and clinical medicine, this thesis explores the development of legal system of patient’s right to good death in Taiwan, and compares it with foreign legal system. Some legislation in the foreign countries permit “active euthanasia”, some allow “physician-assisted suicide”, and some permit “natural death” without limiting the type and progress of the disease. In contrast, only natural death with strictly limited clinical conditions and medical options is permitted in legislation in Taiwan. The Hospice Palliative Care Act was enacted in the 89th year of the Republic Era. This is the first time for Taiwan to have a statue protecting patient’s right to good death. A terminally ill patient is permitted to refuse the life-sustaining treatment according to the letter of his or her intent. The law was further amended three times to gradually broaden the scope of protection, but it was still not considered to be enough. The Patient Right to Autonomy Act was promulgated in the 105th of the Republic Era, and then came into force this year in January. This is the first act to safeguard patient’s right to autonomy in Asia, and also protect patient’s right to good death which broadens scope of application not limited to terminally ill patients anymore. Persons with full disposing capacity may participate in the informed process of advance care planning and then make advance decisions, which include the willingness to accept or refuse life-sustaining treatment and/or artificial nutrition and hydration under the specific clinical conditions.

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YANG, SHU-JUNG, and 楊淑蓉. "A Study of Between Conflict Right to Life and Patient Self Determination." Thesis, 2016. http://ndltd.ncl.edu.tw/handle/01666352789653768900.

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碩士
嶺東科技大學
財經法律研究所
104
“Hospice Palliative Care Act” experience three times repair method course, dying of “Terminal Illness Patient”, before pre State “Living Will” select “Hospice Palliative Care Act” or“Living Medical Choices”defined“Terminal Illness Patient” has medical refused to right, from “Constitution” right to life, and “Physician Method”, and “Medical Method”, and “Hospice Palliative Care Act” are to humanity dignity for legislation based, discussion its basic right occurred pulled , caused conflict, what is “Patient Self Determination” priority or “Right to Life” priority? if over scale flat of line, National mechanisms to protect the Right to Life is? and December 18, 2015 State Court three read through new “Patients Independent Right Act” after three years implemented, with the current “Hospice Palliative Care Act” whether the law applies.

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YANG, JIA-YI, and 楊佳怡. "The Knowledge, Attitude and Willingness toward Advance Care Planning and Patient Self-Determination Act among Patients with Hemodialysis." Thesis, 2019. http://ndltd.ncl.edu.tw/handle/xtzz4a.

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碩士
中臺科技大學
醫療暨健康產業管理系碩士班
107
According to the 2017 US Renal Data Registration System (end -stage renal diseases, ESRD) annual report, the incidence and prevalence of ESRD in Taiwan rank first in the world. How to break through the taboos of the traditional culture of the East, to participate in advance care planning and sign advance decision in order to make healthcare decisions for the end of life, and to reduce the psychological burden of the families have become the most important issue today. The purpose of this study was to investigate the related factors and association between knowledge, attitudes and willingness for advance care planning and patient self-determination among hemodialysis patients. In this study, a structured questionnaire was adopted to 129 hemodialysis patients of a medical center in central Taiwan. The questionnaire included personal characteristics, knowledge, attitude and willingness of advance care planning and Patient Self-Determination Act, and other related issues. Descriptive statistics and inferential statistics were obtained from SPSS 25.0 software, including t-test, one-way ANOVA, Pearson correlation analysis, multiple regression analysis and hierarchical regression. According to the results, the extremely low mean score of the total knowledge was 23.4, and the knowledge of ACP & AD and Patient Self-Determination Act were23.3 and 23.4 respectively. The mean of attitude toward the objectives of ACP & AD, barriers of ACP & AD, the Patient Self-Determination was points, and the importance of ACP were 78.43, 55.77, 69.94, and 77.62 respectively. The standardized mean score of willingness to participate ACP was 69.52, and the willingness to use sustain life treatment was 54.05. Those who educated above college, unmarried, suffering from diabetes mellitus, was not confused with the current dialysis decision, healthcare staff provided information about the advance care planning(ACP) and advance decision(AD), having discussed with the families about the life-threatening medical decisions for the end of life, the advance care planning(ACP) should initiate by the patient himself, willing to pay the all or part of "advance care planning consultation fee" had a significantly higher knowledge about advance care planning and Patient Self-Determination Act. Those who female , educated above college, unmarried, suffering from hypertension, cardiovascular diseases, and heart failure, dialysis twice a week, receiving dialysis treatment for 6 to 10 years, having signed do not resuscitate (DNR) or palliative care willingness, having healthcare professionals discussed medical decision to life-threatening treatments with patients or their families, discussing with their families about the life-threatening medical decisions for the end of life, the most willing to discuss end-of-life with medical staff, initiating ACP discussion when other serious complications beginning, designating patients with siblings as surrogates had positive attitude towards advance care planning and Patient Self-Determination Act. There were higher willingness of participant to advance care planning and patient self-determination among patients those who female, savings or pensions are sufficient to support their life, suffering from hypertension, cardiovascular diseases, and cancers, discussing with their families about the life-threatening medical decisions for the end of life, wanting to discuss the willingness of life with loved ones, and willing to pay the all or part of "advance care planning consultation fee". There was a positive association between attitude toward Patient Self-Determination and total knowledge, the willingness to participant and the importance of ACP, and the willingness to sustain life treatments and the barriers of ACP & AD. Knowledge (such as total, ACP & AD, and Patient Self-Determination Act) has no significant association to the willingness to participant and to sustain life treatments. Consideration both knowledge and attitude, the willingness to participant had a significantly positive association to knowledge of ACP & AD, and the importance of ACP, and had a was significantly negative association to knowledge of Patient Self-Determination Act. There was a significant positive association between ACP & AD barriers and the willingness to sustain life treatments. From the legislation to the actual implementation of the Patient Self-Determination Act, there is still a lack of relevant education, training and promotion. Most hemodialysis patients do not understand the Patient Self-Determination Act. The lack of knowledge leads to low recognition and willingness to this policy. In order to guide the patient's autonomy, the relevant knowledge of the Patient Self-Determination Act should be strengthened to ensure the right to decide the care of end of life.

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Chen, Liting, and 陳立庭. "A study on factors influencing delay in seeking treatment of colorectal patient: Self-Determination Theory." Thesis, 2012. http://ndltd.ncl.edu.tw/handle/06481013485439524927.

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碩士
國立臺北護理健康大學
護理研究所
100
The purpose of this study was to determine the delay diagnosis and delay treatment factors of colorectal patient based on the Self-Determination Theory. Participants were 111 colorectal patients recruited from a cancer center in northern Taiwan. A convenience sample was used to recruited patients. Research questionnaires included Basic Need Satisfaction in General, the Health-Care Climate Questionnaire, the Treatment Motivation Questionnaire, the Hospital Anxiety and Depression Scale, and the Cancer Fear Scale. Statistical analysis included descriptive statistics (mean, SD, %,n) and inferential statistics (t-test, one-way ANOVA, correlation, multiple regression,and Tobit model). Results indicated that colorectal cancer patients have an average delayed diagnosis day was 154.77 天（SD=210.09）. The Pearson Correlation results indicated that Male, no routine health screener and depression were significantly related to delayed diagnosis days. Delay treatment was significantly related to unmarried, divorced, less competency and the early stage cancer patients (p < 0.05). Anxiety was significantly related to intrinsic motivation and help-seeking motivation (p < 0.05). Routine health screener had less depression (p < 0.05). Older patients had less fear then the younger one (p < 0.05). Multiple regression and Tobit model analyses demonstrated that gender（F=5.163, p <0.01) and routine health screening（F=5.109, p <0.01) was predictor of the delay diagnosis, and delayed diagnosis was significantly predicted by competence（F=5.068, p <0.05), marital status（F=5.384, p <0.01) and help-seeking motivation（F=5.744, p <0.01). Gender（F=6.432, p <0.01) was the predictor in total delayed time. Anxiety was predicted by intrinsic motivation（F=14.769, p <0.01). Depression was predicted by anxiety（F=91.433, p <0.01). The fear was predicted by anxiety（F=109.058, p <0.01) and intrinsic motivation（F=58.426, p <0.01). Findings of this study provide references for evaluate the colorectal patient’s mood, psychological need and motivation during the time of period from suspected colorectal symptoms to receive diagnosis and the first treatment.

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25

Grinberg, Eldad. "Occupational therapy leadership: promoting an autonomy-supportive environment based on self-determination theory, to improve patient outcomes in acute and post-acute stroke rehabilitation." Thesis, 2019. https://hdl.handle.net/2144/38178.

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A major dilemma that is being addressed in the current project is the discrepancies between healthcare system's expectations for a rapid and successful rehabilitation process and patients after having a stroke ability to meet these expectations while striving to adapt to the calamitous event in their life. Emphasizing a more biomedical approach and under implementation of psychosocial approaches, poor acknowledging of patients' basic psychological needs lead to poor motivation, therapeutic disengagement and may lead to a rehabilitation failure. To cope with this gap in the process of stroke rehabilitation, an educational program aiming for occupational therapists working with patients after having a stroke in their acute and post-acute rehabilitation phases was constructed. The program guides practitioners for effective communication with their patients, building a needs-supportive environment and addressing their patients' basic psychological needs in light of the selfdetermination theory, theories of adaptation from occupational therapy perspectives and considering occupational justice and the ICF model. A clinical reasoning, step-by-step problem solving is introduced using adaptation of known models and innovated models for interventions that were created for this purpose. Program delivery through a series of 4-webinar modules is illustrated with their learning objectives, assignments and discussions. The program evaluation and implementation are expected to be the initiator of a change in the health and rehabilitation climate and in Israel.

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Gomes, Diana Filipa Dias. "A atual problemática da morte assistida em Portugal." Master's thesis, 2018. http://hdl.handle.net/10316/85826.

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Dissertação de Mestrado em Direito: Especialidade em Ciências Juridico-Forenses apresentada à Faculdade de Direito
A morte assistida é um assunto controverso de enorme delicadeza que tem sido alvo de debate nos últimos tempos, necessitando portanto de um amplo estudo.Com o objetivo de tornar esta discussão mais construtiva, começarei por esclarecer os conceitos que nos permitem perceber melhor a base em que assenta toda esta discussão.É de extrema importância cada um de nós refletir sobre o bem vida e, o valor máximo que tem para cada um, sendo de questionar se será ético deixar um doente terminal que se encontra em efetivo sofrimento à espera do momento que tem como certo, a morte.Assim falar da livre escolha ao níveis dos cuidados de saúde, será afirmar que nada poderá ser feito contra a vontade do doente terminal, devendo no entanto, ser respeitado o direito de objeção de consciência a que os especialistas de saúde têm direito.Não podemos deixar que neste processo, não se respeite a autodeterminação do paciente, optando ele por entregar-se aos cuidados paliativos ou, por outro lado optando por antecipar a sua morte.Apesar das várias posições e opiniões, é necessário que todos os padrões de atuação médica estejam bem definidos, de forma clara e precisa, tendo sempre em vista a defesa dos melhores interesses do doente.De fazer referência as propostas legislativas que neste momento se encontram “em cima da mesa”. Aprovando a morte assistida dar-se-á a possibilidade de cada um decidir como entender sobre a reta final da vida, ninguém fica obrigado a ela recorrer mas também ninguém estará impedido de o fazer.
Medically assisted death is a delicate subject that has been fuelling discussions and making headlines in recent times, showing the need for a deeper study.Aiming a more constructive exposition, I will star by clarifying the definitions that lay the foundation for all the discussion.It is of a great importance that each and every one of us reflect about the legal interest “life” and it´s maximum value for each person, questioning the ethical nature of letting a terminal patient waiting in suffer for a sure death.Therefore, talking about a freedom of choice in health care is stating that nothing can be done against the terminal patient´s will without ever disregard the health care providers’ right of being conscious objectors.We cannot allow the violation of the right of self-determination of the patient when in this situation, being his choice to submit to palliative care or to anticipate his death.Despite the several opinions and standings, a precise and clear definition of the medical intervention parameters is imperative. Only that way we can assure the best interest of patient.Acknowledging the legislative proposals on the table right now, the approval of medically assisted death will give the opportunity for each person to decide about the final stage of their lives. It will not be an obligation but it will also not be out of reach.

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LEE, HSIAO-LING, and 李筱苓. "Hormilization between Patient's Self-determination Rightsand Physician's Duties." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/8rf9jr.

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碩士
東吳大學
法律學系
106
The topic of interest in this article centers around patients’ right to autonomy and self-determination. This study traces back the evolution of the laws and practice relating to the removal of life support in the context of medical decision-making in the United States, where the concept of patient autonomy originates, in the hope to identify relevant connections and examples for limitations on the forms of life support that can be removed upon request under the new Patient Self-Determination Act in Taiwan. Furthermore, the author combs through cases brought before the criminal and civil courts as well as the administrative tribunals since the Hospice Palliative Care Act came in effect more than a decade ago, finding that medical institutions and physicians rarely become involved in suits, actions or legal proceedings for limiting life support procedures as part of the palliative care given to patients in accordance to the law. In the few cases arising out of a dispute over the practice, the decisions handed down by the courts were based on the following grounds: whether the medical institution has fulfilled its duty to disclose and inform the treatment plans, whether a proper consent has been obtained from the patient or his/her family members, and whether the treatment was planned and given in a way that would meet the standards expected of a normally competent doctor. The courts generally dismissed the few cases of limited relevance or ruled in the medical institution or the physician’s favour. The sole exception where a district court ruled against a medical institution and a physician was decided not for a reason related to withdrawal of life support in palliative care. The defendants in the case were found liable because their treatment of bacterial meningitis with antibiotics deviated from the normal medical practice. The case was appealed to the higher courts and decided in favour of the hospital and the physician. It is reasonable to conclude physicians are required to practice medicine in a way that meets the standards expected of a normally competent peer, provided that the patients are fully informed of the treatment plans/risks and giving consent accordingly. The cases were all decided in favour of the medical institutions and physicians because they complied with these rules. In other words, the withdrawal of a patient’s life support by a physician in accordance with the law is already a legally sanctioned act. Moreover, the question of preemption in applying the Patient Self-Determination Act and other statutes still awaits clarification. It is suggested that the competent authority overseeing the Patient Self-Determination Act should study the said question and comes up with a solution in preparation of the introduction of the new Act. The issue of preemption in conflicting laws must be clarified in the regulations and rules in support of the implementation of the Patient Self-Determination Act. This article finds that great ambivalence exists in the regulatory landscape governing terminal care, as the Patient Self-Determination Act and the Hospice Palliative Care Act have conflicting rules to which terminally ill patients are required to comply. The solution to the current legal uncertainties, as proposed by this author, is to revert to the original state of the law and regulate terminal care with the Hospice Palliative Care Act. Finally, the author suggests that a monitoring mechanism be created to keep track of and conduct statistical analysis of the annual number of life support withdrawals as soon as the Patient Self-Determination Act becomes effective in 2019. The statistics should neither be used as evidence supporting any criminal or civil liabilities in legal proceedings, nor for any purpose other than data monitoring and analysis. Such policy will encourage truthful data reporting, allowing the regulators to review and assess the effectiveness of the law and the consequent measures of improvement.

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Tseng, Ying-Lan, and 曾媖蘭. "Self-determination and Quality of Life in Patients with Chronic Kidney Disease." Thesis, 2013. http://ndltd.ncl.edu.tw/handle/23654958392884756621.

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碩士
國立臺北護理健康大學
護理研究所
101
The purpose of this study was to investigate the relationships of self-determination, emotion, kidney function index, and quality of life of chronic kidney disease patients based on the self-determination theory. Participants were 105 chronic kidney patients recruited from a regional hospital in New Taipei City, Taiwan. This study used a cross-sectional study design. Research questionnaires included demographic and disease-related data, Basic Need Satisfaction in General, the Health-Care Climate Questionnaire, the Treatment Motivation Questionnaire, and the Hospital Anxiety and Depression Scale. Statistical analysis included descriptive statistics (mean, SD, %, n) and inferential statistics (t-test, one-way ANOVA, correlation, multiple regressions). The results demonstrated that there was a significant correlation between the basic psychological attribution of autonomy, perceived competence, relatedness, depression, kidney function index, and the quality of life in patients with chronic kidney diseases. Multiple regression analyses indicated that relatedness, autonomy, and perceived health status were the predictor for renal function index (a total of 54% variance). Additionally, perceived competence and perceived disease severity predicted physical component scores of the quality of life, and explained 14% of the variance. Furthermore, perceived health status and perceived disease severity predicted mental component scores of the quality of life, and explained 13% of the variance (p < .05). The result of this study provided references for the care of chronic kidney disease patients. Using the self-determinate theory to design nursing interventions in order to facilitate patients’ autonomy, perceived competence, relatedness, and depression, thus the quality of life could be improved.

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Alves, Raquel Ferreira Pedrosa. "Has end-of-life decisions or advance directives become an economic strategy to contain health care cost as much as a way to respect patient´s informed consent and private autonomy rights? : what can we learn from the american advance care model?" Master's thesis, 2018. http://hdl.handle.net/10400.14/27119.

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30

YANG, YU-LUNG, and 楊玉隆. "The Research of Patients’ Self-determination Rights-with a Special Focus on the Comparison between Taiwan and Japan." Thesis, 2016. http://ndltd.ncl.edu.tw/handle/tum8ga.

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博士
國立中正大學
法律系研究所
104
The purpose of this thesis was to study the issues on the patients’ self-determination rights from the constitutional point of view, with a special focus on the comparison between Taiwan and Japan. Since there were many conflictions existing in mutual exchanges in social life, the conflictions arising between people were relatively increasing, especially in doctors and patients advocating to self-determination rights, and caused tensions between them. Physicians were always confused in whether patients should or should not under the so called on the best or suitable medical treatment for the patients by law, especially in the issues of life emergency. And, the second purpose of this article was to discuss the constitutional issues on the patients’ self-determination rights in medical issues and evaluated the balance between patients’ self-determination rights. Taking into account the current situation in our society, with regard to the applicable conditions of euthanasia, this thesis suggested we should adopt more stringent criteria of euthanasia than Japanese standards. The following criteria should be inclusive: (1). unendurable severe physical pain which has been evaluated medically professionally; (2). the illness was under no hope of cure or it costs too much; (3). the death was coming (not living more than 6 months); (4). there was currently no other exemptions, effectively alleviation or alternative methods to relieve patient's physical pain; (5). patients should acknowledge and declare his/her intention to shorten his/her life in advance. The thesis recommended that the Patients' Self-Determination Act should be renamed as Healthcare Decision Act. And the Ministry of Health and Welfare should issue clear rules of the definition of the special terms, standardize medical procedures and selection criteria of evidence of the Five Special Clinical Categories of patients, in order to help patients in making decision under specific clinical situations for the appropriate medical or palliative care. The thesis also recommended that pregnant women should be excluded to designate the medical advance directives, ass to avoid leading to moral controversies. Besides, the scope of authority of health care proxy should be kept to exclude the prohibition of abortion and hospitalization for mental illness and refusal of life-sustaining treatment of nutrition and water as to avoid leading to moral controversies, too.

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Li, Yu-Han, and 李郁涵. "An Exploration on Nasopharyngeal Carcinoma Patients'' Needs from Self-Determination Theory Perspective via LDA Topic Modeling Analysis." Thesis, 2018. http://ndltd.ncl.edu.tw/handle/sudr9h.

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碩士
國立臺灣大學
商學研究所
107
There is one person got cancer in every 5 minutes in Taiwan. The patient will suffer from the physiology and psychology during the whole process of carcinoma to rehabilitation or death. In addition, the patients with nasopharyngeal cancer feel anxious because of receiving insufficient information or excessive information. Therefore, it is essential to offer the correct and appropriate amount of information to the nasopharyngeal cancer patients at the right time and in the right way and to help the patients to overcome nasopharyngeal cancer by reducing the anxiety. This study integrated the self-determination theory with the data mining analysis technique for the Chinese texts of the Nasopharyngeal Carcinoma Facebook club. In this essay, I do a lot of effort in pre-processing the data and designing suitable cutting words and stop-words because of the limitation of multi-language and the medical and professional related words. Finally, I apply text mining, classification model analysis and advanced sentiment analysis in ACR index to prove that three basic psychological needs of self-determination, Autonomy, Competence, and Relatedness, will be will change as the course of the disease changes. In addition, I apply LDA topic modeling analysis to find out the key topics and the key issues that patients discuss in the Nasopharyngeal Carcinoma cancer community during the shift of the course of the disease and the changes in the basic psychological needs. The result of this essay will eventually be summarized in a patient journey map of nasopharyngeal cancer, and it can help people to understand when and what issue will affect patient’s basic psychological needs. Besides, the timely and appropriate information can be suggested for the information needs of patients under different disease courses to ultimately slow the imbalance of psychological basic needs, and help patients to overcome with nasopharyngeal cancer.

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Martins, Fernanda Gonçalves Galhego. "O Processo Diagnóstico e a Responsabilidade Penal Médica." Doctoral thesis, 2019. http://hdl.handle.net/10316/88770.

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Tese de Doutoramento em Direito, ramo Ciências Jurídico-Criminais e apresentada à Faculdade de Direito da Universidade de Coimbra
A atividade médico-diagnóstica desempenha um papel fundamental para a estruturação dos cuidados médicos. A decisão diagnóstica e a análise conjunta de uma série de elementos capazes de revelar informações sobre o estado físico-psíquico do paciente conferem os alicerces necessários à edificação da assistência, o que se revela sobretudo, no plano dos tratamentos terapêuticos. Nessa fase da assistência, a observação e a análise dos sintomas e sinais presentes auxiliam a revelação do quadro clínico àquele que detém os conhecimentos suficientes para definir ‹‹o que››, ‹‹onde›› e ‹‹como›› pesquisar. E, como o recurso apenas ao olhar atento e treinado se revela geralmente insuficiente ao levantamento dos dados considerados necessários à formação do juízo médico, a busca por respostas para os problemas de saúde do paciente usualmente implica numa ingerência, em maior ou menor medida, sobre o corpo deste último, e que não raro envolve o apelo a medidas inegavelmente capazes de causar danos aos mesmos bens que intenta proteger. Os riscos inerentes às intervenções invasivas, a inevitável ingerência sobre a saúde e a integridade física e a potencial afetação da liberdade daquele que se entrega a tais cuidados atraem a atenção para essa etapa da terapêutica, para problemáticas que de modo algum se restringem ao tirocínio médico ou à decisão diagnóstica. A atenção às vicissitudes desse estágio da assistência, muito embora remeta imediata e, quase, inevitavelmente à ideia do erro diagnóstico, o que justifica a atenção a esse conceito, oferece sobretudo um ponto de partida para uma análise jurídico-penal que orbita essencialmente entre os bens jurídicos que, nesse contexto, se veem direta e inexoravelmente afetados pela ingerência representada pela intervenção médica. A proteção inquestionavelmente conferida à saúde e à integridade física, e a salvaguarda efetivamente proporcionada à liberdade e a autodeterminação do paciente dividem o enfoque. A delicada zona de contato entre esses bens, particularmente caros ao direito penal, e a prática da medicina incita não só a análise da eventual submissão da intervenção diagnóstica a uma figura típica, e, consequentemente, do regime jurídico-penal conferido às intervenções e tratamentos terapêuticos, como, sobretudo, uma perspectivação mais abrangente das soluções e alternativas lançadas, resultando num estudo que proporciona a abordagem do panorama legal pátrio, mas que não se limita apenas a ele.
Medical diagnostic activity plays a key role in planning patient care. The diagnostic decision plus the analysis of a series of elements which can reveal information about a patient’s physical and mental health are the elements which build the foundation of medical care, and this becomes even clearer when it comes to therapeutic treatments. At this key stage of medical care, the observation and analysis of the patient’s symptoms and signs help those who have the knowledge to determine what, where, and how to proceed to establish a clearer clinical picture. But, because this analysis is generally insufficient even for trained and careful eyes to be able to gather all the necessary information which will allow them to form a medical judgement, it is usually necessary to undertake – to a greater or lesser extent – some sort of medical intervention on the patient’s body in order to find answers for their health problems. More often than not, this results in adopting measures which can undeniably cause damage to very same asset which they aim to protect. The inherent risks of invasive interventions, the unavoidable interference in the health and bodily integrity of those who are under medical care, and the potential restriction of their freedom are aspects that draw attention to this stage of the therapeutics, to issues that are not restricted to the doctor’s acumen or diagnostic decision-making. And, although an analysis of the vicissitudes of this stage of patient care immediately and inevitably points to the idea of diagnostic error – thus justifying the attention given to this concept – it is above all a starting point for an investigation of the legal and criminal aspects within the sphere of the legal assets which – in this context – are directly and undeniably affected by the interference represented by medical intervention. The protection of the health and bodily integrity of the patient, and the effective safeguard of their freedom and self-determination are the focus of this investigation. The delicate contact zone between these legal assets (which are so important to criminal law) and the practice of medicine gives rise not only to the idea of occasionally fitting diagnostic intervention into a type of criminal offense, and, consequently, to the legal/penal regime that applies to therapeutic interventions and treatments, but also, and mainly, to the perspectivization of the solutions and alternatives given. This results in a study which presents an overview of the country’s legal practices but is not limited to it.

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CHANG, YI-TING, and 張貽婷. "The Criminal Immunity and Empirical Research of the help of Good Death：focus on the Patient’s Self-determination Right Act." Thesis, 2019. http://ndltd.ncl.edu.tw/handle/3hhc25.

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碩士
中國文化大學
法律學系
107
In recent years, there are more and more discussions about the survival of patients. Because of the famous writer and former national representative in basketball, they actively expressed their hope for the good death, so it contributes society to knowing of the issue of life and death, and then affecting society’s point of view about life and death. Literally, good death means that if I can eventually leave well, it will be a good result. Moreover, there are many methods of good death and everyone has the right to pursue good death, and also has the right to choose the way of good death. Therefore, I explored the impact of good death on patients, families, medical care and society, and how patients should choose their best ways of good death. Although there are Preliminary regulations of Hospice Palliative Care Act, the act is lacking degree of recognition and suitable range. It leads to some legislators because of self’s problems, so they proposed that the demand for the Patient’s Self-determination Right Act. However, in order to subvert the think outside of the box of life and death, and guarantee to the right of good death, and then the Patient’s Self-determination Right Act has been established. The biggest difference of Hospice Palliative Care Act is the Patient’s Self-determination Right Act expands application of the clinical conditions, so this article will introduce five clinical conditions. In addition, the article will discuss the way of medical care to help good death and if helping of good death will be conformed elements of crime, and also if there are some relative affirmative defense to avoid this way to be illegal. Finally, helping of good death need doctors and nurses to enforce, so in order to know the connection between theory and practice. The article will use Empirical Research and will interview doctors and nurse. It will show what opinions of good death and the Patient’s Self-determination Right Act do doctors and nurses have. For example: which options do doctors and nurses choose between good death and positive cure, if doctors and nurses know the Patient’s Self-determination Right Act, if regulations of five clinical conditions are appropriateness, the Patient’s Self-determination Right Act will bring what problems to doctors and nurses, doctors and nurses offer some problems of the Patient’s Self-determination Right Act. It can use on more patients and patients can achieve their wishes to have good death.

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Ulpiano, Renato. "Adopting Physician-Rating Websites: Assessing the Influence of Practitioners’ Motivations and System Perceptions." Thesis, 2021. https://vuir.vu.edu.au/43687/.

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Physician-rating websites (PRWs) are internet-based platforms that allow users to read or contribute to reviews of service performance about healthcare practitioners (HCPs). Healthcare consumers use PRWs to rate healthcare services; however, PRWs are not commonly embraced by HCPs, nor by professional associations. Nonetheless, in a competitive environment, HCPs could benefit their practice by attending to what clients publicly communicate about their services to align with the patient centred care (PCC) movement. The systematic literature review (SLR) revealed a paucity of research in the area. This research sought to understand what influences a HCP’s intention to adopt a PRW. In doing so, this research explored the relationship between HCPs’ motivation to adopt such websites and the role of their perceptions of a PRW’s characteristics. The motivation and system elements were assessed in terms of their relative influence on HCPs’ PRW adoption. This research conducted a narrative and SLR to inform a conceptual model to theoretically explain the relationship between motivation, system characteristics, and intention to adopt a PRW that was tested in a cross-sectional study. The research method and methodology included participants, 249 Australian allied healthcare professionals, who were surveyed using validated scales. Structural equation modelling estimated the model and the relative contribution of motivation and system characteristics on the adoption of PRWs. The Results chapter showed that HCPs’ motivation type external regulation—social had a direct negative effect on their intention to adopt a PRW (r = −.21, p < 0.01). In discussing the findings, they contrasted with the perceived system characteristics of relative advantage and ease of use, which were found to have a direct positive effect on intention to adopt a PRW (r = .88, p < .00) and (r = .24, p < .00), respectively. In conclusion, the results from this study, first, increase current understanding of HCP behavioural intention to adopt a PRW. Second, theoretical contributions are made through the integration of self-determination theory and diffusion of innovation applied to this unique context. Third, this study is the first to apply the Multidimensional Work Motivation Scale in Australia. The findings have implications for healthcare businesses and HCPs’ strategic development of PCC measures. Furthermore, translation of the findings could assist in the design of HCPs’ professional development to use online feedback, to manage patient onboarding, and to identify pathways to innovation adoption by HCPs.

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Belaid, Hayet. "Effet d'une intervention infirmière de soutien favorisant l'autodétermination sur la pratique des auto-soins chez des patients atteints d'insuffisance cardiaque." Thèse, 2012. http://hdl.handle.net/1866/8551.

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L’insuffisance cardiaque (IC) est une maladie chronique dont les symptômes sévères peuvent mener à des hospitalisations répétées. Pour gérer ces symptômes, le plan de traitement implique plusieurs auto-soins, par exemple une diète limitée en sel et en liquide, ce qui est parfois difficile à respecter. Le but de la présente étude pilote randomisée à deux groupes (n = 16 / groupe) était d’évaluer la faisabilité, l’acceptabilité et l’efficacité préliminaire d’une intervention infirmière favorisant la pratique des auto-soins des patients atteints d’IC. L’intervention est basée sur la théorie de l’autodétermination (TAD) qui promeut l’autonomie dans la pratique des auto-soins. L’autodétermination est favorisée par le sentiment de compétence perçue, d’autonomie et d’affiliation. Pour soutenir le besoin d’affiliation, un aidant principal participe à l’intervention qui consiste en cinq entrevues chez le groupe d’intervention (GI) dont deux durant l’hospitalisation et trois par un appel téléphonique suite au congé. Les interventions découlant de cette théorie incluent par exemple de proposer des choix plutôt que d’imposer des restrictions, d’éviter la critique, de favoriser l’empathie et le renforcement positif. Les entrevues ont servi également à guider les aidants principaux pour qu’ils soutiennent à leur tour l’autodétermination de leur parent atteint d’IC. Les résultats soutiennent la faisabilité et l’acceptabilité de l’intervention évaluée dans la présente étude et permettent d’améliorer la pratique des auto-soins avec des résultats favorables pour la majorité des hypothèses évaluées. Ces résultats prometteurs permettront de guider la pratique clinique et offrent des pistes de recherches futures.
Heart failure (HF) is a chronic disease with severe symptoms that may lead to repeated hospitalizations. To manage these symptoms, the treatment plan involves several self-cares, such low-salt diet and fluid restriction, which is sometimes difficult to achieve. The purpose of this randomized pilot study of two groups (n = 16 / group) was to assess the feasibility, acceptability and preliminary effectiveness of a nursing intervention aimed at improving the self-care practice in HF patient’s. The intervention is based on self-determination theory (SDT) which promotes autonomy in self-care practice. Seldetermination is enhanced by individual’s perceived competence, autonomy and relatedness. To sustain affiliation need, a primary caregiver participates in the intervention, which consists of five interviews with the experimental group (EG), two during hospitalization and three by a telephone follow-up after discharge. Interventions based on this theory include offering choice rather than imposing restrictions, avoiding criticism, encouraging empathy and positive reinforcement. The interviews were also used to guide the primary caregivers so they could themselves support their HF relatives’ with self-determination. The results support the feasibility and acceptability of the intervention evaluated in this study and help improve self-care practice with positive results for the majority of the hypotheses tested. These promising results will guide clinical nursing practice and provide avenues for future research.

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Těšinová, Jolana. "Trestněprávní aspekty vztahu lékaře a pacienta." Doctoral thesis, 2015. http://www.nusl.cz/ntk/nusl-352264.

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Medical interventions such as interventions in the physical integrity of the patient are some of the most important interventions in the personal rights of individuals guaranteed by constitutional laws and international conventions. The basis for criminal law investigation of physician's procedure is an issue of professionally correct procedure (procedure called lege artis). The healthcare provision - including the interventions in the physical integrity of the patient - is perceived in Czech law as a law qualified activity undertaken for the purpose approved by the legal order. As a result of the constitution of informed consent of the patient with a medical procedure this fact must be taken into account when defining a new criminal characteristics of medical intervention. The dissertation aims to provide a comprehensive legal analysis of the criminal aspects related to decisions made by physicians and to the medically indicated care provision in the context of legislative changes in healthcare, recodification of criminal law as well as civil law. Issues related to active intentional termination of life on request of the patient (euthanasia) were not subject to the processing of this matter. The dissertation analyzes in detail the individual institutes of healthcare legislation, medico-legal...

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Kalaitzidis, Evdokia. "professional ethics for professional nursing." 2006. http://arrow.unisa.edu.au:8081/1959.8/30081.

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The thesis proposes and defends a maxim which can serve as a foundation and guideline for professional ethics in nursing, the maxim that nurses should act so far as possible to promote patient's self-determination. The thesis is informed by philosophical ethics and by knowledge of professional nursing practice.

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Dissertations / Theses on the topic 'Patient self-determination'

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