Made available in DSpace on 2016-08-18T18:54:03Z (GMT). No. of bitstreams: 1 Tese Luzinea.pdf: 604745 bytes, checksum: 8ab3cac048e418e166bb432e78cdf9f1 (MD5) Previous issue date: 2013-10-24 / The childbirth humanization as a movement searches for changes on the childbirth attention practices, discussing among other questions the abusive use of technology and the woman space in childbirth scene. As a public policy intends to ensure the access to assistance to childbirth in the services of the health unique system (HUS/SUS) and improve the maternal health indicators and neonatal. This study had as goal: Analyze the meaning of the humanization actions proposed by the Childbirth Humanization Program and Birthing in the Materno Infantil Hospital in São Luís-MA, having as empirical support speeches of women about the lived experience in the childbirth and of institutional leaders about the viability of the process of humanization in the maternity. Therefore, was made a qualitative approach research that used the focus group techniques with 28(twenty-eight) women in postpartum period and a semi structured interview with 5(five) female managers of the institution. The material analysis was made through the content analysis technique, showed the following categories: the violence on childbirth assistance and childbirth humanization and their meanings. Data revealed that women lived childbirth as an violent event, which have reveled the search for a bed, devaluation of the partum pain, exam s recurrence and companion s restrictions. The users mean the humanization as an ambience, presence of the father in the partum and the right to cesarean. To the responsible the humanization means the decrease of pain through anesthesia, be empathic and take care of the caregiver. Companion s unpreparedness and lack of professional s evolvement were the main boundaries to humanization and the physical structure and professional ability were advantages. Centralized management, insufficiently participation in decision-making by users and servers, institutional violence in childbirth practices, becomes conflicting and contradictious, besides an obstacle to reach a humanized childbirth attendance at the studied maternity. / A Humanização do Parto como movimento busca mudanças nas práticas de atenção ao parto, discutindo entre outras questões o uso abusivo da tecnologia e o espaço da mulher na cena do parto. Como política pública se propõe a garantir o acesso à assistência ao parto nos serviços de saúde do Sistema Único de Saúde (SUS) e melhorar os indicadores de saúde materna e neonatal. Este estudo teve como objetivo geral: Analisar o significado das ações de humanização propostas pelo Programa de Humanização do Parto e Nascimento no Hospital Universitário Materno Infantil em São Luís-Ma, tendo como suporte empírico discursos de mulheres sobre a experiência vivida no parto e de dirigentes institucionais sobre a viabilização do processo de humanização na Maternidade. Para tanto, foi realizada pesquisa de abordagem qualitativa que utilizou as técnicas de grupo focal com 28(vinte e oito) mulheres no período de pós-parto e a uma entrevista semiestruturada com 5(cinco) mulheres responsáveis na Instituição. A análise do material foi realizada através da técnica de análise de conteúdo, e evidenciou as seguintes categorias: A violência na Assistência ao Parto e Humanização do Parto e seus significados. Os dados revelaram que as mulheres vivenciam o parto como um evento perpassado por situações de violência, as quais se evidenciaram pela busca por leito, desvalorização da dor do parto, exames de repetição, e restrições ao acompanhante. As usuárias significam a humanização como ambiência, presença do pai no parto e direito à cesárea. Para as responsáveis, a humanização significa redução da dor através de analgesia, ser empático e cuidar do cuidador. O despreparo dos acompanhantes e falta de envolvimento dos profissionais foram as principais limites para a humanização e a estrutura física e o preparo profissional um dos principais facilitadores. A gestão centralizada, a pouca participação das usuárias e servidores nas tomadas de decisão, a violência institucional nas práticas de atenção ao parto, tornam conflitante e contraditório, e mesmo empecilhos para a viabilização do atendimento humanizado ao parto na maternidade de ensino.

Made available in DSpace on 2014-12-17T14:13:32Z (GMT). No. of bitstreams: 1 CarmenOMM.pdf: 496226 bytes, checksum: ffe8d9f5c4aeefe21f32ca1fb1b212d5 (MD5) Previous issue date: 2007-08-30 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico / Institutional violence ranges from the most widespread lack of access to the poor quality of services provided. It includes abuses committed by virtue of the unequal power between patients and professionals within institutions. The aim of this study was to analyze the perception of women with regard to this type of violence, in the services offered at a reproductive health facility belonging to the National Health System (SUS) in Natal, Brazil. Interdisciplinary perspective is important, in that it provides interaction and complementarity between various disciplines, favoring, in an integrated way, a thematic approach in research activities, teaching and extension, involving professionals, students and researchers in medicine, social services, psychology, nursing, anthropology and physical therapy. A quantitative/qualitative approach was used, involving a sample of 401 women, as part of a transversal observational study. In the qualitative stage, which consisted of participatory observation and semi-structured interviews, we used an intentional sample of 10 individuals. The data were analyzed using logistic regression techniques, correspondence analysis and categorical thematic content analysis, showing that the 2 questions that investigated directly the perception of institutional violence obtained affirmative response frequencies of 28.2% and 31.8%, respectively. In regard to data collected in a field diary related to participatory observation, the main complaints referred to the health providerpatient relation, translated into dissatisfaction with the interpersonal relationship and with the resolution of the specific demand that required care. From content analysis, we classified 4 categories: Access; Information; Health professionalpatient relation; and Respect/dignity. We identified 6 subcategories: Impossibility of choice; Repressed demand; Communication difficulty; Asymmetric interpersonal relations; Privacy/confidentiality; Disrespect. We concluded, therefore, that the data presented show that in the reproductive health care programs, there are indicators of institutional violence. However, it is difficult to approach this phenomenon, mainly because of the power relations involved in the patient-health care provider interaction, resulting from unawareness that determinate situations violate sexual and reproductive rights. This can be explained by sociostructural questions that reveal marked inequalities, ratified by issues related to violation of the rights of National Health System (SUS) patients / A viol?ncia institucional pode incluir desde a dimens?o mais ampla da falta de acesso ? m? qualidade dos servi?os oferecidos. Abrange abusos cometidos em virtude das rela??es de poder desiguais entre usu?rios(as) e profissionais dentro das institui??es. Esta pesquisa objetiva analisar a percep??o das mulheres em rela??o ? ocorr?ncia deste tipo de viol?ncia no cotidiano dos servi?os de refer?ncia em sa?de reprodutiva, no ?mbito do Sistema ?nico de Sa?de (SUS), na cidade de Natal/ RN. ? pertinente ? perspectiva interdisciplinar, na medida em que proporciona intera??o e complementaridade entre v?rias disciplinas, favorecendo, de forma integrada, a abordagem da tem?tica em atividades de pesquisa, ensino e extens?o. Foi realizado estudo transversal envolvendo amostra de 401 mulheres e abordagem qualitativa com amostra intencional de dez participantes, a qual constou de observa??o participante e entrevistas semi-estruturadas. Os dados foram analisados atrav?s das t?cnicas de regress?o log?stica, an?lise de correspond?ncia e an?lise de conte?do tem?tica categorial.As quest?es que investigaram diretamente a percep??o da viol?ncia institucional obtiveram freq??ncias de respostas afirmativas de 28,2% e 31,8%. Para o c?lculo da amostragem, foi utilizado poder de 80% e alfa de 5% A partir da observa??o participante, foi poss?vel vivenciar que as principais queixas referiram-se ? rela??o entre provedores de sa?de e usu?rias, traduzindo-se numa insatisfa??o quanto ? forma de relacionamento interpessoal e ? resolutividade em rela??o ? demanda espec?fica que motivou o atendimento. Quanto ? an?lise de conte?do, a partir do processo de categoriza??o, destacaram-se 4 categorias: acesso; informa??o; rela??o usu?rias/profissionais de sa?de; e respeito/ dignidade. Foram identificadas seis subcategorias: impossibilidade de escolha; demanda reprimida; dificuldade de comunica??o; rela??es interpessoais assim?tricas; privacidade/confidencialidade; Desrespeito. Pode-se concluir que os resultados apontam para exist?ncia de indicadores de viol?ncia institucional no cotidiano dos programas de aten??o ? sa?de reprodutiva; no entanto, revela-se a dificuldade de abordagem desse fen?meno, principalmente devido ?s rela??es de poder envolvidas na intera??o usu?rias/ provedores, decorrentes do n?o reconhecimento de determinadas situa??es como violadoras dos direitos sexuais e reprodutivos. Esses aspectos remetem, portanto, a quest?es socioestruturais que traduzem marcantes desigualdades, ratificadas por quest?es pertinentes ? viola??o dos direitos das usu?rias no ?mbito do SUS

Notre société possède une vaste coulisse contenant nombre d’individus considérés comme improductifs, déviants, inadaptés. Un partie de cette coulisse a pour fonction de contenir ces individus, et de les maintenir, parfois une vie durant, à la périphérie de notre évolution sociétale, dans des espaces n’ayant qu’une porosité réduite voir nulle avec la matrice sociale de référence. Ce processus de maintien repose sur la logique de filière : institution pour enfants, puis pour adolescents, puis pour adultes travailleurs, puis maison de retraite adaptée. La stabilisation de cette population dans ces cantonnements se fabrique avec les effets pervers du fonctionnement institutionnel, et notamment avec la violence institutionnelle qui régule ce fonctionnement. Pour illustrer cette idée, et tenter de décortiquer cette violence (issue d’une commande utopique, d’une mission originellement impossible à mettre en place) qui entrave les rouages de tout établissement « spécialisé », notre travail de recherche propose de mettre en perspective cette violence institutionnelle, inhérente au fonctionnement d’un institut-médico-professionnel recevant des adolescents placés et orientés par les instances officielles pour « déficience intellectuelle légère ». Cette étude est une ethnographie de terrain, puisque la méthode de travail repose exclusivement sur une observation participante. L’auteur, endossant la mission d’instituteur spécialisé, a passé six ans dans la structure avec ce statut, avant de l’observer pendant deux autres années, consignant sur un carnet de bord des scènes de vie quotidienne se déroulant dans l’institution (salle de classe, couloirs, salle du personnel, salle de réunion, réfectoire, …), mais aussi à l’extérieur de l’institution (rue, espaces divers, …). Inspiré par la sociologie d’Erving Goffman, cette analyse institutionnelle qualifie la structure selon des concepts goffmaniens (institution totale, institution totalitaire), des concepts de l’école de Chicago réajustés (institution bâtarde), voire des concepts élaborés (institution stigmate). Nous proposons de démontrer comment la promiscuité entre les usagers, l’hétérogénéité de la population, la complexité de la mission confiée à l’institution, la sanction du placement institutionnel, et la condition du personnel fabriquent un ensemble complexe, inextricable, pathogène, bridant l’évolution du pensionnaire de l’institution médico-sociale, « l’ajustant » à la filière suivante, et le maintenant dans une coulisse sociale ne lui offrant pas de perspective échappatoire, ni de retour vers « la société mère ». / In our society there is a vast wing containing a number of individuals who are considered unproductive, abnormal or maladjusted. Part of its function is to contain and maintain these individuals, sometimes for an entire lifetime, on the edges of our society's evolution, in spaces, which have only limited or no contact with mainstream society. This process of maintenance follows a chain of logic: an institution for children, likewise for teenagers, then for working adults, then an adapted nursing home. The stabilisation of this population within this system, perversely, is facilitated by function of the institution, and in particular by the culture of institutional violence through which it is regulated. To illustrate this, and to try to analyse this form of violence, which derives from a utopian order, from a mission which is fundamentally impossible to implement, and which hinders the wheels of every 'specialised' establishment: the present research puts into perspective the institutional violence, inherent, as it is, in the operation of an institut-medico-professional (a state special needs training facility) which receives teenagers who have been placed there by officials for 'slight mental retardation'. This research is an insider-study, as the method of research derives exclusively from participatory-observation. The author spent six years working as a Special Needs Teacher inside the establishment studied; then, for a further two years, systematically recorded into his logbook scenes of daily life, which took place within this institution (e.g. in classrooms, corridors, the staff room, meeting rooms, the cafeteria). Inspired by the social theories of Erving Goffman, this institutional analysis describes the target in terms of Goffman's concepts of “Total Institutions”, adjusted concepts from the Chicago School (“Bastard Institutions”), and elaborated concepts of “Stigma Institution”. This research proposes to demonstrate how the proximity and heterogeneity of the inmates, the complexity of the mission entrusted to the institution, the sanction of institutionalising a child, and the working conditions of the staff, all have resulted in a combination which is complex, pathogenic and intractable. Thus it restrains the evolution of the inmates of the institut-medico-professional, it “adjusts” them to follow along within the system, and places them within a social wing, which offers them neither any perspective on how to escape, nor any path to return to the “mainstream society”.

[pt] A presente tese apresenta uma análise do Sistema de Justiça Juvenil brasileiro, com foco nos aminhos percorridos pelos adolescentes na fase de apuração do ato considerado infracional. A pesquisa foi construída com uma abordagem qualitativa e fundamentou-se no materialismo histórico-dialético, com base nos estudos da criminologia crítica. Foram utilizadas como fontes de investigação: observação participante; análise de relatórios técnicos sobre as unidades socioeducativas de acautelamento, elaborados pela equipe técnica de Serviço Social do Ministério Público do RJ e entrevista com profissional do Sistema Socioeducativo do DEGASE. O objetivo geral da pesquisa é analisar o Sistema de Justiça Juvenil, a fim de compreender como o funcionamento, condições de atendimentos, rotinas, fluxos, decisões e demais ações são operacionalizados pelos órgãos do Sistema de Justiça Juvenil, à luz dos instrumentos normativos vigentes. Os resultados demonstraram como o Estado, mesmo com o avanço dos instrumentos normativos de proteção à infância e juventude, criminaliza os adolescentes mais pobres e impõe uma seletividade punitiva racializada para absorvê-los no Sistema de Justiça Juvenil. Uma vez inseridos nas engrenagens do sistema, foi possível constatar a dimensão da violência institucional que atravessa todos os caminhos da apreensão, internação provisória, até a realização das audiências - período em que ainda estão sob a garantia constitucional de presunção de inocência. Nesses casos, opera-se uma punição antecipada de uma infração ainda não julgada, que se naturaliza no cotidiano dos órgãos que compõem esse sistema e se materializa em um cenário de violação de direitos individuais e coletivos, que reforça o processo de desumanização e a banalização de suas vidas. / [en] This Thesis presents an analysis of the Brazilian Juvenile Justice System, focusing on the paths taken by teenagers in the investigation phase of the act considered infraction. The research was built with a qualitative approach and was based on historical-dialectical materialism, based on critical criminology studies. The following research sources were used: participant observation; analysis of technical reports on the socio-educational precautionary units, prepared by the technical team of Social Service of the Public Ministry of RJ and interview with a professional from the Socio-educational System of DEGASE. The general objective of the research is to analyze the Juvenile Justice System, to understand how the functioning, conditions of services, routines, flows, decisions, and other actions are operated by the Juvenile Justice System bodies, in the light of the normative instruments in force. The results showed how the State, even with the advance of normative instruments to protect children and youth, criminalizes the poorest adolescents and imposes a racialized punitive selectivity to absorb them in the Juvenile Justice System. Once inserted into the gears of the system, it was possible to verify the dimension of institutional violence that crosses all paths from apprehension, provisional internment, until the holding of hearings - a period in which they are still under the constitutional guarantee of presumption of innocence. In these cases, there is an early punishment of an infraction not yet judged, which is naturalized in the daily life of the bodies that make up this system and materializes in a scenario of violation of individual and collective rights, which reinforces the process of dehumanization and the trivialization of their lives.

Longtemps ignorés ou déniés, des faits de maltraitance sont aujourd’hui régulièrement signalés et reconnus comme avérés dans des institutions qui accueillent des personnes en situation de handicap. Pour les prévenir, il est préconisé de former le personnel et même de rendre cette thématique obligatoire dans la formation initiale des différents accompagnants. Cependant, pratiquement rien n’est dit sur le contenu des formations à dispenser, ni les modalités pédagogiques à mettre en œuvre. Cette thèse analyse un programme de formation et ses retombées. Ce programme a été élaboré dans une perspective de prévention active en prenant en compte l’évolution du concept de maltraitance, la nécessité d’un travail préalable sur ses représentations et l’option d’une vision écosystémique de cette problématique. Il propose trois modalités pédagogiques distinctes afin d’en vérifier les retombées. Il est dispensé à des travailleurs sociaux en dernière année d’une formation initiale. Notre démarche vérifie l’hypothèse que des changements de représentations sur ce qu’est la maltraitance et ses facteurs de protection surviennent en cours de formation et que ces derniers pourront amener le déploiement d’actions spécifiques afin de la prévenir. Elle permet d’une part de dessiner des perspectives méthodologiques pour l’analyse d’une telle formation et d’autre part de faire des recommandations quant aux contenus et aux modalités pédagogiques à prioriser. / Long ignored or denied, incidents of abuse are now regularly reported and recognized as commonplace in institutions catering for people with disabilities. It is widely recommended that staff should receive training in order to help prevent such abuse, and even that such training modules should now be made compulsory in initial training programmes for all staff working directly with residents. However, virtually nothing is said about the content of such courses, nor about the pedagogical approaches that should be adopted. This thesis analyses such a training program and its outcomes. The programme was conceived with a view to improving active prevention, taking into account the evolution of the concept of abuse, the need for prior work on representations of abuse and the option of an eco-systemic approach to the issue. In order to better understand outcomes, three distinct pedagogical approaches were included. The programme is proposed to social workers during the final year of their initial training. Our approach tests the hypothesis that changes in representations of what constitutes abuse and its factors of protection occur during the training course and may result in specific preventive action. It allows us to develop the methodological approaches needed to analyse such a training programme and also to make recommendations regarding the content and the adoption of appropriate pedagogical methods.