Clinical-qualitative Study Research Articles

"It's a Lot of Closets to Come Out of in This Life": Experiences of Brazilian Gay Men Living with Human Immunodeficiency Virus at the Time of Diagnosis and Its Biopsychosocial Impacts.

We investigated the experiences of Brazilian gay men with HIV, focusing on the moment of diagnosis and its potential biopsychosocial impacts. This clinical-qualitative study involved 15 participants interviewed online and synchronously by a clinical psychologist in 2021. Thematic analysis was employed to analyze the data. Interpretations were grounded in Minority Stress Theory. Four thematic axes emerged, including "Diagnostic Revelation", "Social and Internalized Stigma", "Biopsychosocial Effects of Living with HIV", and "Gratitude for Treatment Advances and the Brazilian Health System". The diagnosis was often experienced as traumatic, exacerbated by the absence of empathy and emotional support from healthcare providers. Participants commonly reported guilt, fear upon learning of their HIV status, social isolation, loneliness, lack of social support, and damage to affective-sexual relationships. Many also noted a decline in mental health, even those without HIV-related medical complications. Despite over 40 years since the HIV epidemic began, the prevalence of homophobia and serophobia among gay men remains widespread, including within the multidisciplinary teams of specialized services. This indicates that the stigma associated with homosexuality and HIV persists, despite significant biomedical progress in the diagnosis and treatment of the infection, particularly in Brazil.

Contradictions in the Breastfeeding Experience: A Clinical-Qualitative Study in Women Who Attended a Breastfeeding Incentive Service

Background: In this study, we explored the mothers perception about their breastfeeding or weaning process. Methods: We conducted a clinical-qualitative study consisting of individual interviews with an intentional sample, closed by theoretical saturation criterion. Results: We analyzed the data using clinical-qualitative content analysis. We interviewed nine mothers aged between 29 and 41 years, who exclusively breastfed for 2 to 6 months. We established three thematic categories: 1) “The weaning paradox: between discomfort and relief from the process”; 2) “Leaving something behind: the bond with the child or with the work?”; and 3) “Ambiguity of control and care”. Women who breastfeed or are in the process of weaning face many contradictory feelings, generating challenges and anguish to decide the best way to care. Conclusions: Health professionals can improve these women's experiences by opening a space for listening and understanding the emotional and social conditions involved.

“We weren’t used to seeing our colleagues hospitalized”: A clinical-qualitative study on reports from an intensivist clinical team at a Brazilian university public hospital

IntroductionThe care relationships of physicians and nurses with patients with Covid-19 had pointed to a scenario explorable from a psychological point of view due to the peculiarities of this pandemic. How do clinicians feel, when caring for their co-workers, in a context that was not so common to see colleagues occupy the patient’s place? What emotional experiences arise from this reality? The results of the present study sought to point out how to handle this caring relationship, in an exceptional context.ObjectivesTo interpret emotional meanings reported by physicians and nurses on their experiences of working at COVID-19 intensive care units during the height of the pandemic.MethodsClinical-qualitative design of Turato. Data collection with semi-directed interviews with open-ended questions in-depth applied to a sample of six professionals, closed by theoretical information saturation according to Fontanella, in a Brazilian university general hospital. Trigger question: “Talk about the psychological meanings of your experience in face of management of patients with COVID-19 at ICU”. Data treatment by the Seven Steps of the Clinical-Qualitative Content Analysis of Faria-Schützer. Theoretical framework from Medical Psychology using Balintian concepts.ResultsWe raised initially 4 categories. Three categories were presented preliminarily in this congress, version last year. In this opportunity, we show this special category of analysis that emerged during the deepened discussion of the final results: “The feeling of insecurity: from technique to affective dimension”.ConclusionsThe care relationships between the health professional and the patient hospitalized in the Covid-19 ICU pointed to peculiar transference and countertransference psychodynamic mechanisms between both. Before the pandemic, the care relationship seemed pragmatic and protocolar. During the pandemic, this relationship seemed “more subjective”, building a strongly emotional dimension, as health professionals also began to care for their colleagues in the profession. The egoic defense mechanisms, such as projective and introjective identification were reported as intense.Disclosure of InterestNone Declared

“You can’t put your head down like an ostrich” - Emotional experiences associated to clozapine treatment protocol reported by patients with schizophrenia seen in a Brazilian university specialized service: a clinical-qualitative study

IntroductionUnderstanding the psychological meanings of a rigorous protocol for introducing a drug to patients is a challenge of emotional management for clinical professionals. Clozapine is an effective drug for patients with schizophrenia resistant to treatment with first and second-generation antipsychotics. This medication has agranulocytosis as an important side effect. The medication protocol requires frequent blood draws to monitor any effect on blood cells. Investigating patients’ emotional perceptions about the experience with this procedure was the triggering question of our study.ObjectivesTo interpret emotional/symbolic meanings attributed by patients with schizophrenia to the protocol of introduction of clozapine in follow-up at a specialized university service.MethodsClinical-qualitative design of Turato. Semi-directed interviews with open-ended questions in-depth were conducted face-to-face with participants using clozapine. Closed sample by the theoretical information saturation criterion described by Fontanella. Data were treated by Faria-Schutzer’s Clinical-Qualitative Content Analysis, employing psychodynamic concepts of the theoretical framework of Medical Psychology.ResultsFrom the analysis of nine patients, three categories emerged: 1) “Anyway, I come here to stay alive”: frequent blood collections of the protocol seem to have a good impact on patient’s adherence to treatment; 2) To re-signify a psychiatric illness: the protocol reinforcing an embodiment of a medical diagnosis; 3) “It is a very big precaution”: the protocol as real and emotional support to deal with the possibility of serious side effects.ConclusionsAlthough blood collection is a repetitive experience for patients, such a routine does not mean that the procedure brings symbolizations that are more charged than the disease itself. Patients can benefit from the commitment to attend blood collection frequently, as it removes them from possible social isolation, allowing social interaction; it brings the perception of emotional security due to the commitment to the clinical team. These benefits can lead the patient to develop new meanings for their life condition. Future qualitative research can be conducted to study the meanings of medical protocols in other diagnostic situations.Disclosure of InterestNone Declared

Desvelando em diferentes culturas a evolução da gestação em óbito fetal

Abstract Objectives: to describe the identification of fetal death during pregnancy in Brazilian and Canadian women. Methods: clinical-qualitative study with women who experienced the outcome of fetal death in their pregnancies, living in Maringá (Brazil) and participating in the Center d’intervention familiale (Canada). Data collection was performed through a semi-structured interview with the question: How did you find out about your baby’s death? Readings were performed and the relevant aspects were categorized into themes according to the places where the death was confirmed. Results: in both countries, the main causes of death were the same, related to complications in pregnancy and childbirth, and health problems of the pregnant woman or fetus. Brazilian women had a higher frequency of deaths in the third trimester and Canadian women experienceda majority of deaths in the second trimester. The stillbirthswere found in different places, times and moments categorized at prenatal routine consultation, emergency care, expected death from congenital malformations of poor prognosis and labor. Conclusions: the determination of fetal death during pregnancy was due to possible intrinsic intercurrences of the pregnancy period. Based on the women’s experiences, it was possible to demonstrate the clinical practice of identifying fetal death according to the cultural scenario. Continuous studies on prenatal care for women who had stillbirths are necessary for early detection of pathological conditions and appropriate interventions.

Significados Psicológicos e Relacionais da Experiência da Maternidade com Toxoplasmose

Abstract With the purpose of understanding the psychological and relational meanings of the experience of motherhood in the face of toxoplasmosis, a clinical-qualitative study was carried out performing semi-directed interviews with five mothers of babies with toxoplasmosis. The information was submitted to Content Analysis, and the results demonstrated that the psychological meanings include both the presence of difficulties and suffering and the potentiality of the babies and the establishment of emotional mother-baby bonds. Relative to the relational meanings, the importance of support networks was identified, emphasizing the role of family members, health services, and religiosity as sources of support in facing difficulties. However, it was identified that the care is provided primordially to the babies, with the emotional assistance to mothers being insufficient. In conclusion, it stands out that each mother experienced toxoplasmosis from their possibilities and available support network, which affected the establishment of the mother-baby bond.

Professional practice in caring for maternal grief in the face of stillbirth in two countries.

to understand professional care for maternal grief in the puerperium of stillbirth. a clinical-qualitative study with all the women who had stillbirths living in Maringá (Brazil) and participating in the Center d'Études et de Recherche in Family Intervention at the University of Quebec in Outaouais in Gatineau (Canada). Semi-structured interviews were carried out and the relevant aspects were categorized into themes. the identified categories were: Assistance received in the puerperium with a focus on grief: hospital and outpatient environment, and Professional support in coping with maternal grief after fetal loss: with contact and memories, without contact and without memories and impossibilities of contact with the baby. considerations: the need for a multidisciplinary support and monitoring network for women who experienced fetal loss was evident. From this study, a routine of care for grief can be implemented in Brazil based on experiences in Canada.

A escuta clínica: análise da linguagem simbólica de pessoas com estomias intestinais

O corpo pode ser compreendido a partir de uma perspectiva simbólica; por representações que abarcam a linguagem, em especial, a simbólica, cuja escuta atenta é importante para o entendimento da dimensão do sofrer. OBJETIVO: Analisar o emprego dos verbos páthicos (querer, poder e dever) na fala quotidiana de pessoas com estomias para compreensão do processo mental e da experiência vivida. MÉTODO: Estudo clínico-qualitativo, dados coletados por entrevistas abertas, submetidas à análise temática. Os sujeitos foram seis pessoas com estomia intestinal em acompanhamento em um hospital Universitário, no Brasil. Critérios de inclusão: ser usuário do serviço de estomaterapia do hospital em questão; apresentar estomia intestinal (definitiva ou provisória); aceitar participar do estudo; assinar o Termo de Consentimento Livre e Esclarecido; ser maior de 18 anos. Critérios de exclusão: não se sentir em condições físicas e/ ou psíquicas para participar. Pesquisa aprovada pelo CEP da Faculdade de Ciências da Saúde da Universidade de Brasília, sob o ofício de nº 033/12. RESULTADOS: Da análise emergiram duas categorias: 1) O corpo biológico: a experiência vivida no corpo efetivo material e, 2) O corpo vivido: a experiência vivida e sentida no corpo erótico-libidinal. CONSIDERAÇÕES FINAIS: Em todos os casos apresentados os verbos páthicos se fizeram presentes marcando o movimento vivido. O método qualitativo permite a significação da linguagem ordinária configurando possibilidades para a praxis do cuidado.

Motivation for alcohol consumption or abstinence during pregnancy: A clinical-qualitative study in Brazil.

BackgroundIn Brazil, alcohol consumption is estimated to range from 7 to 40% in pregnant women. This research investigated the motivation for alcohol consumption or abstinence during pregnancy in a purposive sample of Brazilian women.MethodsClinical-qualitative research was conducted, in which 14 women participated, identified as risk-drinkers during pregnancy by the T-ACE screening tool. Data were collected through semi-structured individual interviews. Reports were recorded, transcribed and investigated by a thematic content analysis approach. The results were discussed based on a comprehensive and interpretive framework.ResultsSixteen themes were extracted and these were then classified into three thematic categories: (a) general motives for alcohol use, (b) specific motives for drinking during pregnancy, and (c) reasons for partly or fully abstaining from drinking during pregnancy. Social motives were the most relevant, particularly due to deeply rooted cultural values. Enhancement motives were widely mentioned and associated with a hedonic posture. Consumption also aimed to deal with negative emotions, characterizing two types of coping specifically to pregnancy: first, perceiving pregnancy as a period of less opportunity for social interaction and, therefore, drinking alcohol at home to compensate; secondly, perceiving pregnancy as a period of greater irritability, and hence experiencing difficulties to abstain. On the other hand, concern about fetal health, disapproval of consumption by relatives and health professionals, as well as the social construction of mothering were reported as reasons to abstain.ConclusionsSome specificities influence the decision to continue or discontinue alcohol consumption during pregnancy. To reduce consumption, we suggest educational actions based on a collective health perspective, articulated with individualized measures that allow identification and proper intervention for women at risk.

Sobre ocupar-se de cuidar do filho no hospital

Este trabalho objetivou compreender os significados de cuidar do filho cardiopata para mães de crianças internadas em um hospital em Belém, Pará. Para isso, foi realizada uma pesquisa clínico-qualitativa, sendo as participantes 06 mães de crianças com cardiopatia congênita. Os significados desvelados pelas mães trataram de aspectos, como: a rotina vivenciada no hospital; o cuidar do filho como “dever” da mãe, permeado por preocupações e medo; sentimentos como tristeza e cansaço, assim como experiências positivas, onde as mães buscavam a recuperação da saúde de suas crianças. Desta forma, acredita-se que analisar a ocupação de cuidar de filhos é relevante na prática da Terapia Ocupacional, para compreender melhor a vivência materna e propor estratégias para facilitar o desempenho de ocupações que se encontrem prejudicadas em seu cotidiano.

Psychological Distress Experienced by Nurses who Work with Patients in Death Process: A Clinical-Qualitative Study

Psychological Distress Experienced by Nurses who Work with Patients in Death Process: A Clinical-Qualitative Study

Clinical-qualitative study on emotional aspects of practices and learning, interviewing Brazilian nurses from a hemato-oncological unit who work with patients in risk or death process

IntroductionThere is no clear limit between the personal and professional dimension, when the health worker cares for patients who have no prospect of cure. This shadowing of the personal dimension causes high emotional demands of the professional in the face of the experiences with the death.ObjectivesIn face of troubles which surround the nurse in the context of death, this article aimed to identify the learning and self-care practices experienced by nurses who work with patients in risk or in death process, in a haematology-oncology unit.MethodThis is a clinical-qualitative study, conducted through individual interviews. The participants were 6 nurses from haematology-oncology unit of a university hospital, covering the sectors of chemotherapy clinic and children's unit.ResultsThe results highlight two phenomena built by the experiences of nurses: long learning experiences with the team work through the maturity arising over time or even with constant monitoring of the death situations; and self-care practices as self-preservation phenomenon through the development of pain by speaking and listening in groups, the motivation through professional achievement and the well-being caused by the charity care each other.ConclusionsWork towards the personal development of nurses as professional who deals with ethical conflicts should be focused on promoting opening spaces for speaking and listening of these nurses. This allows them to create ways of dealing with situations of death, which are professionally responsible.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Emotional expectations reported by hospitalized women in southeastern Brazil before being submitted to mastectomy with immediate breast reconstruction: A clinical-qualitative study

IntroductionBreast cancer is a type that more affects female population in the world. Surgical indication, present in most cases, is a mutilating procedure and mentally traumatic for majority of women subjected. Thus, immediate breast reconstruction, which is the choice to rebuild the breast during the mastectomy surgery, is an alternative to reduce discomforts associated with loss of the breast, in addition to being associated potentially with improved emotional and psychosocial quality of life.ObjectiveTo discuss, from psychological viewpoint, the emotional expectations about surgical results of a planned mastectomy with immediate breast reconstruction, reported by women with breast cancer treated in a university hospital in Campinas, state of São Paulo.MethodQualitative design, particularized in the clinical-qualitative method, adequate to health assistant settings, using the semi-directed interview with open-ended questions in-depth, fully transcribed and after submitted to content clinical-qualitative analysis. Intentional sample closed by criterion of information theoretical saturation with 12 sequential participants.ResultsAmongst the emergent categories from free-floating readings, we have chosen the following to presentation:.–The desire of healing above expectations of the aesthetic aspects;–The perception of the surgical approach predominantly with aesthetic effects;–The desire of a contra-lateral healthy breast withdrawal, too.ConclusionsFace the proposal of mastectomy with immediate reconstruction, days before the surgery, women reported to be well emotionally organized for the procedure, although in different ways. This occurs probably due to emotional meanings built by many experiences from their psychological histories, as well as from values provided by the socio-cultural environments.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Spirituality meanings reported by Southeast Brazilian nursing staff at the psychiatric ward of a university general hospital: A clinical-qualitative study

IntroductionDespites nursing holistic trends for caring, in psychiatric wards of general hospitals the spiritual dimension remains controversy. Evidence shows spirituality rule in recovering and also alerts about complications associated to mental disorders and spirituality.AimTo describe spirituality meanings attributed by a psychiatric nursing team and discuss how they apply them on professional cares.MethodClinical-qualitative design is a particularization of generic qualitative strategies brought from humanities to approach symbolic research questions in clinical settings. A semi-directed interview with open-ended question, in-depth, was carried out with a team of 22 nursing professionals in the psychiatric ward of a general hospital in Southeast Brazil. Data analysis was driven under the Ricoeur understanding of Freudian symbolic meaning, which affirm that a statement revels multiple meanings overwritten.ResultsSpirituality is developed from several sources of restlessness and living together. The function of spirituality is to help fulfill social roles, keep internal balance and to maintain sacred practice attitudes towards life that brings symbolic salvation: help or redemption to hard life times. Nature of mental illness remains as spiritual stigma and a suspicion contradictorily to spiritual approach caring to patients in inpatients services, which is described, as inappropriate or confusable.ConclusionsEven spirituality meanings are covered by symbolism, which expresses human attitudes to help in life crises they are surrounded by contradictions that situate this dimension in the limit of reason, which approximates carriers and patients causing weirdness. Nursing staff still needs training to deliver holistic care, and spiritual counseling to gain clarity in this issue.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Feelings of guilt and fantasies in life experiences of Brazilian parents due to death of their newborn: A clinical-qualitative study conducted at a university hospital

IntroductionThe relationship between parents and children is a complex link. In the process of pregnancy-birth-puerperium, frequent feelings such as responsibility, love, fear, uncertainty, generate strong expectations at birth. The death of a newborn may not be perceived as natural by the parents, considering the local culture and the context of great technological development of neonatology.ObjectiveTo explore possible guilt and fantasies in life experiences of parents during mourning process due to death of their newborn.MethodClinical-qualitative design, a particularization of qualitative methods here applied in clinical assistance settings with highlight to psychological aspects. Data collection with the technique of semi-directed interview with open-ended questions, in-depth. Sample intentionally constructed, with closure by theoretical saturation of information. The participants were 7 parents, mourning by the death of their child at the neonatal intensive care unit, in a university hospital of Campinas, São Paulo State.ResultsFeelings of guilt - conscious or not - lead to an internal and particular movement so that mourning can be lived. The participants showed certain embarrassment, accompanied by natural suffering facing to the cultural pattern that permeates the emotional experience. It predicts types of psychological meanings that the experience will give to the person.ConclusionHealth professionals working with bereaved parents should consider more deeply the moment these one experienced, with emphasis on the details of the death scenery, beside the problems of illness and death properly so called.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Psychological experiences reported in regarding hepatitis C and use of interferon: A clinical-qualitative study in a Brazilian university outpatient service considering its possible side effects

Relevant emotional and behavioural reactions are associated with diagnosis and treatment of hepatitis C that can impair adherence to medical management. Hepatitis C accounts for significant number of both – liver transplants and deaths. Treatment has as major component the interferon alpha, and many of patients can experience side effects that often lead to non-adherence to drug treatment and dose modification.ObjectiveTo discuss psychological meanings attributed to IFN alpha treatment's side effects and its symbolic relation with adherence or not to treatment, on viewpoint of interviewed outpatients at a Hepatitis Service.MethodData collection was conducted using the Clinical-Qualitative Method, utilizing semi-directed interviews with open-ended questions in depth, fully transcribed. Qualitative Content Analysis employed for processing data, emerging meaning cores, with categorization into discussion topics. Sample closed by information saturation.ResultsNine interviews. The analysis revealed:– coping attitude - handling the disease to have willpower; a moral feeling regarding the need to overcome the disease and treatment side effects to demonstrate “strength”, as well as to deny psychologically the occurrence of side effects;– disruptive attitude: reports of anxiety regarding to patients presenting neuropsychiatric symptoms by medication;– realistic attitude: speeches show perception of natural evolution and treatment real function.ConclusionGuilt feelings emerged regarding to difficulties of being loyal to treatment, a strongly valorative speech on being ill what must lead to “overcome the evils of life”. Health teams must understand these meanings to talk openly about human feelings on illness and treatment, promoting an adequate adherence.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Psychological experiences reported by offsprings of mothers with bipolar disorder: A clinical-qualitative study in a Brazilian university outpatient service

IntroductionChildren of patients with bipolar disorder are at increased risk of developing psychopathology and psychosocial difficulties.ObjectivesTo understand the emotional experiences of adult children of mothers with bipolar disorder.MethodQualitative study, using in-depth semi-directed interviews with open-ended questions, sample closed by saturation information criteria, content analysis, discussion under psychodynamic concepts.ResultsFrom interviewees’ reports, it can be seen that offspring's experiences emotional vulnerability, such as directions given by early exposure to self injurious behaviour, psychiatric hospitalizations, routine absences from home and consequent perception of helplessness, especially in periods of the mother's crisis. The findings suggest that for the children the insecurity to assume the precociously inverted responsibility regarding the need of care to mother seems to experience by them as an entrapment to the care of the mother, for the effort they make to keep them alive, with an emotional burden due to both impaired childhood and adolescent.ConclusionIt was analyzed the assumption that the evolution of reactive psychological stages regarding the mother affected by a mental illness marked by bipolarity manifestations, alternating with phases of the normality of psychic manifestations, would follow the evolution of the oscillating psychological stages of his/her own mother, which minimizes often both the disease and the treatment during the phases of remission of manifestations.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Luto antecipatório em pacientes com indicação para o Transplante de Células-Tronco Hematopoéticas

The scope of this study was to understand how the process of anticipated grieving is imbued in patients undergoing Hematopoietic Stem Cell Transplantation (HSCT). A cross-sectional clinical-qualitative study was conducted on a sample of 17 patients, mostly women, married, aged between 20 and 42 years and diagnosed with Chronic Myeloid Leukemia. Data was collected by semi-structured interviews applied individually and subjected to thematic content analysis. The results indicate that the loss of health imposes a new challenge in a life history already permeated by great hardships and premature losses. It was found that the expected reactions faced with normal grieving were expressed by the participants and that the most prevalent coping strategy was holding steadfast to their faith. Future plans involved being healed, returning to normality and vocational rehabilitation. The results may help the multidisciplinary teams to understand the emotional implications of the illness/treatment for implementing both preventive and intervention strategies. The critical aspect is that staff must be attentive as to how to communicate the diagnosis and the possibility of outlining a therapeutic plan, in order to augment the fighting spirit of the patient and strengthen the bond of trust with health professionals.

Treatment of tuberculosis under the view of the user

Clinical-qualitative study aimed at analyzing the experiences of users who completed treatment for tuberculosis in the county of São Carlos-São Paulo, Brazil. Data were collected from February to September 2011, through semi-structured interviews, with 15 users. These were organized according to the content analysis technique, thematic modality. The patients face difficulties in being diagnosed and use different health services; they suffer with the reactions resulting from the treatment, and the supervision of drug intake is seen both as a facilitator for the formation of the link and also as a deterrent to adherence. Assessment researches related to difficulty in establishing the diagnosis and the monitoring of the supervised treatment should be made to minimize the barriers to control the disease.

A Follow-up Study in Psychoanalytic Psychotherapy of Couples

During 11 years we have been working on a research involving intervention with families seeking treatment in a counseling center-school and whose complaints are focused on their children. Using psychoanalytic psychotherapy with the couples, we have tried to achieve symptom remission in the children. The purpose of this study is to reflect on the maintenance, over time, o f the psychological changes obtained in this kind of clinical pract ice, wh ich encompasses both couples and families. Based on clinical-qualitative methodology and case study, two cases have been examined, with emphasis on the follow-up sessions for two couples who were undergoing psychoanalytic couple's therapy for thirty-six and thirty months, respectively, with t wo additional fo ll ow -up sessions after the therapy was finished. The collection of clinical material to be analy zed according to the psychoanalytic references was made using excerpts fro m the session written notes taken by the therapist herself immed iately after the sessions were over. As a result, this kind of intervention proved effective in clarifying latent marital conflicts and in fostering a healthy environment, one that could contribute to the emotional development of the child.