This thesis is an institutional ethnography (IE) examining the social organization of Community Care Access Centre School Health Support Services (CCAC SHSS) for children with diabetes in Ontario schools. More specifically, it explicates the social relations embedded in, and coordinating the work organization of mothering (parenting) and nursing in the school setting. The inquiry begins in my personal experience as a mother of a child with diabetes starting kindergarten, and the troubles I encountered in getting the care and attention needed to keep my child safe at school. Starting from experience, a place outside of theory and institutionalized categories and discourse, I set out on a journey to discover the social organization that coordinates my experience, and to seek answers to my query: how are school health supports put together in such a way that I, as a parent, am left feeling worried about my child’s safety when she is at school, have had to fight to secure the much needed ‘diabetes care’, and even then, am often called upon to provide voluntary supplementary healthcare work to ensure her safety at school? I have structured this thesis into two main parts. The first part provides the set-up for this thesis. First, I orient readers to this distinctive way of doing an IE, directing their attention to how I used the core IE concepts in this research and calling upon them to read the remainder of the thesis taking up this distinctive theoretical and conceptual lens. Indeed, what we know and how we know it has much to do with how knowledge is socially organized. Then, I go on to examine the different ways of knowing about ‘diabetes care’, how these distinctive ways of knowing create a disjuncture for me as a parent and how this disjuncture is used to establish the research standpoint to begin and direct the explication. The last chapter in this part situates health supports for children with diabetes within the services provided by public-funded home care. I sketch three decades of the history of reform and organizational restructuring of home care in Ontario, in particular, the introduction of privatizing relations into the local practices of community nursing and the creation of CCACs. These relations of privatization reorganized the home care sector, the workforce, and the relation between the ‘state’ and its citizens. What went on before sets the groundwork for what can happen next, and it is under this context and conditions in which my inquiry is set. The second part consists of four academic journal manuscripts. They are the descriptive analysis for this IE. These four chapters describe what I have learned and discovered in doing this research, and three of them in particular provide an empirical analysis showing how school health supports for children with diabetes are put together such that the troubles I experienced came into being. These four chapters are conventionally referred to as research ‘findings’ in traditional qualitative research methodology. Each of these chapters speaks to a particular way of knowing about ‘diabetes care’. One focuses on parents’ experiential ways of knowing based on the actualities of their daily and nightly everyday world to show the amount of work and knowledge required to care for and to keep their children with diabetes alive; while the other three underscore the CCACs’ institutional ways of knowing about ‘diabetes care’ in the school setting. I show how these objectified ways of knowing derived from institutional texts (Standardized CCAC Medial Orders, information technology software and the Diabetes Checklist for Independence) are used to determine a child’s eligibility to receive health supports at school. These objectified textual forms of knowing are removed from the actualities of people’s real life circumstances, and differ significantly with how and what parents know is needed for their children with diabetes to stay well and safe at school. It is precisely this form of text-mediated social coordination that leaves parents feeling worried and draws them in to doing voluntary healthcare work at school, without which the child’s safety and the continuity of care is not possible. Tracing the institutional relations organizing how health support services for children with diabetes actually happen in the classroom, I show the kind of work expected of parents, and demonstrate that the CCAC SHSS policy and practices only ‘work’ as they should with the incorporation of parents’ ‘unauthorized’ knowledge and their ongoing voluntary complementary healthcare work. While it is in parents’ interests to ensure their children’s safety and well-being at school, there are differences between parents in how, and if, they can deliver their knowledge and resources. / Thesis / Doctor of Philosophy (PhD) / Diabetes is a chronic health condition that requires individuals with diabetes or their families to maintain a daily well-coordinated and intensive diabetes self-care routine. Lapses in this complex daily regimen can have devastating immediate and long-term consequences. How children’s diabetes, that is children’s health and well-being, are cared for at school is of concern for parents. The inquiry begins in my personal experience as a mother of a child with diabetes starting kindergarten, and the troubles I encountered in getting the care needed to keep my child safe at school. Starting from experience, this thesis examines how the institutional context and routine practices of diabetes care in school affects the care children actually receive. Despite legislation that requires accommodations for students with disabilities, what I found in this study is that parental involvement (which is inequitably available) is essential to ensure diabetes care is adequate for children in schools.

This diploma thesis with the management of health support program in a hospital, because of increesing interest in relevance of health support nowadays. Theoretical section attempts to map out health supportin global context and also outline some health support programs, which are in progress in Czech Republic today. Another goal is to specify the most frequent noncommunicable chronic deseases and their risk factors. The last part of theoretical section deals with quality of health care, implementation of quality management and quality planning and also highlits quality as a result of modification of management process. Practical section analyzes data from questionaire survey, colected from in-patients with ischemic heart disease in The Hospital Pelhřimov. Results show, that patients wanted to change their life style. There is also a big group of patients, who don't think of changes of their habits. But this group is interested in informations about changes of their life style. The informations are provided by physicians. As for this group, group consists of patients with overweight or obesity, and patients who are suffering from their disease less then one year. Level of provided information in The Hospital Pelhřimov is very high. Patients are able to realise recommendations, which personal of the...

Background: This grounded theory study explored the views of adolescent boys aged 12 and 13 on the factors that influence their help-seeking decisions for less severe forms of psychological distress. Method: Semi-structured interviews with 12 participants from a local secondary school and a community setting were analysed according to grounded theory methods. The data analysis abstracted categories of data to construct a substantive theory of helpseeking. Results: Participants’ views revealed an interaction of ‘pressures and promoters’ that affected adolescent boys’ help-seeking decisions. These related to relationships with others, mental health support and education, being a boy, and individual factors. Conclusion: Mental health education and awareness should be promoted amongst adolescent boys and the adults and professionals that they encounter so that they may be encouraged to seek help for psychological distress.

A inserção de profissionais de diferentes áreas do conhecimento nas equipes de atenção primária no país é uma estratégia nova, cujo atual estágio de desenvolvimento viabiliza a implantação de grupos de diferentes formações profissionais. Nessa lógica, a estratégia de Educação Interprofissional (EIP) tem fomentado pesquisas, no sentido de discutir modos de viabilizar uma formação em saúde arraigada no compartilhamento de saberes e na prática da colaboração profissional. Nessa linha se insere esta pesquisa, cujo objetivo foi verificar princípios da EIP nas estratégias de formação para o trabalho em equipe no âmbito dos Núcleos de Apoio à Saúde da Família (NASF) de uma microrregião de saúde de Minas Gerais. Desenvolveu-se um estudo exploratório, qualitativo, com 21 profissionais componentes de equipes NASF da Microrregião de Saúde de Passos/Piumhi. A coleta de dados foi efetivada por meio de três grupos realizados em fevereiro de 2014, nos municípios de Alpinópolis, Passos e Piumhi. Os dados pertinentes à caracterização da amostra foram tratados por estatística descritiva e os depoimentos por análise de conteúdo temática. Dessa emergiu quatro categorias de análise: O trabalho em equipe: conceitos e significações; Interfaces do trabalho em equipe: forças propulsoras e limitantes; Processos acadêmicos de formação em saúde: preparação para o trabalho em equipe?; Processos de formação em serviço para o trabalho em equipe. Amostra majoritariamente feminina; com tempo de formação inferior a 10 anos; inseridos no Sistema Único de Saúde (SUS) há no máximo cinco anos; e no NASF, há no máximo dois anos. Os sujeitos do estudo significam o trabalho em equipe como uma prática interdisciplinar, que transcorre do compartilhamento de conhecimentos e experiências e da conformação de uma rede dialógica entre os diferentes profissionais da Atenção Básica. Como forças limitantes para a atuação em equipe destacaram a resistência aos NASF por parte dos profissionais da ESF; a incipiência do médico como integrante da equipe; a demanda populacional e de atribuições excessivas e; a instabilidade da gestão pública. Como forças propulsoras: o processo de comunicação e perfil profissional que corresponda às necessidades da saúde pública. Evidenciou-se que os profissionais foram submetidos a um processo de formação alicerçado em modelos de ensino baseado na fragmentação do cuidado. No entanto, foi revelado que o estágio curricular é um recurso que oportuniza a formação para o trabalho em equipe. Verificou-se que inexistem processos formais de educação no âmbito do serviço, sobretudo com vistas à aquisição de habilidades para o trabalho em equipe. Nesse cenário, as reuniões de equipe foram apontadas como uma ferramenta profícua ao aprendizado interprofissional, viabilizadas a partir dos pressupostos da Educação Permanente em Saúde. Destarte, reflete-se que mesmo com a inclusão das mais diversas profissões da saúde no campo da Atenção Básica, ainda há grandes desafios para o desenvolvimento do trabalho em equipe na lógica da formação interprofissional. Imprime-se a necessidade de reorientação dos modelos pedagógicos de ensino-aprendizagem com ênfase na EIP e as propostas de ensino no serviço baseada na prática colaborativa e integrada. / The inclusion of professionals from different areas of knowledge in primary care teams in the country is a new strategy, whose current stage of development enables the deployment of groups from different professional backgrounds. In this logic, the strategy of interprofessional education (IPE) has encouraged research in order to discuss ways of facilitating health training based in the sharing of knowledge and the practice of professional collaboration. As part of this idea, this research aimed to verify the principles of IPE in the training strategies for teamwork within the Family Health Support Centers (NASF) of a Minas Gerais state region. An exploratory, qualitative study was developed, with 21 professionals of NASF teams from Passos/Piumhi health region. Data collection was done with three groups, and conducted in February 2014 in the cities of Alpinópolis, Passos and Piumhi. The data relevant to the characterization of the sample data were analyzed via descriptive statistics and testimonials by thematic content analysis. Four categories emerged from this analysis: Teamwork: concepts and meanings; Teamwork interfaces: driving and restraining forces; Health education academic processes: preparation for teamwork?; Service training procedures for teamwork. Mainly female sample, with no more than 10 years of training time, working into the public system for five years max, and in NASF for no more than two years. The study subjects see teamwork as an interdisciplinary practice, which comes from the sharing of knowledge and experience and from the conformation of a dialogical network between different primary care professionals. As limiting forces for teamwork they pointed the resistance to NASF by FHS professionals; the ignorance of the physician as a team member; the population demand and excessive duties and; the public management instability. As driving forces: the process of communication and professional profile that meets the needs of public health. It was evident that professionals have undergone a training process, built on models of teaching based on the fragmentation of care. However, it was revealed that the traineeship is a resource that provides opportunities for teamwork training. No formal in-service education processes was found, particularly if aiming to the acquisition of skills for teamwork. In this scenario, staff meetings have been identified as a useful tool to interprofessional learning, made possible from the assumptions of Continuing Education in Health. Thus, it is clear that even with the inclusion of several health professions in the field of primary care, there are still major challenges to the development of teamwork in the sense of interprofessional education. The need for reorientation of the pedagogical models of teaching and learning with an emphasis on IPE, and the proposals for in-service education based on collaborative and integrated practice are marked.

A inserção de profissionais de diferentes áreas do conhecimento nas equipes de atenção primária no país é uma estratégia nova, cujo atual estágio de desenvolvimento viabiliza a implantação de grupos de diferentes formações profissionais. Nessa lógica, a estratégia de Educação Interprofissional (EIP) tem fomentado pesquisas, no sentido de discutir modos de viabilizar uma formação em saúde arraigada no compartilhamento de saberes e na prática da colaboração profissional. Nessa linha se insere esta pesquisa, cujo objetivo foi verificar princípios da EIP nas estratégias de formação para o trabalho em equipe no âmbito dos Núcleos de Apoio à Saúde da Família (NASF) de uma microrregião de saúde de Minas Gerais. Desenvolveu-se um estudo exploratório, qualitativo, com 21 profissionais componentes de equipes NASF da Microrregião de Saúde de Passos/Piumhi. A coleta de dados foi efetivada por meio de três grupos realizados em fevereiro de 2014, nos municípios de Alpinópolis, Passos e Piumhi. Os dados pertinentes à caracterização da amostra foram tratados por estatística descritiva e os depoimentos por análise de conteúdo temática. Dessa emergiu quatro categorias de análise: O trabalho em equipe: conceitos e significações; Interfaces do trabalho em equipe: forças propulsoras e limitantes; Processos acadêmicos de formação em saúde: preparação para o trabalho em equipe?; Processos de formação em serviço para o trabalho em equipe. Amostra majoritariamente feminina; com tempo de formação inferior a 10 anos; inseridos no Sistema Único de Saúde (SUS) há no máximo cinco anos; e no NASF, há no máximo dois anos. Os sujeitos do estudo significam o trabalho em equipe como uma prática interdisciplinar, que transcorre do compartilhamento de conhecimentos e experiências e da conformação de uma rede dialógica entre os diferentes profissionais da Atenção Básica. Como forças limitantes para a atuação em equipe destacaram a resistência aos NASF por parte dos profissionais da ESF; a incipiência do médico como integrante da equipe; a demanda populacional e de atribuições excessivas e; a instabilidade da gestão pública. Como forças propulsoras: o processo de comunicação e perfil profissional que corresponda às necessidades da saúde pública. Evidenciou-se que os profissionais foram submetidos a um processo de formação alicerçado em modelos de ensino baseado na fragmentação do cuidado. No entanto, foi revelado que o estágio curricular é um recurso que oportuniza a formação para o trabalho em equipe. Verificou-se que inexistem processos formais de educação no âmbito do serviço, sobretudo com vistas à aquisição de habilidades para o trabalho em equipe. Nesse cenário, as reuniões de equipe foram apontadas como uma ferramenta profícua ao aprendizado interprofissional, viabilizadas a partir dos pressupostos da Educação Permanente em Saúde. Destarte, reflete-se que mesmo com a inclusão das mais diversas profissões da saúde no campo da Atenção Básica, ainda há grandes desafios para o desenvolvimento do trabalho em equipe na lógica da formação interprofissional. Imprime-se a necessidade de reorientação dos modelos pedagógicos de ensino-aprendizagem com ênfase na EIP e as propostas de ensino no serviço baseada na prática colaborativa e integrada. / The inclusion of professionals from different areas of knowledge in primary care teams in the country is a new strategy, whose current stage of development enables the deployment of groups from different professional backgrounds. In this logic, the strategy of interprofessional education (IPE) has encouraged research in order to discuss ways of facilitating health training based in the sharing of knowledge and the practice of professional collaboration. As part of this idea, this research aimed to verify the principles of IPE in the training strategies for teamwork within the Family Health Support Centers (NASF) of a Minas Gerais state region. An exploratory, qualitative study was developed, with 21 professionals of NASF teams from Passos/Piumhi health region. Data collection was done with three groups, and conducted in February 2014 in the cities of Alpinópolis, Passos and Piumhi. The data relevant to the characterization of the sample data were analyzed via descriptive statistics and testimonials by thematic content analysis. Four categories emerged from this analysis: Teamwork: concepts and meanings; Teamwork interfaces: driving and restraining forces; Health education academic processes: preparation for teamwork?; Service training procedures for teamwork. Mainly female sample, with no more than 10 years of training time, working into the public system for five years max, and in NASF for no more than two years. The study subjects see teamwork as an interdisciplinary practice, which comes from the sharing of knowledge and experience and from the conformation of a dialogical network between different primary care professionals. As limiting forces for teamwork they pointed the resistance to NASF by FHS professionals; the ignorance of the physician as a team member; the population demand and excessive duties and; the public management instability. As driving forces: the process of communication and professional profile that meets the needs of public health. It was evident that professionals have undergone a training process, built on models of teaching based on the fragmentation of care. However, it was revealed that the traineeship is a resource that provides opportunities for teamwork training. No formal in-service education processes was found, particularly if aiming to the acquisition of skills for teamwork. In this scenario, staff meetings have been identified as a useful tool to interprofessional learning, made possible from the assumptions of Continuing Education in Health. Thus, it is clear that even with the inclusion of several health professions in the field of primary care, there are still major challenges to the development of teamwork in the sense of interprofessional education. The need for reorientation of the pedagogical models of teaching and learning with an emphasis on IPE, and the proposals for in-service education based on collaborative and integrated practice are marked.

Introduction: Increased ill health in the workplace in terms of increased workload, stress and pressure from employers is common in Sweden today, which may lead to a future variety of medical conditions and disabilities. Aim: The aim of the present study was to describe what employees at companies in the health industry experienced as a health and illhealth on a workplace. Method: A qualitative approach was used in which the interviews were based on an interview guide. The method of analysis was thematic analysis in which three themes emerged. Results: Tree themes emerged; a social interaction with colleagues, good leadership, and access to health care and movement. The findings of the study indicated that the tasks themselves were not as important as the social interaction and the leadership so that the workplace was perceived as healthy. Implication: Suggestions for further research is to try to get more equal number of men and women engaged in further study and to develop the questions in the interview more to answer the purpose better. Furthermore, the health factors reported in the results could still be a good foundation to refer to, for interventions in the workplace or for the overall development of a healthy workplace within a specific company.

The thesis looks at developing a new model for a mental health support program which is integrated into a natural recreational environment. Its starting point is Beginning Again, a registered charity in Richmond Hill, Ontario, Canada, which provides a supportive workplace, called Treasures, to engage psychiatric patients in meaningful and productive work. The intent of the thesis is to develop an architecture that reflects the mission and objectives of the program in order to increase the opportunity for recovery and interaction with the local community. This is done by creating a more general prototype or “parent seed” which can be applicable to many locations and then testing the model by planting it in the Oak Ridges Corridor Park, located in the suburban community of Oak Ridges, Ontario. This thesis builds upon the long history of rehabilitative environments to create a community model of care that regards work as primarily a social and cultural activity.

The age of population has been protracting while the age limit for retirement has been increasing. On the one hand there are seniors who live to old age but they are in a relatively good health condition as same as their mental condition and state of mind. On the other hand there are among us the fellow citizens who became ill at a relatively early retirement age of civilization diseases. The aim of this thesis is to map the lifestyle of today´s seniors who lived to old age so that today´s young people and middle-aged people could spend their old age in the best health conditions and leisurely enjoy the retirement age because of its delayed coming. I have chosen qualitative research for ney diploma work. I hawe used the technique af half centrollet interview.

This qualitative case study describes the disparate experiences of how three siblings reacted and were affected by their father's suicide death. Specifically, through individual interviews, this study explores the siblings' individual memories, emotions, and perceptions of support connected with the time directly before and after their father's death. In addition, the researchers considered the long-term effects of their father's death by suicide as lived by the sibling survivors. In seeking to understand the siblings' experiences, this study also explores each sibling's reaction as they were presented with a group of children's picture books that were developed to help children express their emotions and are used by therapists who counsel with children bereaved by suicide. Findings suggested that, although the siblings shared the trauma of the father's suicide, each had different perceptions and experiences surrounding that trauma; they also reacted differently to the books presented to them. Implications for practice for teachers, parents, and school-based mental health practitioners (e.g., school psychologist and school counselors) are provided. These implications include the importance of knowing the specifics of each child's perceptions and providing supportive interventions that match the individual child's needs. Also, when selecting therapeutic books to share with a grieving child, consider presenting options and allowing the child to select a book. Also, be aware that a book that is preferred by one child, may not be preferred by another. Additionally, certain pictures included in children's books may trigger memories of the parent's suicide that could potentially further traumatize the child.

No / The correlation between 'disengagement' and illness in people with dementia living in long-term care settings is becoming more widely recognised, and developing and adapting front-line staff responses to the changing needs of individuals is a crucial factor in addressing this problem. This book presents a complete practical framework for whole person assessment, care planning and review of persons with dementia or signs of dementia (including those with learning disabilities) who are in need of, or already receiving, health and/or social support. The book provides photocopiable assessment forms, guidelines for carrying out the assessment, and suggestions for tailored interventions based on the profile that emerges from the assessment process. The authors also include a clear explanation of the five theoretical components of dementia that are considered in the assessment: health, biography, personality, neurological impairment and social psychology. This good practice guide will provide a step up to the challenge of providing person centred care as a minimum standard rather than just an ideal.