L’hypothèse de cette thèse est qu’une pratique collaborative médecins de famille-pharmaciens communautaires (PCMP) où le pharmacien fournit des soins pharmaceutiques avancés avec ajustement posologique d’une statine permettrait aux patients avec une dyslipidémie une réduction plus importante de leur LDL et augmenterait le nombre de patients atteignant leurs cibles lipidiques. Dans une étude clinique contrôlée et randomisée en grappe visant à évaluer une PCMP pour des patients ayant une dyslipidémie (l’étude TEAM), une journée de formation basée sur un protocole de traitement et des outils cliniques a été offerte aux pharmaciens PCMP pour les préparer à fournir des soins pharmaceutiques avancés. Les connaissances des pharmaciens sur les dyslipidémies étaient faibles avant la formation mais se sont améliorées après (moyenne de 45,8% à 88,2%; p < 0,0001). Après la formation, les pharmaciens avaient un haut niveau d’habiletés cliniques théoriques et pratiques. Bref, une journée de formation basée sur un protocole de traitement et des outils cliniques était nécessaire et adéquate pour préparer les pharmaciens à fournir des soins pharmaceutiques avancés à des patients ayant une dyslipidémie dans le contexte d’une étude clinique. Dans l’étude TEAM, 15 grappes de médecins et de pharmaciens (PCMP : 8; soins habituels (SH) : 7) ont suivi pendant un an, 225 patients (PCMP : 108; SH : 117) à risque modéré ou élevé de maladie coronarienne qui débutaient ou étaient déjà traités par une monothérapie avec une statine mais qui n’avaient pas atteint les cibles lipidiques. Au départ, par rapport aux patients SH, les patients PCMP avaient un niveau de LDL plus élevé (3,5 mmol/L vs 3,2 mmol/L) et recevaient moins de statine à puissance élevée (11,1 % vs 39,7 %). Après 12 mois, la différence moyenne du changement de LDL entre les groupes était égale à -0,2 mmol/L (IC95%: -0,3 à -0,1) et -0,04 (IC95%: -0,3 à 0,2), sans ajustement et avec ajustement, respectivement. Le risque relatif d’atteindre les cibles lipidiques était 1,10 (IC95%: 0,95 à 1,26) et 1,16 (1,01 à 1,32), sans ajustement et avec ajustement, respectivement. Les patients PCMP ont eu plus de visites avec un professionnel de la santé et d’analyses de laboratoire et étaient plus enclins à rapporter des changements de style de vie. La PCMP a amélioré l’adhésion aux lignes directrices en augmentant la proportion de patients aux cibles lipidiques. Les données intérimaires de l’étude TEAM (PCMP : 100 patients; SH : 67 patients) ont permis d’évaluer les coûts directs annuels du suivi du pharmacien du groupe PCMP (formation, visites, laboratoire), du médecin (visites, laboratoire) et du traitement hypolipémiant. Le suivi du pharmacien a coûté 404,07$/patient, incluant 320,67$ pour former les pharmaciens. Le coût global incrémental était 421,01$/patient. Une pratique collaborative pour des patients ayant une dyslipidémie engendre un coût raisonnable. / The hypothesis was that a family physician-community pharmacist collaborative care (PPCC) model where the pharmacist provides advanced pharmaceutical care including statin dosage adjustment would provide a greater LDL reduction to dyslipidemia patients and increase the number of patients reaching their target lipid levels. . In a cluster randomised controlled trial to evaluate a PPCC model for patients with dyslipidemia (TEAM study), a one-day workshop based on a treatment protocol and specific clinical tools was offered to prepare PPCC pharmacists to provide advanced pharmaceutical care to dyslipidemia patients. Pharmacists knowledge on dyslipidemia was low before the workshop but significantly improved thereafter (overall score from 45,8% to 88,2%; p < 0,0001). After the workshop, pharmacists showed a high level of theoretical and practical skills. Finally, a one-day workshop based on a treatment protocol and clinical tools was necessary and adequate to prepare pharmacists to provide advanced pharmaceutical care to patients with dyslipidemia in the context of a clinical trial. In the TEAM study, 15 clusters of physicians and pharmacists (PPCC: 8; usual care (UC) : 7) followed for 1 year, 225 patients (PPCC: 108; UC:117) at moderate or high risk of coronary heart disease who initiated or were already treated with a statin monotherapy but who did not achieved target lipid levels. At baseline, compared to UC patients, PPCC patients had a higher level of LDL (3.54 mmol/L vs 3.22 mmol/L) and were prescribed less high-potency statin (11,1% vs 39,7%). At 12 months, the crude and adjusted between group-differences in the mean change in LDL-C were equal to -0.2 mmol/L (95%CI: -0.3 to -0.1) and -0.04 (95%CI: -0.3 to 0.2), respectively. The crude and the adjusted relative risk of achieving lipid targets were equal to 1.10 (95%CI: 0.95 to 1.26) and 1.16 (1.01 to 1.32), respectively. PPCC patients had more health-professional visits and laboratory tests, were more likely to have their lipid-lowering treatment changed, and to report lifestyle changes. PPCC improved adherence to treatment-guideline recommendations with higher proportion of patients achieving their target lipid levels. From an interim analysis of the TEAM study (PPCC: 100 patients; UC: 67 patients) the annual direct costs for the pharmacist follow-up in the PPCC group (training, visits, laboratories), physician follow-up (visits, laboratories) and lipid-lowering treatment were evaluated. The cost for the pharmacist follow-up was $404.07/patient, including $320.67 to train pharmacists. The incremental overall cost was $421.01/patient. Finally, a PPCC for patients with dyslipidemia entails a reasonable cost.

Nos últimos trinta anos, pesquisadores da área da saúde tem dado especial atenção ao tema da educação interprofissional (EIP), por esta estar relacionada com uma maior satisfação dos usuários e a oferta de uma assistência em saúde mais resolutiva e satisfatória. A necessidade de adotarmos a EIP como uma ferramenta para a formação de profissionais da saúde surge a partir do momento que percebemos que nosso sistema de saúde presta cuidados fragmentados e pouco resolutivos. Atualmente, estudos científicos comprovam que a prática colaborativa e um cuidado ofertado com qualidade é facilmente alcançável se os profissionais trabalharem em equipe com objetivos comuns, sendo imprenscindível o desenvolvimento de habilidades de comunicação interprofissional e prática colaborativa desde o início da graduação. Desta forma, este estudo tomou como objeto de investigação a educação interprofissional, no contexto da atenção primária a saúde e na perspectiva da integração do ensino com os serviços públicos de saúde, por meio do programa Pró PET-Saúde USP-Capital 2012/2014. A escolha do programa para o presente estudo foi devido a natureza interprofissional do projeto, visto que engloba estudantes, preceptores e tutores de diversos cursos da área da saúde e por este ter constituído um espaço privilegiado de aprendizado e aperfeiçoamento na formação em saúde, dando origem a outras iniciativas interprofissionais na Universidade de São Paulo (USP). A coleta de dados ocorreu de duas formas, sendo a primeira por meio de questionários individuais destinado aos profissionais de saúde (preceptores) e estudantes, com trechos da obra de Lewis Carroll \"As Aventuras de Alice no País das Maravilhas\", e por meio de um roteiro de entrevista destinado aos docentes (tutores) participantes do programa. Os dados obtidos foram analisados através da análise temática proposta por Minayo. Os resultados mostram que assim como a personagem Alice do livro de Carroll, muitas vezes ficamos confusos sobre quais opções escolher para aperfeiçoar a nossa formação em saúde. Se não soubermos onde queremos chegar, qualquer caminho se torna o certo, porém as evidências comprovam que a escolha por oportunidades de educação interprofissional na graduação e na pós graduação em saúde podem minimizar estereótipos e preconceitos formados pelos estudantes em relação as outras categorias profissionais e desenvolver habilidades de comunicação interprofissional e resolução de conflitos que contribuirá para uma prática colaborativa e a melhor assistência em saúde. Como produto do mestrado profissional foi elaborado um plano de aula destinado aos estudantes da USP com a finalidade de problematizar e permitir uma breve experiência da educação interprofissional. / For the last thirty years, healthcare researchers were giving special attention to the interprofessional education subject (IPE), for it being related to a more positive feedback from the user and a more accurate and satisfactory health care assistance. The need to adopt the IPE as a tool for the formation of professionals on the health area comes from moment where we realize that our health system is delivering a fragmented and less accurate health care. Nowadays, scientific studies show that collaborative practice and the quality of the offered care is more likely if professionals work in a team with common aim, being necessary to develop interprofessional communication skills and collaborative practice since the beginning of the course. Thus, this study took as investigation object the interprofessional education, in the context of the primary health care and the perspective of the integration between education and the public health services, through the program Pró PET-Saúde USP-Capital 2012/2014. The choice of the program for this study was due the interprofessional nature of the project, since it includes students, preceptors and tutors from many healthcare courses and for it being structured in a privileged space for learning and improvement in health training, promoting development to other interprofessional initiatives at Universidade de São Paulo (USP). Data collection occurred in two ways, the first one being through an individual questionnaire with quotes from the book of Lewis Carroll \"Alice in Wonderland\" designed for the students who attended to the program, another individual questionnaire intended for health professionals (preceptors) and an interview script destined the professors (tutors) who participated on the program. The data collected were analyzed by the researcher using the thematic analysis proposed by Minayo. Results show that likewise the character Alice from \"Alice in wonderland\", often we get confused about which options should we chose in order to improve our health training. If we don\'t know where we want to get to, any path would suffice, however, evidences show that a choice for an opportunity in interprofessional education while in health training could minimize the stereotypes and prejudices formed by students in relation to other professional categories and develop interprofessional communication abilities and conflict management, which will contribute to a collaborative practice and a better health care. As result of the professional master\'s degree, it was developed a class plan for the students at USP in order to problematize and allow a brief interprofessional education experience.

Nos últimos trinta anos, pesquisadores da área da saúde tem dado especial atenção ao tema da educação interprofissional (EIP), por esta estar relacionada com uma maior satisfação dos usuários e a oferta de uma assistência em saúde mais resolutiva e satisfatória. A necessidade de adotarmos a EIP como uma ferramenta para a formação de profissionais da saúde surge a partir do momento que percebemos que nosso sistema de saúde presta cuidados fragmentados e pouco resolutivos. Atualmente, estudos científicos comprovam que a prática colaborativa e um cuidado ofertado com qualidade é facilmente alcançável se os profissionais trabalharem em equipe com objetivos comuns, sendo imprenscindível o desenvolvimento de habilidades de comunicação interprofissional e prática colaborativa desde o início da graduação. Desta forma, este estudo tomou como objeto de investigação a educação interprofissional, no contexto da atenção primária a saúde e na perspectiva da integração do ensino com os serviços públicos de saúde, por meio do programa Pró PET-Saúde USP-Capital 2012/2014. A escolha do programa para o presente estudo foi devido a natureza interprofissional do projeto, visto que engloba estudantes, preceptores e tutores de diversos cursos da área da saúde e por este ter constituído um espaço privilegiado de aprendizado e aperfeiçoamento na formação em saúde, dando origem a outras iniciativas interprofissionais na Universidade de São Paulo (USP). A coleta de dados ocorreu de duas formas, sendo a primeira por meio de questionários individuais destinado aos profissionais de saúde (preceptores) e estudantes, com trechos da obra de Lewis Carroll \"As Aventuras de Alice no País das Maravilhas\", e por meio de um roteiro de entrevista destinado aos docentes (tutores) participantes do programa. Os dados obtidos foram analisados através da análise temática proposta por Minayo. Os resultados mostram que assim como a personagem Alice do livro de Carroll, muitas vezes ficamos confusos sobre quais opções escolher para aperfeiçoar a nossa formação em saúde. Se não soubermos onde queremos chegar, qualquer caminho se torna o certo, porém as evidências comprovam que a escolha por oportunidades de educação interprofissional na graduação e na pós graduação em saúde podem minimizar estereótipos e preconceitos formados pelos estudantes em relação as outras categorias profissionais e desenvolver habilidades de comunicação interprofissional e resolução de conflitos que contribuirá para uma prática colaborativa e a melhor assistência em saúde. Como produto do mestrado profissional foi elaborado um plano de aula destinado aos estudantes da USP com a finalidade de problematizar e permitir uma breve experiência da educação interprofissional. / For the last thirty years, healthcare researchers were giving special attention to the interprofessional education subject (IPE), for it being related to a more positive feedback from the user and a more accurate and satisfactory health care assistance. The need to adopt the IPE as a tool for the formation of professionals on the health area comes from moment where we realize that our health system is delivering a fragmented and less accurate health care. Nowadays, scientific studies show that collaborative practice and the quality of the offered care is more likely if professionals work in a team with common aim, being necessary to develop interprofessional communication skills and collaborative practice since the beginning of the course. Thus, this study took as investigation object the interprofessional education, in the context of the primary health care and the perspective of the integration between education and the public health services, through the program Pró PET-Saúde USP-Capital 2012/2014. The choice of the program for this study was due the interprofessional nature of the project, since it includes students, preceptors and tutors from many healthcare courses and for it being structured in a privileged space for learning and improvement in health training, promoting development to other interprofessional initiatives at Universidade de São Paulo (USP). Data collection occurred in two ways, the first one being through an individual questionnaire with quotes from the book of Lewis Carroll \"Alice in Wonderland\" designed for the students who attended to the program, another individual questionnaire intended for health professionals (preceptors) and an interview script destined the professors (tutors) who participated on the program. The data collected were analyzed by the researcher using the thematic analysis proposed by Minayo. Results show that likewise the character Alice from \"Alice in wonderland\", often we get confused about which options should we chose in order to improve our health training. If we don\'t know where we want to get to, any path would suffice, however, evidences show that a choice for an opportunity in interprofessional education while in health training could minimize the stereotypes and prejudices formed by students in relation to other professional categories and develop interprofessional communication abilities and conflict management, which will contribute to a collaborative practice and a better health care. As result of the professional master\'s degree, it was developed a class plan for the students at USP in order to problematize and allow a brief interprofessional education experience.

This collective case study examined the factors affecting the collaborative relationship between teachers and early childhood educators (ECEs) teaching together in elementary schools as Early Learning Teams in the first year of implementation of full-time kindergarten in Ontario. There are six major adjustments required concurrently by the Ontario government’s new policy in all kindergarten classrooms: team-teaching (sharing instruction, not just classroom management); supporting ECEs as new staff; changing from theme-based to inquiry-based; balancing the School District’s literacy goals with provincial play-based curriculum; double the instructional time, and the increased number of children in the classroom (up from 19 to 24-30). Two of the four classrooms studied in a rural Ontario school district were full-day, every day kindergartens (FDK) for 4 and 5 year olds and the other two were alternate full-days. Data were collected through classroom observations and interviews with principals, kindergarten teachers and ECEs. Case study theory guided the collection and analysis of data with open coding of transcripts, active code notes and memos to help answer the question of how to best implement FDK programs in Ontario. Results indicated that the FDK Team relationship itself enabled and constrained classroom instructional strategies, which would in turn have an impact on student outcomes. Collaborative practice involved a process that was affected by both internal factors (such as teacher foreknowledge of ECE skills), and thirteen external factors which arose from government and school district mandates, as well as practices of the school principal. Examples are: planning time, pay differential, hiring practices and adjusting to the new curriculum at the same time as the team adjusts to team teaching. The collaboration of more than 9,500 teacher and ECE teams is key to the success of Ontario’s new full-time early learning program. The education sector needs to adopt the long-established business practice of supporting team development through recognizing progressive teaming stages, such as those identified by Tuckman (1965). Recommendations are made for principals, school districts offices, government policy, FDK teachers, ECEs, and colleges that provide ECE training. A mnemonic for the four attributes evident in high-functioning collaborative integrated teaching teams (RISE) is proposed.

L’hypothèse de cette thèse est qu’une pratique collaborative médecins de famille-pharmaciens communautaires (PCMP) où le pharmacien fournit des soins pharmaceutiques avancés avec ajustement posologique d’une statine permettrait aux patients avec une dyslipidémie une réduction plus importante de leur LDL et augmenterait le nombre de patients atteignant leurs cibles lipidiques. Dans une étude clinique contrôlée et randomisée en grappe visant à évaluer une PCMP pour des patients ayant une dyslipidémie (l’étude TEAM), une journée de formation basée sur un protocole de traitement et des outils cliniques a été offerte aux pharmaciens PCMP pour les préparer à fournir des soins pharmaceutiques avancés. Les connaissances des pharmaciens sur les dyslipidémies étaient faibles avant la formation mais se sont améliorées après (moyenne de 45,8% à 88,2%; p < 0,0001). Après la formation, les pharmaciens avaient un haut niveau d’habiletés cliniques théoriques et pratiques. Bref, une journée de formation basée sur un protocole de traitement et des outils cliniques était nécessaire et adéquate pour préparer les pharmaciens à fournir des soins pharmaceutiques avancés à des patients ayant une dyslipidémie dans le contexte d’une étude clinique. Dans l’étude TEAM, 15 grappes de médecins et de pharmaciens (PCMP : 8; soins habituels (SH) : 7) ont suivi pendant un an, 225 patients (PCMP : 108; SH : 117) à risque modéré ou élevé de maladie coronarienne qui débutaient ou étaient déjà traités par une monothérapie avec une statine mais qui n’avaient pas atteint les cibles lipidiques. Au départ, par rapport aux patients SH, les patients PCMP avaient un niveau de LDL plus élevé (3,5 mmol/L vs 3,2 mmol/L) et recevaient moins de statine à puissance élevée (11,1 % vs 39,7 %). Après 12 mois, la différence moyenne du changement de LDL entre les groupes était égale à -0,2 mmol/L (IC95%: -0,3 à -0,1) et -0,04 (IC95%: -0,3 à 0,2), sans ajustement et avec ajustement, respectivement. Le risque relatif d’atteindre les cibles lipidiques était 1,10 (IC95%: 0,95 à 1,26) et 1,16 (1,01 à 1,32), sans ajustement et avec ajustement, respectivement. Les patients PCMP ont eu plus de visites avec un professionnel de la santé et d’analyses de laboratoire et étaient plus enclins à rapporter des changements de style de vie. La PCMP a amélioré l’adhésion aux lignes directrices en augmentant la proportion de patients aux cibles lipidiques. Les données intérimaires de l’étude TEAM (PCMP : 100 patients; SH : 67 patients) ont permis d’évaluer les coûts directs annuels du suivi du pharmacien du groupe PCMP (formation, visites, laboratoire), du médecin (visites, laboratoire) et du traitement hypolipémiant. Le suivi du pharmacien a coûté 404,07$/patient, incluant 320,67$ pour former les pharmaciens. Le coût global incrémental était 421,01$/patient. Une pratique collaborative pour des patients ayant une dyslipidémie engendre un coût raisonnable. / The hypothesis was that a family physician-community pharmacist collaborative care (PPCC) model where the pharmacist provides advanced pharmaceutical care including statin dosage adjustment would provide a greater LDL reduction to dyslipidemia patients and increase the number of patients reaching their target lipid levels. . In a cluster randomised controlled trial to evaluate a PPCC model for patients with dyslipidemia (TEAM study), a one-day workshop based on a treatment protocol and specific clinical tools was offered to prepare PPCC pharmacists to provide advanced pharmaceutical care to dyslipidemia patients. Pharmacists knowledge on dyslipidemia was low before the workshop but significantly improved thereafter (overall score from 45,8% to 88,2%; p < 0,0001). After the workshop, pharmacists showed a high level of theoretical and practical skills. Finally, a one-day workshop based on a treatment protocol and clinical tools was necessary and adequate to prepare pharmacists to provide advanced pharmaceutical care to patients with dyslipidemia in the context of a clinical trial. In the TEAM study, 15 clusters of physicians and pharmacists (PPCC: 8; usual care (UC) : 7) followed for 1 year, 225 patients (PPCC: 108; UC:117) at moderate or high risk of coronary heart disease who initiated or were already treated with a statin monotherapy but who did not achieved target lipid levels. At baseline, compared to UC patients, PPCC patients had a higher level of LDL (3.54 mmol/L vs 3.22 mmol/L) and were prescribed less high-potency statin (11,1% vs 39,7%). At 12 months, the crude and adjusted between group-differences in the mean change in LDL-C were equal to -0.2 mmol/L (95%CI: -0.3 to -0.1) and -0.04 (95%CI: -0.3 to 0.2), respectively. The crude and the adjusted relative risk of achieving lipid targets were equal to 1.10 (95%CI: 0.95 to 1.26) and 1.16 (1.01 to 1.32), respectively. PPCC patients had more health-professional visits and laboratory tests, were more likely to have their lipid-lowering treatment changed, and to report lifestyle changes. PPCC improved adherence to treatment-guideline recommendations with higher proportion of patients achieving their target lipid levels. From an interim analysis of the TEAM study (PPCC: 100 patients; UC: 67 patients) the annual direct costs for the pharmacist follow-up in the PPCC group (training, visits, laboratories), physician follow-up (visits, laboratories) and lipid-lowering treatment were evaluated. The cost for the pharmacist follow-up was $404.07/patient, including $320.67 to train pharmacists. The incremental overall cost was $421.01/patient. Finally, a PPCC for patients with dyslipidemia entails a reasonable cost.

Collaborative care is a philosophy which guides the work of interdisciplinary teams and patients and their families internationally. It has been demonstrated to improve quality of care, safety, and patient and staff satisfaction, yet applying this philosophy still requires much investigation. This thesis describes processes of change directed towards a vision to enhance collaborative care relationships with patients and families within one hospital site of a non-acute academic health science centre in Ontario, Canada. By building focused conversations around existing patient and family centred education and using an initial conceptual framework of customer service, healthcare providers, mid- and senior level leaders shared their perspectives, negotiated meanings and created innovations to enhance collaborative relationships within the organization. Based within the critical paradigm, a critical collaborative ethnography was constructed with the use of sequential and mixed research methodologies. The ethnography evolved over three phases in a step-wise and additive design during the three year period of study. Phase 1 examined the perspectives of healthcare providers in an exploratory case study which contributed to mid-level leaders’ discussions in Phase 2. Cumulative findings from Phases 1 and 2 were brought to discussions with senior leaders in Phase 3. Members of a participative action research team assisted with research design and study processes. Shared meanings and innovative change ideas were developed and captured through the use of semi-structured focus groups and interviews, survey, participant observation and inductive analysis. A conceptual framework of ‘partners-in-care’ emerged and was used to assist participants to make sense of the values and factors important in their work with respect to collaborative relationships. The research processes facilitated the development of many innovations to enhance collaborative practice within the hospital. The organization was described by the research as undergoing directed change to enhance collaborative care as evidenced through participant self-reports, observed initiatives and the ethnographic descriptions. / Thesis (Ph.D, Rehabilitation Science) -- Queen's University, 2012-06-25 15:06:24.687

This collective case study examined the factors affecting the collaborative relationship between teachers and early childhood educators (ECEs) teaching together in elementary schools as Early Learning Teams in the first year of implementation of full-time kindergarten in Ontario. There are six major adjustments required concurrently by the Ontario government’s new policy in all kindergarten classrooms: team-teaching (sharing instruction, not just classroom management); supporting ECEs as new staff; changing from theme-based to inquiry-based; balancing the School District’s literacy goals with provincial play-based curriculum; double the instructional time, and the increased number of children in the classroom (up from 19 to 24-30). Two of the four classrooms studied in a rural Ontario school district were full-day, every day kindergartens (FDK) for 4 and 5 year olds and the other two were alternate full-days. Data were collected through classroom observations and interviews with principals, kindergarten teachers and ECEs. Case study theory guided the collection and analysis of data with open coding of transcripts, active code notes and memos to help answer the question of how to best implement FDK programs in Ontario. Results indicated that the FDK Team relationship itself enabled and constrained classroom instructional strategies, which would in turn have an impact on student outcomes. Collaborative practice involved a process that was affected by both internal factors (such as teacher foreknowledge of ECE skills), and thirteen external factors which arose from government and school district mandates, as well as practices of the school principal. Examples are: planning time, pay differential, hiring practices and adjusting to the new curriculum at the same time as the team adjusts to team teaching. The collaboration of more than 9,500 teacher and ECE teams is key to the success of Ontario’s new full-time early learning program. The education sector needs to adopt the long-established business practice of supporting team development through recognizing progressive teaming stages, such as those identified by Tuckman (1965). Recommendations are made for principals, school districts offices, government policy, FDK teachers, ECEs, and colleges that provide ECE training. A mnemonic for the four attributes evident in high-functioning collaborative integrated teaching teams (RISE) is proposed.

Submitted by Glauber de Assunção Moreira (glauber.moreira@ufba.br) on 2018-09-21T17:06:26Z No. of bitstreams: 1 TESE FINAL.pdf: 11808708 bytes, checksum: c024f24c260a47eaf98470dcbb623cfb (MD5) / Approved for entry into archive by Ednaide Gondim Magalhães (ednaide@ufba.br) on 2018-09-25T12:48:09Z (GMT) No. of bitstreams: 1 TESE FINAL.pdf: 11808708 bytes, checksum: c024f24c260a47eaf98470dcbb623cfb (MD5) / Made available in DSpace on 2018-09-25T12:48:09Z (GMT). No. of bitstreams: 1 TESE FINAL.pdf: 11808708 bytes, checksum: c024f24c260a47eaf98470dcbb623cfb (MD5) / A pesquisa qualitativa visa demonstrar uma maneira de constituir redes de aprendizagem para o desenvolvimento cultural, contribuindo com a sustentabilidade de projetos artístico-pedagógicos em artes cênicas. A hipótese é: a implementação de práticas colaborativas, definidas provisória e suscintamente como dialógicas, baseadas na presença e afetividade, nas quais a participação retroalimenta a rede e os(as) participantes, favorece a coimplicação com o processo de desenvolvimento cultural. A abordagem é mit-disciplinar e multirreferencial, com contribuições do campo da arte, sobretudo de Bishop, Kester, Collados e Rodrigo, e da educação, com Freire, Maturana e Rancière. Trata-se, em acordo com Yin, de um estudo de caso único longitudinal das abordagens artístico-pedagógicas do projeto Mediação Cultural: Programa de Formação em artes Cênicas, nas edições 2013 e 2014, em Salvador e Região Metropolitana. Foram avaliadas as práticas colaborativas implementadas no projeto. Verificou-se que em 2013 a tônica foi a realização de ações pré-estabelecidas pela equipe do projeto. Em 2014, os acompanhamentos pedagógicos inspirados em Freire e Pacheco, como círculos de formação participativos e corresponsáveis, constituíram ambiente para as práticas colaborativas. Seguindo a tipologia de Kwon, o Núcleo de Educadores(as) do Subúrbio Ferroviário de Salvador constituiu uma “comunidade inventada em andamento”. A rede de aprendizagem sustentável se verifica: na atitude dos(as) educadores(as) de mapear contextos e possibilidades no território; no estabelecimento de parcerias para fortalecer suas produções culturais; na reinvenção das relações sociais no núcleo, integrando educandos(as) e parentes na “Família Mediação”; e na autogestão do núcleo. A pesquisa confirmou a hipótese inicial e a formulação conceitual provisória apresentada. / The qualitative research aims to demonstrate a way to constitute networks of collective learning for cultural development, contributing to the sustainability of pedagogical artistic projects of performing arts. The hypothesis is: the implementation of collaborative practices, provisionally and concisely defined as dialogical, based on presence and affection, in which participation feeds back the network and participants, encourages the co-involvement with the cultural development process. The approach is mit-disciplinary and multi-referential, with contributions from the field of art, especially from Bishop, Kester, Collados and Rodrigo, and education, with Freire, Maturana and Rancière. This is in accordance with Yin, a single longitudinal case study of pedagogical artistic approaches in Cultural Mediation project: Training Program in Performing arts, editions 2013 and 2014, in Salvador and the Metropolitan Area. Collaborative practices implemented in the project were evaluated. It was found that in 2013 the emphasis was the fulfillment of pre-established actions by the project team. In 2014, the pedagogical accompaniments inspired by Freire and Pacheco as circles of participatory and coresponsible formation constituted an environment for collaborative practices. Following Kwon’s typology, o Núcleo de Educadores do Subúrbio Ferroviário de Salvador constituted an invented community ongoing. The sustainable learning network is evidenced in: the attitude of educators to map contexts and opportunities in the territory; the establishment of partnerships to strengthen their cultural productions; the reinvention of social relations in core, integrating students and relatives in "Mediation Family"; the self-management of the core. The survey confirmed the initial hypothesis and the provisional conceptual formulation presented. / La recherche qualitative vise démontrer une manière de constituer des réseaux d'apprentissage collectif pour le développement culturel. En contribuant, pour la soutenabilité des projets artistiques pédagogiques dans les arts de la scène. L'hypothèse est: la mise en oeuvre des pratiques de collaboration, provisoirement et succinctement définis comme pratiques dialogiques, basé en la présence et l'affectivité dans lesquels la participation réinjecte au réseau et les participants euxmêmes, favorise la sensibilisation et co-implication dans et avec le processus de développement culturelle collective. C'est une approche mit-disciplinaire et multiréférentielle, avec les contributions théoriques et pratiques au domaine de l'art, en particulier de Bishop, Kester, Collados et Rodrigo, et de l'éducation, avec Freire, Maturana et Rancière. C'est, conformément au Yin, d'une étude de cas unique et longitudinale des approches artistiques et pédagogiques du projet Médiation Culturelle: Programme de Formation en Arts de la Scène, dans ses éditions en 2013 et 2014, à Salvador et Région Métropolitaine. Ont été évalué les pratiques de collaboration mis en oeuvre dans le projet. Il a été constaté que, à la édition 2013, la tonique était l'accomplissement d'actions préétablies par l'équipe du projet. En 2014, les accompagnements pédagogiques inspirés par Freire et Pacheco comme des cercles de formation participative et co-responsables ont constitué un environnement pour les pratiques collaboratives. Selon la typologie de Kwon, le Núcleo de Educadores do Subúrbio Ferroviário de Salvador a constitué une "communauté en cours". Le réseau d'apprentissage soutenable est mis évidence en: l'attitude des éducateurs en identifier des contextes et des possibilités dans le territoire; l'établissement de partenariats entre les éducateurs pour renforcer leurs productions culturelles; la réinvention des relations sociales dans le noyau intégrant étudiants et des familiers à la ”Famille Médiation”; l'autogestion du noyau. La recherche a confirmé l'hypothèse initiale et la formulation conceptuelle provisoire présenté.

The development of language and communication skills in young children is directly related to future academic success. Young children who are at risk for language impairment should, therefore, be identified as early as possible so that their language development may be optimised. Multilingualism, which has become a universal phenomenon, may mask the presence of language impairment if the pre-school teacher or speech-language therapist is not proficient in the young multilingual learner’s primary language. In some urban areas of South Africa, where many languages are represented in each pre-school classroom, it is likely that the teacher or therapist will lack proficiency in the primary language of quite a number of the pre-school learners. In these contexts, the language of mutual understanding is English and assessment of learners’ language behaviour will also be conducted in English. Against this background the aim of this study was to determine the feasibility of constructing a profile of typical English language behaviours for pre-school EAL learners in a circumscribed urban area. The profile is intended to provide speech-language therapists and pre-school teachers in collaborative practice with a dual-purpose tool: an instrument for identifying those learners who are at risk for language impairment/language learning disabilities, and a means of obtaining guidelines for the development of an appropriate programme for facilitating language development. The literature study reviewed the language diversity in South African pre-schools, and the role of speech-language therapists in these multilingual pre-schools. The aspects of language to be included in a profile of typical English language behaviours for young EAL learners were discussed. A quantitative descriptive research design was selected. The language database for 30 EAL pre-schoolers from a circumscribed geographical area was collected during 20 minutes of conversation between each pre-school participant and a trained speech-language therapist who acted as research fieldworker. The language data was analysed to identify typical language behaviours relating to language form, language content and language use. The results show that it was possible to construct a profile of typical English language behaviours for nine aspects of language form, one aspect of language content, and six aspects of language use. The information was used to construct two versions of a profile of typical English language behaviours, as well as a profile of risk indicators for language impairment in the specified group of EAL pre-schoolers. An action plan was designed to indicate the way in which these three profiles – the comprehensive profile, the essential classroom profile, and the profile of risk indicators – may be used by the collaborative team of speech-language therapist and pre-school teacher for language assessment, the identification of learners with language impairment, and the facilitation of language development for all EAL learners. / Thesis (DPhil (Communication Pathology))--University of Pretoria, 2007. / Speech-Language Pathology and Audiology / Unrestricted

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