Darbo tikslas. Ištirti pacientų požiūrį į pirminės sveikatos priežiūros įstaigose (PSPĮ) teikiamas paslaugas. Uždaviniai: 1. Ištirti privačios ir viešosios PSPĮ pacientų požiūrį į teikiamas paslaugas. 2. Palyginti privačios ir viešosios PSPĮ pacientų nuomonę apie gydytojo teikiamą informaciją susijusią su ligos diagnoze ir gydymu. 3. Palyginti privačios ir viešosios PSPĮ pacientų požiūrį į teikiamas paslaugas. Tyrimo metodika. Viešosios ir privačios pirminės sveikatos priežiūros įstaigų pacientų anoniminė anketinė apklausa, kurios metu išdalinta 800 anketų (350 privačioje ir 450 viešojoje gydymo įstaigoje). Privačioje gydymo įstaigoje atsako dažnis 92,6 proc., viešojoje – 63,1 proc. Anketiniai duomenys apdoroti ir analizuoti naudojant statistinį duomenų analizės paketą SPSS 13.0. Rezultatai. 94,4 proc. pacientų teigiamai vertina bendrosios praktikos gydytojų darbą. 30,2 proc. pacientų mano, jog šeimos gydytojo konsultacijos laukia per ilgai ir 36,5 proc. mano, jog gydytojo specialisto konsultacijos laukia per ilgai. 39,4 proc. sutinka jog laukimo eilės prie gydytojų kabinetų susidaro dėl prasto darbo organizavimo. 15,1 proc. nuomone, visada sunku gauti siuntimą pas gydytoją specialistą, kartais sunku - 43,9 proc. Viešojoje (68,7 proc.) ir privačioje (64,0 proc.) įstaigoje teigia, jog šeimos gydytojas visada tariasi dėl gydymo galimybių pasirinkimo, tačiau viešosios (6,7 proc.) o privačios (0,3 proc.) įstaigos pacientų teigia, jog gydytojas niekada nesitaria. 53,8 proc... [toliau žr. visą tekstą] / Aim of the work. To examine patients attitude towards services provided in primary health care institutions (PHCI). Objectives: 4. To investigate patients attitude towards services provided in primary health care institutions. 5. To compare patients of private and public primary health care institutions opinion about the information on their diagnosis and cure that doctors provide. 6. To make a comparison of the private and public primary health care institutions to provided services. Research methodology. It was done an anonymous questionnaire survey of public and private primary health care institutions patients, distributed 800 of questionnaires ( 350 in private and 450 in public primary health care institutions). In private health care institution 92,6% of answers were received, in public institution - 63,1%. Data of the questionnaire were processed and analysed using statistical data analysis packet SPSS 13.0. Results. 94,4% of patients positively evaluated the work of family doctors. 30,2% of patients think, that they have to wait too long for family doctors consultations, 36,5% think, that they wait too long for the consultation of specialist. 39,4% agree that they have to wait long because of bad work planning. 15,1% of respondents think that, it is always difficult to get a committal to the specialists, sometimes difficult - 43,9%. 68,7% of public and 64,0% of private institutions respondents says that, family doctor always consults about choosing a cure, but 6... [to full text]

Žmogaus sveikata – multidimensinis reiškinys, tai – tarpusavyje susijusių veiksnių: fizinės, emocinės/dvasinės sveikatos, socialinės gerovės, visuma. Todėl integruotos sveikatos priežiūros pagrindas yra visuminė (holistinė) idėja, reikalaujanti reiškinį suvokti kaip tam tikrą visumą, netolygią jos elementų sumai. Siekiant visapusiškai padėti sergančiam žmogui reikia ne tik medicininės srities specialistų pagalbos, tačiau reikalinga ir svarbi tampa sveikatos priežiūros įstaigoje dirbančio kompetentingo socialinio darbuotojo veikla. Socialinis darbas sveikatos priežiūroje yra pakankamai nauja socialinio darbo sritis Lietuvoje, dėl to susiduriama su: informacijos apie socialinio darbo profesiją, socialinio darbuotojo veiklą ir jo funkcijas, problema. Pastebėta, kad socialinio darbo problematika sveikatos priežiūros įstaigose aktuali, todėl reikalinga sistemingų ir išsamių tyrimų šioje srityje. Lietuvos sveikatos priežiūros įstaigose socialinio darbo profesija nuvertinama, o socialinio darbo specialistai susiduria su įvairiais sunkumai ir problemomis dirbdami medikų apsuptyje. Nors socialinių darbuotojų padėtis sveikatos priežiūros srityje nėra palanki, tačiau profesija reikalinga dėl sveikatos ir socialinių klausimų susietumo bei naujo požiūrio, kad sveikatos priežiūros paslaugos turi būti teikiamos kartu su socialinėmis paslaugomis. Socialinis darbuotojas, remdamasis savo profesine kompetencija, sveikatos priežiūros įstaigose, teikia socialines paslaugas, padeda asmenims... [toliau žr. visą tekstą] / Health is a multidimensional concept. It is a complex combination of a person's physical, mental, emotional and social health factors. Therefore an integrated health care is based on the total (holistic) concept and requires understanding the phenomenon into account and seen as a whole. In order to fully help to sick person need not only medical professionals, necessary and important are qualified social worker’s activities working in health care institutions. Social work in health care is quite new field of social work in Lithuania, therefore faced with: information about the social work profession, social worker’s activities and social worker’s functions, problems. It was noticed that social work issues is relevant in health care institutions and requires systematic and comprehensive research in this social work area. Social work profession is downplayed in health care institutions in Lithuania and social work professionals are facing to various difficulties and problems of working in the medical teams. Although the social worker’s status in the health care sector is not favorable, but the social work profession is necessary for the relationship between health and social issues as well as the new approached that health care services must be providing integrated with social services. In health care institutions, social worker on the basis of the professional competence, provides social services, he helps people with health problems to integrate into society and encourages... [to full text]

Cette thèse étudie les pratiques, les conditions et la division contemporaine du travail de care pour les personnes âgées, en examinant à la fois le travail qualifié et non qualifié, le travail formel et informel, le travail dans les institutions et dans l’aide à domicile. Elle repose sur une enquête qualitative menée en Ile-De-France. Cent vingt-Huit entretiens semi-Directifs ont été réalisés avec des employées qui ont travaillé ou travaillent en emploi direct et dans des organismes (deux EHPAD et une Association d’aide à domicile). La démarche comparative des dynamiques de professionnalisation, ainsi que des formes d’organisation et de hiérarchisation du travail a permis de mettre en lumière les différentes façons dont se construisent les frontières entre le social, la santé et le travail dit non qualifié. La conception fragmentée du travail de care contribue à sa dévalorisation. Dans ce cadre, nous avons développé une approche méthodologique et théorique qui montre l’importance de la relation active entre pourvoyeur et bénéficiaire qui se développe à long terme et englobe l’ensemble des aspects du travail. À partir des expériences de femmes sans-Papiers et de la question du mal-Être au travail, nous avons étudié les modalités selon lesquelles les rapports sociaux de sexe, classe et race s’inscrivent dans la relation du care. La thèse s’inscrit au croisement de plusieurs champs : la sociologie du travail, la sociologie du genre, la sociologie des migrations, la sociologie des émotions. Nous intégrons également dans notre réflexion et dans notre approche les apports pluridisciplinaires des théories du care. / This thesis studies the practices, conditions and contemporary division of care for the elderly, by examining skilled and ‘unskilled’ labour as well as formal and informal labour, at home and in care institutions. It is based on a qualitative survey carried out in Ile-De-France. We conducted 128 semi-Structured interviews with employees who have worked or work with the elderly directly and through organisations (two nursing homes, one home-Support association). Comparing the dynamics of professionalization, as well as the forms of organisation and the development of hierarchies of labour, has brought to light the different ways in which boundaries are built between social work, healthcare and ‘unskilled’ labour. The fragmented concept of care contributes to its devaluation. In this context, we have developed a methodological and theoretical approach that shows the importance of the active relationship between caregiver and care-Receiver that develops over time and encompasses all aspects of care. Based on the experiences of undocumented immigrant women and the issue of poor quality of work life, we have examined the role of gender, class and race in care relationships. This thesis touches on several fields of sociology: labour, gender, migration and emotions. We also include the multidisciplinary contributions of care theories.

Fundação de Amparo a Pesquisa no Estado do Rio Grande do Sul / The long-term care institutions for the elderly are becoming one of the house source and support to the elderly in need of long-term care. Be admitted in these places has a great impact in the life of these people, which in addition to adapt to the routine, need also to establish new relationships and state their spaces. In these situations, conflicts between elderly residents or between them and professionals working at the institution may arise, which facilitates the occurrence of disharmonious conditions. Thus, situations that triggers conflicts and creates possible implications in daily life and health of institutionalized elderly are identified. This study has the main aim: to analyze the perception of the nursing team about the occurrence of relational conflicts of eldery in a long-term care institution. It is a qualitative study with 15 nursing professionals, that was conducted in March and July 2015 in an institution located in the central region of Rio Grande do Sul State. Data collecting was made using semi-structured interviews, recorded, transcribed and analyzed according to thematic content analysis of Minayo operative proposal. The ethical aspects of research involving human beings were respected following the Resolution 466/12 of the National Health Council. Conflict situations experienced by nurses and elderly of the institution, the aspects that led to these conflicts, and the management of nursing professionals at these situations were identified. Among the situations identified in this study, conflicts emerges in moments when the emotional and inclusion needs of elderly women were not met; when them try to preserve their identity and autonomy within the institution; and in situations where their behaviors are modified by the presence of psychological/psychiatric symptoms and have their attitudes contradicted by others. Factors that motivated the emergence of conflicts included attitudes from habits and the individuality created before the institutionalization and changes in behavior caused by neurological and / or psychiatric diseases. The performance of some professionals in an attempt to stop the conflicts are focused on authority, intimidation, punishment attitudes and the administration of medications. Other professionals have chosen to use conversation as an alternative for solving the conflicts. The results show that nursing professionals have difficulties for the management of relational conflicts of eldery that often come from the lack of skills of interpersonal relationships and knowledge about the specificities of fragile elderly population. / As Instituições de Longa Permanência para Idosos vem tornando-se uma das fontes de residência e amparo à população idosa que necessita de cuidados de longo prazo. Ser admitido nesses locais é um fator de grande impacto na vida do idoso, que além de adequar-se às regras, necessita estabelecer novos relacionamentos e demarcar seus espaços. Frente a essas situações, podem surgir conflitos entre os idosos residentes ou entre eles e profissionais que atuam no local, o que favorece a ocorrência de condições desarmônicas. A partir disso, identifica-se situações propulsoras de conflitos e que geram possíveis implicações no cotidiano e na saúde dos idosos institucionalizados. Este estudo tem como objetivo geral: analisar a percepção da equipe de enfermagem acerca da ocorrência de conflitos interpessoais de idosas em Instituição de Longa Permanência. Trata-se de uma pesquisa qualitativa com 15 profissionais de enfermagem, realizada nos meses de março a julho de 2015, em uma instituição localizada na região central do Estado do Rio Grande do Sul. A coleta dos dados ocorreu por meio de entrevista semiestruturada, gravada, transcrita e, após, os dados foram analisados conforme a análise de conteúdo temática da proposta operativa de Minayo. Os aspectos éticos das pesquisas com seres humanos foram respeitados seguindo a Resolução 466/12 do Conselho Nacional de Saúde. Foram identificadas as situações de conflito vivenciadas por profissionais de enfermagem e idosas da instituição, os fatores que ocasionaram esses conflitos e as condutas dos profissionais de enfermagem nessas ocasiões. Dentre as situações de conflitos identificadas destacam-se momentos em que as necessidades afetivas e de inclusão das idosas não foram satisfeitas, quando as idosas tentam preservar a identidade e autonomia no âmbito da instituição e em ocasiões que apresentam comportamentos alterados pela presença de sintomas psíquicos/ psiquiátricos e tem suas atitudes contrariadas pelos demais. Quanto aos fatores que motivaram o surgimento de conflitos foram evidenciadas as atitudes provenientes de costumes e da individualidade construídos anterior a institucionalização e de alterações no comportamento ocasionadas por doenças neurológicas e/ou psiquiátricas. As condutas de alguns profissionais no intuito de cessar os conflitos centraram-se em atitudes como autoridade, intimidação, punição e administração de medicações. Outros profissionais optaram por utilizar a conversa como alternativa de grande potencial para resolutividade frente aos conflitos. Os resultados apontam que existem dificuldades dos profissionais de enfermagem para o manejo dos conflitos interpessoais das idosas que, muitas vezes, são provenientes da falta de habilidades com os relacionamentos interpessoais e do conhecimento frágil às especificidades da população idosa.

Made available in DSpace on 2015-05-08T14:47:37Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 1300353 bytes, checksum: 39acb0cac98335dd40f03f759e73d77c (MD5) Previous issue date: 2013-03-12 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / A pressure ulcer (PU), important harm found in the institutionalized elderly population, and increases spending on care, has important repercussions in their lives, such as increased morbidity and decreased quality of life. The elderly are more susceptible to developing PU, because of changes that occur with aging, especially in the skin. This is a cross-sectional, observational, descriptive predominantly, quantitative approach and aimed to determine the prevalence and risk factors for the development of pressure ulcers in institutionalized elderly. It was developed with 160 individuals, aged 60 or older, living in two long-stay institutions for the elderly (nursing home) city of João Pessoa. Data were obtained through physical examination, interview and analysis of medical records. The data analyses were obtained distributions absolute percentage unitary and bivariate and inferential statistical techniques. The data collected were organized in Microsoft Excel and exported into Statistical Package for Social Sciences (SPSS) 20.0. The literature review included national and international scientific articles, thesis and dissertation. Most seniors were female (67.5%) with mean age of 81.9 years old, literate (36.9%), colored or white (55%), single (49.4%) , retired (91.4%), sent to institutions by relatives (45.6%) and used for the SUS access to health services (56.9%). There was a predominance of cardiovascular diseases (65.6%) and use of psychotropic medication (65%). Among the risk factors, showed statistical significance for the presence of PU: dependence on position change (p<0,001), fecal (p=0,004) and urinary incontinence (p=0,001), cognitive impairment (p=0,013) and physical limitations (p=0,030). The PU prevalence in this population was 7.5%, the anatomical locations of higher frequencies were gluteal region (49.9%) and sacral (25.3%). There was a prevalence of pressure ulcers stage II (68.5%). The mean score of the Braden Scale was 18.3 points, with 45.6% of the elderly were at risk for development of PU. Among seniors, 71.3% had some dependence for activities of daily living and 34.4% were at risk for malnutrition. So much of the institutionalized elderly presents risk for development of PU, demand assistance with bathing, dressing, toileting, transferring from one place to another and feed and is at risk for malnutrition or malnourished. / A úlcera por pressão (UPP), agravo importante encontrado na população idosa institucionalizada, além de aumentar os gastos com os cuidados prestados, tem repercussões relevantes em suas vidas, como o aumento na morbidade e diminuição da qualidade de vida. As pessoas idosas são mais susceptíveis ao desenvolvimento de UPP, em virtude das alterações que ocorrem com o envelhecimento, sobretudo na pele. Este é um estudo transversal, observacional, predominantemente descritivo, de abordagem quantitativa e teve como objetivo geral conhecer a prevalência e os fatores determinantes para o risco de desenvolvimento de úlcera por pressão em idosos institucionalizados. Foi desenvolvido com 160 idosos, com 60 anos ou mais, residentes em duas instituições de longa permanência para idosos (ILPI) da cidade de João Pessoa-PB. Os dados foram obtidos através do exame físico, entrevista e análises dos prontuários. Para análise dos dados foram obtidas distribuições absolutas, percentuais uni e bivariadas, e técnicas de estatística inferencial. Os dados coletados foram organizados no Microsoft Excel e exportados para Statistical Package for Social Science (SPSS) 20.0. O levantamento da literatura contemplou artigos científicos nacionais e internacionais, tese e dissertações. A maioria dos idosos era do sexo feminino (67,5%), com média de idade de 81,9 anos, alfabetizados (36,9%), de cor ou raça branca (55%), solteiros (49,4%), aposentados (91,4%), encaminhado às instituições por familiares (45,6%) e utilizavam o SUS para o acesso aos serviços de saúde (56,9%). Houve predomínio de doenças do aparelho circulatório (65,6%) e uso medicamentoso de psicotrópicos (65%). Dentre os fatores de risco, apresentaram significância estatística para a presença de UPP: a dependência de mudança de decúbito (p<0,001), incontinência fecal (p=0,004) e urinária (p=0,001), déficit cognitivo (p=0,013) e limitação física (p=0,030). A prevalência de UPP nesta população foi de 7,5%, as localizações anatômicas de maior frequências foram as regiões glútea (49,9%) e sacral (25,3%). Houve predomínio de úlceras por pressão em estágio II (68,5%). O escore médio da escala de Braden foi de 18,3 pontos, sendo que 45,6% dos idosos apresentaram risco para desenvolvimento de UPP. Entre os idosos, 71,3% possuíam alguma dependência para atividades de vida diária e 34,4 % foram classificados com risco para desnutrição. Portanto, parte dos idosos institucionalizados apresenta risco para desenvolvimento de UPP, demanda ajuda para tomar banho, se vestir, ir ao banheiro, se transferir de um lugar a outro e se alimentar, além de encontrarem-se em risco para desnutrição ou desnutridos.

[pt] Diante do cenário epidêmico das demências e do crescente envelhecimento populacional, esta pesquisa teve como foco o desenvolvimento de produtos e serviços reabilitadores e preventivos do Alzheimer para/com idosos institucionalizados. O objetivo do estudo foi melhorar a cognição e a qualidade de vida dos hóspedes, bem como valorizar seu papel social. Quanto à estrutura, a pesquisa se articulou em 5 etapas: (1) revisão bibliográfica sobre memória, processos cognitivos e Alzheimer; (2) estudo de caso no Bem Viver, que cumulou: observações das atividades, da rotina e das respostas dos idosos aos estímulos aplicados, entrevistas com os hóspedes, funcionários e familiares, e desenvolvimento de conceitos projetuais voltados à criação de produtos e serviços com foco no Alzheimer e na institucionalização; (3) cocriação de artefatos interdisciplinares e multifacetados em parceira com os profissionais da casa, amparada pela ferramenta Card Sorting e por um diagrama interdisciplinar; (4) implementação dos produtos e serviços pelos funcionários da casa nas atividades do Bem Viver; e (5) identificação dos resultados dos estímulos na cognição e na qualidade de vida dos idosos, mediante comparação dos dados coletados no momento inicial e final da pesquisa. No desfecho desta investigação, observou-se que os artefatos em formato aberto e as oficinas foram capazes de melhorar a orientação temporal e as habilidades de escrita e de cálculo de idosos, bem como permitiram despertar a criatividade dos hóspedes, fortalecer os laços de amizade e estimular memórias e funções mentais de indivíduos com os mais variados tipos de demência e perfis cognitivos. / [en] Taking into account the epidemic scenario of dementias and the increased growth of the elderly population, this research consisted of proposing products and services for both recovery and prevention of the Alzheimer s disease among institutionalized elderly. The aim of this study was to enhance cognition and the quality of life of patients, as well as promoting their social role. Regarding structure, this project was organized around 5 stages: (1) a bibliographic review on memory, cognitive processes and the Alzheimer s disease; (2) a case study at the nursing home Centro de Atividades Bem Viver that included observations of activities, routine, and the elderly responses to the stimuli applied; interviews with the guests, employees and relatives; and the development of design concepts for the creation of products and services that focused on the Alzheimer s disease and institutionalization; (3) cocreation of interdisciplinary and multifaceted artifacts in partnership with the instructors of the institution, as well as the support of Card Sorting and an interdisciplinary diagram; (4) implementation of products and services by the staff of the nursing home in the activities at Bem Viver; and (5) identification of results, with respect to cognition and quality of life, by drawing a comparison of the data gathered early and later on. At the end, it was possible to assess that the open-design objects and the workshops improved spatial orientation and also the elderly s writing and math skills, along with the guests creative awakening, the strengthening of friendship ties and the stimulation of memories and mental functions of individuals with different types of dementia and cognitive profiles.

Many studies have focused on the concept of humanization of birth in normal pregnancy cases or at low obstetric risk, but no studies, at our knowledge, have so far specifically focused on the humanization of birth in both high-risk, and low risk pregnancies, in a highly specialized hospital setting. The present study thus aims to: 1) define the specific components of the humanized birth care model which bring satisfaction to women who seek obstetrical care in highly specialized hospitals; and 2) explore the organizational and cultural dimensions which act as barriers or facilitators for the implementation of humanized birth care practices in a highly specialized, university affiliated hospital in Quebec. A single case study design was chosen for this thesis. The data were collected through semi-structured interviews, field notes, participant observations, selfadministered questionnaire, relevant documents, and archives. The samples comprised: 11 professionals from different disciplines, 6 administrators from different hierarchical levels within the hospital, and 157 women who had given birth at the hospital during the study. The performed analysis covered both quantitative descriptive and qualitative deductive and inductive content analyses. The thesis comprises three articles. In the first article, we proposed a conceptual framework, based on Allaire and Firsirotu’s (1984) organizational culture theory. It attempts to examine childbirth patterns as an organizational cultural phenomenon. In our second article, we answered the following specific question: according to the managers and multidisciplinary professionals practicing in a highly specialized hospital as well as the women seeking perinatal care in this hospital setting, what is the definition of humanized care? Analysis of the data collected uncovered the following themes which explained the perceptions of what humanized birth was: personalized care, recognition of women’s rights, humanly care for women, family-centered care,women’s advocacy and companionship, compromise of security, comfort and humanity, and non-stereotyped pregnancies. Both high and low risk women felt more satisfied with the care they received if they were provided with informed choices, were given the right to participate in the decision-making process and were surrounded by competent care providers. These care providers who humanly cared for them were also able to provide relevant medical intervention. The professionals and administrators’ perceptions of humanized birth, on the other hand, mostly focused on personalized and family-centered care. In the third article of the thesis, we covered the dimensions of the internal and external components of an institution which can act as factors that facilitate or barriers that prevent, a specialized and university affiliated hospital in Quebec from adopting a humanized child birthing care. The findings revealed that both the external dimensions of a highly specialized hospital -including its history, society, and contingency-; and its internal dimensions -including culture, structure, and the individuals present in the hospital-, can all affect the humanization of birth care in such an institution, whether separately, simultaneously or in interaction. We thus hereby conclude that the humanization of birth care in a highly specialized hospital setting, should aim to meet all the physiological, as well as psychological aspects of birth care, including respect of the fears, beliefs, values, and needs of women and their families. Integration of competent and caring professionals and the use of obstetric technology to enhance the level of certainty and assurance in both high-risk and low risk women are both positive factors for the implementation of humanized care in a highly specialized hospital. Finally, the humanization of birth care approach in a highly specialized and university affiliated hospital setting demands a new healthcare policy. Such policy must offer a guarantee for women to have the place of birth, and the health care professional of their choice as well as those, which will enable women to make informed choices from the beginning of their pregnancy. / De nombreuses études ont mis l'accent sur le concept de l'humanisation des soins de naissance d’une grossesse normale ou à faible risque obstétrical. Mais, à notre connaissance, aucune étude à ce jour n’a spécifiquement porté sur l'humanisation des soins de la naissance dans les grossesses à haut et à faible risque dans un hôpital hautement spécialisé. La présente étude vise à: 1) définir les composantes spécifiques de l'humanisation des soins qui apportent satisfaction aux femmes qui cherchent des soins obstétricaux dans un hôpital hautement spécialisé; 2) explorer les dimensions organisationnelles et culturelles qui constituent des obstacles ou des facilitateurs pour les pratiques périnatales favorisant l'humanisation des soins dans un centre hospitalier universitaire très spécialisé, au Québec. Une étude de cas unique a été choisie pour notre thèse. Les données ont été recueillies au moyen d'entrevues semi-structurées, de notes de terrain, d’observation des participants, d’un questionnaire auto-administré, et de documents et d’archives pertinents. L’échantillon est composé de : 11 professionnels de différentes disciplines, six administrateurs de différents niveaux hiérarchiques de l'hôpital et 157femmes qui ont accouché à l'hôpital durant la période de l’étude. Une analyse à la fois descriptive quantitative et qualitative déductive et inductive a été réalisée. La thèse comprend trois articles. Dans le premier article, nous proposons un cadre conceptuel fondé sur la théorie de la culture organisationnelle développée par Allaire et Firsirotu (1984). Le but de cet article est d’examiner les tendances d’accouchement en tant que phénomène de culture organisationnelle. Le second article, répond à une question spécifique : quelle est la définition des soins humanisés selon les administrateurs et des professionnels multidisciplinaires oeuvrant dans un hôpital hautement spécialisé, ainsi que celle des femmes soignées dans cet hôpital ? L'analyse des données permet de ressortir les thèmes suivants sur la perception de l'humanisation de la naissance : les soins personnalisés, la reconnaissance du droit desfemmes, des soins humains, des soins centrés sur la famille, la défense des femmes et de leur compagnon, le compromis de sécurité, le confort et l'humanité, et les grossesses non stéréotypées. Les femmes à risque élevé et à faible risque semblent plus satisfaites des soins s'ils sont fournis selon un choix éclairé et qu’elles ont participé au processus décisionnel, tout en étant entourées par des fournisseurs de soins compétents, qui soignent de façon humaine et font des interventions médicales lorsque requises. Les perceptions des professionnels et des administrateurs à propos de la naissance humanisée mettent principalement l'accent sur des soins personnalisés et centrés sur la famille. Dans notre troisième article, nous traitons les composantes internes et externes d'une institution, qui prédisposent ou qui empêchent un hôpital spécialisé et universitaire affilié au Québec d'adopter des soins humanisés de naissance. Les résultats révèlent qu’à la fois des dimensions externes d'un hôpital hautement spécialisé, -son histoire, son affiliation, et ses contingences - ainsi que des dimensions internes- sa culture, sa structure et ses individus - peuvent tous influer sur l'humanisation de la pratique des soins de naissance dans un tel établissement, que ce soit séparément, simultanément ou en interaction. Nous avons donc conclu que l'humanisation des soins de naissance dans un l'hôpital hautement spécialisé doit répondre à tous les aspects physiologiques et psychologiques des soins périnatals dont le respect des craintes, des croyances et des valeurs et besoins des femmes et de leur famille. L'intégration de professionnels compétents et attentionnés utilisant la technologie obstétrique améliore le niveau de certitude et d'assurance dans les grossesses à haut et à faible risque dans un hôpital hautement spécialisé. Enfin, l'humanisation de l'approche de la naissance dans un centre hospitalier très spécialisé et universitaire affilié requiert des nouvelles politiques de système de santé. Une telle politique garantit, pour une femme enceinte dès le début de sa grossesse, une place dans une institution, un professionnel de la santé de son choix et la possibilité de faire des choix éclairés tout au long du processus de la naissance.

Made available in DSpace on 2016-04-27T18:47:30Z (GMT). No. of bitstreams: 1 Viviane da Silva Bianco.pdf: 914511 bytes, checksum: 32446c8bfac0bf8b0f9e66b81da44b71 (MD5) Previous issue date: 2008-08-25 / The present aging scenario brings about the need to adapt society to meet particularities of the individuals involved in this stage of the vital cycle. In Brazil the aging population has been growing considerably and the alternatives of assistance and resources for such population are still deficient. Families are seldom prepared to face the aging process of their relatives and, especially because of difficulties related to finances and home care, they eventually choose institutions. Living at a long term care institution can be the very elder s choice seeking to preserve their selves and their belongings so as to keep their life history alive. The natural aging process brings along numerous changes, with the loss or slowering of body response. Pathology prevention and symptom minimization allow aging people to attain a better quality of life, and various segments are assigned this task geriatric and gerontologic multidisciplinary teams, among them. Among the problems aging people face, the falls are relevant and worrying because of their consequences. Because falls are frequent and can bring injuries to the elderly, the present study gathered institutional fall protocols from the residents of the Residencial Israelita Albert Einstein who were involved in falls during a pre-established period and analyzed the number of falls, the form of their occurrence and who were involved in this type of event with the purpose of preventing new episodes as well as providing post-fall assistance / O atual cenário do envelhecimento traz consigo a necessidade de adaptação da sociedade visando atender as particularidades dos indivíduos envolvidos nessa etapa do ciclo vital. No Brasil o número de idosos tem crescido consideravelmente e as opções de assistência e recursos que prestam atendimento a essa população ainda encontram-se deficientes. As famílias muitas vezes não estão preparadas para enfrentar o processo de envelhecimento de seus entes e diante das dificuldades que podem ser de vários motivos entre eles de natureza financeira ou deficiência para prestar assistência ao idoso em suas residências, acabam por buscar a institucionalização. A opção de morar em uma instituição de longa permanência pode partir do próprio idoso que busca nesta nova moradia poder preservar um pouco do seu eu e mediante a presença de alguns pertences pessoais manter viva a sua história de vida. O processo de envelhecimento natural é acompanhado de inúmeras alterações que levam a perda ou diminuição da capacidade de resposta do organismo. A prevenção para as patologias que possam vir a surgir e a minimização dos sintomas decorrentes desse processo possibilitam ao idoso uma melhor qualidade de vida, cabendo esse trabalho a vários seguimentos que atuam na velhice entre eles a equipe multidisciplinar geriátrica e gerontológica. Inúmeras são as complicações que podem acometer o idoso entre elas as quedas ocupam um papel importante e preocupante pelas conseqüências desastrosas que podem deixar. Por ser um evento não pouco freqüente e que pode trazer vários danos ao idoso o presente estudo reuniu protocolos de quedas institucionais dos moradores do Residencial Israelita Albert Einstein que estiveram envolvidos em queda em período pré-estabelecido, e procurou analisar o número de quedas, como ocorrem e quem são os idosos envolvidos nesse tipo de evento, buscando contribuir na prevenção de novos episódios assim como na assistência pós-queda

Many studies have focused on the concept of humanization of birth in normal pregnancy cases or at low obstetric risk, but no studies, at our knowledge, have so far specifically focused on the humanization of birth in both high-risk, and low risk pregnancies, in a highly specialized hospital setting. The present study thus aims to: 1) define the specific components of the humanized birth care model which bring satisfaction to women who seek obstetrical care in highly specialized hospitals; and 2) explore the organizational and cultural dimensions which act as barriers or facilitators for the implementation of humanized birth care practices in a highly specialized, university affiliated hospital in Quebec. A single case study design was chosen for this thesis. The data were collected through semi-structured interviews, field notes, participant observations, selfadministered questionnaire, relevant documents, and archives. The samples comprised: 11 professionals from different disciplines, 6 administrators from different hierarchical levels within the hospital, and 157 women who had given birth at the hospital during the study. The performed analysis covered both quantitative descriptive and qualitative deductive and inductive content analyses. The thesis comprises three articles. In the first article, we proposed a conceptual framework, based on Allaire and Firsirotu’s (1984) organizational culture theory. It attempts to examine childbirth patterns as an organizational cultural phenomenon. In our second article, we answered the following specific question: according to the managers and multidisciplinary professionals practicing in a highly specialized hospital as well as the women seeking perinatal care in this hospital setting, what is the definition of humanized care? Analysis of the data collected uncovered the following themes which explained the perceptions of what humanized birth was: personalized care, recognition of women’s rights, humanly care for women, family-centered care,women’s advocacy and companionship, compromise of security, comfort and humanity, and non-stereotyped pregnancies. Both high and low risk women felt more satisfied with the care they received if they were provided with informed choices, were given the right to participate in the decision-making process and were surrounded by competent care providers. These care providers who humanly cared for them were also able to provide relevant medical intervention. The professionals and administrators’ perceptions of humanized birth, on the other hand, mostly focused on personalized and family-centered care. In the third article of the thesis, we covered the dimensions of the internal and external components of an institution which can act as factors that facilitate or barriers that prevent, a specialized and university affiliated hospital in Quebec from adopting a humanized child birthing care. The findings revealed that both the external dimensions of a highly specialized hospital -including its history, society, and contingency-; and its internal dimensions -including culture, structure, and the individuals present in the hospital-, can all affect the humanization of birth care in such an institution, whether separately, simultaneously or in interaction. We thus hereby conclude that the humanization of birth care in a highly specialized hospital setting, should aim to meet all the physiological, as well as psychological aspects of birth care, including respect of the fears, beliefs, values, and needs of women and their families. Integration of competent and caring professionals and the use of obstetric technology to enhance the level of certainty and assurance in both high-risk and low risk women are both positive factors for the implementation of humanized care in a highly specialized hospital. Finally, the humanization of birth care approach in a highly specialized and university affiliated hospital setting demands a new healthcare policy. Such policy must offer a guarantee for women to have the place of birth, and the health care professional of their choice as well as those, which will enable women to make informed choices from the beginning of their pregnancy. / De nombreuses études ont mis l'accent sur le concept de l'humanisation des soins de naissance d’une grossesse normale ou à faible risque obstétrical. Mais, à notre connaissance, aucune étude à ce jour n’a spécifiquement porté sur l'humanisation des soins de la naissance dans les grossesses à haut et à faible risque dans un hôpital hautement spécialisé. La présente étude vise à: 1) définir les composantes spécifiques de l'humanisation des soins qui apportent satisfaction aux femmes qui cherchent des soins obstétricaux dans un hôpital hautement spécialisé; 2) explorer les dimensions organisationnelles et culturelles qui constituent des obstacles ou des facilitateurs pour les pratiques périnatales favorisant l'humanisation des soins dans un centre hospitalier universitaire très spécialisé, au Québec. Une étude de cas unique a été choisie pour notre thèse. Les données ont été recueillies au moyen d'entrevues semi-structurées, de notes de terrain, d’observation des participants, d’un questionnaire auto-administré, et de documents et d’archives pertinents. L’échantillon est composé de : 11 professionnels de différentes disciplines, six administrateurs de différents niveaux hiérarchiques de l'hôpital et 157femmes qui ont accouché à l'hôpital durant la période de l’étude. Une analyse à la fois descriptive quantitative et qualitative déductive et inductive a été réalisée. La thèse comprend trois articles. Dans le premier article, nous proposons un cadre conceptuel fondé sur la théorie de la culture organisationnelle développée par Allaire et Firsirotu (1984). Le but de cet article est d’examiner les tendances d’accouchement en tant que phénomène de culture organisationnelle. Le second article, répond à une question spécifique : quelle est la définition des soins humanisés selon les administrateurs et des professionnels multidisciplinaires oeuvrant dans un hôpital hautement spécialisé, ainsi que celle des femmes soignées dans cet hôpital ? L'analyse des données permet de ressortir les thèmes suivants sur la perception de l'humanisation de la naissance : les soins personnalisés, la reconnaissance du droit desfemmes, des soins humains, des soins centrés sur la famille, la défense des femmes et de leur compagnon, le compromis de sécurité, le confort et l'humanité, et les grossesses non stéréotypées. Les femmes à risque élevé et à faible risque semblent plus satisfaites des soins s'ils sont fournis selon un choix éclairé et qu’elles ont participé au processus décisionnel, tout en étant entourées par des fournisseurs de soins compétents, qui soignent de façon humaine et font des interventions médicales lorsque requises. Les perceptions des professionnels et des administrateurs à propos de la naissance humanisée mettent principalement l'accent sur des soins personnalisés et centrés sur la famille. Dans notre troisième article, nous traitons les composantes internes et externes d'une institution, qui prédisposent ou qui empêchent un hôpital spécialisé et universitaire affilié au Québec d'adopter des soins humanisés de naissance. Les résultats révèlent qu’à la fois des dimensions externes d'un hôpital hautement spécialisé, -son histoire, son affiliation, et ses contingences - ainsi que des dimensions internes- sa culture, sa structure et ses individus - peuvent tous influer sur l'humanisation de la pratique des soins de naissance dans un tel établissement, que ce soit séparément, simultanément ou en interaction. Nous avons donc conclu que l'humanisation des soins de naissance dans un l'hôpital hautement spécialisé doit répondre à tous les aspects physiologiques et psychologiques des soins périnatals dont le respect des craintes, des croyances et des valeurs et besoins des femmes et de leur famille. L'intégration de professionnels compétents et attentionnés utilisant la technologie obstétrique améliore le niveau de certitude et d'assurance dans les grossesses à haut et à faible risque dans un hôpital hautement spécialisé. Enfin, l'humanisation de l'approche de la naissance dans un centre hospitalier très spécialisé et universitaire affilié requiert des nouvelles politiques de système de santé. Une telle politique garantit, pour une femme enceinte dès le début de sa grossesse, une place dans une institution, un professionnel de la santé de son choix et la possibilité de faire des choix éclairés tout au long du processus de la naissance.

Nowadays the insufficient facilities of social and health care institutions in Rokycany region don{\crq}t get a motivation to participate in finance of different institutions, in spite of the fact that they are placed in its territory, and provide services for their citizens.From the point of view of residential structure in Rokycany region it seems to be clear that the region itself has to play a big role so that the services would be provided even in small municipalities, and distant urban areas of the region. The above remarks confirm the hypothesis: 1. Social hospitalization in a health care institution results in insufficient facilities of places in retirement homes and in residence institutions of social care. I propose to improve the organiation of social and health care services for old and handicapped people in SO ORP Rokycany region, which I can regard as an availability of social and health care services in the whole region, as an icrease and enlargement of the social services mainly in non-governmental and nonprofitable sector, and as an increase of the quality of provided social services. The range of social hospitalization in Rokycany hospital, Corp., conditions was investigated within the practical part of my thesis. Both aims were fulfilled by working up the practical part of the thesis, and by carrying out the social demographic analysis. By observing the basic data and information while observing the social care in the health care institution, it definitely bears to the hypothesi 2.: The refund of social hospitalization doesn{\crq}t include the costs of sickbed in a health care institution, which is contributing tounfavourable economical situation in a health care institution. The new law doesn{\crq}t solve this problem of financing the social sickbeds. This law insufficiently solves conditions of social allowance belonging, on the contrary, the allowence depends on agreement.This results in repeated and longtime people{\crq}s hospitalization,who are being given this health care allowance. I think it is necessary to ammend the accepted law 108/2006, of Law Digest, abot social services. The matter of finance of longtime hospitalization in health care institution could be solved by the items up increase for longtime lying people. I can see the other aspect of solution in setting up the clear conditions to provide the social care allowance.