This study addresses the effectiveness of communication between the team (doctors, sisters and social workers) and patients at the Breast Cancer Clinic of the Johannesburg Hospital. Tue needs of patients were highlighted, as well as the role of care-giver, both as a group and in their separate disciplines, in attempting to meet these needs. Tue empirical survey was carried out through the use of questionnaires as well as interview schedules. Patients, doctors, nurses and social workers were used as respondents. Results indicated that the majority of patients' needs for information and support were met by the team in general; however, a need for further social work intervention seemed to be apparent. In addition, several barriers were found to inhibit both team-patient and inter-team communication. Tue researcher used the information gathered in this study to make recommendations that will facilitate improved communication in the clinic, with specific reference to the role of the social worker. / Social Work / M.A.(Social Science: Mental Health)

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Esta pesquisa é fruto de inquietações e questionamentos da pesquisadora em uma UTI geral/adulto, seu campo de ação clínica. A questão que norteou a pesquisa buscou compreender a experiência de uma equipe de saúde em uma UTI/geral adulto. A interrogação inicial desdobrou-se em novas perguntas: como as ações da equipe podem ser complementares no contexto da UTI, cuja prioridade é salvar a vida do paciente, considerando, também, o cuidado integral do paciente. Como a equipe lida com as questões da morte e do morrer em seu cotidiano de trabalho, e quais as repercussões dessa experiência no modo como acontecem as intervenções junto ao paciente e familiares? Quais os prejuízos decorrentes da fragmentação do saber na modernidade, nas ações da equipe de saúde na situação de intervenção em uma UTI geral/ adulto. E quais as possíveis contribuições da ação clínica do psicólogo, fundada numa perspectiva fenomenológica existencial, no modo de funcionar da equipe de saúde. A dissertação está organizada em três artigos: dois teóricos e um empírico. O primeiro artigo teórico, trata da ação de uma equipe de saúde em UTI, teve como metodologia a pesquisa bibliográfica. Em seu desenvolvimento, busca traçar o surgimento da UTI e a evolução da assistência hospitalar ao doente grave, ressaltando os eminentes personagens da história do intensivismo; caracteriza o modelo atual de UTI no Brasil e descreve como a equipe multiprofissional foi se estabelecendo neste contexto de ação; apresenta, ainda, o cotidiano de trabalho da equipe e o quanto sua rotina é atravessada pelas questões da vida e da morte. O segundo artigo, também com metodologia bibliográfica, enfoca o acontecer da equipe de saúde em uma Unidade de Terapia Intensiva. Para tanto, aborda a fragmentação do saber na modernidade e sua ressonância na prática do profissional de saúde, delineando o fenômeno da hiperespecialização e as relações disciplinares; além disso, demarca a ação do psicólogo na equipe da UTI, numa perspectiva da fenomenologia existencial. Por fim, o terceiro artigo foi desenvolvido a partir de uma pesquisa qualitativa de cunho fenomenológico. A questão da pesquisa, vinculada aos objetivos da dissertação, foi trabalhada em um encontro com seis profissionais de saúde que fazem parte de equipes multidisciplinares em um Centro de Terapia Intensiva de um hospital da rede privada na cidade de Recife, cujos dados foram analisados a partir da Analítica de Sentido de Critelli. Como resultado observou-se que uma única área de conhecimento não pode dar conta da complexidade do fenômeno do adoecimento; que o trabalho em equipe exige colaboração, de modo que as ações no campo possam revelar uma fusão de horizontes, com possibilidades para o iniciar de uma outra/nova compreensão da ação em con-junto.

Made available in DSpace on 2017-06-01T18:08:40Z (GMT). No. of bitstreams: 1 dissertacao_josemary_costa.pdf: 1358075 bytes, checksum: f08c82f557d08e3c315127ab5d5433a1 (MD5) Previous issue date: 2012-11-09 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This research is the result of concerns and questions of the researcher in a general ICU / adult, in his field of clinical action. The question that guided the research sought to understand the experience of a team of health care at ICU / general adult. The paper is organized into three parts: two theoretical papers and empirical one. The initial interrogation lead us to new questions: how the team's actions may be complementary in the context of the ICU, whose priority is to save the patient´s life, considering also the holistic care of the patient. As the team deals with issues of death and dying in their daily work, and what the repercussions of this experience happen in the way the interventions with the patient and family? What are the negative effects of fragmentation of knowledge in modernity, the actions of the health team in a position to intervene at the ICU / general adult. And what are the possible contributions of the psychologist's clinical action based on an existential phenomenological perspective, mode of functioning of the health team. The first theoretical paper deals with the action of a health team in the ICU, had the methodology literature.About the development outlines around the emergence of the historical evolution of the ICU and hospital care to the ill person, emphasizing the prominent characters in the history of intensive care. It also aims to characterize the current model of ICU in Brazil and it describes how the multidisciplinary team was establishing itself in this context of action. It also displays the daily work of the team and how your routine is crossed by the issues of life and death. The second article, also with the methodology literature, focuses on the happening of the health team at intensive care unit. To do so, addresses the fragmentation of knowledge in modernity and resonances in the practice of health professionals outlining the phenomenon of hyperdisciplinary and relationships. Moreover, the action marks the psychologist in ICU team perspective of existential phenomenology. Finally, the third article was developed from a qualitative study of a phenomenological. The question of research, linked to the aims of the dissertation, was crafted in a meeting with six health professionals who are part of multidisciplinary teams in the intensive care unit of a private hospital network in the City of Recife and the data were analyzed from the Analytical Sense Critelli. As a result it was observed that a single area of knowledge does not account for the complexity of the phenomenon of illness that requires teamwork, collaboration, so thatthe actions in the field may prove a "fusion of horizons" with possibility to start another /new understanding of action in a set. / Esta pesquisa é fruto de inquietações e questionamentos da pesquisadora em uma UTI geral/adulto, seu campo de ação clínica. A questão que norteou a pesquisa buscou compreender a experiência de uma equipe de saúde em uma UTI/geral adulto. A interrogação inicial desdobrou-se em novas perguntas: como as ações da equipe podem ser complementares no contexto da UTI, cuja prioridade é salvar a vida do paciente, considerando, também, o cuidado integral do paciente. Como a equipe lida com as questões da morte e do morrer em seu cotidiano de trabalho, e quais as repercussões dessa experiência no modo como acontecem as intervenções junto ao paciente e familiares? Quais os prejuízos decorrentes da fragmentação do saber na modernidade, nas ações da equipe de saúde na situação de intervenção em uma UTI geral/ adulto. E quais as possíveis contribuições da ação clínica do psicólogo, fundada numa perspectiva fenomenológica existencial, no modo de funcionar da equipe de saúde. A dissertação está organizada em três artigos: dois teóricos e um empírico. O primeiro artigo teórico, trata da ação de uma equipe de saúde em UTI, teve como metodologia a pesquisa bibliográfica. Em seu desenvolvimento, busca traçar o surgimento da UTI e a evolução da assistência hospitalar ao doente grave, ressaltando os eminentes personagens da história do intensivismo; caracteriza o modelo atual de UTI no Brasil e descreve como a equipe multiprofissional foi se estabelecendo neste contexto de ação; apresenta, ainda, o cotidiano de trabalho da equipe e o quanto sua rotina é atravessada pelas questões da vida e da morte. O segundo artigo, também com metodologia bibliográfica, enfoca o acontecer da equipe de saúde em uma Unidade de Terapia Intensiva. Para tanto, aborda a fragmentação do saber na modernidade e sua ressonância na prática do profissional de saúde, delineando o fenômeno da hiperespecialização e as relações disciplinares; além disso, demarca a ação do psicólogo na equipe da UTI, numa perspectiva da fenomenologia existencial. Por fim, o terceiro artigo foi desenvolvido a partir de uma pesquisa qualitativa de cunho fenomenológico. A questão da pesquisa, vinculada aos objetivos da dissertação, foi trabalhada em um encontro com seis profissionais de saúde que fazem parte de equipes multidisciplinares em um Centro de Terapia Intensiva de um hospital da rede privada na cidade de Recife, cujos dados foram analisados a partir da Analítica de Sentido de Critelli. Como resultado observou-se que uma única área de conhecimento não pode dar conta da complexidade do fenômeno do adoecimento; que o trabalho em equipe exige colaboração, de modo que as ações no campo possam revelar uma fusão de horizontes , com possibilidades para o iniciar de uma outra/nova compreensão da ação em con-junto.

The purpose of this qualitative study is to explore how narrative therapy may facilitate not only a lessening of distressing symptoms for bereaved persons, but may also facilitate growth in identity. Five case studies are presented. The participants were chosen to illuminate different grief experiences. The case studies include a description of grieving people from different backgrounds, each with a unique relationship with the person or people who died, all of whom had different causes of death such as suicide, murder and natural causes. These differences provide an opportunity to explore the application of the therapy model with a range of grief experiences. A full and rich description of the experiences of the participants yield insight into the shared themes such as the impact of social expectations of how a grieving person should conduct him or herself, difficult physical and emotional experiences, the many losses flowing from the death, as well as an in-depth discussion of the identity growth that takes place as the bereaved person takes on different roles and tasks. Postmodern epistemology and social constructivism informed the praxis and interpretation of narrative therapy as bereavement model. Narrative therapy is shown as especially effective for grief therapy with therapeutic tenets such as deconstructing and creating richer narratives and alternative stories that enables the bereaved to explore diverse aspects of their character. The emphasis on what remains rather than what is lost, and the concept of remembering the loved one who died in the community of those who stay behind, transmute the loss-story to one of remembering and incorporating, which tends to bring significant emotional relief. This study contributes towards the field of growth through bereavement for which there seems to be a paucity in research. Furthermore, it provides additional evidence for post-traumatic growth in general, especially with the assistance of narrative therapy. / Psychology / Ph. D. (Psychology)

Text in German / Forschungsgegenstand dieser Arbeit ist das Bewältigungsverhalten von schwer kranken und sterbenden Menschen, die in einer Gesellschaft ihren bevorstehenden Tod bewältigen müssen, die ambivalent mit dieser Thematik umgeht. Die unterschiedlichen menschlichen Bewältigungsformen können mit den bisher gängigen Zugangswegen über Phasenmodelle nicht immer befriedigend erklärt werden. Hilfreich erscheint hier das aus der Stressforschung stammende Copingmodell von Richard S. Lazarus und seiner Forschungsgruppe, um Menschen verstehen zu lernen. In wieweit dieses Verstehensmodell aus einem säkularen Forschungszweig für die Seelsorgearbeit unterstützend sein kann, soll in dieser Arbeit geklärt werden. Als Grundlage dienen Seelsorgegespräche mit unterschiedlichen Menschen, die eine große Bandbreite an Bewältigungsverhalten demonstrierten. Die Herausforderung lag darin, Menschen in ihrem Sterben umfassend wahrzunehmen, um möglichst viele Impulse zu erkennen, die ihr Bewältigungsverhalten beeinflussten. Aus der Aufarbeitung dieses Verhaltens ergaben sich Perspektiven für die Begleitung sterbender Menschen. Dies hat gleichbedeutend Konsequenzen für den seelsorgerlichen Umgang mit Sterbenden. Das Wissen um das christlich-biblische Menschenbild und die umfassende Kenntnis der Copingforschung können sich durchaus gegenseitig befruchten, denn beide gehen auf die Individualität des Menschen ein und unterstützen ihn seinen eigenen Zugang zu seinem Leben und seinem Tod finden zu lassen. Dies führt letztlich zu einer intensiven Kommunikation zwischen Patient und Seelsorger, der den Mut und das Vertrauen haben darf, dem Sterbenden eigenständig sein Leben bewältigen zu lassen. Die Ansätze der Copingforschung bieten weitreichende Impulse für vielfältige seelsorgerliche Fragestellungen auch außerhalb der Sterbebegleitung. Object of research of this thesis is the specific behaviour of seriously ill and dying humans coping with their impending death and being members of a society having an ambivalent attitude towards death. People's different and individual ways of coping cannot always be sufficiently explained by the current use of phasing models. In this context the "Coping Model" by Richard S. Lazarus and his stress research group seems to be helpful in understanding dying humans. In how far this comprehension model from a secular branch of research can be supportive of pastoral counselling is the objective of this thesis. Counselling dialogues with different persons who show a wide range of coping form the basis of this research. The challenge of this paper was to observe and sense humans in their death experiences from a broader point of view in order to identify as much as possible kinds of impulses crucial to their coping behaviour. Analysing the behaviour of dying humans led to new perspectives on spiritual guidance. Tantamountly, this has its consequences for spiritual dealing with dying humans. The comprehension of the biblical Christian idea of man and a detailed knowledge of coping research can, by all means, be interactive and thus show positive results as both respond to a person's individuality and support them in their own ways of approach to life and death. Finally, this leads to an intensive dialogue between patient and pastor who can have the courage and the confidence in letting the person find his own way of coping. The different kinds of approach of the coping model research offer far-reaching impulses to various pastoral questions going even beyond terminal care. / Philosophy, Practical & Systematic Theology / D.Th. (Practical Theology)

Text in German / Forschungsgegenstand dieser Arbeit ist das Bewältigungsverhalten von schwer kranken und sterbenden Menschen, die in einer Gesellschaft ihren bevorstehenden Tod bewältigen müssen, die ambivalent mit dieser Thematik umgeht. Die unterschiedlichen menschlichen Bewältigungsformen können mit den bisher gängigen Zugangswegen über Phasenmodelle nicht immer befriedigend erklärt werden. Hilfreich erscheint hier das aus der Stressforschung stammende Copingmodell von Richard S. Lazarus und seiner Forschungsgruppe, um Menschen verstehen zu lernen. In wieweit dieses Verstehensmodell aus einem säkularen Forschungszweig für die Seelsorgearbeit unterstützend sein kann, soll in dieser Arbeit geklärt werden. Als Grundlage dienen Seelsorgegespräche mit unterschiedlichen Menschen, die eine große Bandbreite an Bewältigungsverhalten demonstrierten. Die Herausforderung lag darin, Menschen in ihrem Sterben umfassend wahrzunehmen, um möglichst viele Impulse zu erkennen, die ihr Bewältigungsverhalten beeinflussten. Aus der Aufarbeitung dieses Verhaltens ergaben sich Perspektiven für die Begleitung sterbender Menschen. Dies hat gleichbedeutend Konsequenzen für den seelsorgerlichen Umgang mit Sterbenden. Das Wissen um das christlich-biblische Menschenbild und die umfassende Kenntnis der Copingforschung können sich durchaus gegenseitig befruchten, denn beide gehen auf die Individualität des Menschen ein und unterstützen ihn seinen eigenen Zugang zu seinem Leben und seinem Tod finden zu lassen. Dies führt letztlich zu einer intensiven Kommunikation zwischen Patient und Seelsorger, der den Mut und das Vertrauen haben darf, dem Sterbenden eigenständig sein Leben bewältigen zu lassen. Die Ansätze der Copingforschung bieten weitreichende Impulse für vielfältige seelsorgerliche Fragestellungen auch außerhalb der Sterbebegleitung. Object of research of this thesis is the specific behaviour of seriously ill and dying humans coping with their impending death and being members of a society having an ambivalent attitude towards death. People's different and individual ways of coping cannot always be sufficiently explained by the current use of phasing models. In this context the "Coping Model" by Richard S. Lazarus and his stress research group seems to be helpful in understanding dying humans. In how far this comprehension model from a secular branch of research can be supportive of pastoral counselling is the objective of this thesis. Counselling dialogues with different persons who show a wide range of coping form the basis of this research. The challenge of this paper was to observe and sense humans in their death experiences from a broader point of view in order to identify as much as possible kinds of impulses crucial to their coping behaviour. Analysing the behaviour of dying humans led to new perspectives on spiritual guidance. Tantamountly, this has its consequences for spiritual dealing with dying humans. The comprehension of the biblical Christian idea of man and a detailed knowledge of coping research can, by all means, be interactive and thus show positive results as both respond to a person's individuality and support them in their own ways of approach to life and death. Finally, this leads to an intensive dialogue between patient and pastor who can have the courage and the confidence in letting the person find his own way of coping. The different kinds of approach of the coping model research offer far-reaching impulses to various pastoral questions going even beyond terminal care. / Philosophy, Practical and Systematic Theology / D.Th. (Practical Theology)