Bakgrund: Barnmorskeyrket har gått från att främst fokusera på vård under graviditet och förlossning till ett bredare arbetsfält inom sexuell och reproduktiv hälsa som även innefattar arbete på ungdomsmottagning. Barnmorskan på ungdomsmottagningen arbetar förebyggande mot oönskade graviditeter och möter unga kvinnor och män i samtal om graviditet och abort. Att ställas inför ett oväntat graviditetsbesked kan vara omvälvande och barnmorskan är central i att finnas till hands för den unga gravida kvinnan, samt för hennes partner och familj så att hon lättare kan utföra ett informerat beslut. Syfte: Att beskriva barnmorskans erfarenheter av att möta oplanerat gravida unga kvinnor på ungdomsmottagning som beslutar sig för att genomgå en abort. Metod: Semistrukturerade individuella intervjuer användes som insamlingsmetod och analys utfördes med kvalitativ innehållsanalys. Resultat: Två kategorier och sju subkategorier identifierades: Att vara en inlyssnande samtalspartner; Vid graviditetsbeskedet, Inför abortbeslutet och Efter aborten. Individanpassat stöd; Att ge praktiskt och kunskapsmässigt stöd vid den oplanerade graviditeten, Att se till det sociala sammanhanget, Ge stöd för en fortsatt säker sexualitet och Att stödjas för att stödja. Slutsatser och klinisk tillämpbarhet: Barnmorskan fångade in tankar och känslor hos den unga kvinnan och bemötte henne där hon befann sig. Barnmorskan tydliggjorde att abortbeslutet var den unga kvinnans och skyndade inte på beslutet. De betonade vikten av att inte förutsätta abort som det enda handlingsalternativet. Genom att lyssna in individuella behov av stöd kunde barnmorskan tillgodose det stöd som saknades. Att stödja för en fortsatt säker sexualitet såg barnmorskorna som en viktig men utmanande arbetsuppgift som väckte mycket känslor och därför var det viktigt med stöd för barnmorskan i form av kollegor, fortbildning och riktlinjer. Genom att öka kunskapen om barnmorskornas möten med oplanerat gravida unga kvinnor har författarna en förhoppning om ökad förståelse för arbetet och dess utmaningar. Genom fortbildning, hospitering, tydligare riktlinjer och stöttning inom preventivmedelsrådgivning efter aborten kan barnmorskan få mer stöd i sitt arbete och därmed möjlighet att förbättra mötet individanpassat utifrån den unga kvinnans behov. / Background: The midwifery profession has developed from focusing solely on pregnancy and childbirth to a broader field of sexual and reproductive health, including also meeting young people at youth clinics. The midwife at the youth clinic works preventively against unplanned pregnancies and meet young women and men in conversations about pregnancy and abortion. Facing a positive pregnancy notice may be overwhelming and the midwife is central in supporting the young woman, her partner and family in order for her to carry out an informed decision. Objective: To describe the midwife's experiences in meeting unplanned pregnant young women at the youth clinic who decide to have an abortion. Design/Methods: Semi-structured individual interviews were used as the method of data collection and analysis was conducted using qualitative content analysis. Results: Two categories and seven subcategories were identified: Being a listening partner; At the pregnancy announcement, In front of the abortion decision and After the abortion. Individualized support; To provide practical and knowledge based support related to the unplanned pregnancy, To consider the social context, Providing support for a continuing safe sexuality and Achieving support to support. Conclusion and clinical applicability: The midwife captured the thoughts and feelings of the young woman and responded to her where she was. The midwife made it clear that the decision about abortion should be the young woman’s own and not to rush the decision. They stressed the importance of not pre-assume abortion as the only treatment option. By listening to the individual needs of support midwife could meet the support that the young woman was missing. To support the continued safe sexuality were considered important but a challenging aspect of the work evoked emotions, and therefore support to the midwife in the form of colleagues, training and guidelines is important. By increasing the knowledge of the midwives' meetings with unplanned pregnant young women, the authors hope to contribute to a better understanding of Midwifery work and challenges. Through training, field studies, clearer guidelines and support in post abortion contraceptive counseling the midwives can get more support in their work and thus the opportunity to improve person-centered care based on the young woman's needs.

Ce travail porte sur la fonction des éducateurs spécialisés en institution. Malgré les différents profils des éducateurs et leurs différents cadres d’intervention (spatiaux et temporels), la fonction éducative peut être définie comme fonction « chorale », en référence au choeur de la tragédie grecque, dans sa qualité première d’institution. La métaphore tragique a permis d’envisager cette fonction selon le paradigme groupal proposé par la métapsychologie. Les théories psychanalytiques du groupe rendent possible l’examen du travail du lien intersubjectif et de la question des transferts dans l’éducation spécialisée, tant du coté de l’équipe éducative que du coté des « confiés ». La fonction éducative conçue comme fonction « chorale », fonction d’une psyché groupale, permet de penser les relations éducatives plurielles dans leur potentiel de figuration, contribuant à la tâche primaire. La problématique du lien intersubjectif s’avère pertinente pour fonder une « clinique éducative ». / This work concerns the educative function of caseworkers in institution. Despite the caseworkers‘ different profiles and their different frameworks (time and space related), the educative function could be described as a choral function in reference to the Greek tragedy’s choir, in its institution first quality. The tragic metaphor made it possible to think this function according to the group paradigm offered by metapsychology(psychoanalysis). Group psychoanalytical theories made it possible to examine the inter‐subjective link and the question of transfer in social work, so much for the caseworkers than the “users”. The educative function, as a choral function, function of group psyche, allowed us to think the plural educative relationship in their conformation potential, contributing to the primary task. The inter‐subjective link problematic turns out to be relevant to found a “clinic of education”.

Com a longevidade, os indivíduos desenvolvem doenças crônicas e degenerativas, aumentando o número de internações hospitalares e, consequentemente, o tempo de internação. Para a gestão eficaz, é fundamental que o cuidado seja integrado. Assim, os objetivos deste estudo foram: analisar a utilização do Interdisciplinary Method Instrument (Método INTERMED) durante a internação e pós-alta hospitalar; enumerar os aspectos biopsicossociais e o sistema de saúde de pessoas idosas hospitalizadas; identificar a presença de reinternação; correlacionar os escores do INTERMED com as variáveis tempo de permanência hospitalar e reinternação. Para isso, foram utilizadas informações de banco de dados de 180 pessoas idosas internadas em hospital filantrópico do município de São Paulo, como os sociodemográficos, tempo de permanência hospitalar, número de reinternações, Método INTERMED e Escala de Mayo. Houve predomínio de participantes do sexo masculino com média de idade de 72,1 anos, casados (80,5%), e diferença significativa entre os grupos para idade, estado civil, tempo de permanência, escore do INTERMED, encaminhado ao serviço de psicologia e social, o uso de antimicrobiano e solicitação de home care. O escore do domínio biológico foi o de maior valor (p=0,479), porém não houve diferenças significativas entre os escores do INTERMED e reinternação. Nas análises de curva ROC, a área sob a curva foi de 0,426, com ponto de corte de 10/15 pontos e com sensibilidade de 0,714 e especificidade de 0,316, indicando ponto de corte ideal para o INTERMED para predição de Mayo>= 10 é 15 pontos. Os resultados têm que ser encarados como sua aplicação ampliada a diferentes populações e melhor avaliado sob a perspectiva de implicação no processo de trabalho diário da equipe interprofissional. No entanto, visualiza-se vantagens na operacionalização do modelo biopsicossocial, visando a integralidade do cuidado e a influência na gestão da clínica de idosos internados em instituição hospitalar. Espera-se que este estudo possa contribuir para melhoria da gestão clínica, buscando a integralidade do cuidado e aprimorar o processo de trabalho da equipe interprofissional / With longevity, individuals develop chronic and degenerative diseases, increasing the number of hospital admissions and consequently the length of hospital stay. For effective management, it is critical that care be integrated. Thus, the objectives of this study were: to analyze the use of the Interdisciplinary Method Instrument during hospitalization and after hospital discharge; to enumerate the biopsychosocial and health system aspects of hospitalized elderly people; identify the presence of readmission; to correlate the INTERMED scores with the variables length of hospital stay and readmission. For this, we used information from a database of 180 elderly people hospitalized in a philanthropic hospital in the city of São Paulo. Data were: sociodemographic, length of hospital stay, number of readmissions, INTERMED Method and May Scale. There was a predominance of male participants, mean age of 72.1 years, married. There was a significant difference between groups for age, marital status, length of stay, INTERMED score, referral to psychology and social service, antimicrobial use and Home Care request. The biological domain score was the highest value. There were no significant differences between the INTERMED scores and re-hospitalization. The results have to be considered as preliminary, that their application has to be extended to different populations and better evaluated from the perspective of their implication in the daily work process of the interprofessional team. However, it is possible to visualize advantages in the operationalization of the biopsychosocial model aiming at the integrality of the care and its influence in the management of the clinic of elderly hospitalized in a hospital institution. It is hoped that this study may contribute to the improvement of clinical management aiming at the integrality of care and to improve the work process of the interprofessional team

"The purpose of this study was to find out whether there are observable differences between the social characteristics and problems of civilian and military families that use a child guidance clinic. The subjects consist of twenty-six military and twenty-six non-military families using the services of the Escambia County Child Guidance Clinic, Pensacola, Florida"--Introduction. / Typescript. / "August 1959." / "Submitted to the Graduate Council of Florida State University in partial fulfillment of the requirements for the degree of Master of Social Work." / Advisor: Robert Lansdale, Professor Directing Study. / Includes bibliographical references.

"The purpose of this study was to determine the distribution of selected non-symptomatic characteristics collected through the administration of a schedule to 119 cases known to the Child Guidance Clinic of Pinellas County, St. Petersburg, Florida. This study has attempted to ascertain the significant differences between cases classified as schizophrenic reactions and cases classified under "no psychiatric disorder found" with respect to the distribution of these characteristics"--Introduction. / Typescript. / "June, 1959." / "Submitted to the Graduate Council of Florida State University in partial fulfillment of the requirements for the degree of Master of Social Work." / Advisor: Dixie B. Jones, Professor Directing Study. / Includes bibliographical references.

"The purpose of this study was to discover some psychosocial characteristics of fifty out-patients who re-opened their cases two or more times, and to investigate the extent of change that some of these psychosocial characteristics underwent, by comparing the data collected at the first intake interview with the data collected at the latest intake interview"--Introduction. / Typescript. / "June, 1959." / "Submitted to the Graduate Council of Florida State University in partial fulfillment of the requirements for the degree of Master of Social Work." / Advisor: William L. Leap, Professor Directing Study. / Includes bibliographical references.

"The purpose of this study was to analyze data collected through the administration of a schedule to the records of the Dade County Child Guidance Clinic, Miami, Florida during the first 11 years of the Clinic's existence, in order to ascertain if there was an age, sex, and/or referral source pattern in the cases which were opened. Data were collected from 4,706 cases with whom the Clinic staff had contact for one or more interviews. The Child Guidance Clinic serving Dade County opened for service in January, 1948, and the records were examined from that date through December, 1958. The hypothesis of this study is that there is an age, sex, and/or referral source pattern revealed in the distribution of cases opened during an 11-year period at the Dade County Child Guidance Clinic, Miami, Florida, and that there are no differences in these patterns between the first 5 years and the last 5 years of the Clinic's 11-year existence. The word "pattern" is used to mean a distribution which was evidenced consistently throughout the Clinic records and which could be expected to continue unless extensive changes are made in Clinic policies or within the community"--Introduction. / Typescript. / "June, 1959." / "Submitted to the Graduate Council of Florida State University in partial fulfillment of the requirements for the degree of Master of Social Work." / Advisor: Dorothy D. Hayes, Professor Directing Study. / Includes bibliographical references.

"The purpose of this study was to explore the parental participation of each parent in the Human Development Clinic during the treatment of the child's problem to determine the extent to which 66 parent-child treatment cases differed when dichotomized by outcome of service (improved, unimproved) according to clinic judgment at closing. The improved and unimproved treatment cases were compared in regard to 18 selected family and clinic items. Service to these cases was discontinued between September, 1957, and September, 1960, a period of 37 months"--Introduction. / Typescript. / "June, 1961." / "Submitted to the Graduate School of Florida State University in partial fulfillment of the requirements for the degree of Master of Social Work." / Advisor: Dixie B. Jones, Professor Directing Study. / Includes bibliographical references (leaves 52-54).

"The purpose of this study was to determine whether or not 82 adults who continued treatment and 42 adults who discontinued treatment at the Leon County Mental Health Clinic differed significantly when cross-tabulated with seven baseline characteristics, six agency-client descriptive items, and eight items designed to reveal 'perception of the client's problem.' It was hoped that additional knowledge of and insight into the problem of discontinuance by a study of closed adult treatment records during a period of one year would help the Clinic serve, more effectively, adult clients in Leon County"--Introduction. / Typescript. / "June, 1961." / "Submitted to the Graduate School of Florida State University in partial fulfillment of the requirements for the degree of Master of Social Work." / Advisor: Dorothy D. Hayes, Professor Directing Study. / Includes bibliographical references (leaves 63-65).

O presente trabalho se propõe a discutir os destinos psíquicos da experiência traumática, tanto em seus aspectos defensivos, restritivos das capacidades de realização do si-mesmo, quanto no que diz respeito a seus potenciais de simbolização e transformação. Referimo-nos aqui, porém, a uma modalidade particular de traumatismo: aquela que se define por um distanciamento afetivo dos pais em relação à criança, distanciamento esse responsável pelo confronto do sujeito a uma condição de desamparo e impotência insuportáveis. O fracasso dos esforços que, no passado, o indivíduo realizou na tentativa de socorrer os pais em seu sofrimento e de recuperar seu amor deixou como herança um terrível abismo interno e, para sobreviver a essa condição, o psiquismo irá estruturar defesas sofisticadas contra a perda do sentido de si e o colapso da estrutura psíquica de que se vê permanentemente ameaçado, as quais se definem, de nosso ponto de vista, a partir de três vértices principais. Num primeiro plano de análise, pudemos reconhecer que a situação traumática para a qual não se vislumbra nenhuma possibilidade de saída torna-se para o sujeito signo de uma realidade não dimensionável, sem começo, meio e fim, ou seja, uma condição existencial definitiva e inquestionável. Num segundo, fomos levados a tratar os efeitos do abandono afetivo, também, nos termos de um fenômeno de auto-alienação, já que, em meio a uma situação de sofrimento intolerável, uma das primeiras tendências evidenciadas pelo psiquismo é a de mergulhar em um processo de transe, semelhante a uma anestesia, cujo resultado é um estado de desorientação psíquica capaz de suspender a percepção do mal e, junto com ela, a de uma boa parcela da realidade. Consideramos ainda, num terceiro plano, o fato de que, nessa condição, o indivíduo tende a localizar em si mesmo a origem da violência que se abate sobre ele, purificando os pais e a família de todo o seu potencial enlouquecedor e o atribuindo exclusivamente a si. Tais perspectivas se apresentaram para nós como dimensões concomitantes e indissolúveis das configurações subjetivas em que podem ser reconhecidas. A partir de cada uma delas, vemo-nos diante de diferentes aspectos de organizações defensivas criadas contra a angústia de fragmentação e despersonalização gerada pela profunda insegurança a respeito da confiabilidade do objeto. Na última parte da pesquisa, buscamos apresentar possibilidades para o trabalho com pacientes traumatizados, a partir do que nos parecem ser as condições imprescindíveis à simbolização de angústias profundas produzidas pela situação traumática / The present work proposes to discuss the psychic destinies of the traumatic experience, both in their defensive aspects, restrictive of the capacities for realization of the self, and in their potential of symbolization and transformation. We make reference here, however, to a specific modality of traumatism: one which is defined by the affective distance of the parents from the children, distance responsible for the confrontation of the subject with the condition of helplessness and unbearable powerlessness. The failure of the efforts which, in the past, the individual has realized in the attempt to rescue the parents from their suffering and to recover their love left as heritage a terrible interior abyss and, to survive this condition, the psychism will structure sophisticated defences against the loss of the meaning of the self and the collapse of the psychic structure with that is seen permanently threatened, which are defined, in our point of view, from three main angles. In a first level of analysis, we could recognise that the traumatic situation for which is not glimpsed none possibility of exit turns out to be for the subject a sign of a reality which cannot be measured, without beginning, middle and end, that is, a definitive and unquestionable existential condition. In a second level, we were led to treat the effects of the affective abandonment, also, in the terms of a phenomenon of self-alienation, since, in the midst of a situation of intolerable suffering, one of the first tendencies evidenced by the psychism is to submerge in a process of trance, similar to an anesthesia, whose result is a state of psychic disorientation able to cease the perception of the evil and, with it, of a good part of the reality. We also consider, in a third level, the fact that, in this condition, the individual tends to situate in himself or herself the origin of the violence which is inflicted upon him or her, purifying the parents and the family of their whole maddening potential and laying it exclusively to himself or herself. These perspectives have been presented for us as concomitant and indissoluble dimensions of the subjective configurations in which can be recognised. From each one of them, we see us in front of different aspects of defensive organizations created against the angst of fragmentation and depersonalization engendered by the deep insecurity about the confiability of the object. In the last part of the research, we try to present possibilities for a work with traumatized patients, from that appear us to be the essential conditions for the symbolization of deep angsts produced by the traumatic situation