Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Le vieillissement de la population et les différentes réformes du système de santé au Québec ont mené à divers bouleversements, et à un déplacement des soins et des services vers le domicile. Les groupes professionnels travaillant dans le secteur du maintien à domicile ont vu leur travail se transformer et évoluer au fil des ans. Selon R. Bourque (1992), qui s’est intéressée à la professionnalisation du métier d’auxiliaire familiale et sociale dans les années 1980 et au début des années 1990, les auxiliaires familiales et sociales font partie des travailleuses ayant connu le plus de changement dans la nature de leurs tâches depuis leur intégration à l’intérieur de la santé et des services sociaux en 1972. Notre recherche s’intéresse à l’évolution des pratiques professionnelles des auxiliaires familiales et sociales en CLSC au Québec depuis les années 1990. L’étude réalisée à l’aide de huit entretiens semi-dirigés portant sur l’évolution des pratiques des AFS depuis les années 1990, a permis de saisir et de comprendre l’évolution des tâches et des fonctions de ces AFS à partir de leur quotidien. Les résultats démontrent une spécialisation accrue du travail vers les soins d’hygiène et les actes délégués de type infirmier. Toutefois, l’hétérogénéité des pratiques de ces AFS témoigne de la survie de certaines tâches, notamment au niveau des activités de la vie domestique (AVD). L’enjeu majeur de ce groupe professionnel se situe dans la consolidation d’une association plus forte et plus inclusive afin de faire valoir leurs revendications et faire face aux défis qu’elles doivent surmonter au quotidien afin de faire reconnaître leur travail. / The aging population and the various reforms within the health system in Quebec have led to various changes over the years. Professional groups working in the field of home care services have seen their work transformed and evolved over the past decades. According to Bourque (1992), who was interested in the professionalization of home-care workers in the 1980s and the early 1990s, home-care workers are among the workers who experienced the most change in the nature of their tasks since their integration in the Health and Social Services in 1972. Our research focuses on the evolution of the professional practices of home-care workers in CLSC in Quebec since 1990. This study that was realized with semi-structured interviews with eight home-care workers led to understand the evolution of the tasks and functions of these workers. The result of this research shows a growing specialization of their work as well as increased tasks related to nursing care. However, the heterogeneity of these practices demonstrates the survival of certain tasks, particularly in terms of the activities of daily living. The major challenge in this group lies in the consolidation of a stronger and more inclusive association to assert their claims and to meet the challenges they face every day in order to recognize their work.

La recherche portant sur les expériences reliées aux services sociaux et de santé chez les aînés gais reçoit une attention croissante; cependant, les expériences dans le contexte des services à domicile demeurent peu documentées. Les deux principaux objectifs de cette étude sont d’explorer le vécu des aînés gais recevant des services à domicile relativement à leurs stratégies identitaires et de décrire leurs besoins spécifiques en vue de l’adaptation des pratiques sociales à domicile. Les propos de six aînés gais ont été recueillis dans la région de Montréal par entrevues semi-dirigées. Les résultats montrent que les expériences des aînés recevant des services à domicile sont généralement satisfaisantes; parmi eux, certains se sont sentis stigmatisés, mais seulement dans de rares moments et nous ont rapporté avoir plutôt vécu des situations les rendant mal à l’aise. Les résultats présentent aussi une utilisation variée des quatre stratégies identitaires (divulgation active, divulgation passive, dissimulation passive, dissimulation active) d’après une adaptation du modèle d’Eliason et Schope (2001). Si des facteurs individuels et interactionnels ont influencé les stratégies des aînés, ce sont cependant des facteurs contextuels (le type de service d’aide à domicile, le temps, le contexte social immédiat) qui ont pris une importance significative. Enfin, diverses pistes d’action sont à explorer pour l’adaptation des pratiques sociales auprès de cette population, notamment à l’égard de la formation des intervenants sociaux et de la santé, de l’amélioration de l’organisation des services à domicile, du développement de ressources spécifiques et de la contribution du travailleur social auprès des minorités sexuelles âgées. / The research on experiences related to social and health services among gay seniors is receiving increasing attention. However, their experiences in the context of home care services remain poorly documented. The two main objectives of this study are to explore the experiences of gay seniors receiving home care services in relation to their identity strategies and to describe their specific needs for the adjustment of social practices at home. The comments of six gay elders were collected in the Montreal area by semi-structured interviews. The results show that the experiences of seniors receiving home care services are generally satisfactory; among them, some have felt stigmatized but only in rare moments and have reported mostly having experienced situations making them uncomfortable. The results also show a varied use of the four identity strategies (active disclosure, passive disclosure, active concealment, passive concealment) based on an adaptation of the Eliason and Schope (2001) model. If individual and interactional factors have influenced the strategies of seniors, the contextual factors (type of care or service, time, immediate social context) have taken a more significant importance. Finally, various courses of action should be explored for the adaptation of social practices with this population, particularly regarding the training of health and social workers, the improvement of the home care services organization, the development of specific resources and the social worker’s contribution with older sexual minorities.

There is renewed interest in the role that direct work and relationship-based practice does, should, or could play, in social work practice with children and young people. This study used a qualitative approach to explore day-to-day direct work with children and young people who are ‘looked after’ at home, from the perspectives of children, social workers and those supervising practice. The thesis explores the meanings ascribed to direct work, and identifies factors which enable direct work, and those which act as barriers. The research was undertaken in Scotland, and although the legislation, policy, and guidance underpinning practice differ from other jurisdictions, the messages to emerge are relevant across the UK and beyond. The study found that despite the existence of barriers, direct work which is characterised as meaningful by children, young people and professionals does happen; and that the relationships formed between children and social workers are both a precursor to and an outcome of direct work. A core theme is that although individual relationships are central, the everyday encounters between children and their social workers need to be understood and situated within the personal, professional and structural contexts in which they take place.

O acelerado processo de envelhecimento populacional é desafiador para a elaboração de estratégias de atenção à saúde nos diferentes níveis de complexidade. Em concordância com a integralidade do cuidado em assistência domiciliar, o interRAI-Home Care é um exemplo de avaliação multidimensional utilizado em vários países na gerência de casos, gestão em saúde pública e cooperação internacional na busca de melhores soluções para gestão de saúde. As características culturais e do funcionamento dos serviços de assistência domiciliar podem influenciar o processo de adaptação transcultural e uso desses instrumentos. Os objetivos desse estudo foram realizar a adaptação transcultural do interRAI-Home Care para a população brasileira e verificar a validade de conteúdo e face da versão em português brasileiro em um serviço de assistência domiciliar. Foram seguidas as etapas do processo de adaptação transcultural com tradução do instrumento, retro tradução para a língua de origem, avaliação de equivalência das versões do instrumento por uma comissão de especialistas e pré-teste com aplicação da versão pré-final em uma amostra selecionada por conveniência de 30 indivíduos (n=30), matriculados e atendidos no Núcleo de Assistência Domiciliar Interdisciplinar do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Os resultados mostram que os procedimentos para a adaptação transcultural foram realizados com ajustes necessários para garantir a equivalência de conteúdo das versões original, traduzida e retro traduzida após revisão e consenso da comissão de especialistas. Na fase pré-teste, verificou-se compreensão de todos os itens da versão pré-final por parte dos entrevistados e concordância entre os avaliadores >= 85% para cada item do instrumento, obtendo-se a versão final do interRAI-Home Care, traduzido e adaptado para o português, interRAI-Assistência Domiciliar. Conclui-se que a adaptação transcultural de um instrumento de avaliação multidimensional em assistência domiciliar foi realizada com verificação da validade de conteúdo e face dos itens do instrumento e elaboração da versão brasileira do interRAI-Home Care, em português brasileiro, interRAI-Assistência Domiciliar. Em etapas futuras, sugere-se a avaliação das propriedades psicométricas do interRAI-Assistência Domiciliar para viabilizar o seu uso e aplicabilidade prática em nosso meio / The accelerated population aging process is challenging for health care strategies development at different levels of complexity. In agreement with the integrality of care in home care, the interRAI-Home Care is an example of multidimensional assessment used in different countries in case and public health management and international cooperation for better solutions to health management. The culture and functioning of home care services can influence the process of cross-cultural adaptation and use of these instruments. This study aims to perform the cross-cultural adaptation of interRAI-Home Care for the Brazilian population and verify the content and face validity of the Brazilian Portuguese version in a home care service. Cross-cultural adaptation process stages were followed with translation, back translation, assessment of equivalence by an expert committee and pretesting with the pre-final version in a sample selected by convenience of 30 subjects (n = 30) registered and attended by the Núcleo de Assistência Domiciliar Interdisciplinar do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. The results shows that the procedures for cross-cultural adaptation were carried out with adjustments to ensure the equivalence of content of the original, translated and back translated versions after the committee experts review and consensus. Pretesting resulted in understanding of all items in the pre-final version by the interviewees and agreement between observers >= 85% for each item of the instrument thus obtaining the final version of interRAI-Home Care, translated and adapted to Brazilian Portuguese, interRAI-Assistência Domiciliar. In conclusion, the cross-cultural adaptation of a home care multidimensional assessment instrument was performed with statement of content and face validity of the instrument items and development of brazilian interRAI-Home Care version, in Brazilian Portuguese, interRAI-Assistência Domiciliar. In future steps, we suggest the evaluation of the psychometric properties of the interRAI-Assistência Domiciliar to enable its use and practical applicability in home care in Brazil

Este estudo teve como objetivo conhecer a percepção do cuidador domiciliar do idoso sobre o cuidado de si e o cuidado que a equipe de saúde lhe proporciona, tendo como base teórica o referencial de Jean Watson em sua Teoria do Cuidado Humano. A pesquisa caracterizou-se por uma abordagem qualitativa, do tipo exploratório descritiva. O estudo foi desenvolvido na Unidade da Vila Floresta que faz parte do Serviço de Saúde Comunitária do Grupo Hospitalar Conceição. Participaram do estudo nove cuidadores domiciliares de idosos integrantes do Programa de Assistência Domiciliar, da unidade campo deste estudo. A coleta de informações se deu através de entrevista semi-estruturada (TRIVIÑOS, 1987), realizada no domicílio dos participantes ou na Unidade de Saúde. Para análise das informações foi utilizada a análise de conteúdo proposta por Bardin (1977). Os aspectos éticos foram atendidos de acordo com as Diretrizes e Normas Regulamentadoras da resolução 196/96. Da análise das entrevistas emergiram as seguintes categorias: consciência intencional: olhares necessários para cuidar de si; compromisso moral com a consciência de cuidado do outro resultando no (des)cuidado de si; consciência, sensibilidade e espiritualidade: transcender no encontro de cuidado para melhor cuidar de si; a equipe de saúde e o cuidador domiciliar: a necessidade do cuidado transpessoal. Conclui-se que o cuidador domiciliar é o principal responsável pelo cuidado ao idoso, mas conta com apoio de familiares e vizinhos em alguns momentos. O cuidado de si se faz presente em certos momentos na realidade dos participantes do estudo e, em outros, alguns fatores impedem a sua realização. O cuidador domiciliar reconhece a presença da espiritualidade na relação de cuidado para consigo e do idoso. Quanto ao atendimento que recebem da equipe de saúde, os participantes do estudo expressam que sentem-se acolhidos e cuidados, e em outros momentos encontram dificuldades em relação ao acesso à equipe de saúde e à falta da sua presença no domicílio. / The main objective of this study was to know the perception of self care and the care the health team gives to the elderly home care giver, having as theoretical basis, John Watson’s referential in her Theory of Human Caring. The research was characterized by a qualitative approach of the descriptive exploratory type. The study was carried out in the Unidade da Vila Floresta, which is part of the community health service of the Grupo Hospital Conceição. Nine elderly home care givers have participated and are members of the Programa de Assistência Domiciliar da Unidade (Unit Home Care Program), this field of study. The data gathering was performed through a semi-structured interview (TRIVIÑOS, 1987), taken place in the participants’ homes or in the Health Unit. For the information analysis, the content analysis proposed by Bardin (1977) was used. The ethical aspects were respected according to the Diretrizes and Normas Regulamentadoras - 196/96 resolution, through a Free Informed Consent Term and by the consent of the Institution Ethical Committee, where this research was developed. From the interviews analyzed, the following categories came up: intentional conscience: necessary looks to take care of one’s self; moral commitment with the care conscience of the other resulting in someone’s own care or carelessness; consciousness, sensitivity and spirituality: to transcend in the care meeting to better take care of themselves; the health team and the home care giver: the need for transpersonal care. It is concluded that the home caregiver is the main person responsible for the elderly care, but they also count on the support of the family members and neighbors in some moments. Self care sometimes is present in some moments in the reality of the participants of this study, and in others, some factors do not allow its fulfillment. The home care giver recognizes the presence of spirituality in the care relationship with himself and with the elderly. Regarding the service they receive from the health team, the study participants express that they feel welcomed and taken care of and in other moments they find difficulties in relation to the access of the health team and their absence in their homes. / Este estudio tuvo como objetivo conocer la percepción del cuidador domiciliario del anciano cuidado de sí mismo y del cuidado que el equipo de salud proporciona, teniendo como base teórica el modelo de Jean Watson en su Teoría del Cuidado Humano. La pesquisa se caracterizó por un abordaje cualitativo, de tipo exploratoriodescriptivo. El estudio fue desarrollado en la Unidad de la Vila Floresta que hace parte del Servicio de Salud Comunitaria del Grupo Hospitalario Conceição. Participaron del estudio nueve cuidadores domiciliarios de ancianos, integrantes del Programa de Asistencia Domiciliaria de la Unidad, campo de este estudio. La recolección de informaciones se realizó por medio de una entrevista semiestructurada (TRIVIÑOS, 1987), realizada en el domicilio de los participantes o en la Unidad de Salud. Para el análisis de las informaciones se utilizó el análisis de contenido propuesto por Bardin (1977). Los aspectos éticos fueron atendidos de acuerdo a las Directrices y Normas Reglamentadoras de la resolución 196/96, a través del Término de Consentimiento Libre y Esclarecido (Consentimiento Informado) y por la aprobación ante el Comité de Ética de la Institución en donde esta investigación fue desarrollada. A partir de las entrevistas analizadas emergieron las siguientes categorías: consciencia intencional: miradas necesarias para cuidar de sí mismo; compromiso moral con la consciencia de cuidado del otro resultando en (des)cuidado de sí mismo; consciencia, sensibilidad y espiritualidad: trascender en el encuentro de cuidado para mejor cuidar de sí mismo; el equipo de salud y el cuidador domiciliario: la necesidad del cuidado transpersonal. Se concluye que el cuidador domiciliario es el principal responsable por el cuidado del anciano, pero cuenta con el apoyo de familiares y vecinos en algunos momentos. El cuidado de sí mismo se hace presente en algunos momentos en la realidad de los participantes del estudio y en otros, algunos factores impiden su realización. El cuidador domiciliario reconoce la presencia de la espiritualidad en la relación del cuidado consigo mismo y del anciano. Con relación a la atención que reciben del equipo de salud, los participantes del estudio expresan que se sienten acogidos y cuidados y en otros momentos, encuentran dificultades en relación al acceso al equipo de salud y la falta de su presencia en domicilio.

Notre recherche vise à identifier pour notre partenaire socio-économique, le Pôle services à la personne PACA (PSP PACA), les manières possibles dont il peut soutenir l’activité d’innovation de ses adhérents et des acteurs du champ des services à domicile. Nous avons dans un premier temps, à l’aide de revues de littérature, bâti un modèle théorique d’analyse nous permettant de mettre en évidence l’ensemble des activités cognitives, politiques, constructives et productives, fondamentales dans la conduite de projet entrepreneuriaux visant à transformer ou à renforcer un champ. Nous nous sommes pour cela appuyés sur une littérature portant sur la perspective fondée sur le projet, et sur trois ensembles de littérature sur l’appropriation d’objets de conception. Nous avons ensuite mobilisé ce modèle d’analyse dans la lecture approfondie de deux cas de projets conduits par le PSP sous forme d’actions collectives. La mobilisation de ce modèle d’analyse nous a permis d’examiner les dispositifs (organisationnels, d’animation, d’accompagnement, …) mis en place par l’équipe du pôle au niveau des actions collectives, et leur incidence sur les activités qui s’y sont déroulées. Celle-ci nous a également permis d’identifier, en contexte, les éléments qui ont été par la suite appropriés ou adoptés par les opérateurs de services, durant la conduite de leurs propres projets. Nous avons alors mis en évidence un certain nombre de leviers d’ordre méthodologique, sur lesquels peut s’appuyer l’équipe du pôle pour optimiser l’organisation et l’animation de telles actions collectives. Ces résultats nous ont alors conduits à émettre trois principaux axes de discussion théorique / Our research aims to identify, for the PSP PACA our socio-economic partner, the possible ways to support the innovation activity of its members and the home-care services field players. Firstly, based on an expanded literature review, we built a theoretical model of analysis allowing us to highlight all the cognitive, political, constructive and productive fundamental activities in the implementation of entrepreneurial projects intended to transform or strengthen a field. Thus, we rely on a project-based view literature and on three sets of literature on the appropriation of human artefacts. Secondly, we mobilized this model of analysis in the in-depth reading of two cases of projects carried out by the PSP PACA, setting up collective actions. Mobilizing this analytical model allowed us to examine the different ways (organization, collective animation and individual support) by which the PSP team carried out theses collective actions, and their subsequent impact on the activities. It also allowed us to identify, in context, the elements that were appropriated or adopted by the participants while conducting their own projects. We then highlighted a certain number of methodological levers, on which the team of the cluster can rely to optimize - according to its aims and its orientations - the organization and the animation of such collective actions. We articulated these levers according to four different modalities in order to facilitate their mobilization by participants or project carriers. These results then led us to put forward three main axes of theoretical discussion

Le vieillissement de la population et les différentes réformes du système de santé au Québec ont mené à divers bouleversements, et à un déplacement des soins et des services vers le domicile. Les groupes professionnels travaillant dans le secteur du maintien à domicile ont vu leur travail se transformer et évoluer au fil des ans. Selon R. Bourque (1992), qui s’est intéressée à la professionnalisation du métier d’auxiliaire familiale et sociale dans les années 1980 et au début des années 1990, les auxiliaires familiales et sociales font partie des travailleuses ayant connu le plus de changement dans la nature de leurs tâches depuis leur intégration à l’intérieur de la santé et des services sociaux en 1972. Notre recherche s’intéresse à l’évolution des pratiques professionnelles des auxiliaires familiales et sociales en CLSC au Québec depuis les années 1990. L’étude réalisée à l’aide de huit entretiens semi-dirigés portant sur l’évolution des pratiques des AFS depuis les années 1990, a permis de saisir et de comprendre l’évolution des tâches et des fonctions de ces AFS à partir de leur quotidien. Les résultats démontrent une spécialisation accrue du travail vers les soins d’hygiène et les actes délégués de type infirmier. Toutefois, l’hétérogénéité des pratiques de ces AFS témoigne de la survie de certaines tâches, notamment au niveau des activités de la vie domestique (AVD). L’enjeu majeur de ce groupe professionnel se situe dans la consolidation d’une association plus forte et plus inclusive afin de faire valoir leurs revendications et faire face aux défis qu’elles doivent surmonter au quotidien afin de faire reconnaître leur travail. / The aging population and the various reforms within the health system in Quebec have led to various changes over the years. Professional groups working in the field of home care services have seen their work transformed and evolved over the past decades. According to Bourque (1992), who was interested in the professionalization of home-care workers in the 1980s and the early 1990s, home-care workers are among the workers who experienced the most change in the nature of their tasks since their integration in the Health and Social Services in 1972. Our research focuses on the evolution of the professional practices of home-care workers in CLSC in Quebec since 1990. This study that was realized with semi-structured interviews with eight home-care workers led to understand the evolution of the tasks and functions of these workers. The result of this research shows a growing specialization of their work as well as increased tasks related to nursing care. However, the heterogeneity of these practices demonstrates the survival of certain tasks, particularly in terms of the activities of daily living. The major challenge in this group lies in the consolidation of a stronger and more inclusive association to assert their claims and to meet the challenges they face every day in order to recognize their work.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

Darbo tikslas – ištirti senyvo amžiaus asmenų, gyvenančių namuose, integruotų sveikatos priežiūros ir socialinių paslaugų poreikį bei teikimo organizavimą. Tyrimo klausimai: Koks yra integruotų sveikatos priežiūros ir socialinių paslaugų poreikis senyvo amžiaus asmenims namuose? Kaip organizuojamos integruotos sveikatos priežiūros ir socialinės paslaugos senyvo amžiaus asmenims namuose? Su kokiais iššūkiais susiduriama teikiant integruotos sveikatos priežiūros ir socialines paslaugas senyvo amžiaus asmenims namuose? Tyrimo metodika: Tyrimo tikslui pasiekti buvo atliktas kokybinis atvejo analizės tyrimas. Tyrime duomenys rinkti vadovaujantis metodų trianguliacija: duomenų rinkimo, giluminio pusiau struktūruoto interviu, stebėjimo ir dokumentų analizės. Apklausti 12 trijų komandų skirtingus lygmenis ir sritis atstovaujantys specialistai: socialinė darbuotoja – projekto administratorė, kineziterapeutė, 4 socialinio darbuotojo padėjėjos, 4 slaugytojo padėjėjos, 2 bendrosios praktikos slaugytojos. Tyrimo objektas: integruotų sveikatos priežiūros ir socialinių paslaugų poreikis bei teikimo organizavimas senyvo amžiaus asmenų namuose. Rezultatai: Integruotų paslaugų poreikis bei teikimo organizavimas senyvo amžiaus asmenims, gyvenantiems namuose, atsiskleidė per apklaustųjų patirtis ir požiūrį, per socialinių aplinkybių, kuriose gyvena senyvi asmenys, analizę, pastebima su kokiais sunkumais ir iššūkiais susiduria paslaugų gavėjai ir teikėjai. Pažymima, kaip yra identifikuojami ir... [toliau žr. visą tekstą] / Aim of the study – to explore the need and provision of integrated health and social home care services for elderly. Research questions. What is the need for integrated social and health home care services for elderly? How is organised provision of integrated social and health home care services for elderly? What kind of challenges face the provision of integrated social and health home care services for elderly? Methods. Conducted qualitative case study. For validity of findings used data triangulation, semi structured in depth interviews, observation and document analyses. Interviewed 12 mobile team members: project administrator - social worker, direct service providers professionals from all three mobile teams of integrated care: 2 nurses, 4 assistant nurses, physiotherapist, 4 assistant social workers. Research object: the need and organization of integrated social and health home care services for elderly provision. Results: The need for integrated services organization of the provision of elderly people living at home, revealed through the experiences and attitudes of the respondents, through the social circumstances in which they live in elderly subjects, analysis, noted the difficulties and challenges faced by users and providers. It is noted, as is the identification and assessment of the needs of elderly persons and who does it. During the course of the study, an integral - mobile teams, as innovations in the creation process, the way in which communication... [to full text]