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This qualitative study describes the experience of eight men with fibromyalgia (FM). Data from repeated semi-structured interviews was analysed using the constant comparative method, in order to generate a grounded theory. The specific aims were to explore how individuals perceived and made sense of their condition, and to discover the impact of FM upon their sense of identity and intimate relationships. Two core categories emerged from data analysis - loss and limited understanding. Losses pertained to the men's capabilities and activities; role and identity; work; and relationships. Limited understanding was described in relation to three levels of experience: limited understanding by the individual sufferer; by other people; and by health care professionals. Various intervening and contextual variables were identified for each phenomenon. Analysis suggested that loss is more likely to be pronounced where pain is severe and constant; the degree of incapacity is high; and there is a complete cessation of work. Intervening conditions likely to reduce the sense of loss included role expectations consistent with capabilities; absence of young dependants; a flexible work environment; living with a partner; favourable social comparisons; high self-efficacy and accepting attitude towards illness. Limited understanding was likely to be more pronounced where the individual perceived no rational link between the triggering event and symptoms of FM, and where new difficulties were encountered. The individual was more likely to perceive that others misunderstood their situation if they were not using a mobility aid themselves. Individuals were more likely to perceive limited understanding by the medical profession where the GP had not been especially supportive, and where contact with the specialist was unsatisfactory. Limited understanding was exacerbated by intervening variables including lack of contact with other FM sufferers and a treatment history focusing on 'fixing' the problem. Men with FM struggled to find meaning in their experience. Some individuals were able to locate possible causes, but all the men were unable to fully understand their condition. The analysis suggested that the experience of FM varies for different men. The study reveals that FM is a complex experience characterised by loss, which sufferers and health care professionals struggle to understand. Implications for health care practice and further research are discussed. This study will help FM sufferers understand their condition more fully. Moreover, it should enrich the understanding of health care professionals - thereby facilitating encounters characterised by greater support and empathy for men with FM.

No description available.

Managed clinical and care networks (MCNs) have emerged in Scotland as a collaborative form of organising within health and between health and social services. Bringing together disparate disciplines and professions their aim has been to allow work across service and sector boundaries to improve care for patients. Whilst MCN prevalence has increased and policy has moved to centralise this method of organising, many research questions remain. These include: how can we understand the form, function and impact of MCNs, and further, what are the underlying motivations for practitioners and managers to organise in this way? Focussing in on the work of 3 voluntary MCNs operating in Scotland, the centrality of practice emerges. Practice is defined broadly to encompass both the interactions between practitioner-patient and practitioner-population. From this, the MCN becomes conceptualised as a set of activities focussed around ground-level clinical MCN service issues and top-level policy direction. Through considering work the interplay between ethics and scientific evidence emerges. The inherent uncertainty and suffering of daily practice comes to the fore, these concepts are brought together within a framework, morals-in-practice. Further, using the hermeneutic dynamics of alterity, openness and transcendence, MCNs can be understood as providing a space to foster creative responses to the wicked problems created by health and social service design and delivery. The organising opportunities provided by MCNs thus arguably serve several organisational and social functions, providing a forum to: mutually support and respond to the intrinsically challenging nature of practice understood; debate morals-in-practice helping to ensuring collective clinical governance; sharing of organisational knowledge; planning, delivery and audit of services; and creatively respond to wicked problems. By focussing in on the work, the practice particularities of each individual MCN are resultantly emphasised, whilst still maintaining recognition that much of the NHS operational context is more widely shared. Through this these voluntary MCNs, at least, can be viewed as an organising form which has emerged in response to the complexities of modern health and social service, care, design and delivery.

A imigração boliviana para São Paulo remonta ao início do ano 1950, quando Brasil e Bolívia estabeleceram um programa de intercâmbio cultural. Os bolivianos migram para o Brasil em busca de melhores condições de vida e, quando chegam, geralmente, vão trabalhar em indústrias de confecções têxteis, em condições de trabalho muito precárias, quase sob o regime de escravidão. Não se sabe ao certo a quantidade de bolivianos imigrantes, contudo as pesquisas chegam a um consenso que, atualmente, São Paulo é o destino mais procurado e que a maioria dos imigrantes que tem chegado ao Brasil são bolivianos. Os imigrantes bolivianos muitas vezes são marginalizados e excluídos do campo social, no sentido de não ter garantia dos direitos universais, e o seu acesso aos serviços de saúde muitas vezes ser dificultado pelas questões culturais. Nota-se que a estrutura social é extremamente importante na relação com o sofrimento social, entendido como a humilhação, vergonha e falta de reconhecimento, este não tem visibilidade visto que é inscrito no interior das subjetividades e não há um compartilhamento coletivo. Esta forma de sofrimento é mais comum na contemporaneidade, já que há uma veneração excessiva ao individualismo, um crescimento de um ideal pseudo meritocrático, onde há a ilusão de que todos têm oportunidades para ter êxito social - exceder sua classe social, ter uma liberdade econômica para suprir seu consumo - quando o sistema social não suporta que todos tenham essa ascensão. Propõe-se compreender sobre as práticas de cuidado à saúde dos imigrantes bolivianos relacionando isto ao acesso ao serviço de saúde, a partir do que eles entendem por saúde e o que, para eles, está relacionado a ela: medicação, bem estar, processo saúde-doença, equipamentos e profissionais de saúde. Trata-se de uma etnografia realizada com os usuários bolivianos da Unidade Básica de Saúde Jd. Japão, localizada na Vila Maria, município de São Paulo. Um estudo qualitativo que lançou mão da observação participante e de entrevistas semiestruturadas para ser concretizado. Constatou que o trabalho na vida do imigrante boliviano sustenta e baliza todos os outros eventos da vida é o eixo central. Durante a maior parte do tempo estão trabalhando e isso é um empecilho para se divertir ou para cuidar da própria saúde. Eles entendem que saúde é estar bem para poder trabalhar é poder resistir ao que pode te destruir. Sentem-se respeitados pelos profissionais de saúde, mas não cuidados. Quando estavam na Bolívia não iam ao médico ou a serviços de saúde, o cuidado era feito com ervas, folhas, medicamentos alopáticos. Suas práticas de cuidado à saúde não são muitas, são principalmente relacionadas à alimentação. Evidenciou-se forte a questão de gênero nas relações familiares e violência contra mulher por parceiro íntimo sugerindo como possibilidade, estas questões, serem mais aprofundadas em novos estudos. Bem como às condições das crianças nascidas no Brasil e filhos de bolivianos. / The Bolivian immigration to São Paulo started in the beginning of 1950s, when Brazil and Bolivia placed a cultural interchange program. Bolivians migrate to Brazil looking for better conditions of life and, when arriving, they usually end up working in textile manufacturing companies under considerably precarious work conditions, almost under slavery regime. It is not known the exact amount of Bolivian immigrants, however researches agree that, currently, São Paulo is the most common destiny and that the majority of the immigrants that has been arriving in Brazil are Bolivians. Bolivian immigrants are, many times, made apart of the society and excluded of social life, in terms of having no guarantee of universal rights, and their access to health services are frequently more difficult due to cultural issues. It is remarkable that the social structure is extremely important on the relation with the social suffering - understood as humiliation, shame and lack of recognition -, which has no visibility once it is inscribed inside the subjectivity and there is no collective sharing. Such kind of suffering is more frequent on the contemporaneity, once there is an excessive veneration to the individualism, an increase of a pseudo meritocratic ideal, where there is the illusion that everyone has opportunities to succeed in the society to overcome their social level, to have an economical freedom to fulfill their consumption - while the social system do not stand that everyone ascend like this. The proposal is to understand about the Bolivian immigrants health care practices relating with the access to health service, starting on their understanding on health and what, for them, is related to it: medication, welfare, process health-sickness, equipments and health care professionals. The present study is an ethnography developed with Bolivian users of Health Primary Unit Jd. Japão, in Vila Maria, São Paulo district. A qualitative study that drew on participant observation and semi-structured interviews to be developed. Found out that the work on Bolivian immigrants life sustains and marks all other events in life, it is the central axle. During the most part of the time, they are working and it is an obstacle to have fun or take care of their own health. They understand that health is being fine to be able to work, it is being able to resist to what could destroy them. They feel respected by the health professionals, but not taken care. When in Bolivia they did not go to the doctor or to health services, the care was taken with herbs, leaves, allopathic medicines. They do not have too many health care practices, just some related to food. It became strongly evident the matter of gender in familiar relationships and the violence towards woman by intimate partner, suggesting as possibility in future studies to get deeper in this matters. As well the conditions of Bolivians Brazilian born children.

A imigração boliviana para São Paulo remonta ao início do ano 1950, quando Brasil e Bolívia estabeleceram um programa de intercâmbio cultural. Os bolivianos migram para o Brasil em busca de melhores condições de vida e, quando chegam, geralmente, vão trabalhar em indústrias de confecções têxteis, em condições de trabalho muito precárias, quase sob o regime de escravidão. Não se sabe ao certo a quantidade de bolivianos imigrantes, contudo as pesquisas chegam a um consenso que, atualmente, São Paulo é o destino mais procurado e que a maioria dos imigrantes que tem chegado ao Brasil são bolivianos. Os imigrantes bolivianos muitas vezes são marginalizados e excluídos do campo social, no sentido de não ter garantia dos direitos universais, e o seu acesso aos serviços de saúde muitas vezes ser dificultado pelas questões culturais. Nota-se que a estrutura social é extremamente importante na relação com o sofrimento social, entendido como a humilhação, vergonha e falta de reconhecimento, este não tem visibilidade visto que é inscrito no interior das subjetividades e não há um compartilhamento coletivo. Esta forma de sofrimento é mais comum na contemporaneidade, já que há uma veneração excessiva ao individualismo, um crescimento de um ideal pseudo meritocrático, onde há a ilusão de que todos têm oportunidades para ter êxito social - exceder sua classe social, ter uma liberdade econômica para suprir seu consumo - quando o sistema social não suporta que todos tenham essa ascensão. Propõe-se compreender sobre as práticas de cuidado à saúde dos imigrantes bolivianos relacionando isto ao acesso ao serviço de saúde, a partir do que eles entendem por saúde e o que, para eles, está relacionado a ela: medicação, bem estar, processo saúde-doença, equipamentos e profissionais de saúde. Trata-se de uma etnografia realizada com os usuários bolivianos da Unidade Básica de Saúde Jd. Japão, localizada na Vila Maria, município de São Paulo. Um estudo qualitativo que lançou mão da observação participante e de entrevistas semiestruturadas para ser concretizado. Constatou que o trabalho na vida do imigrante boliviano sustenta e baliza todos os outros eventos da vida é o eixo central. Durante a maior parte do tempo estão trabalhando e isso é um empecilho para se divertir ou para cuidar da própria saúde. Eles entendem que saúde é estar bem para poder trabalhar é poder resistir ao que pode te destruir. Sentem-se respeitados pelos profissionais de saúde, mas não cuidados. Quando estavam na Bolívia não iam ao médico ou a serviços de saúde, o cuidado era feito com ervas, folhas, medicamentos alopáticos. Suas práticas de cuidado à saúde não são muitas, são principalmente relacionadas à alimentação. Evidenciou-se forte a questão de gênero nas relações familiares e violência contra mulher por parceiro íntimo sugerindo como possibilidade, estas questões, serem mais aprofundadas em novos estudos. Bem como às condições das crianças nascidas no Brasil e filhos de bolivianos. / The Bolivian immigration to São Paulo started in the beginning of 1950s, when Brazil and Bolivia placed a cultural interchange program. Bolivians migrate to Brazil looking for better conditions of life and, when arriving, they usually end up working in textile manufacturing companies under considerably precarious work conditions, almost under slavery regime. It is not known the exact amount of Bolivian immigrants, however researches agree that, currently, São Paulo is the most common destiny and that the majority of the immigrants that has been arriving in Brazil are Bolivians. Bolivian immigrants are, many times, made apart of the society and excluded of social life, in terms of having no guarantee of universal rights, and their access to health services are frequently more difficult due to cultural issues. It is remarkable that the social structure is extremely important on the relation with the social suffering - understood as humiliation, shame and lack of recognition -, which has no visibility once it is inscribed inside the subjectivity and there is no collective sharing. Such kind of suffering is more frequent on the contemporaneity, once there is an excessive veneration to the individualism, an increase of a pseudo meritocratic ideal, where there is the illusion that everyone has opportunities to succeed in the society to overcome their social level, to have an economical freedom to fulfill their consumption - while the social system do not stand that everyone ascend like this. The proposal is to understand about the Bolivian immigrants health care practices relating with the access to health service, starting on their understanding on health and what, for them, is related to it: medication, welfare, process health-sickness, equipments and health care professionals. The present study is an ethnography developed with Bolivian users of Health Primary Unit Jd. Japão, in Vila Maria, São Paulo district. A qualitative study that drew on participant observation and semi-structured interviews to be developed. Found out that the work on Bolivian immigrants life sustains and marks all other events in life, it is the central axle. During the most part of the time, they are working and it is an obstacle to have fun or take care of their own health. They understand that health is being fine to be able to work, it is being able to resist to what could destroy them. They feel respected by the health professionals, but not taken care. When in Bolivia they did not go to the doctor or to health services, the care was taken with herbs, leaves, allopathic medicines. They do not have too many health care practices, just some related to food. It became strongly evident the matter of gender in familiar relationships and the violence towards woman by intimate partner, suggesting as possibility in future studies to get deeper in this matters. As well the conditions of Bolivians Brazilian born children.

This study examines the influence of an educational program on the nursing assessment and management of post-operative pain. A problem-based retrospective audit was implemented to initially determine the nursing assessment and management of post-operative pain. Based on the results of the audit, educational strategies were implemented and a re-audit was carried out to evaluate the changes in nursing practice. There was evidence in the study to support the notion that nurses do not assess or manage post-operative pain effectively. The study suggested that an educational program based on the results of the problem-based audit may improve the frequency and accuracy of documentation of the assessment of pain and the documentation of the utilization of a variety of alternate approaches to relieve post-operative pain. However, the results also indicated that an educational program may not increase the frequency and dosage of analgesic administration and that nurses' perception of their nursing practice may be inconsistent with their actual practice. The study also indicated that nurses will attend educational programs if given the opportunity to participate in the development of these programs. Further studies should be carried out to examine the relationship between written documentation of assessment and management of pain and the actual assessment and management of pain by nurses, between nurses' perceptions of their clinical practice and their actual practice, and among variables environment which may affect nurses' clinical performance. Further studies should also be undertaken to determine if practice-based education programs can influence nurses' clinical practice. / Thesis / Master of Science (Teaching)

This study is designed to assess the effectiveness of closed-circuit television (CCTV) as a post-partum teaching tool using an interactive problem-solving approach, compared with conventional group classes, in fostering the acquisition of skills and knowledge around baby care. A second primary objective is to determine the level of satisfaction of respondents with both approaches to post-partum education. An extensive discussion of the theoretical basis for the proposal is presented, drawing upon and synthesising concepts from the literature of Sociology, Education and Health Sciences. The conceptual model (Sword 1990) represents a synthesis of Mezirow’s (1978) theory of the transformation of meaning perspective with D’Zurilla’s (1986) cognitive-appraisal approach to the acquisition of new knowledge. In addition, adult learning principles are applied to the selected teaching strategies to identify optimal conditions of learning (Zemke and Zemke 1988). A two-group cohort design was used for randomisation, and the data collected was subjected to both quantitative and qualitative analysis. Two measures of learning were not significantly different for the videotape and live class groups. Statistically significant differences were identified between the groups in the attitude measures of convenience and ease of understanding. There was also a measurable difference in levels of satisfaction with the different approaches used. However, the results of this study suggest that combining an interactive, problem-solving approach to post-partum education with CCTV, is no more effective than live group classes in achieving knowledge acquisition for new mothers. CCTV can be used to address the basic and repetitive aspects of patient education and it appears to be effective for short-term knowledge gain. Several issues for further study are proposed in relation to the planning and implementation of alternative approaches to conventional post-partum teaching, as well as the design of future televised patient education programmes. / Thesis / Master of Science (MSc)