La collaboration est une compétence essentielle que les futurs médecins doivent développer. La détermination des niveaux de compétence est cruciale dans la planification de cet apprentissage. Les échelles descriptives suscitent un intérêt croissant, car elles décrivent en termes qualitatifs les performances attendues. Nous inspirant de la méthodologie mixte de Blais, Laurier, & Rousseau (2009), nous avons construit en cinq étapes une échelle de niveau de compétence de collaboration: 1) formulation d’une liste d’indicateurs situés à quatre niveaux de la formation médicale (préclinique, externat, résidence junior et sénior) par les chercheurs (n= 3) et un groupe d’éducateurs (n=7), leaders pédagogiques possédant une expertise pour la compétence de collaboration; 2) sondage en ligne comprenant quatre questionnaires portant sur les niveaux de 118 indicateurs, auprès d’enseignants cliniciens représentant les différentes spécialités (n=277); 3) analyse, avec le modèle partial credit de Rasch, des réponses aux questionnaires appariés par calibration concurrente; 4) détermination des niveaux des indicateurs par les éducateurs et les chercheurs; et 5) rédaction de l’échelle à partir des indicateurs de chaque niveau. L’analyse itérative des réponses montre une adéquation au modèle de Rasch et répartit les indicateurs sur l’échelle linéaire aux quatre niveaux. Les éducateurs déterminent le niveau des 111 indicateurs retenus en tenant compte des résultats du sondage et de la cohérence avec le curriculum. L’échelle comporte un paragraphe descriptif par niveau, selon trois capacités : 1) participer au fonctionnement d’une équipe; 2) prévenir et gérer les conflits; et 3) planifier, coordonner et dispenser les soins en équipe. Cette échelle rend explicites les comportements collaboratifs attendus à la fin de chaque niveau et est utile à la planification de l’apprentissage et de l’évaluation de cette compétence. La discordance entre les niveaux choisis par les éducateurs et ceux issus de l’analyse des réponses des enseignants cliniciens est principalement due au faible choix de réponse du niveau préclinique par les enseignants et aux problèmes d’adéquation pour les indicateurs décrivant la gestion des conflits. Cette recherche marque une avan- cée dans la compréhension de la compétence de collaboration et démontre l’efficacité de la méthodologie de Blais (2009) dans un contexte de compétence transversale, en sciences de la santé. Cette méthodologie pourrait aider à approfondir les trajectoires de développement d’autres compétences. / Being able to collaborate is a key competence that physicians need to learn. Determining competence levels is crucial to planning the learning process. By defining performance levels in qualitative terms, descriptive scales are a promising avenue. We developed a five-stage competence-level scale based on Blais, Laurier & Rousseau (2009) mixed methodology: 1) having researchers (n= 3) and a group of educators (n= 7), pedagogical leaders with expertise in the field of collaboration, list indicators that apply to the four training levels (preclinical, clerkship, junior and senior residencies); 2) conducting with clinician teachers, representative of various specialties (n= 277), an online survey that includes four questionnaires on the 118 indicator levels; 3) performing an analysis using the Rasch partial credit model on responses to questionnaires linked through concurrent calibration; 4) having educators and researchers determine the indicator levels; 5) creating a scale based on indicators at each level. The iterative analysis of the responses shows that it fits the Rasch model and distributes indicators on the linear scale on the four levels. The educators were responsible for determining the level of 111 selected indicators by taking into account the results of the survey and coherence with the curriculum. The scale includes a descriptive paragraph for each level as it applies to the 3 abilities : 1) taking part in running the team; 2) preventing and managing conflicts; 3) planning, coordinating and providing care as a team. The scale explains the collaborative behaviors expected at the end of each level and can be used to plan learning and evaluate competence. The source of disagreement between the levels set by the educators and those resulting from the analysis of clinician teacher responses are mostly explained by the low response by teachers at the preclinical level and misfit issues for the indicators describing conflict management. The research provided a broader understanding of collaboration competency and demonstrated the effectiveness of the Blais et al.1 methodology within the context of cross-curricular competency in health sciences. The methodology could be useful to go deaper into other competencies development path.

Esta tese consiste na identificação de contribuições político-pedagógicas dos movimentos sociais populares nas experiências e práticas culturais, integrativas, tradicionais de cuidado e de educação popular em saúde, especialmente do Movimento de Mulheres Camponesas, que poderão compor a caixa de ferramentas pedagógicas dos processos de formação de profissionais/trabalhadores (as) da saúde para sua atuação no Sistema Único de Saúde (SUS) em comunidades do campo, da floresta e das águas. A pesquisa foi realizada junto ao Movimento de Mulheres Camponesas através de análise de observações, registros, documentos, histórias de vida, oficinas e círculos de cultura feitos com mulheres que participam dessa organização, como também as redes de interação com a educação popular e permanente em saúde. A pesquisa articula essas experiências e seus saberes no contexto de produção de vida, saúde e adoecimento das populações que vivem nesses territórios e os desafios para o cuidado integral e a educação em saúde. Territórios marcados pelos interesses do capital transnacional e seus impactos sobre os camponeses (as), onde os determinantes sociais e as desigualdades compõe a complexidade da situação de saúde dessas populações. Traz a ação das mulheres camponesas na produção de cuidado da vida e da saúde na sua trajetória histórica, os eixos estruturantes articulados às relações sociais de gênero, raça/etnia, classe e orientação sexual, ao feminismo e ao projeto popular de agricultura camponesa. Pelo caminho percorrido, foi possível perceber que as políticas públicas de saúde no Brasil, especialmente nos territórios de atuação dessas mulheres camponesas, são recentes e frágeis na garantia do acesso e na atenção integral à saúde. O MMC surge como espaço de luta e valorização das mulheres camponesas na conquista de direitos e a saúde emergem como uma das lutas importantes do movimento. Nele as mulheres se ressignificam, tem o cuidado com vida e a saúde como base central do seu agir e fazem experiências de libertação e emancipação, enquanto sentido profundo de sua práxis portadora de uma dinâmica educativo-terapêutica e uma mística libertadora. Dessa forma, constroem novos significados à integralidade da saúde, fortalecem o sentimento de pertença das mulheres para com o movimento, ao mesmo tempo em que fazem o enfrentamento ao agronegócio, ao neoliberalismo, à cultura machista e às formas de opressão, de exploração, de discriminação e de violência. Das experiências de organização, de cuidado, de luta e de formação que o movimento desenvolve, bem como a interação com os movimentos e práticas de educação popular em saúde e de educação permanente em saúde emergem as contribuições politico-pedagógicas que ajudam a repensar o modo de cuidar a vida e a saúde, bem como as políticas públicas de educação da saúde, tanto para o meio acadêmico, como para os processos de trabalho e educação na saúde junto ao Sistema Único de Saúde e seus atores, principalmente para a atuação no campo, nas florestas e nas águas. / This thesis consists in the identification of the social movements political-pedagogical contributions in the cultural, integrative, traditional experiences and practices of care and the popular education in health, especially in the Rural Women Movement, that would compose the pedagogical toolbox of the workers and health professional formation process to their actuation in the Single Health System in the field, forest and water communities. The search was realized along with the Rural Women Movement, through analysis of observations, records, documents, life stories, workshops and cultural circles made with women that make part of this organization, as well the interaction network with the popular and permanent health education. The search articulate these experiences and its knowledge in the life, health and illness production contest of the population that live in these territories, and the challenges for the comprehensive care and the health education. Territories marked by transnational capital interests and its impacts on farmers, were the social determinants and the inequalities make the complexity of these people health situation. It brings the rural women action in the life and health care in this historical trajectory, the structural axis articulated to social relation of gender, race/ethnicity, class and sexual orientation to the feminism and to the popular design of peasant agriculture. By the path taken, it was possible realize that the public health politics in Brazil, especially on the action territory of these rural women, are recent and frail in the ensuring access and in the comprehensive health care. The Rural Women Movement arises as a fight and valorization space of the rural women in the rights conquers and the health emerges as one of the most important movement fights. In it, women reframe there selves, have care with life, and have the health as a central bases of their action, and make liberation and emancipation experiences, as a deep sense of their praxis carried of a educative-therapeutic dynamics and a liberating mystic. Thereby, they construct new meanings to the health integrality, strengthen the women sense of belonging to the movement, at the same time that make the confronting agribusiness, neoliberalism, machist culture, and the forms of oppression, exploitation, discrimination and violence. From the organization, care, fight and formation experiences that the movement develops, as well as the interaction with the movements and health popular education practices and permanent health education emerges the political-pedagogical contributions that helps to rethink the way of care life and health, as well the health education public policy, both for academic as for the work processes and health education in the Single Health System and its actors, mainly to the field, forests and water action. / Esta tesis es la identificación de las contribuciones políticas y pedagógicas de los movimientos sociales populares en las experiencias y las prácticas culturales, de integración, de cuidado tradicional y un programa de educación para la salud, especialmente el Movimiento de Mujeres Campesinas, que podrán componer la caja de herramientas pedagógicas de procesos de formación de los trabajadores (as) y profesionales de la salud para actuación en el Sistema Único de Salud (SUS ) en comunidades del campo, de los bosques y de las aguas. La encuesta fue realizada junto al Movimiento de Mujeres Rurales a través del análisis de las observaciones, registros, documentos, historias de vida, talleres y círculos culturales realizados con mujeres que participan de esta organización, así como las redes de interacción con la educación popular y permanente en salud. La investigación articula estas experiencias y su sabiduría en el contexto de la producción de vida, salud y enfermedad de las poblaciones que viven en estos territorios y los desafíos para el cuidado integral y la educación en salud. Territorios marcados por los intereses del capital transnacional y su impacto sobre los campesinos (as), donde los determinantes sociales y las desigualdades constituyen la complejidad de la situación de salud de estas poblaciones. Trae la acción de la mujer rural en la producción del cuidado de la vida y la salud en su trayectoria histórica, los ejes estructurales articulados a las relaciones sociales de género, raza/etnia, clase y orientación sexual, al feminismo y proyecto popular de la agricultura campesina En el camino recorrido, se reveló que las políticas de salud pública en Brasil, sobre todo en los territorios de acción de estas mujeres agricultoras, son recientes y frágiles para garantizar el acceso y la atención integral de la salud. El MMC aparece como un espacio de lucha y valoración de las mujeres rurales en la conquista de los derechos y la salud surge como una de las importantes luchas del movimiento. En ella las mujeres se resignifican, tienen el cuidado con la vida y la salud como base central de su actuar y hacen experiencias de liberación y emancipación, mientras sentido profundo de su praxis portadora de una dinámica educativa-terapéutica y una mística liberadora. Por lo tanto, construyen nuevos significados a la integralidad de la salud, fortalecen el sentimiento de pertenencia de las mujeres al movimiento, mientras hacen el enfrentamiento a la agroindustria, al neoliberalismo, la cultura machista e las formas de opresión, de explotación, de discriminación y de violencia. De las experiencias de organización, de cuidado, de lucha y de formación que el movimiento desarrolla, así como la interacción con los movimientos y prácticas de la educación popular e continua en salud emergen las contribuciones políticas y pedagógicas que ayudan a repensar la forma de cuidar la vida y la salud, así como las políticas públicas de educación para la salud, tanto para la comunidad académica como de los procesos de trabajo y educación en la salud por el Sistema Nacional de Salud y sus actores, principalmente para actuar en el campo, bosques y aguas.

Against the perspectives of the mental health needs of the people of Africa, this study explored and compared the models of psychiatric-mental health nursing education in two sub-Saharan African countries - Botswana and Nigeria. The primary purpose of the study was to assess the design, the implementation, the factors that influence and the perceived usefulness of psychiatric-mental health nursing education programmes in developing African countries, using Nigeria and Botswana as examples. A self-reporting questionnaire, administered to psychiatric nurse educators from the two countries of concern, provided the primary source of data. A curriculum evaluation checklist based on Horan, Knight, McAtee and Westrick (1984) was used to assess the components of the existing psychiatric nursing education curricula from the two countries. Discussions were also held with practising psychiatric nurses and officials of the nursing regulatory bodies from the two countries. Data from both countries revealed that participants used various terms to describe the same model for psychiatric-mental health nursing education adopted in their countries. Botswana, however, adopted a more functional generalist basic diploma nursing education approach which encouraged a more advanced post-basic diploma specialisation and practice in community psychiatric-mental health nursing. Nigeria's model leaned towards a hospital centred basic specialisation with no defined role for the generalist nurse within the psychiatric-mental health nursing care system. Community theme occurred in both countries' curricula with varying degrees of emphasis, as all the programmes claimed the intent to make psychiatric-mental health nursing service available to individuals, families and the communities at all levels of care. Psychiatric-mental health nursing education programmes of the two countries had been influenced at different times by war, colonial history, changing standards of health care delivery, government health policies, economic status of the country, professional status of nursing and the changing standard of education. A model that streamlined psychiatric-mental health nursing education within the general system of education in both countries was proposed. It was stressed that one key concept that must underlie the development of psychiatric-mental health nursing education was the need to create a mental health nursing role that would be appropriate for people's health needs rather than the needs of the health care system. / Advanced Nursing Science / D.Litt. et Phil.

Made available in DSpace on 2011-05-04T12:36:21Z (GMT). No. of bitstreams: 0 Previous issue date: 2010 / Essa pesquisa tem como objetivo analisar a produção do material didático-pedagógico da SES, buscando compreender os limites e as possibilidades da sua construção no âmbito de uma instituição pedagógica de educação não formal, tendo em vista a implantação da política de educação permanente em saúde e da reforma sanitária no Estado de Sergipe. Foi realizado um estudo de caso, em uma pesquisa essencialmente qualitativa, que analisou dados referentes às oficinas de autores e validação do material didático-pedagógico, etapas constitutivas da estrutura metodológica da produção do material didático, além de dados coletados em entrevistas semi-estruturadas com gestores, e grupo focal com autores dos livros didáticos. O material didático da SES Sergipe toma como base as Políticas de Saúde do SUS em Sergipe, buscando ser um veículo de comunicação das concepções ideológicas e das bases tecnológicas necessárias à implementação do SUS no contexto estadual. A Secretaria deEstado da Saúde toma como Política central a Reforma Sanitária e Gerencial do SUS no Estado de Sergipe, projeto que envolve amplo investimento na organização e funcionamento do sistema de saúde pressupondo revisão dos processos produtivos, e qualificação profissional dos trabalhadores envolvidos diretamente com as mudanças a serem implantadas. A análise dos registros das oficinas de autores e validação pedagógica evidenciou que os livros possibilitaram em seu processo de elaboração articulação entre a ciência e a intuição criativa, entre a técnica e a arte, buscando em várias pedagogias coerentes entre si do ponto de vista ideológico, elementos que puderam ser recompostos, recombinados, ressignificados em uma produção específica. O material didático enquanto veículo das idéias pedagógicas transforma políticas de saúde em livros didáticos, buscando despertar militância, investindo em processos reflexivos construídos em torno dos saberes tecnológicos para operacionalização cotidiana dos serviços, e das concepções ideológicas relacionadas com o Sistema Único de Saúde. Os limites e as possibilidades do material didático-pedagógico organizado pela SES, enquanto uma instituição pedagógica de educação não formal, surge na fala dos autores e gestores como uma relação de tensão entre a missão assistencial e a missão pedagógica a ser desempenhada. Limites e possibilidades estão imbricados por uma relação de confrontação, onde o limite ao ser superado, ou compreendido sobre uma perspectiva dialética transforma-se em possibilidade. A práxis surge como grande possibilidade em todo o processo, enfatizada pela participação dos sujeitos do trabalho frente à teorização exigida pela formulação dos livros. A pesquisa traz reflexões sobre a implantação da política de educação permanente a ser operacionalizada com a utilização do material didático e a importância dos agentes pedagógicos em seu papel técnico e político. / This research aims to analyze the production of didactic and pedagogical material of SES, trying to understand the limits and possibilities of its construction as part of a pedagogical institution of informal education with a view to implementing the health continuing education policy and health reform in the state of Sergipe. A case study was accomplished in a mainly qualitative research, which analyzed data about authors’ workshops and didactic and pedagogical material validation, constituent stages of methodological structure of the production of didactical materials, beyond data collected in semi-structured interviews with managers, and focus group with authors of textbooks. The didactical material of SES Sergipe has as its basis the Health Policies of SUS (Unified Health System) in Sergipe, trying to be a communication vehicle of ideological conceptions and technology foundations necessary for the implementation of SUS in the state context. The State Department of Health takes as a central policy the Health and Management Reform of SUS in the state of Sergipe, a project that involves large investment in the organization and functioning of the health system presupposing a review of productive processes, and professional qualification of the workers directly involved with the changes to be implemented. Analysis of data from authors’ workshops and pedagogical validation showed that the books allowed into their development process linking between the science and the creative intuition, between the technique and the art, seeking, in several coherent pedagogies among themselves, with an ideological point of view, elements that could be recomposed, recombined, reinterpreted in a specific production. The didactical material as a vehicle of pedagogical ideas makes health policy into textbooks, trying to awake militancy, investing in reflective processes built around the technological knowledge to everyday operation of services, and ideological conceptions related to the Unified Health System. Limits and possibilities of the didactic and pedagogical materials organized by SES as a pedagogical institution of informal education appears in the authors’ and managers’ speech as a relationship of tension between the assistance mission and the pedagogical mission to be performed. Limits and possibilities are intertwined by a confrontation relationship, where the limit to be exceeded, or understood about a dialectical perspective becomes a possibility. The practice appears as a large possibility in the whole process, emphasized by the participation of those ones who are in the front of the theorization required by the formulation of the books. The research reflects on the implementation of continuing education policy to be operated with the use of didactical material and the importance of pedagogical agents in their technical and political role.

Esta tese consiste na identificação de contribuições político-pedagógicas dos movimentos sociais populares nas experiências e práticas culturais, integrativas, tradicionais de cuidado e de educação popular em saúde, especialmente do Movimento de Mulheres Camponesas, que poderão compor a caixa de ferramentas pedagógicas dos processos de formação de profissionais/trabalhadores (as) da saúde para sua atuação no Sistema Único de Saúde (SUS) em comunidades do campo, da floresta e das águas. A pesquisa foi realizada junto ao Movimento de Mulheres Camponesas através de análise de observações, registros, documentos, histórias de vida, oficinas e círculos de cultura feitos com mulheres que participam dessa organização, como também as redes de interação com a educação popular e permanente em saúde. A pesquisa articula essas experiências e seus saberes no contexto de produção de vida, saúde e adoecimento das populações que vivem nesses territórios e os desafios para o cuidado integral e a educação em saúde. Territórios marcados pelos interesses do capital transnacional e seus impactos sobre os camponeses (as), onde os determinantes sociais e as desigualdades compõe a complexidade da situação de saúde dessas populações. Traz a ação das mulheres camponesas na produção de cuidado da vida e da saúde na sua trajetória histórica, os eixos estruturantes articulados às relações sociais de gênero, raça/etnia, classe e orientação sexual, ao feminismo e ao projeto popular de agricultura camponesa. Pelo caminho percorrido, foi possível perceber que as políticas públicas de saúde no Brasil, especialmente nos territórios de atuação dessas mulheres camponesas, são recentes e frágeis na garantia do acesso e na atenção integral à saúde. O MMC surge como espaço de luta e valorização das mulheres camponesas na conquista de direitos e a saúde emergem como uma das lutas importantes do movimento. Nele as mulheres se ressignificam, tem o cuidado com vida e a saúde como base central do seu agir e fazem experiências de libertação e emancipação, enquanto sentido profundo de sua práxis portadora de uma dinâmica educativo-terapêutica e uma mística libertadora. Dessa forma, constroem novos significados à integralidade da saúde, fortalecem o sentimento de pertença das mulheres para com o movimento, ao mesmo tempo em que fazem o enfrentamento ao agronegócio, ao neoliberalismo, à cultura machista e às formas de opressão, de exploração, de discriminação e de violência. Das experiências de organização, de cuidado, de luta e de formação que o movimento desenvolve, bem como a interação com os movimentos e práticas de educação popular em saúde e de educação permanente em saúde emergem as contribuições politico-pedagógicas que ajudam a repensar o modo de cuidar a vida e a saúde, bem como as políticas públicas de educação da saúde, tanto para o meio acadêmico, como para os processos de trabalho e educação na saúde junto ao Sistema Único de Saúde e seus atores, principalmente para a atuação no campo, nas florestas e nas águas. / This thesis consists in the identification of the social movements political-pedagogical contributions in the cultural, integrative, traditional experiences and practices of care and the popular education in health, especially in the Rural Women Movement, that would compose the pedagogical toolbox of the workers and health professional formation process to their actuation in the Single Health System in the field, forest and water communities. The search was realized along with the Rural Women Movement, through analysis of observations, records, documents, life stories, workshops and cultural circles made with women that make part of this organization, as well the interaction network with the popular and permanent health education. The search articulate these experiences and its knowledge in the life, health and illness production contest of the population that live in these territories, and the challenges for the comprehensive care and the health education. Territories marked by transnational capital interests and its impacts on farmers, were the social determinants and the inequalities make the complexity of these people health situation. It brings the rural women action in the life and health care in this historical trajectory, the structural axis articulated to social relation of gender, race/ethnicity, class and sexual orientation to the feminism and to the popular design of peasant agriculture. By the path taken, it was possible realize that the public health politics in Brazil, especially on the action territory of these rural women, are recent and frail in the ensuring access and in the comprehensive health care. The Rural Women Movement arises as a fight and valorization space of the rural women in the rights conquers and the health emerges as one of the most important movement fights. In it, women reframe there selves, have care with life, and have the health as a central bases of their action, and make liberation and emancipation experiences, as a deep sense of their praxis carried of a educative-therapeutic dynamics and a liberating mystic. Thereby, they construct new meanings to the health integrality, strengthen the women sense of belonging to the movement, at the same time that make the confronting agribusiness, neoliberalism, machist culture, and the forms of oppression, exploitation, discrimination and violence. From the organization, care, fight and formation experiences that the movement develops, as well as the interaction with the movements and health popular education practices and permanent health education emerges the political-pedagogical contributions that helps to rethink the way of care life and health, as well the health education public policy, both for academic as for the work processes and health education in the Single Health System and its actors, mainly to the field, forests and water action. / Esta tesis es la identificación de las contribuciones políticas y pedagógicas de los movimientos sociales populares en las experiencias y las prácticas culturales, de integración, de cuidado tradicional y un programa de educación para la salud, especialmente el Movimiento de Mujeres Campesinas, que podrán componer la caja de herramientas pedagógicas de procesos de formación de los trabajadores (as) y profesionales de la salud para actuación en el Sistema Único de Salud (SUS ) en comunidades del campo, de los bosques y de las aguas. La encuesta fue realizada junto al Movimiento de Mujeres Rurales a través del análisis de las observaciones, registros, documentos, historias de vida, talleres y círculos culturales realizados con mujeres que participan de esta organización, así como las redes de interacción con la educación popular y permanente en salud. La investigación articula estas experiencias y su sabiduría en el contexto de la producción de vida, salud y enfermedad de las poblaciones que viven en estos territorios y los desafíos para el cuidado integral y la educación en salud. Territorios marcados por los intereses del capital transnacional y su impacto sobre los campesinos (as), donde los determinantes sociales y las desigualdades constituyen la complejidad de la situación de salud de estas poblaciones. Trae la acción de la mujer rural en la producción del cuidado de la vida y la salud en su trayectoria histórica, los ejes estructurales articulados a las relaciones sociales de género, raza/etnia, clase y orientación sexual, al feminismo y proyecto popular de la agricultura campesina En el camino recorrido, se reveló que las políticas de salud pública en Brasil, sobre todo en los territorios de acción de estas mujeres agricultoras, son recientes y frágiles para garantizar el acceso y la atención integral de la salud. El MMC aparece como un espacio de lucha y valoración de las mujeres rurales en la conquista de los derechos y la salud surge como una de las importantes luchas del movimiento. En ella las mujeres se resignifican, tienen el cuidado con la vida y la salud como base central de su actuar y hacen experiencias de liberación y emancipación, mientras sentido profundo de su praxis portadora de una dinámica educativa-terapéutica y una mística liberadora. Por lo tanto, construyen nuevos significados a la integralidad de la salud, fortalecen el sentimiento de pertenencia de las mujeres al movimiento, mientras hacen el enfrentamiento a la agroindustria, al neoliberalismo, la cultura machista e las formas de opresión, de explotación, de discriminación y de violencia. De las experiencias de organización, de cuidado, de lucha y de formación que el movimiento desarrolla, así como la interacción con los movimientos y prácticas de la educación popular e continua en salud emergen las contribuciones políticas y pedagógicas que ayudan a repensar la forma de cuidar la vida y la salud, así como las políticas públicas de educación para la salud, tanto para la comunidad académica como de los procesos de trabajo y educación en la salud por el Sistema Nacional de Salud y sus actores, principalmente para actuar en el campo, bosques y aguas.

Esta tese consiste na identificação de contribuições político-pedagógicas dos movimentos sociais populares nas experiências e práticas culturais, integrativas, tradicionais de cuidado e de educação popular em saúde, especialmente do Movimento de Mulheres Camponesas, que poderão compor a caixa de ferramentas pedagógicas dos processos de formação de profissionais/trabalhadores (as) da saúde para sua atuação no Sistema Único de Saúde (SUS) em comunidades do campo, da floresta e das águas. A pesquisa foi realizada junto ao Movimento de Mulheres Camponesas através de análise de observações, registros, documentos, histórias de vida, oficinas e círculos de cultura feitos com mulheres que participam dessa organização, como também as redes de interação com a educação popular e permanente em saúde. A pesquisa articula essas experiências e seus saberes no contexto de produção de vida, saúde e adoecimento das populações que vivem nesses territórios e os desafios para o cuidado integral e a educação em saúde. Territórios marcados pelos interesses do capital transnacional e seus impactos sobre os camponeses (as), onde os determinantes sociais e as desigualdades compõe a complexidade da situação de saúde dessas populações. Traz a ação das mulheres camponesas na produção de cuidado da vida e da saúde na sua trajetória histórica, os eixos estruturantes articulados às relações sociais de gênero, raça/etnia, classe e orientação sexual, ao feminismo e ao projeto popular de agricultura camponesa. Pelo caminho percorrido, foi possível perceber que as políticas públicas de saúde no Brasil, especialmente nos territórios de atuação dessas mulheres camponesas, são recentes e frágeis na garantia do acesso e na atenção integral à saúde. O MMC surge como espaço de luta e valorização das mulheres camponesas na conquista de direitos e a saúde emergem como uma das lutas importantes do movimento. Nele as mulheres se ressignificam, tem o cuidado com vida e a saúde como base central do seu agir e fazem experiências de libertação e emancipação, enquanto sentido profundo de sua práxis portadora de uma dinâmica educativo-terapêutica e uma mística libertadora. Dessa forma, constroem novos significados à integralidade da saúde, fortalecem o sentimento de pertença das mulheres para com o movimento, ao mesmo tempo em que fazem o enfrentamento ao agronegócio, ao neoliberalismo, à cultura machista e às formas de opressão, de exploração, de discriminação e de violência. Das experiências de organização, de cuidado, de luta e de formação que o movimento desenvolve, bem como a interação com os movimentos e práticas de educação popular em saúde e de educação permanente em saúde emergem as contribuições politico-pedagógicas que ajudam a repensar o modo de cuidar a vida e a saúde, bem como as políticas públicas de educação da saúde, tanto para o meio acadêmico, como para os processos de trabalho e educação na saúde junto ao Sistema Único de Saúde e seus atores, principalmente para a atuação no campo, nas florestas e nas águas. / This thesis consists in the identification of the social movements political-pedagogical contributions in the cultural, integrative, traditional experiences and practices of care and the popular education in health, especially in the Rural Women Movement, that would compose the pedagogical toolbox of the workers and health professional formation process to their actuation in the Single Health System in the field, forest and water communities. The search was realized along with the Rural Women Movement, through analysis of observations, records, documents, life stories, workshops and cultural circles made with women that make part of this organization, as well the interaction network with the popular and permanent health education. The search articulate these experiences and its knowledge in the life, health and illness production contest of the population that live in these territories, and the challenges for the comprehensive care and the health education. Territories marked by transnational capital interests and its impacts on farmers, were the social determinants and the inequalities make the complexity of these people health situation. It brings the rural women action in the life and health care in this historical trajectory, the structural axis articulated to social relation of gender, race/ethnicity, class and sexual orientation to the feminism and to the popular design of peasant agriculture. By the path taken, it was possible realize that the public health politics in Brazil, especially on the action territory of these rural women, are recent and frail in the ensuring access and in the comprehensive health care. The Rural Women Movement arises as a fight and valorization space of the rural women in the rights conquers and the health emerges as one of the most important movement fights. In it, women reframe there selves, have care with life, and have the health as a central bases of their action, and make liberation and emancipation experiences, as a deep sense of their praxis carried of a educative-therapeutic dynamics and a liberating mystic. Thereby, they construct new meanings to the health integrality, strengthen the women sense of belonging to the movement, at the same time that make the confronting agribusiness, neoliberalism, machist culture, and the forms of oppression, exploitation, discrimination and violence. From the organization, care, fight and formation experiences that the movement develops, as well as the interaction with the movements and health popular education practices and permanent health education emerges the political-pedagogical contributions that helps to rethink the way of care life and health, as well the health education public policy, both for academic as for the work processes and health education in the Single Health System and its actors, mainly to the field, forests and water action. / Esta tesis es la identificación de las contribuciones políticas y pedagógicas de los movimientos sociales populares en las experiencias y las prácticas culturales, de integración, de cuidado tradicional y un programa de educación para la salud, especialmente el Movimiento de Mujeres Campesinas, que podrán componer la caja de herramientas pedagógicas de procesos de formación de los trabajadores (as) y profesionales de la salud para actuación en el Sistema Único de Salud (SUS ) en comunidades del campo, de los bosques y de las aguas. La encuesta fue realizada junto al Movimiento de Mujeres Rurales a través del análisis de las observaciones, registros, documentos, historias de vida, talleres y círculos culturales realizados con mujeres que participan de esta organización, así como las redes de interacción con la educación popular y permanente en salud. La investigación articula estas experiencias y su sabiduría en el contexto de la producción de vida, salud y enfermedad de las poblaciones que viven en estos territorios y los desafíos para el cuidado integral y la educación en salud. Territorios marcados por los intereses del capital transnacional y su impacto sobre los campesinos (as), donde los determinantes sociales y las desigualdades constituyen la complejidad de la situación de salud de estas poblaciones. Trae la acción de la mujer rural en la producción del cuidado de la vida y la salud en su trayectoria histórica, los ejes estructurales articulados a las relaciones sociales de género, raza/etnia, clase y orientación sexual, al feminismo y proyecto popular de la agricultura campesina En el camino recorrido, se reveló que las políticas de salud pública en Brasil, sobre todo en los territorios de acción de estas mujeres agricultoras, son recientes y frágiles para garantizar el acceso y la atención integral de la salud. El MMC aparece como un espacio de lucha y valoración de las mujeres rurales en la conquista de los derechos y la salud surge como una de las importantes luchas del movimiento. En ella las mujeres se resignifican, tienen el cuidado con la vida y la salud como base central de su actuar y hacen experiencias de liberación y emancipación, mientras sentido profundo de su praxis portadora de una dinámica educativa-terapéutica y una mística liberadora. Por lo tanto, construyen nuevos significados a la integralidad de la salud, fortalecen el sentimiento de pertenencia de las mujeres al movimiento, mientras hacen el enfrentamiento a la agroindustria, al neoliberalismo, la cultura machista e las formas de opresión, de explotación, de discriminación y de violencia. De las experiencias de organización, de cuidado, de lucha y de formación que el movimiento desarrolla, así como la interacción con los movimientos y prácticas de la educación popular e continua en salud emergen las contribuciones políticas y pedagógicas que ayudan a repensar la forma de cuidar la vida y la salud, así como las políticas públicas de educación para la salud, tanto para la comunidad académica como de los procesos de trabajo y educación en la salud por el Sistema Nacional de Salud y sus actores, principalmente para actuar en el campo, bosques y aguas.

La collaboration entre les professionnels de la santé s’avère être nécessaire pour faire face au vieillissement de la population, à la prévalence des maladies chroniques et à la pénurie de personnel chez certaines professions de la santé (OMS, 2010). De plus, pour favoriser une collaboration optimale et offrir des soins de qualité, des équipes choisissent désormais d’adopter une approche de soins en partenariat patient où la collaboration interprofessionnelle se déroule en valorisant les savoirs expérientiels du patient à l’égard de la vie avec la maladie et en l’intégrant dans l’équipe de soins. L’Université de Montréal (UdeM) offre une formation à l’éducation à la collaboration interprofessionnelle (EIP) visant à enseigner des compétences de la pratique collaborative en sciences de la santé et en sciences psychosociales en partenariat avec le patient. L’EIP est confrontée à divers défis, entre autres, de logistique, de communication et de cloisonnement des professions. Pour surmonter ces obstacles, l’UdeM s’est donc tournée vers le numérique afin de permettre à des équipes interprofessionnelles d’étudiants de collaborer en ligne et en présentiel. Cette étude s’intéresse donc à décrire comment les étudiants réunis en équipe interprofessionnelle collaborent dans le contexte du cours hybride de Collaboration en sciences de la santé (CSS) en partenariat avec le patient offert par l’UdeM. Nous décrivons comment les étudiants collaborent en ligne et en présentiel et nous identifions les compétences du référentiel de compétences mobilisées. Notre étude propose un cadre conceptuel basé sur l’apprentissage collaboratif en mode hybride (en ligne et en présentiel) de l’EIP composé 1) du modèle de Chiocchio, Grenier, O’Neill, Savaria et Willms (2012) permettant de décrire comment les équipes d’étudiants mobilisent les dimensions de la collaboration (communication, synchronisation, coordination implicite et explicite); 2) du référentiel de compétences de la pratique collaborative et de partenariat patient en santé et services sociaux (Direction collaboration partenariat patient [DCPP] et Comité interfacultaire opérationnel l’Université de Montréal [CIO-UdeM], 2016) et 3) de la typologie du travail interprofessionnel de Xyrichis, Reeves, Zwarenstein (2018). 18 Notre étude emploie une méthodologie mixte convergente. Nous avons mené cette étude auprès d’une cohorte de 1435 étudiants de deuxième année de baccalauréat dans le cadre du cours CSS2900 provenant de treize programmes à l’UdeM. Ce cours se divise en trois volets: 1) formation en ligne 2) activité intraprogramme, 3) atelier interprofessionnel en présentiel coanimé par un professionnel de la santé et un patient formateur. Premièrement, nous avons analysé le Journal de bord collaboratif (JBC) de douze équipes interprofessionnelles d’étudiants (n=60), soit un corpus de cette cohorte. Deuxièmement, nous avons partagé un questionnaire La collaboration en équipes interprofessionnelles à la cohorte à la fin du cours et celui-ci a été répondu par 321 participants. Les résultats indiquent que les participants de l’étude ont majoritairement et similairement mobilisé les dimensions de la collaboration. La communication et la coordination seraient tributaires de la synchronisation lorsque la collaboration se déroule en ligne. L’usage des médias sociaux et d’un outil d’écriture collaborative en ligne auraient favorisé la collaboration en mode hybride. En présentiel, le patient partenaire coanimateur a soutenu des équipes pour faire le point sur leurs apprentissages et ainsi développer des compétences du référentiel du cours CSS2900. Le contexte de l’étude en mode hybride permet aux équipes de collaborer sur une longue période, à la manière d’une classe inversée (figure 29). Ceci favoriserait le développement des compétences du référentiel (DCPP et CIO-UdeM) et le décloisonnement des professions. Les contextes d’apprentissage où les pratiques des compétences effectives ont été mobilisées semblent se rapprocher du réseautage interprofessionnel et de la collaboration consultative de la typologie de Xyrichis et coll. (2018). / Collaboration among health professionals is required to contend with population aging, the prevalence of chronic illnesses, and staff shortages in certain health professions (WHO, 2010). As well, to foster optimal collaboration and provide good quality of care, some teams are now adopting a patient partnership approach in which the patient’s experiential knowledge of living with illness is valued as part of the interprofessional collaboration and the patient is integrated into the healthcare team. The Université de Montréal (UdeM) offers a program in interprofessional collaboration education (IPE) geared towards teaching the competencies required for collaborative practice in both health sciences and psychosocial sciences in partnership with patients. The IPE is confronted with a variety of challenges related to logistics, communication, and the compartmentalization of professions, among others. To overcome these obstacles, the UdeM has turned to digital technology to help interprofessional teams of students to collaborate online and in person. This study focused on describing how students in interprofessional teams collaborate in the hybrid course entitled Health Sciences Collaboration in Partnership with Patients, offered by the UdeM. We describe how students collaborate online and in the classroom, and we identify the competencies in the competency framework used. Our study proposes a conceptual framework based on the IPE’s hybrid (online and in person) collaborative learning model, which we constructed using: 1) the model of Chiocchio, Grenier, O’Neill, Savaria, and Willms (2012), to describe how the student teams collaborate and used dimensions of collaboration (communication, synchronisation, explicit and implicit coordination) ; 2) the competency framework for collaborative practice and patient partnership in health and social services (Direction collaboration et partenariat patient [DCPP] and Comité interfacultaire opérationnel de formation à la collaboration, l’Université de Montréal [CIO-UdeM], 2016); and 3) the interprofessional work typology of Xyrichis, Reeves, and Zwarenstein (2018). Our study used a convergent mixed methodology. We conducted this study with a cohort of 1,435 second-year undergraduate students in course CSS2900 coming from 13 20 different UdeM programs. This course is divided in three parts: 1) online training 2) intra- program activity, 3) interprofessional workshop coanimated by a health professional and patient-partner facilitator in classroom. First, we analyzed the online collaboration journal (OCJ) of 12 interprofessional student teams (n = 60). Second, we distributed a questionnaire on Collaboration in Interprofessional Teams to the entire cohort at the end of the course, to which 321 participants responded. The results show that the majority of study participants used the dimensions of collaboration in a similar manner online and in person. Communication and coordination were dependent on synchronization when collaboration occurred online. The use of both social media and an online collaborative writing tool fostered collaboration in hybrid mode. In the classroom, the patient-partner co-facilitator supported the teams as they reviewed their learning (coordination) and, in this way, developed the competencies of the framework for course CSS2900. Under the hybrid study model, the teams were able to collaborate over an extended period, similar to a flipped classroom approach (Figure 29). This fostered development of the framework competencies (DCPP and CIO-UdeM) and helped break down professional boundaries. The learning contexts in which effective competency practices were mobilized appeared analogous to the interprofessional networking and consultative collaboration categories in the typology of Xyrichis et al. (2018).

Nurse Practitioners (NPs) comprise a significant portion of the U.S. primary care workforce and play an essential role in patients' health awareness, prevention strategies, disease management, and in providing appropriate provider referrals. Nurse Practitioners receive education on the oral-systemic connection, yet there have been limited studies on the clinical practice of NPs assessing the oral cavity to evaluate the condition of the teeth and the oral tissues. The purpose of this study was to explore the nurse practitioners’ knowledge and practice habits of assessing the oral cavity for diseases or abnormalities in the mouth that can, in turn, affect overall health. A total of 66 NPs were included in the study, primarily female (91%) with master’s degrees (77%). While knowledge and education were not significantly associated, this research found significant associations between confidence and assessments, less than one-third (30.3%) were confident in their knowledge and ability to evaluate oral abnormalities.

L'arthrite juvénile idiopathique (AJI) est une des maladies chroniques les plus prévalentes chez les adolescents au Canada (Levy & Twilt, 2017). Son diagnostic repose en grande partie sur l'examen musculosquelettique pédiatrique (MSQp). Or, il semble exister un besoin de développer de nouvelles stratégies pour son enseignement (Foster & Rapley, 2010), comme en démontre d’une part la faible confiance de plusieurs médecins de première ligne en leurs capacités à la réaliser (Jandial, Myers, Wise, & Foster, 2009), et d’autre part le fait que l’enseignement de cet examen est bien souvent absent du curriculum de base des facultés de médecine (Jandial, Rapley, & Foster, 2009). Chez les adultes, plusieurs programmes engageant des patients formateurs avec arthrite chronique ont été développés et ont démontré des bénéfices tant pour les apprenants que pour les patients eux-mêmes (Hassell, 2012). À notre connaissance, ce type de programme n'existe pas actuellement pour la population adolescente avec arthrite juvénile ou autre maladie chronique. Nous proposons de développer un programme de patients formateurs engageant des adolescents avec AJI pour permettre 1) de répondre à un besoin de formation spécifique et 2) d’inclure la perspective d’un groupe de patients sous-représentés en éducation médicale. Nous avons donc comme objectif principal d'explorer les facteurs et processus à prendre en considération dans la création, la mise en oeuvre éventuelle et l'évaluation de ce futur programme. En vue de répondre à cet objectif, nous avons adopté une méthodologie qualitative. Des entrevues semi-structurées ont été effectuées avec 19 adolescents atteints d'arthrite juvénile provenant de deux centres tertiaires pédiatriques canadiens. Le premier des trois articles composant cette thèse s'attarde à explorer les perceptions des adolescents avec arthrite juvénile sur leurs habiletés à enseigner en tant que patient formateur. Il apparaît que les adolescents se sentent habiletés à réaliser ce rôle essentiellement parce qu’ils reconnaissent avoir acquis un savoir expérientiel du fait de vivre avec leur maladie. Ces derniers souhaitent par ailleurs aller au-delà de l'enseignement de l'examen MSQp et désirent incorporer l'enseignement de leur expérience de la maladie ainsi que des aspects de la communication. L'importance d'intégrer ces messages éducatifs au futur programme afin qu'il reflète la vision des adolescents est discutée. Une fois la question de savoir « comment » les adolescents avec arthrite juvénile souhaitent s'engager comme patient formateur, nous nous intéressons à savoir « pourquoi » ils désireraient faire partie d'un tel programme. Notre deuxième article explore donc les diverses sources de motivation des adolescents à s'engager comme patient formateur à travers la lentille du cadre conceptuel d'auto-détermination (Ryan & Deci, 2000). Des thèmes associés à la motivation intrinsèque (s'aider soi-même, vivre une expérience de socialisation) et extrinsèque à régulation intégrée (défendre la cause, aider les autres) sont identifiés. Des facilitateurs et obstacles à l'engagement des adolescents sont aussi explorés. La pertinence d'incorporer ces divers éléments dans le développement du programme afin de s'assurer d'un bon niveau d'engagement des participants est discuté. Dans notre troisième et dernier article, nous proposons un cadre générique de développement et d'évaluation des programmes en sciences de la santé basé sur une revue de différents modèles dans la discipline plus large de l'évaluation de programme. Nous discutons par la suite de l'application de ce cadre spécifiquement au programme proposé de patients formateurs avec arthrite juvénile, et délimitons des facteurs et processus à prendre en compte lors de sa création, sa mise en oeuvre et son évaluation future, en lien avec les résultats obtenus. Nous concluons par une discussion sur les implications éducatives de cette étude doctorale et élaborons des pistes de recherche futures. / Juvenile idiopathic arthritis (JIA) is one of the most prevalent chronic diseases among adolescents in Canada (Levy & Twilt, 2017). Its diagnosis is largely based on the pediatric musculoskeletal examination (pMSK). However, there seems to be a need to develop new strategies for the pMSQ exam teaching (Foster & Rapley, 2010). In adults, several programs involving patient educators with chronic arthritis have been developed and have shown benefits for both learners and patients themselves (Hassell, 2012). To our knowledge, this type of program does not currently exist for the adolescent population with juvenile arthritis, or with other chronic illness. Therefore, we propose to develop a patient educator program engaging adolescents with JIA with the aims to 1) respond to a specific identified training need and 2) include the perspective of a group of underrepresented patients in medical education. Our main objective is to explore factors and processes that need to be considered in the creation, eventual implementation and evaluation of this future program. In order to meet this objective, we adopted a qualitative methodology. Semi-structured interviews were conducted with 19 adolescents with juvenile arthritis from two Canadian pediatric tertiary centers. The first article of this thesis focuses on exploring adolescents with JIA perceptions of their ability to teach as a patient educator. It appears that adolescents feel empowered to perform this role primarily because they recognize that they have acquired experiential knowledge by living with their illness. Teens also want to go beyond the MSQp exam teaching and incorporate teaching of their experience of the disease as well as aspects of communication. The importance of integrating these educational messages into the future curriculum to reflect adolescents' visions is discussed. Following the question of 'how' adolescents with juvenile arthritis envisage to be actively involved as patient educators, we then explore in more details 'why' they would 6 like to be part of such a program. Our second article therefore explores the various sources of motivation for adolescents to engage as patient educators through the lens of the self-determination conceptual framework (Ryan & Deci, 2000). Themes associated with intrinsic motivation (helping oneself, experiencing socialization) and extrinsic motivation (advocating for the cause, helping others) are identified. Facilitators and barriers to adolescents' engagement are also explored. The relevance of incorporating these various elements in the program development to ensure an adequate level of participants' commitment is discussed. In our third and final article, we propose a generic framework for curriculum development and evaluation in health sciences based on a review of different models in the broader discipline of program evaluation. We then discuss the application of this framework specifically to the proposed adolescents with juvenile arthritis patient educator program and delineate factors and processes that need to be considered in its creation, implementation, and future evaluation. We conclude with a discussion of this doctoral study's educational implications and development of future lines of research.

Indiana University-Purdue University Indianapolis (IUPUI) / Although interprofessional education (IPE) opportunities can help prepare students for future practice and patient-centered care, many health professions students in the country are not educated in an environment with opportunities to learn with, from, or about students from other health professions. With upcoming curricular changes at the Indiana University School of Medicine (IUSM) and the Indiana University School of Nursing (IUSN), IPE remains at the forefront of these changes in both schools. To date, few studies have explored student, faculty, and administrators’ conceptualizations of IPE prior to formal implementation. Additionally, previous studies have not compared IPE conceptualizations across these groups. This multiple-case study explores and compares how groups of stakeholders from the IUSM (Indianapolis) and the IUSN (Indianapolis) conceptualize IPE. Data collection included the examination of discipline-specific public documents and one-on-one interviews (N=25) with pre-licensure students, clinical faculty, and administrators from each school. Coding and extraction of themes transpired through within-case and cross-case analysis and data supported the following findings: the ‘business of medicine’ may prevent IPE from becoming a priority in education; stakeholders’ conceptualizations of IPE are shaped through powerful experiences in education and practice; students desire more IPE opportunities at the institution; stakeholders at the IUSN have a long-standing investment in IPE; and the institution requires a ‘culture shift’ in order to sustain IPE efforts. The findings suggest that IPE belongs in all education sectors and IPE efforts deserve reward and reimbursement. The findings also insinuate that leadership, roles, and team training education belong in IPE and IPE culture requires all individuals’ (e.g., student, faculty, administrators, patients) commitment. Importantly, the institution must continue IPE development, research, and dissemination. These findings can help shape curricula as time progresses, increase the likelihood of developing a successful new curriculum, and prompt ongoing reflection about IPE. This information can influence how institutions approach IPE and may lead to a more successful and informed IPE curriculum in the first years of implementation. And, hopefully what is learned through IPE will be translated into healthcare practice environments.