Sammanfattning  Bakgrund:Att fara illa som barn leder till negativa konsekvenser både på kort och lång sikt. Därför måste dessa barn tillkännages socialtjänsen av anmälningsskyldiga. Specialistsjuksköterskor inom barnhälsovården och elevhälsan har denna skyldighet men forskning visar att en anmälan inte alltid görs trots oro för barnet.  Syfte: Syftet var att beskriva specialistsjuksköterskans upplevelse av att arbeta med barn som far illa eller misstänks fara illa inom barnhälsovården och elevhälsan.  Metod:En kvalitativ intervjustudie genomfördes med 12 specialistsjuksköterskor inom barnhälsovården och elevhälsan. Data analyserades med konventionell innehållsanalys.  Resultat:Arbetet med barn som far illa beskrevs som komplext. Anmälningsskyldigheten var en viktig men svår uppgift. Att bedöma var gränsen går för när ett barn far illa samt bristande samarbete med socialtjänsten var svårigheter som framkom, en anmälan kunde av den anledningen ibland dröja eller utebli. Flera strategier användes i arbetet där relationen med barnet och familjen var av stor betydelse.  Konklusion: Ämnet är komplext. Specialistsjuksköterskor beskriver att de saknar metoder och arbetssätt för att på bästa sätt hantera arbetet med barn som far illa. Specialistsjuksköterskorna har utarbetat egna strategier för att hjälpa barnet eller familjen på andra sätt först, innan en anmälan skrivs. / Abstract Background:Child maltreatment can have negative consequences in both the short and long term. Therefore, these children must be reported to the social services by persons liable to report. Specialist nurses in child health care and student health have this obligation, but research shows that a report is not always made despite concerns for the child.  Aim:The aim of the study was to describe the specialist nurse's experience of working with children who are maltreated or suspected of being maltreated in child health care and school.  Method:A qualitative interview study was conducted with 12 specialist nurses in child health care and school. Data were analyzed using conventional content analysis.  Results:The work with maltreated children was described as complex. The reporting obligation was an important but difficult task. Assessing where the limit is for when a child becomes maltreated as well as a lack of cooperation with social services were difficulties that emerged, for which reason a report could sometimes be delayed or absent. Several strategies were used in the work where the relationship with the child and the family was of great importance.  Conclusion:The subject is complex. The specialist nurses describe a lack of methods and working methods to best manage work with maltreated children. The specialist nurses have developed their own strategies to help the child or the family in other ways first, before a report is written.

Submitted by Mario Mesquita (mbarroso@fiocruz.br) on 2014-10-17T16:58:31Z No. of bitstreams: 1 Lausanne Souza Borges.pdf: 1549168 bytes, checksum: 73bc31064108d9f311005bbadccab403 (MD5) / Approved for entry into archive by Mario Mesquita (mbarroso@fiocruz.br) on 2014-10-17T18:22:32Z (GMT) No. of bitstreams: 1 Lausanne Souza Borges.pdf: 1549168 bytes, checksum: 73bc31064108d9f311005bbadccab403 (MD5) / Made available in DSpace on 2014-10-17T18:22:32Z (GMT). No. of bitstreams: 1 Lausanne Souza Borges.pdf: 1549168 bytes, checksum: 73bc31064108d9f311005bbadccab403 (MD5) / Fundação Oswaldo Cruz. Escola Politécnica de Saúde Joaquim Venâncio. Programa de Pós-Graduação em Educação Profissional em Saúde. / O estudo analisa os condicionantes histórico-sociais da prática de parturizar e a formação dual dos trabalhadores que atuam na área materno-infantil no Brasil. Para tanto, a dissertação considera o trabalho na área referida, à luz das especificidades que o orientam. Na introdução, apresenta-se um breve panorama do trabalho de partejar, discutindo a transmissão deste saber nas distintas civilizações humanas, até ser nominado como função especializada, ou seja, como um ramo tecnocientífico unidimensional restrito ao conhecimento médico da área obstétrica. O Capítulo 1 problematiza o paradigma político-econômico que envolve o parto atual enquanto produto constituído no âmbito da sociedade capitalista, abordando dois pontos: a divisão social do trabalho e a realização de distintas tarefas pelos trabalhadores de saúde; e a comparação, a partir do contexto referido, entre assistência hospitalar tecnocrata e o cuidado domiciliar baseado no saber ancestral das parteiras tradicionais. O Capítulo 2 analisa o Programa de Humanização no Pré-Natal e Nascimento do Ministério da Saúde brasileiro – nos aspectos relacionados à garantia de cuidados profissionais para a gestante no momento do parto – e, neste contexto, a proposta do Programa Rede Cegonha direcionada à qualificação do trabalhador da área materno-infantil. A dissertação conclui indicando, a partir da perspectiva de que o parto não constitui um fato natural e sim um ato socialmente produzido, a necessidade de superar a contradição histórica discutida na formação desigual do trabalhador que atua no âmbito da saúde materno-infantil no Sistema Único de Saúde (SUS). / The study analyses the social and historical conditionants of parturition and the dual formation of workers involved in the maternal and child area in Brazil. For both topics, the dissertation considers the job in the refered area, regarding the specificities the abide it. In the introduction, a brief outlook about midwifery is presented, discussing the transmission of this knowledge amongst distinctic human civilizations, until it is nominated as an expertise, in other words, as an technoscientific unidimensional branch restricted to medical knowledge in obstetrics. Chapter 1 problematizes the political and economic paradigm that involves the nowadays parturiton as a constituted product in the scope of capitalist society, addressing two points: social division of labor and the execution of distinct tasks by healthcare workers; and the comparison, from the refered context, between technocrat hospital assistance and home care based upon traditional midwifes' ancestral knowledge. Chapter 2 analyses the brazilian Healthcare Ministry Prenatal and Birth Humanization Program - in the aspects related to the guarantee of professional care for pregnants in the moment of parturition - and, in this context, the proposal of Rede Cegonha Program towards qualification of maternal and child area worker. The dissertation concludes indicating, from the perspetive that the parturition does not constitute a natural fact but a socially produced act, the need to overcome the historical contradition discussed in the unequal formation of the worker that is involved in the scope of Sistema Único de Saúde(SUS) maternal and child healthcare.

This dissertation investigates the mutual life project of Signe (1896-1988) and Axel Höjer (1890-1974), a married couple who were key actors in the construction of the Swedish welfare state. It emphasises the ways in which they went about asserting a special public health expertise in different contexts. As starting points I take the malleability of the concept folkhälsa (people’s health or population health) and the centrality of expertise in the governance of modern societies. Theoretical concepts such as gender, policy transfer, biopower and governmentality are central to the analysis. The dissertation includes three parts. The first part investigates how the Höjers agreed to coordinate their work and how they, with reference to ideas picked up in France and England at the end of World War I, attempted to reform mother and child health care in Sweden. Their strategies where rhetorical but also practical, using Hagalund outside Stockholm as their experimental ground. The second part investigates, firstly, how Axel Höjer, as General-Director of the Medical Board of Sweden (1935-52) asserted a sociomedical expertise, integrating the emerging social sciences and universalist views on the organisation of the welfare state into the realm of medicine, in order to launch ideas of a thorough reorganisation and expansion of the Swedish health care system. His focus was on preventive medicine and health care, with the complete physical, mental and social health of the whole population as an explicit goal. Secondly, it explores how Signe Höjer at the same time tried to launch ideas on health and wellbeing as a social politician and a public committee member. She also tried to define family policy as a specific policy area. However, despite her training as a nurse and a social worker, she was largely confined to asserting a particularly ”female” expertise, which made her position rather ambiguous in terms of authority. The third part investigates how the Höjers, in the 1950s and 60s, worked with international health, Axel mainly for the WHO in India and Ghana, Signe as a policy entrepreneur, primarily in the fields of childcare and family planning. My findings partly confirm theories that see development aid as an extension of domestic social policy, but they challenge the view of aid as a simple one-way process. I demonstrate how the Höjers at least tried to adapt their projects abroad to meet local circumstances, and also show how they brought lessons from the third world to a domestic public. In the latter case they did not primarily act as experts of Swedish-style social policy, but as experts on the developing countries and on development aid.