Dissertations / Theses on the topic 'Professional-Family Relations'

Communication with healthcare providers (HCP’s) at the end-of-life (EOL) is a crucial process that can make a difference in the quality of the EOL experience for patients and their families. Targeting EOL communication interventions between patients, their families, and HCP’s is better informed from an understanding of what family members perceive as good and bad communication. The purpose of this study was to explore experiences related to communication with HCP’s in central Massachusetts during EOL care. Data from the parent study (n = 373) included responses from an open ended question at the end of the survey. The larger, qualitative descriptive study, from the parent study, (n = 218 ) that examined the open ended question revealed communication as the overarching theme. A secondary analysis of this open ended survey data using qualitative content analysis was used to describe next of kin’s perspectives of communication with HCP’s during the decedents’ end-of-life experience (n = 171). Family members (children = 38.4% and spouse = 22.0%) comprised the majority of the sample. Decedents were mostly 80 or older (47.6%), died in an acute care setting of mostly cancer (33.0 %) and cardiovascular disease (32.3%). Accessing information, emerged as the overarching theme. Continuum of information, healthcare provider sensitivity, having the answers and raising awarenesswere revealed as subthemes. The majority of respondents reported good aspects versus bad aspects of communication at the EOL. The framework for a good death (Emanuel & Emanuel (1998) under-girded the study but was not supported as it relates to these findings. The framework was useful in capturing the multidimensional process that each patient and their family could experience during the EOL process. The findings from this study provide insight for HCP’s about which aspects of communication are helpful at the EOL. Continuing education of the health care team on these identified helpful communication aspects will provide better access for patients and families for a quality EOL experience.

Background: When the patient is critically ill the family is in a vulnerable position. The nurse's role is to support and help the family to find meaning in the difficult situation and to provide realistic hope. Balancing between the patient's and the family's needs is difficult. Knowledge about how nurses experience difficulties in the interaction with family is required in order to grant good care too critically ill patients and their family-members. Aim: To describe nurses' perceived difficulties in the interaction with family-members of critically ill patients. Method: The study is a qualitative literature-based study based on qualitative research. Results: The analysis resulted in four main themes; difficult disunion, environmental constraints, interpersonal difficulties and communicative difficulties. Conflicts, disagreement and expectations in the interaction with family-members are difficult. There are environmental constraints in the form of family's presence, lack of space and time constraints. Nurses find it difficult to manage their emotions, family who get to close and to support the family. Information, comprehension, knowledge, language barriers and cultural differences represents communicative difficulties. Conclusion: There is a lack of knowledge among nurses about how to handle difficult situations where family is involved. Doctors and nurses need to collaborate more. Conflicts, disagreements and expectations can put severe pressure on the nurse. It is difficult for the nurse to strike a balance between being professional and being personal. Environmental constraints are an organizational problem which creates difficulties for the nurse in the interaction with family.

Atualmente, já é consolidada a idéia de que as condições de saúde-doença dos membros da família e a família enquanto unidade influenciam-se mutuamente. A Entrevista de 15 minutos foi desenvolvida como uma forma condensada do Modelo Calgary de Avaliação e Intervenção com famílias, objetivando contribuir para o estabelecimento de um relacionamento entre enfermeiro e família de modo que, mesmo em uma breve interação, possibilite intervenções que promovam saúde e alívio de sofrimento. O Programa/Estratégia Saúde da Família (PSF) foi implantado em 1994 para reorganizar o Sistema Único de Saúde no Brasil, preconizando que a família e seu espaço social sejam eleitos como núcleo básico de abordagem no atendimento à saúde. Esse estudo objetivou conhecer a experiência de enfermeiros do Programa de Saúde da Família no uso da Entrevista de 15 minutos nas visitas domiciliares realizadas no período puerperal. Para tanto, foi realizada uma pesquisa qualitativa que ocorreu em três etapas: Etapa 1 treinamento dos participantes, Etapa 2 utilização da Entrevista de 15 minutos pelos enfermeiros, Etapa 3 entrevistas com os enfermeiros. Os dados foram coletados por meio de entrevistas semi-estruturadas, totalizando oito participantes, e foram analisadas através de Análise Temática. Dois temas centrais foram evidenciados: VIVENDO O DESAFIO DE UMA NOVA EXPERIÊNCIA e AVALIANDO A EXPERIÊNCIA. Ao enfrentar o desafio de utilizar a Entrevista de 15 minutos em sua prática profissional o enfermeiro do PSF percebe o impacto positivo dessa nova ferramenta em seu relacionamento com as famílias atendidas, ampliando seu olhar sobre elas como uma unidade e aprofundando o vínculo entre família e profissional. Esse olhar ampliado contribui para uma avaliação mais precisa das necessidades e anseios da família, facilitando a implementação de novas intervenções, como o uso de elogios e orientações. Por outro lado, o profissional vivencia dificuldades ao construir os genogramas e ecomapas e também ao perceber que aquele momento não é adequado para a realização da entrevista com a família. Esse trabalho evidencia que a Entrevista de 15 minutos pode atuar como um contexto que facilita o aprofundamento das relações entre enfermeiros e famílias no PSF, o que aproxima a preconização da família como foco de atenção no atendimento à saúde da sua concretização.
The idea that the conditions of health-illness of the members of a family influence one another mutually is widely known nowadays. The 15 minute family interview was developed as a condensed form of the Calgary Family Assessment and Intervention Models, aiming to contribute to the establishment of a therapeutic relationship between nurse and family and the implementation of interventions to promote health and the relief of suffering, even in a brief interaction. The Family Health Program (FHP) was implemented to reorganize the National Health System in Brazil, recommending that the family and their social space to be elected as the nucleus of approach in health care. This study investigated the experience of nurses from the Family Health Program in the use of the 15 minutes family interview on home visits in the postpartum. Thus, a qualitative study was conducted and took place in three stages: Stage 1 Participants Training Program, Stage 2 Utilization of the 15-minute family interview by participants and Stage 3 Interviews with participants. The data were collected through semi-structured interviews with the nurses, a total of eight participants, and were analyzed using thematic analysis. Two main themes were highlighted: Living the challenge of a new practice and Evaluating the assignment. Facing the challenge of using the 15-minute family interview in his/her practice, the nurse realizes the positive impact of this new tool in his/her relationship with the families, broadening his/her view of them as a unit and deepening the bond with the families. This expanded view of the family contributes to a more accurate assessment of the familys needs and wishes, facilitating the implementation of new interventions, as the use of commendations and orientations. On the other hand, the professional also experiences difficulties in constructing genograms and ecomaps and when realizes that that moment is not suitable for the 15-minute family interview. This work shows that the 15-minute family interview can serve as a context that facilitates the deepening of relations between nurses and families in the FHP, which approximates the proposal of the family as the focus of attention in health care of its fulfillment.

 

The purpose of this study was to investigate registered nurses experiences about giving support to relatives to patients within palliative home care. This study was descriptive with qualitative approach. The data collection was made in the form of semi structured qualitative interviews which took place in a Swedish city of medium size, in an area for palliative homecare. Six registrated nurses were interviewed which all gave informed consent. The study suffered no losses and permission from the director of the concerned department had been given prior to the start of this study. The interviews were transcribed and analyzed whereupon three themes followed by seven categories entered.

In the main results difficulties appeared, such as when the family of a patient was unwilling to realize the situation. However the results also showed opportunities, for example the importance of the support which the nurses constituted. Many informants witnessed about the individual needs that existed among the relatives.  Foremost emphasize was on the importance of relatives and how the contact with them took place. Finally the study shows a picture of the supporting aspects that exists, for example to be able to sense the relatives needs and se their unspoken demands.

 

 

Syftet med studien var att undersöka sjuksköterskors upplevelser av att ge stöd till anhöriga till patienter inom palliativ hemsjukvård. Studien var deskriptiv med kvalitativ ansats. Datainsamling skedde i form av semistrukturerade intervjuer utifrån ett intervjuschema, intervjuerna spelades in på band. Detta ägde rum i en medelstor svensk stad i en verksamhet för palliativ hemsjukvård. Sex legitimerade sjuksköterskor intervjuades, varav samtliga lämnade informerat samtycke. Studien erfor inget bortfall och tillstånd från berörd verksamhetschef hade erhållits innan studiens start. Intervjuerna transkriberades och analyserades vartefter tre teman med sju kategorier kom fram.

I huvudresultatet framkom svårigheter som när anhöriga har en ovilja att inse situationen. Även möjligheter, till exempel betydelsen av det stöd som sjuksköterskorna utgjorde för de anhöriga belystes.   Många informanter vittnade om individuella behov bland de anhöriga. Framförallt betonades vikten av anhöriga och hur kontakten med dem skede. Slutligen gavs en bild av vilka stödjande aspekter som fanns till exempel sjuksköterskornas förmåga att kunna känna av de anhöriga och se deras osagda behov.

 

Este estudo teve como objetivos: compreender o processo de cuidar de famílias de idosos em situação de final de vida para a equipe da Estratégia Saúde da Família (ESF), identificar os significados que a equipe da ESF atribui à experiência de cuidar dessas famílias e construir um modelo teórico representativo da experiência. Utilizou-se a abordagem qualitativa, tendo como referencial teórico o interacionismo simbólico e como método a teoria fundamentada nos dados. O estudo foi realizado em unidades da ESF de Botucatu/SP. Os dados foram obtidos por meio de foto imagem e entrevistas abertas com 14 integrantes das equipes da ESF. A análise comparativa identificou que oferecer o cuidado à família e ao idoso, durante o processo de morrer, significa o profissional superar desafios para acolhê-los com honestidade, comunicação aberta, disponibilidade e manutenção do vínculo conquistado. O processo de cuidar é composto por quatro sub-processos: Identificando a problemática da situação, Planejando uma nova estratégia para o cuidar, Manejando o cuidado e Avaliando a sua trajetória de cuidado. A articulação desses sub-processos permitiu identificar a categoria central SUPERANDO OS DESAFIOS PARA ACOLHER A FAMÍLIA E O IDOSO DURANTE O PROCESSO DE MORRER, a partir da qual propõe-se um modelo teórico explicativo da experiência. O processo vivenciado pela equipe mostra que ela enfrenta as dificuldades para alcançar seu melhor desempenho profissional, acolhendo as necessidades biológicas e emocionais das famílias e buscando oferecer dignidade aos idosos em situação de final de vida, ampliando assim o seu acesso à saúde. Os resultados permitem o avanço do conhecimento sobre o processo de morrer no contexto da atenção primária à saúde.
The aims of this study were to understand the caregiving process for families of the elderly at the end of life for the Family Health Strategy (FHS) team; identify the meanings that the FHS team attributes to the experience of caregiving for these families and construct a theoretical model representing this experience. A qualitative approach was used with the symbolic interactionism as theoretical framework and the grounded theory as methodological reference. The study was carried out in units of FHS in Botucatu/SP. Data were collected using photo image and open interviews with 14 team members of the FHS. The comparative analysis identified that providing care to the family and to the elderly during the dying process means professionals overcoming challenges to embrace them with honesty, open communication, availability and maintenance of the bond established. The caregiving process encompasses four sub-processes: identifying the problem-situation; planning a new strategy for caring, managing of care and assessing the trajectory of care. The articulation of these sub-processes allowed identification of the core category: OVERCOMING CHALLENGES TO EMBRACE THE FAMILY AND THE ELDERLY DURING THE DYING PROCESS. Based on it, a theoretical model which explains the experience is proposed. The process experienced by the team shows that it has faced the difficulties to achieve their best professional performance, embracing biological and emotional needs of families and seeking to provide dignity to the elderly at the end of life, and therefore, expanding their access to health. The results allow the advancement of knowledge about the dying process in the context of primary health care.

O objeto deste estudo foram as relações estabelecidas entre os trabalhadores e os usuários do serviço de saúde sob a perspectiva do trabalhador no contexto de uma unidade da Estratégia Saúde da Família situada na cidade de Franca, SP. Para isso foram utilizados os referenciais teóricos dos processos de trabalho em saúde, da micropolítica do processo de trabalho e da produção de subjetividade. Sabemos que o trabalho em saúde implica um espaço relacional, ou seja, para que exista esse trabalho, deve existir o outro, compreendido como alguém que possui necessidades de cuidado, e é no encontro com esse outro que há a produção de um ato de saúde. Diante dessa temática, a pesquisa teve por objetivo geral mapear e analisar as relações entre profissionais e usuários da Estratégia Saúde da Família na produção de atendimentos sob a ótica dos trabalhadores. Para responder aos objetivos do estudo, foram necessários procedimentos investigativos mais abertos e inventivos, um olhar vibrátil, sensível aos movimentos e que conseguisse captar as vibrações. Portanto, para atender a essa finalidade de estudar os processos de produção de subjetividade nas relações entre profissionais e usuários da ESF, a pesquisa fez uma aproximação ao método cartográfico, que diz respeito às estratégias das formações do desejo no campo social, aos seus movimentos e suas conexões que podem surgir de diversos lugares. O cartógrafo faz um mergulho nos afetos e sempre busca elementos para compor e complementar suas cartografias. Aqui o conhecimento é dado em processo, sendo inseparável do movimento da vida e dos afetos que a acompanham. Nesse mesmo movimento o estudo adotou a pesquisa- intervenção, que parte do princípio de que o processo de conhecer e fazer, pesquisar e intervir são inseparáveis. Aqui, as metas e os caminhos são traçados ao longo do processo a ser pesquisado, tendo como norte seu objeto e objetivo. Para a produção dos dados, foi importante estabelecer algumas ferramentas, dentre elas a observação participante, o uso do diário de bordo e a entrevista semiestruturada. Além dessas ferramentas, o estudo também contou com uma primeira fase, a exploração de campo, o que permitiu um rico diálogo com a realidade. Diante do cenário estudado, pude observar que o que mais se destaca nas relações é ainda a prevalência do modelo hegemônico de saúde, do cuidado centrado em técnicas procedimentais e protocolos em detrimento das tecnologias leves, relacionais, que possibilitam e ampliam um cuidado mais integral e de produção de vida. No estudo, também percebemos a existência de algumas instituições que estão presentes no momento do encontro trabalhador-usuário e que perpassam esse primeiro, dentre elas a instituição saúde, a enfermagem e a assistência social que, no caso, dão-se por uma faceta do controle, do seguimento de regras, e estão intensamente presentes nas relações estudadas. Por outro lado também pude captar alguns momentos em que os trabalhadores conseguiram realizar um cuidado mais ampliado, exercendo uma escuta empática e deixando para segundo plano as tecnologias duras e leve-duras, experimentando um pouco mais das tecnologias relacionais, de comunicação e escuta, colocando o usuário em evidência e tentando realizar um cuidado usuário-centrado e em suas reais necessidades. A perspectiva do estudo era a produção de vida e autonomia do usuário nos encontros. Algumas questões foram compreendidas e outras não devido à complexidade do tema ao se tratar das relações. A pesquisa também explorou apenas a perspectiva do trabalhador, ficando desconhecida a perspectiva do usuário, por isso a necessidade de novos estudos que caminhem por esse universo relacional por meio de um olhar vibrátil que consiga enxergar o que se passa entre as forças presentes nesses encontros
The object of this study were the relations between workers and users of the health service under the worker\'s perspective in the context of a Family Health Strategy (ESF) unit in the city of Franca, SP. For this, the theoretical references of the work process in health, the micropolitics of the work process and the subjectivity production were used. We know that the work in health involves a relational space, in other words, for this work, there must be another one, this one, understood as someone who has care needs, and it is in the encounter with this other one that there is the production of an act of health. On this thematic, the research aimed to map and to analyze the relationships between professionals and users of the ESF in the care production from the workers\' perspective. To respond the study objectives, more open and inventive investigative procedures were needed; one vibratable look, sensitive to movements that could pick up the vibrations. Therefore, to meet this purpose, of studying the subjectivity production processes in relations between professionals and users of the ESF, the research made an approach to the cartographic method, that regards to the strategies of desire formations in the social field, their movements and their connections that can arise from several places. The cartographer dives into the affections and always seeks elements to compose and complement its cartography. Here, the knowledge is given in the process, being inseparable from the movement of life and its affections. In this same movement, the study adopted the intervention research that assumes that the process of knowing and doing, and of researching and intervening, are inseparable. Thus, the goals and the paths are traced throughout the process to be searched, with its object and purpose as north. It was important to establish some tools for the data production, among them, the participative observation, the use of the on board diary and the semi-structured interview. In addition to these tools the study also included a first phase which was the field exploration, which allowed a rich dialogue with reality. Given the scenario studied, I could see that what stands out the most in relationships is still the prevalence of a hegemonic model of health care centered on technical and procedural protocols to the detriment of lightweight relational technologies, which enables and expands a more comprehensive care and of production of life. In the study we also realize that some institutions are present in the worker-user encounter, running through this first, among them, there are the institution health, nursing and social assistance that in the case emerge by a control facet of following rules and are intensely present in the studied relations. On the other hand, I could also capture moments in which workers managed to realize a broader care acting for an empathic listening and to leave in the background the hard and soft-hard technologies, experimenting relational technologies a little more, communication and listening, putting the user in evidence and trying to accomplish an user-centered care based in their real needs. The study perspective was the production of life and user autonomy in encounters. Some questions were understood and others not due to the issue\'s complexity when dealing with relations. The research also explored the worker\'s perspective only, being unknown the user\'s perspective, therefore, new studies are needed to walk this relational universe through a vibratable look that can see what goes on between the forces presents in those encounters

I Sverige insjuknar 250-300 barn varje år av cancer. De cancertyper som drabbar barn är vanligtvis inte de samma som vuxna utvecklar. Olika cancerformer kräver olika typer av behandling, dessa är cytostatika, operation samt strålbehandling. Sjuksköterskan skall kunna möta föräldrar och barn samt uppfatta deras lidande för att kunna tillfredställa behovet av en god omvårdnad. För föräldrarna upplevs barnets cancerdiagnos ofta som ett svårt lidande, som kan kännas helt outhärdligt. När ett barn är svårt sjukt i cancer innebär detta en långvarig kontakt med sjukvården för hela familjen. Det är en svår och stressfull situation för familjen och deras välbefinnande påverkas av vårdarens agerande.Syftet med studien är att beskriva föräldrarnas uppfattning av vad som är god vård i samband med behandling av det cancersjuka barnet på sjukhus. Metoden är en litteraturstudie där åtta kvalitativa artiklar analyseras enligt Evans (2003) metod.Resultatet presenteras utifrån fem teman som är: Anpassad information, Kontinuerlig vårdrelation, Emotionellt stöd, Familjens delaktighet i vården samt Lugn vårdmiljö.Det mest framträdande i resultatet är att information är grunden till att föräldrarna skall uppleva att deras barn får en god vård. En adekvat given information med lyhördhet inför den enskilde förälderns behov och önskemål resulterar i en mer tillfredställd förälder.
Program: Fristående kurs

Orientador: Regina Yu Shon Chun
Dissertação (mestrado profissional) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Introdução: Diversos fatores como a desnutrição materna, a prematuridade extrema e síndromes diversas, dentre outros, podem acarretar alterações no desenvolvimento infantil. Mediante as alterações, a intervenção oportuna pode favorecer o progresso global dessas crianças com risco, considerando-se que essa atuação envolve a participação de familiares/cuidadores e de uma equipe interdisciplinar, dentre os quais o fonoaudiólogo. No Brasil, são poucos os protocolos padronizados para avaliação de linguagem. Nas áreas de terapia ocupacional e fisioterapia, um dos instrumentos utilizados para avaliação pediátrica de incapacidade é o PEDI - Pediatric Evaluation of Disability Inventory que se mostrou viável para investigação dos aspectos de comunicação e interação social das crianças de risco que compõem este estudo. Objetivos: Analisar a interação social e comunicação de crianças com alterações neuromotoras sob a ótica de familiares/cuidadores e do fonoaudiólogo e caracterizar o perfil das crianças e dos familiares/cuidadores. Sujeitos e Método: A pesquisa foi aprovada pelo CEP-FCM/UNICAMP e submetida à anuência da Instituição e dos sujeitos do estudo. Participaram 35 familiares/cuidadores de 38 crianças de 12 a 36 meses, com alteração neuromotora e fatores de risco para o desenvolvimento, atendidas no Programa de Estimulação Precoce da APAE de uma cidade de médio porte do interior de São Paulo e uma fonoaudióloga (terapeuta e pesquisadora). A coleta de dados foi feita por meio de três fontes: (i) estudo dos prontuários para caracterização dos perfis das crianças quanto à idade, sexo, diagnóstico e tempo de atendimento na Instituição; (ii) levantamento de informações com familiares/cuidadores para caracterização dos seus perfis quanto à idade, escolaridade e profissão e (iii) aplicação do PEDI, tendo sido utilizada a primeira parte desse instrumento, voltada as habilidades de função social, em que se incluem os aspectos de comunicação e de interação social. Os procedimentos de coleta de dados envolveram, com os familiares/cuidadores, o método de entrevista e com a profissional, o método de julgamento clínico. Foi realizada análise estatística descritiva, inferencial e fatorial dos dados em comparação aos valores de referência do PEDI. Resultados: Em relação à distribuição por diagnóstico das crianças, a paralisia cerebral apresentou maior freqüência. A maioria dosfamiliares/cuidadores são mães (88%) e uma parcela pequena, avós (6%) e pais (3%), com idade variando entre 19 e 45 anos, com predominância de ensino médio completo e de profissão relatada como sendo profissional do lar (67%). As respostas dos familiares/cuidadores demonstraram maior concordância na habilidade de comunicação (68%), seguida das habilidades de casa/comunidade (56%) e de interação social (53%). As respostas do PEDI evidenciam atraso no desenvolvimento nas habilidades de comunicação e interação social das crianças estudadas em relação aos valores desse instrumento tanto na ótica dos familiares/cuidadores quanto na do profissional/pesquisador. Conclusões: De modo geral, a maioria das crianças do estudo apresenta valores abaixo daqueles de referencia do PEDI, evidenciando atraso em habilidades de interação social e comunicação. Os resultados demonstram o PEDI como um instrumento útil e complementar à avaliação clínica, no caso fonoaudiológica. Oferece subsídios ao conhecimento das habilidades funcionais referentes à função social (comunicação e interação), que podem auxiliar a nortear o profissional, assim como a equipe, no delineamento de estratégias de intervenção, obtendo-se dados junto à família e aos profissionais envolvidos tendo em vista o favorecimento da linguagem e interação, e conseqüente, autonomia e qualidade de vida do da criança com risco para o desenvolvimento. Tal perspectiva evidencia as possibilidades do instrumento em uma abordagem multi ou interdisciplinar tendo em vista a atenção integral à saúde do grupo populacional estudado
Abstract: Introduction: Several factors such as maternal malnutrition, extreme prematurity, and various syndromes, among others, could cause changes in child development. In this case, timely intervention can promote the overall progress of these children at risk, considering that this action involves the participation of family / carers and a multidisciplinary team, of which the audiologist. In Brazil, there are few standardized protocols for assessment of language. In the areas of occupational and physical therapy, one of the instruments used for pediatric evaluation of disability is the PEDI - Pediatric Evaluation of Disability Inventory that proved viable for investigation of aspects of communication and social interaction of children at risk making up this study. Objectives: To analyze the social interaction and communication of children with neuromotor from the perspective of family / caregivers and the Speech and Language Pathologist and to characterize the profile of children and families / caregivers. Subjects and Methods: The study was approved by CEP-FCM/UNICAMP and submitted for approval at the institution of the study. Participated in 35 family members / caregivers of 38 children aged 12 to 36 months, with neuromotor and risk factors for the development, attended the Early Stimulation Programme of APAE of a midsize city in the interior of São Paulo and a Speech and Language Pathologist (therapist and researcher). Data collection was done through three sources: (i) study of medical records to characterize the profiles of children in age, sex, diagnosis and time of attendance at the institution, (ii) information gathering with family / caregivers to characterize their profiles as to age, education and occupation, and (iii) implementation of the PEDI, has been used the first part of this instrument, focused social function skills, which include aspects of communication and social interaction. The data collection procedures involved with the family / caregivers, the interview method and with the professional, clinical trial method. We performed descriptive statistics, inferential and factorial data compared to the reference values of the PEDI. Results: Regarding the distribution of diagnosis, children with cerebral palsy was more frequent. Most family members / caregivers were mothers (88%) and a small portion, grandparents (6%) and parents (3%), aged between 19 and 45 years, withpredominance of high school education and occupation as reported work from home (67%). The responses of family members / caregivers showed greater agreement on communication skills (68%), followed by the skills of home / community (56%) and social interaction (53%). The responses of the PEDI showed developmental delays in communication skills and social interaction of children studied in relation to the values of the instrument both in the perspective of family / caregivers and the professional / researcher. Conclusions: In general, the majority of children in the study presents reference values below those of the PEDI, showing delay in skills of social interaction and communication. The results demonstrate the PEDI as a useful and complementary to clinical evaluation, speech therapy in the case. Provides grants to the knowledge of functional skills related to social function (communication and interaction), which can help to guide the professional as well as the team, the design of intervention strategies, obtaining data from family and professionals involved, in light of language's and interaction's view and consequently, autonomy and quality of life of the child at risk for development. This perspective highlights the possibilities of the instrument in a multi-or interdisciplinary approach with a view to comprehensive health care for the population group studied
Mestrado
Mestre em Saúde, Interdisciplinaridade e Reabilitação

The hospitalization of a family member in an intensive care unit can be a very stressful time for the family. Family bedside rounds is one way for the care team to inform family members, answer questions, and involve them in care decisions. Few studies have examined the experiences of family members with ICU bedside rounds. A qualitative descriptive study, undergirded by the Family Management Style Framework developed by Knafl and Deatrick (1990, 2003) and Knafl, Deatrick, and Havill (2012), was done at an academic medical center examining families who both participated and did not participate in the family bedside rounds. The majority of families who participated (80%) found the process helpful. One overarching theme emerged from the data of participating families: Making a Connection: Comfort and Confidence. Two major factors influenced how that connection was made: consistency and preparing families for the future. Three types of consistency were identified: consistency with information being shared, consistency about when rounds were being held, and consistency with being informed of delays. The second major contributing factor was preparing families for the future. When a connection was present, families felt comfortable with the situation. When any of the factors were missing, families described feelings of anger, frustration, and fear. Family members who did not participate described feelings of disappointment and frustration about not having participated. As healthcare providers, what we say to families matters. They need to be included in decision-making with honest, consistent, easy-to-understand information.

What is the nature and purpose of Family Learning? The discourses relating to how a strong home-school relationship affects attitudes to Lifelong Learning and the impact of paternal involvement in young children's development have been well researched and document clear links and positive, enduring benefits for families and professionals. In spite, or perhaps because of this focus, the means by which these connections are achieved and maintained remains less well explored. The issues that need addressing now are more tangible challenges, such as: what does good practice look like, who decides which notions are consolidated, when and why? Coupled with questions such as how do we get more fathers more involved and what will enable these relationships to flourish, this research reports on the initial findings from a small-scale exploratory inquiry, conducted as part of a professional doctorate, which considers a possible approach to these issues. It is an illuminative case study, located within an interpretive research paradigm, based on ontological assumptions of empowerment and emancipation for participants. A sociocultural epistemology informs and frames the work. The study sets out to explore the value and potential of Family Learning as a means of focused intervention in response to the questions raised, whilst also examining and increasing awareness of the issues involved, as seen by participants, to facilitate the expression of paternal agency and voice within the research process. The data collection, conducted over a period of six months, focuses on an existing Fathers’ Group, as they participate in a Family Learning project. It seeks to establish the nature and purpose of this type of provision, by clarifying the processes, outcomes and determinants of involvement through the eyes of the fathers, as they define and ultimately come to terms with their own identity and roles, in relation to their young children's development. The research centres on two workshops supported by several participant-led focus meetings. Two semi-structured staff interviews offer insight into the role that both professional and personal cultural and historical understandings of Family Learning play in the process, whilst the data analysis illuminates and describes the relationships between parents and practitioners, policy and pedagogy. The research observations could be used to inform approaches to both the establishment and the development of individual, personalised family frameworks for Lifelong Learning. The findings may also contribute towards a fresh perspective and offer creative approaches for professionals, in which pedagogical practice is not pre-determined but constantly evolving, on an equal and collaborative basis, between professionals and participants. This study offers a critical examination of grassroots Family Learning in practice. It is firmly embedded within and responsive to the needs of its local community. It aims to provide independent evidence to reinforce and extend the current knowledge base and ultimately, to maintain, strengthen and expand the connections between Family and Lifelong Learning.

Studiens syfte var att undersöka sjuksköterskors upplevelser av att ge stöd till anhöriga till patienter inom palliativ hemsjukvård.

Designen var deskriptiv med en kvalitativ ansats. Informanterna var strategiskt utvalda och bestod av fem sjuksköterskor som arbetade i ett palliativt hemsjukvårdsteam i Upplands län. Bandinspelade personliga intervjuer analyserades med en kvalitativ innehållsanalys.

Sjuksköterskorna upplevde att deras arbete kändes meningsfullt och utvecklande. Att arbeta i team var en mycket positiv aspekt. De svårigheter som framkom handlade om att anpassa sig efter olika situationer. Sjuksköterskorna gav stöd till anhöriga främst genom att kommunicera och samtala, samt förmedla trygghet. Det var viktigt att även både verbalt och praktiskt visa anhöriga att det fanns tid även för detta.

Eftersom det blir allt vanligare med palliativ vård i hemmet och den inte kan ske utan de anhörigas insats är det mycket viktigt att utveckla och optimera sjuksköterskans stöd till dem. Denna studie kan ge en insikt i de problem som finns i anhörigstödet, men även ge en insikt om de organisatoriska och personella insatser som fungerar.

The aim of this study was to investigate nurses' experiences in supporting next of kin to patients in palliative home care.

The design was descriptive with a qualitative approach. The informants were strategically selected and consisted of five nurses, working in a palliative home care team in Uppland, in Sweden. Tape-recorded personal interviews were analysed with a qualitative content analysis.

The nurses experienced that their work felt meaningful and developing. To work in a team was a very positive aspect. Difficulties that appeard involved adjusting to different situations. The nurses supported next of kin mainly by communicating and conversing, and mediating safety. It was important to as well both verbally and practically show next of kin that there was also time for this.

Since palliative care in the home is getting more common, and since it cannot happen without the effort of next of kin, it is very important to develop and optimize the nurses' support to them. This studie can give insight in the problems that exist in this support, but also give insight about the organizational and personal achievements that work.

A presença da família durante a realização de procedimentos invasivos e/ou da reanimação cardiopulmonar em pediatria é um tema presente nos debates desencadeados pela literatura nos últimos anos. Atualmente essa é uma prática determinada pelas atitudes dos profissionais em permitir que a família esteja presente nesses momentos. É fundamental conhecer o significado que a própria família atribui ao fato de permanecer ou não no atendimento de emergência. Os objetivos deste estudo foram: conhecer a experiência e as crenças das famílias a respeito de sua permanência na sala durante o atendimento de emergência à criança e identificar as percepções e as crenças de profissionais de saúde em relação a presença da família durante o atendimento de emergência. Método: Trata-se de estudo exploratório, com abordagens quantitativa e qualitativa. A amostra foi constituída por 46 profissionais de saúde de um serviço de emergência pediátrica de um Hospital Universitário de São Paulo e 6 famílias de crianças atendidas na sala de emergência do mesmo serviço. Para a identificação da percepção e crenças dos profissionais foi utilizado um questionário semi-estruturado de auto-preenchimento e a análise foi realizada segundo os parâmetros da estatística descritiva. Com as famílias foi utilizada a investigação narrativa e os dados obtidos foram analisados buscando identificar temas principais. Resultados: Os profissionais de saúde possuem dois tipos de crenças relacionadas à experiência: (1) crenças que apoiam a presença da família a família observa os esforços realizados para salvar a vida da criança; a família fornece informações importantes; a família possibilita que a criança fique mais colaborativa; a família não interfere no atendimento; dar tranquilidade à família; é um direito da família; o lugar dos pais é do lado do filho; e a família dá conforto à criança e (2) crenças que restringem a presença da família a família interfere na atuação dos profissionais; não ter tempo para dar atenção à família; a família restringe o ensino aos estudantes; um profissional deve ficar junto com a família; gera memórias negativas do atendimento; e a família interfere no atendimento. A experiência das famílias foi organizada em cinco temas: a iminência de morte do filho; meu lugar é do lado do meu filho; ser reconhecido como importante; eu sei o que é melhor para mim; se eu tiver que passar por isso que seja assim. Os temas revelam a vulnerabilidade da família e a necessidade de estar presente e fazer escolhas na situação de atendimento de emergência do filho. Conclusões: O estudo revelou que tanto as famílias quanto os profissionais de saúde tem a necessidade de dar um sentido às experiências que vivem frente ao atendimento de emergência da criança. Para que se possa prestar uma assistência pautada no modelo do Cuidado Centrado na Família, é necessário que os profissionais de saúde compreendam as crenças de cada membro da família e possam reconhecer as suas próprias crenças, modificando-as quando não cooperam para as necessidades das famílias e para um relacionamento entre a família e os profissionais baseado no respeito, parceira e colaboração.
Family presence during invasive procedures and/or cardiopulmonary resuscitation in children is a recent and increasingly important issue in health practice. Currently it is determined by the attitudes of professionals to allow or not the family to be present in those moments. It is essential to understand the meaning of staying or not in emergency care for the family. The objectives of this study were to understand the experience and beliefs of families regarding their stay in the emergency room during care to children and to identify the perceptions and beliefs of health professionals regarding this family presence. Methods: This is an exploratory study with quantitative and qualitative approaches. Sample size was 46 health professionals from a pediatric emergency department of a university hospital in Sao Paulo and 6 families of children treated in the emergency room of the same service. To identify the perception of professionals was used a semi-structured self-completion questionnaire and analysis was performed according to the parameters of descriptive statistics. Narrative inquiry was used with families, the data obtained from interviews were analyzed in order to identify key themes in the narratives constructed. Results: Health professionals have two types of beliefs related to the experience: (1) beliefs that support family presence - efforts to save the child\'s life, provide important information, child becomes more collaborative, family does not interfere in attendance, allows tranquility to the family, is a family right, the place of a parent is the child\'s hand and comfort for the child and (2) beliefs that restrict the presence of the family - family interferes with the performance of professional; there is no time to give attention to the family; restricts students knowledge, a professional should be together with family, negative memories of care and family interferes in attendance. The experience of families was organized into five themes: the imminent death of his son, and my place is beside my son, be recognized as important, I know what\'s best for me if I have to go through it to be so . The themes reveal the vulnerability of the family and the need to be present and make choices in situations of emergency care of the child. Conclusions: The study revealed that both families and health professionals have the need to give meaning to experiences that live across the emergency care of the child. This sense can come to the fore through the stories told about these experiences: narratives of illness. To be able to provide assistance based on the model of the Family Centered Care, it is necessary that health professionals understand the beliefs of each family member and can recognize their own beliefs, modifying them when they do not cooperate in the choice of the family and a relationship between the family and professionals based on respect, partnership and collaboration.

A questão que orienta esse estudo se insere no contexto da orientação profissional que busca ocupar-se da pessoa que traz conflitos frente às suas escolhas de carreira e não dos conflitos em si. Aqueles que buscam por orientação em suas carreiras aqui considerados são jovens que na sua maioria almejam a entrada no mundo do trabalho através da porta do curso superior, e adultos vivendo momentos de crise em suas carreiras e necessidade de reconstrução de caminhos e também de estranhamentos com relação aos novos rumos que o contexto de trabalho vem assumindo. A lógica das relações de trabalho vem sofrendo alterações nos últimos trinta anos, como o escasseamento de contratos de trabalho formal, o aumento da oferta de mão de obra, as mudanças de cultura nas organizações, fruto de fusões ou aquisições por outras empresas, entre outras. A questão que se colocou, portanto, foi de como seriam afetados os adultos mais representativos de uma família nos grupos selecionados para esse estudo, os pais pelas mudanças da realidade das relações de trabalho por eles vivenciadas e a transmissão dessas vivências dentro do seio familiar. O objetivo deste trabalho, como um estudo exploratório, foi buscar subsídios que permitissem amparar a hipótese percebida empiricamente da existência de uma inter-relação entre a maneira como o adulto que trabalha enfrenta os desafios impostos pelo mundo do trabalho e o processo de escolha profissional do seu filho jovem, em fase de entrada nos cursos superiores. Para tal, foram delimitados alguns fatores que afetam diretamente a abrangência do fenômeno estudado. A família considerada foi a família de classe média, com seus valores, expectativas, participação social e projetos de futuro. As famílias observadas são compostas por pais casados morando junto com os filhos. Os pais são ambos profissionais ativos em suas áreas de trabalho, tendo grau de formação superior. Os filhos são estudantes egressantes de escolas particulares que buscam um curso superior. Foram entrevistadas quatro tríades familiares pai, mãe e filho que escolhe uma profissão e analisados os seus discursos com relação às dificuldades e estratégias de enfrentamento perpetradas pelos pais e expectativas e projeções no futuro elaboradas pelos filhos. Foram constatadas convergências nos discursos familiares de pais e filhos, no que concerne às dificuldades e estratégias de enfrentamento dos desafios vividos pelos pais e a possibilidade de elaboração de projetos de carreira dos filhos. Os modelos de carreira construídos pelos pais também tiveram correlação com as fantasias de futuro profissionais dos filhos. Assim, concluiu-se que, no âmbito do grupo social estudado, existe inter-relação entre a vivência profissional dos pais e o projeto profissional dos filhos
The question driving this study exists in the context of career counseling and focuses on individuals who are presented conflicting career choices, as opposed to the conflicting choices themselves. Among those seeking career counseling, the group selected consists of teenagers who in their vast majority are looking to enter the workforce through an undergraduate course; and adults undergoing a career crisis who need to rebuild their career paths, as well as those at odds with the new direction their work context is headed. The logic of the work relationships has gone through changes in the last thirty years, such as the diminishment of formal work contracts, the increase in labor supply, the organizational culture changes due to mergers or acquisitions by other companies, among others. Thus, the question placed was how the most representative adults in a family would be affected in the groups selected for this study, the parents by the changes in the reality of the work relationships they experience and the conveyance of these experiences to the family. The objective of this work as an exploratory study was to seek supporting evidence to the hypothesis observed empirically of the existence of a correlation between the manner in which a working adult faces the challenges imposed by the work space and the career planning process of their teenage children about to begin their undergraduate studies. To this end, a number of constraints were set in order to limit the scope of the study. The familial group considered was the middle class household with its values, expectations, social participation and projected future. The families observed were composed of married parents with live-in children. Both parents were active professionals in their respective work fields and had at least undergraduate degrees. The children were high school students graduating from private schools and seeking an undergraduate degree. Four family triads were interviewed father, mother and teenage child choosing a career and their discourse analyzed in relation to the difficulties and coping strategies engineered by the parents against the expectations and projected future formulated by the children. A correlation was found in the speech of parents and children relative to the challenges and coping strategies lived by the parents and the career planning composed by the children. The career models constructed by the parents also had correlation to the professional future fantasies of the children. Therefore, it was concluded that in the scope of the social group studied there is an interrelationship between the professional experiences of the parents and the career planning of their children

Aim: The overall aim of this thesis is, from the point of view of parents of a child with asthma, to describe meanings of being a parent, parents’ quality of life, and to describe how family relations are influenced by their child’s disease. The aim is also to increase the understanding of what strategies professional caregivers use in their work with teenagers suffering from asthma. Methods: Informants in the three qualitative studies were 29 parents (17 mothers and 12 fathers) of children with asthma and 7 professional caregivers. Informants in a quantitative quality of life study were 371 parents. The data collections were undertaken by means of interviews, observations and a questionnaire. The data was analysed by means of a phenomenological-hermeneutic method, grounded theory and statistics. Results: A meaning of being a parent of a child with asthma is to live a strenuous life and to fear that the child might die during a severe asthma attack. The parents’ actions involve both protecting and liberating and their feelings involve sadness as well as acceptance. Mostly the mothers act in a protecting manner and express feelings of sadness. The fathers mostly act in a liberating manner and express feelings of acceptance. The core concern in families of a child with asthma was found to be disease-engendered uncertainty. The mothers describe that feelings of uncertainty always are present owing to the unpredictability of the disease. These feelings make the mothers more or less available for family members. For the child with asthma the mothers’ experience that they are always available. Thus, control and tight bonds characterize the mother-child relationships. The mothers’ constant availability for the child with asthma is experienced to lead to a decreased availability for other family members and theses relationships are characterised by feelings of forsakenness and lack of understanding. However, when parents of children with asthma estimate their quality of life by a questionnaire, they estimate it as comparatively high. In the same family the parents scoring of separate items was to a large extent similar. The result also shows that professional caregivers’ central concern is to assist teenagers with asthma to conquer life. This gives rise to five strategies: showing respect, being at hand, promoting personal sense of responsibility, promoting exceeding boundaries, and promoting reflections. In professional caregivers’ attempt to assist teenagers to conquer life some differences are seen in the way they support boys and girls. Conclusion: One conclusion drawn from this thesis is that being a parent of a child with asthma involves feelings of uncertainty. In meeting the parents in question, caregivers should reflect upon these feelings and consider how the parents could be assisted. As mothers and fathers describe different attitudes in relation to the care of the child, it is also important to reflect upon how professional caregivers can assist the balance between the mothers’ protecting and the fathers’ liberating attitudes. It is also important for professional caregivers to reflect upon how they meet teenage girls and boys with asthma respectively, and to take their needs and understanding of the situation into consideration.

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
caretakers of children with hearing loss that would foster their adherence to the use of HA and their understanding of the initial orientation regarding auditory and language abilities. The applicability of the use of such material with Public Hearing Health Care Service users was investigated. Method: The material development was based on the underlying principles observed in clinical appointments at Centro Audição na Criança, which subsidized the structure and content to be addressed. A version was made using the following steps: organization of a prototype, partnership with a graphic designer and virtual group discussion with the professionals involved. The applicability of the material was assessed by means of its use with parents and caretakers during the routine process of HA selection/adaptation, the early stages of therapy and follow up appointments with children with hearing loss. The subjects were: parents/ caretakers accompanying the patients, children whose HA would allow daily measures of use, and audiologists responsible for the therapy sessions with these subject children. For the analysis of the preliminary version of the material, the following steps were used: a script for registering applicability, measurements of average daily use of HA and interview guides for parents/ caretakers and audiologists. A brainstorming session with qualified professionals in the area of hearing loss was conducted to refine and collect ideas to inform the production of the final version of the illustrated material. Results: The preliminary version of the illustrated material was presented in A5 size booklet format with spiral binding. The booklet content addressed the following matters: HA handling and care, and orientation on hearing and oral language development. Participants of this study were: eight audiologists and 16 families, whose children s chronological age ranged between 6 (six) and 53 (fifty-three) months. The communication strategy of the contents was an interactive and pictographic one. As for adherence, many factors interfered in daily average use of HA. As for the general evaluation of the material, all parents/ caretakers considered it good and fifteen of them (93,75%) used it at home. All audiologists reported that the material addressed important issues of the early stages of HA adaptation and supported families and audiologists during the development process. The most frequently treated subjects were: adherence to use of HA (45%) and HA care (32%). The final version was prepared taking into account comments from parents, audiologists/ speech therapists who applied the preliminary version of the illustrated material and brainstorming results. Conclusion: The material was used at home by families and seemed to contribute to family involvement, since it expanded its influence to beyond the person accompanying the child to therapy sessions. The audiologists of the Public Hearing Health Care Service demonstrated good acceptance to the material because it has guided the rehabilitation process and was regarded as support both for the family and therapist. Adherence to HA use was heterogeneous among subjects and suffered interference from several factors during the HA process of adaptation. The use of the material can be considered as a facilitator in the communication process between families and therapist
Objetivo: desenvolver e avaliar um material ilustrado para pais e responsáveis de crianças com deficiência auditiva que facilitasse a adesão ao uso do AASI e a compreensão das orientações iniciais quanto as habilidades auditivas e de linguagem. Investigou-se sua aplicabilidade em usuários do SUS. Método: Para o desenvolvimento do material realizou-se um levantamento das premissas observadas nos atendimentos feitos no CeAC que subsidiaram a estrutura e conteúdo a serem abordados. Foi confeccionada uma versão por meio das seguintes etapas: organização de um protótipo, parceria com designer gráfico e discussão em grupo virtual com os profissionais envolvidos. A aplicabilidade do material foi avaliada a partir do uso com pais/responsáveis na rotina do processo de seleção/adaptação de AASI, etapas iniciais de terapia (ADAPTI) e dos retornos para acompanhamento de crianças com deficiência auditiva. Foram sujeitos: os pais/responsáveis que acompanhavam as crianças no fluxo do serviço, crianças cujos os AASI possibilitassem a medida diária de uso e fonoaudiólogos que realizassem as terapias das crianças que entraram como sujeito. Para análise da versão preliminar do material foram utilizados: roteiro de registro de aplicabilidade, medidas de uso médio diário dos AASI e roteiros de entrevista para responsáveis e fonoaudiólogos. Foi realizado um brainstorming com profissionais habilitados na área da deficiência auditiva para aperfeiçoar e coletar ideias para subsidiar a confecção da versão final do material ilustrado. Resultados: A versão preliminar do material ilustrado se apresentou em formato de livreto no tamanho A5, com encadernação espiral. O conteúdo abordou questões referentes: ao manejo, cuidados com o AASI e orientações quanto ao desenvolvimento da audição e linguagem oral. Participaram desta pesquisa oito fonoaudiólogos e 16 famílias, cuja idade cronológica das crianças variou entre seis e 53 meses. Seu conteúdo teve como estratégia de comunicação um modelo interativo e pictográfico. Quanto à adesão, muitos fatores interferiram na média diária do uso dos AASI. Quanto a avaliação geral do material, todos os pais/responsáveis analisaram como bom e quinze deles (93,75%) o utilizaram em casa. Todos os fonoaudiólogos justificaram que o material abordou assuntos importantes da fase inicial de adaptação dos AASI e sobre o desenvolvimento, apoiou a família e o profissional durante esse processo. Os assuntos mais tratados estiveram centrados na adesão ao uso (45%) e cuidados com os AASI (32%). A versão final foi confeccionada considerando as observações dos pais, fonoaudiólogos que aplicaram a versão preliminar do material ilustrado e os resultados do brainstorming. Conclusões: O material foi utilizado em casa pelas famílias e pareceu colaborar para o envolvimento familiar, já que ampliou sua influência para além da pessoa que acompanhava a criança as sessões de terapia. Os fonoaudiólogos de um serviço do SUS demonstraram boa aceitação ao material pois norteou o processo de reabilitação e foi considerado como apoio à família e ao terapeuta. A adesão ao uso do AASI foi muito heterogênea entre os sujeitos e sofreu interferência de diversos fatores durante o processo de adaptação dos AASI. A utilização do material pode ser considerado como um facilitador no processo de comunicação entre famílias e terapeuta

A presente tese propõe a análise das racionalidades que orientam as condutas produtivas dos agricultores familiares modernos. Estes, ao viabilizarem sua sustentabilidade social promovem diferentes ajustes nos sistemas de produção. O estudo das condutas foi realizado a partir das suas práticas sociais, tendo como eixo as relações estabelecidas entre os agricultores e o mercado nas dimensões de comercialização, de tecnologias e de sociabilidade. Levantaram-se duas hipóteses: a primeira está assentada na ideia de que os agricultores familiares modernos, para orientar suas condutas, constroem diferentes racionalidades, resultantes de significados embasados pela sustentabilidade social; a segunda destaca que a construção das identidades socioprofissionais dos agricultores são definidas pelas racionalidades. A perspectiva de abordagem baseou-se nos agricultores familiares. Para melhor entendimento destas condutas sociais, o estudo fundamentou-se nos tipos ideais de Weber, o que possibilitou substituir a diversidade de condutas por um conjunto inteligível, coerente e racional. O universo social desta investigação contemplou duas regiões políticas do Paraná, o Sudoeste e o Oeste, um espaço continuum em que predominam estabelecimentos de agricultores familiares e heterogeneidade produtiva. Para o levantamento das informações, foram realizadas entrevistas com auxílio de roteiros semi-estruturados com agricultores e informantes qualificados. O conceito de racionalidade social de Weber foi utilizado para compreender as condutas sociais dos agricultores. Os homens, ao criarem valores, atribuem significados as suas condutas cujos valores orientadores expressam-se em racionalidades. Os resultados do estudo permitiram verificar que os agricultores forjam diferentes racionalidades e que a (re)construção das identidades socioprofissionais são definidas pelas racionalidades adotadas, confirmando as hipóteses da tese. As racionalidades que orientam as condutas dos agricultores têm importante contribuição na construção do conceito de agricultura familiar; os agricultores podem, também, ser definidos pela sua racionalidade na interação que estabelecem com o mercado. Esta especificidade entre os agricultores familiares, por sua vez, passa a demandar das políticas públicas de Estado um caráter cada vez menos universal e mais específico.
The present study proposes the analysis upon the rationalities that guide the production conducts of modern family farmers who foster different adjustments in the production systems through their social sustainability practices. The study of these conducts was carried out based on their social practices, always from the axis of the relations established between the farmers and the market as far as commercialization, technologies and sociability are concerned. Two hypothesis were assumed: the first one is founded on the idea that modern family farmers make different rationalities in order to guide their conducts, and these rationalities are the result of significations which are based upon social sustainability; the second hypothesis suggests that the construction of farmers' social identities is defined by these rationalities. The approach perspective was based on family farmers. So as to better understand these social conducts, this study was grounded on Weber's ideal types, and that made it possible to substitute the diversity of conducts for an intelligible, coherent and rational material. The social universe of this research involved two political regions of Paraná: southwest and west, which are a continuum space where family farmers' establishments and productive heterogeneity dominate. In order to provide information gathering, interviews were conducted with farmers and qualified informants with the use of semi structured scripts. Weber's concept of social rationality was used to comprehend farmers' social conducts. Men attribute meaning to their conducts when they create values, and the values that guide their conducts are expressed in rationalities. The results of the present study made it possible to determine that farmers build different rationalities and that the (re)construction of their social professional identities are defined by the rationalities adopted by them, which confirms the initial hypothesis herein stated. The rationalities that guide farmers conducts strongly contribute to the construction of the concept of family farming; farmers can also be defined by their rationality regarding the interaction they establish with the market. Hence, this specificity concerning family farmers calls for state public policies that are characteristically more specific and less universal.

Background: To care for someone with a mental illness can be strenuous both mentally, socially and economically. Those close to the patient are often there as support before mental health care can intervene, and they are often there when the patient is discharged from the hospital. A good relationship between mental health care personnel and those close to the patient is of most importance for creating a feeling of participation in the care of the patient. This requires that the mental health care personnel are aware of the needs of those close and have knowledge of how to meet these. Aim: To describe how those close to someone - usually a relative or loved one - with a mental illness experience the treatment from mental health personnel Method: Literature review based on 17 articles with a qualitative perspective. Analyzed using a descriptive data analysis technique. Results: Results show that those close to someone with a mental illness often feel excluded in the care of their loved ones, and mental health personnel fail to satisfy the relative or loved one’s basic needs - especially in the area of providing them with information and showing them respect. This exclusion can be felt when the care provider shows the loved one / family member an authoritarian attitude rather than appreciating or acknowledging the importance of the knowledge that these loved one possess regarding the patient’s mental illness. The results show that in cases when mental health personnel have been accommodating to the needs of the next of kin by making them feel respected, heard and taken seriously the loved one have feelings of inclusion and participation in the caring process. Discussions: The foundation of the relationship between mental health personnel and those close to the patient is often established within the first meeting. It is therefore of utterly importance that the mental health professionals are aware of how their demeanor and attitude are affecting the next of kins perception of participation. The needs of those close to the patient can, in most cases, be satisfied with relatively small means. Keywords: Relative, relatives of the mentally ill, treatment by mental health care professionals, participation, professional-family relations
Bakgrund: Att vara anhörig till en närstående med psykisk ohälsa kan vara påfrestande såväl ekonomiskt som psykiskt och socialt. Anhöriga är oftast de som är där och stöttar och hjälper till både innan och efter sjukhusvistelsen. Ett gott bemötande från vårdpersonalen är ytterst viktigt för att känna delaktighet i vårdandet, detta förutsätter att personalen är väl medveten om anhörigas behov och kan tillgodose dessa. Syfte: Att beskriva anhörigas erfarenheter av bemötandet från psykiatrisk vårdpersonal Metod: Kvalitativ litteraturstudie inkluderat 17 artiklar med kvalitativt perspektiv. Data har analyserats med tolkande dataanalys. Resultat: Resultatet visar på att anhöriga till stor del känner sig exkluderade i vårdandet av deras närstående, vårdpersonalen misslyckas ofta med att tillgodose anhörigas behov, genom att visa upp en auktoritär attityd, inte erbjuda adekvat information och uppmärksamma anhöriga som den tillgång de faktiskt är. Resultatet visar även på tillfällen då vårdpersonalens agerande får anhöriga att känna sig inkluderade och respekterade genom att skapa en känsla av delaktighet i vårdandet. Diskussion: Mötet mellan vårdpersonal och anhöriga tenderar att fallera redan på ett tidigt stadium, då innerbörden av ett gott bemötande samt vikten av att etablera en fungerade kontakt många gånger glöms bort eller inte uppmärksammas. Delaktighet i vårdandet förutsätter att vårdpersonalen är uppmärksam på anhörigas behov, genom relativt enkla medel kan dessa i de flesta fall tillgodoses.

När döden inträffar plötsligt, har efterlevande inte fått någon chans till mental förberedelse inför dödsfallet. Efterlevande löper därmed stor risk att drabbas av komplicerade sorgereaktioner, med psykisk och fysisk ohälsa som följd. Denna grupp möts inte i tillräckligt stor utsträckning av strukturerad evidensbaserad omvårdnad, i proportion till efterlevande vid väntade dödsfall. Syftet med litteraturstudien var att belysa närståendes behov vid plötslig död samt att understryka relevanta omvårdnadsåtgärder i akuta skeden. Litteraturstudien är baserad på 13 vetenskapliga artiklar som på olika sätt behandlar närståendes behov vid plötslig död. Resultatet behandlar närståendes behov utifrån fem kategorier: bemötande, information, närvaro, avsked och uppföljning. Närstående upplever ofta brister i sjukvårdspersonalens förmåga att möta deras behov. Brister som rapporterats gäller framförallt närståendes behov av bemötande och information, vilket kan sätta djupa spår hos efterlevande. Kunskapen om nyttan av att möta efterlevandes behov av uppföljning efter plötsliga dödsfall bedöms i dagsläget inte vara tillräcklig. Kunskapen om närståendes behov vid plötsliga dödsfall behöver fördjupas. Ytterligare forskning krävs, då området i dagsläget är eftersatt. Initialt bör dock existerande forskning implementeras.

When sudden death occurs, the survivors do not have a chance to mentally prepare for the loss. Survivors suffer high risk of complicated grief reactions, resulting in mental and physical illness. This group is not met sufficiently by structured evidence-based care, in proportion to the care of survivors expecting the loss. The purpose of the literature study was to highlight the needs of relatives confronted with sudden death, and to emphasize relevant nursing measures in acute stages. This paper is a survey of literature based on 13 research articles, in various ways dealing with needs of bereaved confronted with sudden death. The result deals with the needs of close relatives based on five categories: caring, information, proximity, viewing the body and follow-up. Survivors often experience gaps in health professionals' ability to meet their needs. Deficiencies regarding relatives’ needs of caring and information often results in negative long lasting memories. Knowledge of the benefits of meeting the needs of survivors regarding follow-up after a sudden death, is to this date considered insufficient. Knowledge of survivors confronted with sudden death need to be further explored. Further research is required, since the area of current situation is neglected. Initially, however, existing research need to be implemented.

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CAPEs
Os profissionais da área de saúde muitas vezes se deparam com o desafio de comunicar más notícias aos familiares de recém-nascidos. Má notícia é definida como qualquer informação que produza uma alteração nas perspectivas da pessoa e/ou família sobre o seu presente e futuro. Estes profissionais podem apresentar dificuldades e desconforto ao comunicar más notícias, sendo necessário o desenvolvimento de habilidades comunicacionais, na perspectiva de uma relação empática, de uma atuação interdisciplinar e estabelecer uma relação humanizada para que esse processo seja realizado com mais efetividade, evitando danos e/ou traumas aos familiares dos recém-nascidos. Diante desse contexto, o objetivo do presente estudo foi compreender como se dá o processo de comunicação de más notícias no contexto de uma Unidade de Terapia Intensiva Neonatal (UTIN) na perspectiva dos profissionais. O estudo foi descritivo e exploratório, de abordagem qualitativa. Foram realizadas entrevistas com 16 profissionais da área de saúde de nível superior que atuam no contexto de uma UTIN, em um hospital localizado em Recife/PE. As entrevistas foram gravadas e transcritas. Para análise dos dados foi utilizada a técnica de análise de conteúdo na modalidade temática, teve o auxílio do software Atlas.ti (versão 7.0). Após a análise das entrevistas, os resultados foram agrupados em quatro códigos analíticos/temáticos: concepção de má notícia, comunicação da má notícia, sentimentos em relação à má notícia, estratégias na comunicação da má notícia. Os achados desta pesquisa servem de subsídios para nortear novos estudos, ampliando a discussão sobre o tema em questão. É importante que as Instituições de Ensino Superior da área de saúde no Brasil construam novas propostas curriculares pautadas nas orientações definidas pelas Diretrizes Curriculares Nacionais para os cursos de saúde. Além de trabalhar estas questões dentro da academia durante a formação, é prudente que o tema estudado esteja inserido nos diversos cenários do cuidar em saúde, através da Educação Permanente, promovendo desta forma humanização, integralidade, trabalho interdisciplinar, visão holística, ou seja, valorização do ser humano em todos os seus aspectos.
Health professionals are often faced with the challenge of communicating bad news to families of newborns. Bad news is defined as any information that produces a change in a person and / or family’s perspectives about your present and future. These professionals may have difficulty and discomfort when communicating bad news, being necessary to the development of communication skills, the prospect of an empathic relationship, an interdisciplinary approach and establish a humanized respect for this process to be done more effectively, preventing damage and / or trauma to the families of newborns. In this context, this study aimed to understand how is the process of breaking bad news in the context of a Neonatal Intensive Care Unit (NICU) from the perspective of professionals. The study was descriptive and exploratory qualitative approach. Interviews were conducted with 16 healthcare professional operating in the context of a NICU in a hospital located in Recife/PE. The interviews were recorded and transcribed. For data analysis we used the content analysis technique in thematic modality, had the help of Atlas.ti software (version 7.0). After analyzing the interviews, the results were grouped into four analytical / theme codes: conception of bad news, bad news communication, feelings about the bad news, strategies in communicating bad news. The findings of this research serve as subsidies to guide further studies, expanding the discussion on the topic in question. It’s important that the health of Higher Education Institutions in Brazil to build new curricular proposals guided by the guidelines defined by the National Curriculum Guidelines for health courses. In addition to discuss these issues during the academic studies, it’s prudent that the studied subject is inserted in various scenarios in health care, through Continuing Education, thus promoting humanization, completeness, interdisciplinary work, holistic view, in other words, recovery of the human being in all its aspects.

La literatura científica sitúa la autonomía del paciente en la toma de decisiones en el ámbito clínico, en una encrucijada entre dos posiciones éticas; el paternalismo y la elección informada. Analizar los textos de los registros de las historias clínicas y los discursos de las enfermeras, mediante una metodología cualitativa y desde la perspectiva de la ética foucaultiana, permite conocer los factores que determinan el poder de decisión de los pacientes. Este estudio revela que el paciente no es autónomo en la toma de decisiones sobre sus cuidados debido; a una determinada institucionalización de la atención, que marca los ritmos de las decisiones, a las características de las relaciones interprofesionales y a las dinámicas relacionales que se establecen entre los profesionales, en particular, de la enfermera con el paciente y la familia. Se debe liberar al paciente de las reglas impuestas, promoviendo su propia conducta, su propio estilo de vida.
The scientific literature places the patient autonomy in decision-making in the clinical setting, at a crossroads between two ethical positions, paternalism and informed choice. Analyze records of clinical histories and nurses discourses, using a qualitative methodology and from the perspective of foucauldian ethics, allows knowing the factors that determine the power of patient decision. This study reveals that the patient is not autonomous in making decisions about your care because, to a certain institutionalization of care, which marks the rhythms of the decisions, the characteristics of the interprofessional-relationships and relational dynamics that exist between professionals, in particular, of the nurse with the patient and family. It should free the patient from the rules imposed by promoting their own behavior, their own lifestyle.
La literatura científica situa l'autonomia del pacient en la presa de decisions en l'àmbit clínic, en una cruïlla entre dues posicions ètiques, el paternalisme i l'elecció informada. Analitzar els textos dels registres de les històries clíniques i els discursos de les infermeres, mitjançant una metodologia qualitativa i des de la perspectiva de l'ètica foucaultiana, permet conèixer els factors que determinen el poder de decisió dels pacients. Aquest estudi revela que el pacient no és autònom en la presa de decisions sobre les seves cures a causa, a una determinada institucionalització de l'atenció, que marca els ritmes de les decisions, a les característiques de les relacions interprofessionals i les dinàmiques relacionals que s'estableixen entre els professionals, en particular, de la infermera amb el pacient i la família. Cal alliberar el pacient de les regles imposades, promovent la seva pròpia conducta, el seu propi estil de vida.

Introdução: O relacionamento estabelecido entre profissionais de saúde, criança e família durante os cuidados de final de vida é complexo e multidimensional. Poucas evidências mostram como os relacionamentos são estabelecidos no contexto de final de vida da criança e influenciam no luto após a morte de um filho. Objetivo: Interpretar a experiência de pais sobre os relacionamentos estabelecidos com os profissionais de saúde durante o final de vida da criança com câncer no hospital. Método: Trata-se de uma pesquisa qualitativa, guiada pela hermenêutica filosófica de Gadamer. A coleta dos dados foi realizada por meio de observações de campo em um hospital oncológico pediátrico com famílias de crianças hospitalizadas em situação de final de vida, entrevista com pais enlutados pelo menos 6 meses após o óbito da criança e análise de prontuários. Para a análise dos dados, o processo de transcrição, leitura e releitura dos dados, revisão das notas de campo e reflexão sobre os dados com outros pesquisadores ajudaram na compreensão do fenômeno para a geração de interpretações. Para tanto, foram identificadas unidades de significados nos dados que, posteriormente, foram agrupadas por similaridade para a formação indutiva de temas. Resultados: Os relacionamentos entre pais e profissionais da saúde no final de vida da criança com câncer hospitalizada desvelam fenômenos do encontro e da interação interpessoal presentes na situação de doença, morte e perda. Esses relacionamentos são permeados pela presença de valores humanos e são estabelecidos de forma dinamica com vínculos diversos. Existem componentes evidentes no relacionamento durante o final de vida da criança no hospital, tal como o amparo, o silêncio, a deterioração, a tolerância, a hierarquia, o compartilhamento e a confiança, bem como, fatores internos e externos que influenciam nas interações. Por meio dos relacionamentos, os pais reavaliam o próprio papel, enquanto vivenciavam a experiência inesperada de perder um filho e significados atribuídos à doença e à perda são associados aos encontros mesmo anos após a morte do filho. Considerações finais: Os relacionamentos servem de base para fortalecer e suportar os pais a exercerem o papel de cuidadores para garantir a excelência no cuidado do filho. A qualidade dos relacionamentos entre pais e profissionais da saúde torna-se uma lembrança marcante no processo de luto e estabelecem uma conexão permanente com o filho falecido. Um olhar para o relacionamento entre familiares e profissionais integrando a ciência do cuidado proporciona a base de paradigmas não positivistas, que são urgentes nas situações de final de vida. Este estudo pode contribuir com as políticas de enfermagem na consolidação de futuras diretrizes sobre a qualidade na prática do cuidado de final de vida da criança, facilitando para as famílias manter vínculos significativos durante o processo de doença, perda e luto.
Introduction: The relationship established between family and healthcare providers during the childs end-of-life care is complex and multidimensional. There are few evidences which explore how these relationships during the childs last hospitalization influence familial adaptation after loss. Objective: To interpret parents experience in their relationship with healthcare providers during the childs end-of-life with cancer in the hospital. Methods: This is a qualitative research, guided by Gadamers philosophical hermeneutics. Data collection was through field observations conducted in a pediatric oncology hospital with hospitalized families in end-of-life situation, interviews with bereaved parents at least 6 month after the childs death and medical records analysis. For the data analysis, the process of transcription, reading and re-reading the data, reviewing field notes and reflection on the data with other researchers helped understand the phenomenon to generate interpretations. Therefore, units of meaning emerged from the data were grouped, and themes were inductively determined and submitted to an interpretation process. Results: Relationships between parents and healthcare providers during a childs end-of-life process unveil the encounters and interpersonal interactions phenomena in illness and loss trajectory. These relationships are permeated with human values and are established in a dynamic way with various bondings. There are evident components in a child´s end-of-life context, such as presence, silence, deteriorations, tolerance, hierarchy, collaboration and trusting, as well as internal and external factors which influence the interactions. Through relationships, parents reevaluate their own role, while they live the unexpected experience of losing a child and attribute meanings to the loss. Final considerations: Relationships serve as a basis for strengthening and supporting parents in providing excellence in the child\'s care. The quality of the relationship between parents and healthcare providers is a remarkable memory of the child\'s life during the bereavement process. Looking into the relationship between parents and providers integrating it with caring science provides a basis for non-positivist paradigms which are urgent in end-of-life situations. This study aims to contribute to end-of-life nursing policies in recognizing the components to improve the quality of the relationships as a starting point for care which will allow families to have a safe base while experiencing the child\'s illness and the bereavement process.

Este estudo teve como objetivo conhecer a percepção da equipe de enfermagem sobre a presença e a participação do acompanhante da criança na Unidade de Internação Pediátrica UIP. O local de coleta foi a UIP de um hospital terciário de referência da zona leste de São Paulo. Incluiu 19 profissionais da equipe de enfermagem, sendo: 05 enfermeiros e 14 auxiliares de enfermagem. Método: utilizou-se a análise temática de conteúdo de entrevistas individuais semiestruturadas, que possibilitou a identificação de quatro categorias que explicam tal percepção: 1) permanência do acompanhante: entre direito e dever, que descreve aspectos referentes ao conhecimento dos profissionais da equipe de enfermagem em relação à permissão da permanência do acompanhante, bem como as atribuições que estes outorgam aos acompanhantes; 2) responsabilidades da equipe de enfermagem frente aos acompanhantes, que descreve as percepções dos participantes sobre suas funções em relação ao acompanhante; 3) presença do acompanhante: benefícios e transtornos, que mostra a percepção da equipe quanto aos benefícios dessa presença à criança, à família e à equipe e, relaciona transtornos como as situações de desrespeito às normas e rotinas, falta de apoio ao trabalho da equipe de enfermagem, bem como descuido da criança e 4) conhecimento ético-legal sobre ações privativas da equipe de enfermagem na UIP, que apresenta as opiniões sobre o que seria permitido, ou não, em relação aos cuidados prestados pelos acompanhantes às crianças, de acordo com o código de ética e a lei do exercício profissional de enfermagem. Em todas as categorias, existem percepções divergentes, até conflitantes, o que aponta para a necessidade de incluir o tema na formação permanente dos trabalhadores. O estudo possibilitou conhecer as percepções da equipe de enfermagem sobre o acompanhante, proporcionando subsídios para um plano de desenvolvimento dessa equipe com vistas a melhorar suas atividades educacionais e assistenciais à criança e à família.
This study aimed to understand the perception of the nursing staff about the presence and involvement of the companion of children in the Pediatric Inpatient Unit - PIU. The collection site was the PIU in a tertiary hospital in the area east of Sao Paulo. Included 19 professional nursing staff, as follows: 05 nurses and 14 nursing assistants. Method: we used the thematic content analysis of semistructured interviews, which allowed the identification of four categories that explain this perception: 1) permanence of the companion: between the right and duty, which describes aspects related to the knowledge of professional nursing staff permission in relation to the permanence of the companion, as well as the functions that these caregivers to bestow, 2) responsibilities of the nursing staff compared to the attendants, who describes the participants\' perceptions about their duties in relation to companion, 3) presence of the partner: benefits and disorders, which shows the staff perception of the benefits that presence of children, family and staff, and related disorders such as situations of disrespect for rules and routines, lack of support for the work of the nursing staff, as well as oversight child and 4) knowledge about ethical and legal actions involving deprivation of nursing staff in the IPU, which presents the views on what is permitted or not in relation to the care of the companions to children, according to the code of ethics and law of professional nursing. In all categories, there are differing perceptions, even conflicting, pointing to the need to include the topic in the training of workers. The study allowed to know the perceptions of the nursing staff on the companion, providing subsidies for a development plan for this team in order to improve its educational and welfare of children and family.

This study compared the levels of professionalism among Indiana corporate and agency public relations practitioners. The entire population, 339 individuals, was contacted via telephone and administered McLeod and Hawley's professional orientation instrument, yielding 183 usable responses.Respondents rated the importance of 24 items on a 5point Likert scale, and provided information on age, education, undergraduate major, salary, and length of time with current organization, in public relations, and in the workforce.Professionalism scores were calculated by subtracting the sum of answers to the non-professional items from the sum of answers to the professional items. Scores were ranked, then divided at the median. "Professionals" fell at or above the median; "semi-professionals" fell below the median,following McLeod/Hawley methodology.A multiple regression analysis determined the only significant relationship between level of professionalism and demographics occurred with undergraduate major--a slight negative correlation. Frequency distribution showed journalism/public relations majors had higher percentages of professionals than either English or other majors.
Department of Journalism

Sammanfattning Nyckelgården är ett HVB-hem med inriktning på behandling av föräldrar och barn. Den primära anledningen till att familjer placeras är omsorgsbrist hos föräldrarna. Detta innebär vanligen föräldrarnas svårigheter att kontrollera sina egna känslor och frustrationer, vilket har lett till en oförmåga att prioritera barnens känslomässiga behov. Nyckelgården erbjuder kvalificerad behandling i förälder-barnrelationen och arbetar även med svårigheter knutna till självutveckling, social kompetens och nätverk. Syftet med vår studie var att utvärdera Nyckelgården för att arbetet där ska kunna utvecklas och förbättras. Vi har genomgående utgått från ett brukarperspektiv för att förmedla tidigare klienters upplevelse av sin vistelse på behandlingshemmet. De frågeställningar som konkretiserar vårt syfte är; Hur har tidigare klienter upplevt bemötande och möjlighet till delaktighet under sin vistelse på behandlingshemmet? Har tidigare klienter upplevt någon form av förändring i sin livssituation till följd av familjebehandlingen? Vad upplevde tidigare klienter som mest givande under behandlingstiden och vad behöver förbättras? För att uppnå syftet med studien har vi genom kvalitativ metod genomfört intervjuer med fem av Nyckelgårdens tidigare klienter. Resultatet av intervjuerna har analyserats utifrån två teorier; Aaron Antonovsky’s teori om KASAM samt John Bolwby’s anknytningsteori, vilken Kari Killén utgår ifrån i sitt resonemang om professionell-klient relationen. Utvärderingen visar att respondenterna har upplevt delaktighet under sin behandling och att detta i flertalet fall har bidragit till motivation under behandlingsprocessen. Vidare visar resultatet att personalens förmåga att lyssna och visa empati upplevs som viktigt för respondenterna. Det mest givande med behandlingen upplevdes vara att de fick verktyg i form av kunskap för att bättre hantera sin föräldraroll samt hjälp till självhjälp i sin övriga livssituation. Majoriteten av respondenterna uttryckte att de upplevt positiva förändringar till följd av Nyckelgårdens behandling i form av mer fungerande relation och bättre samspel med sina barn. Vår slutsats av resultatet är att Nyckelgården är en väl fungerande verksamhet och att personalen fortsatt bör reflektera över sin förmåga att lyssna, visa empati samt bekräfta klienter i sin föräldraroll.
Abstract Nyckelgården is a treatment home that focuses on family preservation. The primary reason for placing families is care shortage from the parents. This means that parents display difficulties controlling their emotions and frustrations, which have led to an inability to prioritize the emotional needs of the children. Nyckelgården offers qualified treatment of the parent-child relationship and also work with difficulties regarding self-development, social abilities and social networks. The aim of our study was to evaluate Nyckelgården in order to develop and evaluate their work. Throughout our evaluation we originated from a client’s perspective in order to convey former clients experience of their time spent at the treatment home. The questions of issue have been; how have former clients experienced refutation and ability to participate during their stay at the treatment home? Have former clients experienced any kind of change in their life situation related to the family treatment? What did former clients experience to be most rewarding about their stay and what is in need of improvement? In order to attain the aim of the study we have trough qualitative method performed five interviews with former clients of Nyckelgården. The result of the interviews have been analyzed with the help of two theories; Aaron Antonovsky and his theory of KASAM and John Bolwby’s theory of attachment from which Kari Killén have discussed professional- client relationships. The evaluation show that the respondents have experienced participation during their treatment and that in many cases this has led to improved motivation during the treatment process. Further, the result show that professional ́s ability to listen and display empathy proved important to the respondents. Most rewarding in relation to treatment was receiving tools in terms of knowledge to better deal with the parenting role and to experience a sense of empowerment. The majority of the respondents expressed that they experienced positive changes in relation to their treatment at Nyckelgården as well as improved interaction with their children. Our conclusion is that Nyckelgården is a well-functioning organization and that the professionals continuously should reflect on their ability to listen, display empathy and acknowledge clients in regards to their parenting role.

Sammanfattning

I Sverige avlider ca 90 000 personer varje år och antalet som avlider någon annanstans än på sjukhus ökar. Detta ställer högre krav på den palliativa hemsjukvården. Genom utbildning och riktlinjer kan sjuksköterskor i den palliativa vården ge patienter och närstående ökad livskvalitet och möjliggör valet av platsen att få avsluta sitt liv.

Syftet: med denna studie var att undersöka om samspelet mellan sjuksköterska, närstående och patient möjliggör en god omvårdnad och död i palliativ vård. Metod: Studien genomfördes som en litteraturstudie där sju kvantitativa och tio kvalitativa vetenskapliga artiklar granskades. Resultat: Fyra kategorier identifierades som hade betydelse för omvårdnaden och döden i den palliativa vården, Kommunikation, Relation mellan sjuksköterska, patient och närstående, Att dö hemma eller på hospice och Den goda döden. Kommunikationen visade sig ha en stor betydelse för samspelet i den palliativa vården. Resultatet visade att kommunikationen innefattar mycket mera än bara det verbala. Även humor som kan anses som banalt och oprofessionellt visade sig ha stor betydelse för samspelet i den palliativa vården och bidrog till att sjuksköterskan kom närmare patienten och närstående. Behovet av utbildning och kunskap inom den palliativa vården visades sig vara viktig för sjuksköterskor men även för patienter och närstående för att kunna ta beslut om var och hur patienten vill bli vårdad 

 

In Sweden the death of about 90 000 people each year and the number who die elsewhere than in hospital increases. This places greater demands on the palliative home care. Through education and guidelines can nurses in palliative care give patients and relatives increased quality of life and allow the choice of place to end his life.

The aim: of this study was to investigate if the interaction between nurse, relatives and patient facilitates a good care and death in palliative care. Method: The study was conducted as a literature study in which seven quantitative and ten qualitative research articles were reviewed. Results: Four categories were identified that were relevant for nursing care and death in palliative care, Communication, Relationships between nurses, patients and relatives, To die at home or in hospice and The good death. The communication was found to have a large impact on the interaction in the palliative care. The results showed that the communication involved much more than just verbal. Although humor can be regarded as trivial and unprofessional proved to have a significant impact on the interaction and contributed to the nurse came closer to the patient and the relatives. The need for education and knowledge in palliative care were found to be important for nurses but also for patients and relatives to make decisions about where and how the patient wants to be nursed.

En intensivvårdssjuksköterska kommer i sin yrkesutövning ofta att möta närstående till svårt sjuka patienter. Tidigare studier har påvisat närståendes betydelse inom intensivvården och hur komplicerat samspelet med närstående kan vara, under de speciella omständigheter som råder på en intensivvårdsavdelning. Syftet med denna studie var att belysa intensivvårdssjuksköterskans erfarenheter av aspekter som bidrar till att främja ett gott samspel med patientens närstående. En kvalitativ ansats har använts i studien. Datainsamling utfördes via halvstrukturerade intervjuer, styrda av en intervjuguide. Tio intervjuer genomfördes med intensivvårdssjuksköterskor som arbetade på två olika intensivvårdsavdelningar i mellansverige. Inklusionskriterier var sjuksköterskor med specialistutbildning inom intensivvård med minst tre års erfarenhet av arbete inom specialiteten. Innehållsanalys av data genomfördes och tre huvudkategorier framträdde: Aspekter i intensivvårdsmiljön, Aspekter i den egna kompetensen samt Aspekter hos närstående. Resultatet visar att det finns åtskilliga aspekter, såväl i intensivvårdsmiljön som hos sjuksköterskorna själva samt hos de närstående, som kan bidra till att främja ett gott samspel. Intensivvårdsjuksköterskorna framhåller vikten av att vara förberedd samt att etablera en relation till de närstående. Hur väl detta lyckas påverkas av såväl yttre förutsättningar i intensivvårdsmiljön som den egna kompetensen. Resultatet indikerar även att färdigheter i att möta närstående erhålls genom yrkeserfarenhet, vilket väcker frågor om hur en oerfaren intensivvårdssjuksköterska hanterar samspelet med närstående.
A critical care nurse will in the course of her work often meet relatives of severely ill patients. Previous studies have confirmed the importance of relatives in intensive care and how complex the interaction with these may be, due to the special conditions existing in an intensive care unit. The purpose of this study was to highlight the critical care nurse's experiences of aspects that help improve a sound relationship with the patient's relatives. A qualitative approach was used in the study. Data collection was conducted through semi-structured interviews, guided by an interview guide. Ten interviews were conducted with ICU nurses who worked in two different intensive care units in central Sweden. Inclusion criteria were nurses with specialist training in intensive care, with at least three years experience of working in the ICU. Content analysis was conducted and three main categories emerged: Aspects of the intensive care environment, Aspects of their own competence and Aspects of significant others. The results show that there are several aspects. Both the intensive care environment, the nurses themselves as well as the patients relatives can help promote a sound relationship. Intensive care nurses stressed the importance of being prepared and to establish a relationship with the relatives. How well this succeeds is affected by both external conditions in the intensive care environment and the nurses own competence. The results also indicate that skills in meeting relatives is obtained by work experience, which raises questions about how an inexperienced ICU nurse does interact with relatives of patients.

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The problem of violence practiced in the family environment presents itself as a reality which is lived by a large number of children and adolescents nowadays, bringing about, together with the abusive use of parents’ authority, consequences to the children’s health. Facing such a problem, this research aimed at raising the discussion on home violence against children and adolescents and the fight against it in the Health System, through the Family Health Program in the city of Ponta Grossa. The general objective of this work is to discuss the phenomenon of home violence and analyze the interference of professionals in the Family Health Teams in this town. In order to achieve this objective, within a proposal of quantitative and qualitative research, an ample literature review was carried out to provide the basis and approach the reality directly, as well as to support the analysis of data collected. A questionnaire with open and closed questions and a semi-structured interview were used. The work is divided into four chapters. In the first chapter, the violence in social relations, including home violence against children and adolescents, is approached, considering its historical aspects and the legal constituted basis for its combat. The second chapter discusses home violence against children and adolescents, its concepts, manifestations, characteristics and its expression in the current social context. The relation between violence fighting and the Brazilian Health Policy as well as the role of the Family Health Program intervention on the problem are surveyed. Chapter four deals with the data analysis, the fight against home violence against children and adolescents by the Family Health Program in Ponta Grossa - PR. The research tried to contribute to the widening of the discussion about home violence against children and adolescents, pointing out the importance of the Family Health Program professionals’ interference. As final considerations we present suggestions to optimize these teams work towards the problem.
A problemática da violência praticada no meio familiar apresenta-se como uma realidade vivida por um grande número de crianças e adolescentes na conjuntura atual, trazendo, juntamente como o uso indevido da autoridade dos pais, conseqüências à saúde de quem a sofre. Diante dessa constatação, buscamos, com a presente pesquisa, trazer à tona discussão sobre a violência familiar contra crianças e adolescentes e seu enfrentamento na área da saúde, através do Programa Saúde da Família no Município de Ponta Grossa. Temos como objetivo geral discutir o fenômeno violência familiar contra crianças e adolescentes e analisar a atuação dos profissionais das Equipes de Saúde da Família desse Município junto aos casos de ocorrência desse problema. Para tanto, dentro de uma proposta de pesquisa quantitativa e qualitativa, valemo-nos de ampla revisão bibliográfica para fundamentar a abordagem direta da realidade, procedida através questionário com perguntas abertas e fechadas e de entrevista semi-estruturada, bem como para subsidiar a análise das informações obtidas através desses instrumentos. Nosso trabalho encontra-se dividido em quatro capítulos. No primeiro capítulo, abordamos a violência nas relações sociais, incluindo a violência ocorrida no meio familiar contra crianças e adolescentes, considerando seus aspectos históricos e as bases legais constituídas para seu combate. No segundo capítulo, discutimos o fenômeno violência familiar contra crianças e adolescentes, seus conceitos, suas manifestações, suas características e sua expressão na conjuntura atual. No terceiro capítulo, abordamos a relação entre o combate à violência e a política de saúde brasileira e o papel do Programa Saúde da Família na intervenção sobre a problemática. E, por fim, no quarto capítulo, apresentamos, através da análise dos dados coletados, o enfrentamento da violência familiar contra criança e adolescente pelo Programa Saúde da Família do Município de Ponta Grossa – PR. Buscamos, com a pesquisa proposta, contribuir para a ampliação da discussão sobre violência familiar dirigida a crianças e adolescentes, apontando a importância da atuação dos profissionais do Programa Saúde da Família frente a essa realidade. Em considerações finais, apresentamos sugestões no sentido de otimizar a atuação dessas equipes em relação ao problema.

Cette recherche s’intéresse particulièrement aux savoirs et aux compétences mobilisés par les parents haïtiens analphabètes pour favoriser la réussite scolaire de leurs enfants. Elle accorde une place de choix à la parole des enfants. Le département du Nord’Est, notamment la ville de Fort-Liberté est notre terrain de recherche. La population ciblée est composée de parents haïtiens analphabètes ayant des enfants en âge de scolarisation (7eme, 8eme ou 9eme année fondamentale), des élèves, des enseignants, des directeurs d’établissement. Notre objet de recherche porte spécialement sur l’étude des conditions d’aide et de médiation dans les interactions entre parents et enfants.Pour parvenir aux résultats de cette recherche, nous avons mobilisé l’approche de la didactique professionnelle tout en croisant les apports théoriques et conceptuels de nombreux auteurs, tels que Line Numa-Bocage pour la médiation didactique, Bernard Charlot pour le rapport au savoir, Pierre Pastré pour la didactique professionnelle, Lev Vygotski pour une approche socioconstructiviste. L’appareil méthodologique mobilisé englobe trois types de données : un questionnaire d’enquête, des entretiens semi-directifs, et des films-vidéos. Pour analyser les données, l’analyse de contenu préconisée par Laurence Bardin est mobilisée. L’objectif de cette recherche est d’une part, de cerner les stratégies éducatives parentales qui sont à l’œuvre dans l’éducation de leurs enfants afin de mettre à jour les savoirs et les compétences de ces parents considérés comme analphabètes; et d’autre part d’apporter un nouvel éclairage sur le problème de l’éducation en Haïti. En fait, nous espérons faire bouger les certitudes en y apportant des outils de réflexion permettant de mieux saisir les enjeux de la réussite scolaire
This research explores the knowledge and skills mobilized by illiterate Haitian parents to promote the academic success of their children, in the department of Nord’Est, the city of Fort-Liberté in particular. It gives a special place to children's words. The target population consists of illiterate Haitian parents with school-age children (grade 7 to grade 9), students, teachers, school principals.More precisely, our research looks into the conditions of help and mediation in the interactions between parents and children. To do so, we opted for the construct of professional didactics while crossing the theoretical and conceptual contributions of many authors, such as Line Numa-Bocage for didactic mediation, Bernard Charlot for the relation to knowledge, Pierre Pastré for professional didactics, Lev Vygostki for the socioconstructivist approach. Three types of data were collected via a questionnaire, semi-structured interviews, and video-films. To analyze the data, the content analysis advocated by Laurence Bardin was used. The objective of this research is, on the one hand, to identify the educational strategies parents resort to in the education of their children in order to update the knowledge and skills of these parents considered as illiterate; and on the other hand, to shed new light on the problem of education in Haiti. In fact, we hope to challenge established certainties by providing tools for reflection so as to better understand the issues of academic success

Este estudo qualitativo exploratório tem como principal objetivo de analisar a perceção de educadores de sala de jardim de infância, pais e profissionais de intervenção precoce na infância (IPI) sobre as diferentes fases do processo de intervenção e os limites da sua implementação. Neste estudo participaram oito profissionais de IPI, cinco educadoras e quatro pais divididos por três focus group. Para a análise de conteúdo foram criados 68 códigos, 13 categorias e cinco headlines que demonstram os principais resultados. Assim, os principais resultados deste trabalho foram: (1) o trabalho do profissional é descrito consistentemente com palavras positiva, implementado no contexto e com exemplos de práticas de apoio à participação e relacionais; (2) existe um contínuo de práticas de colaboração sendo a prática mais predominante o apoio de um-para-um com a criança; (3) os profissionais de IPI esperam que os cuidadores estejam envolvidos, que aceitem a situação do seu filho e que sejam honestos em relação aos apoios sendo que o maior número de justificações para a escolha de práticas estão relacionadas com limitações dos mesmos; (4) os cuidadores demonstram receio pelo fim do apoio da ELI ao mesmo tempo que desejam uma intervenção centrada na criança e aliada à família; e (6) os cuidadores reconhecem existir dificuldades ao nível da organização do SNIPI e de articulação com outros serviços prestados.
This descriptive exploratory study’s main purpose is to analyse educators, parents and ECI (Early Childhood Intervention) professionals’ perception about the diferente phases of the intervention process and its implementation’s limits. In this study, eight professionals, five educators and four parents participated, divided by three focus group. For the content analysis were created 68 codes, 13 categories, and five headlines that demonstrate the main results. Therefore, the main results of this study were: (1) the professional’s work is described consistently with positive words, implemented in the context and with exemples of support practices towards participation and relational; (2) there is a continuum of collaborative practices, being the one-on-one with children support the most prevalent one; (3) ECI professionals hope the caretakers are involved, that accept the children’s situation and are honest about support and that the greater number of justifications for the choice of practices are related to their limitations; (4) the caretakers are apprehensiveness about ECI’s end, while hoping there’s a child-centered intervention allied do their families; (6) the caretakers recognize that there’s difficulties associated with SNIPI’s level of organization and articulated with other provided services.