Historically, child abuse and neglect (CAN) prevention efforts have focused on individuals and families, with disregard for the contexts and conditions that may underlie family challenges. There is increased recognition that efforts to support families and children must include focus on the societal level (Browne, 2014), yet few studies have examined how institutional processes influence community-based CAN prevention services. I utilized institutional ethnography to identify institutional factors that impact family well-being and CAN prevention work in Alabama. I relied on three primary forms of data: 1) focus group discussions; 2) interview discussions; and 3) analysis of key documents. Preliminary analysis indicates prevention work is diverse and occurs within a system of limited institutional and public support. I will discuss the specific institutional factors that influence child and abuse prevention work in Alabama and close with a discussion of how institutional ethnography can be used to strengthen family research and policy.

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The intent of this thesis was to better understand the educative role of group exercise instructors, and how this role is approached when working with older exercisers. Data were collected using textual analysis, observations of instructors’ teachings in group exercise classes, semi-structured interviews with instructors and older exercisers, and go-alongs with older exercisers. This thesis is comprised of four papers (three journal articles and one book chapter). The first paper reports findings from a scoping review and elucidates that the educative role of exercise instructors is vital but under researched. Paper 2, a book chapter, reports findings from a qualitative content analysis of eight curricula used to train and certify fitness instructors in Canada and the United States. This paper proposes strategically employing compassionate ageism to meet older exercisers’ needs without (re)producing social inequalities in response to finding that the curricula conceive the older body as different from the healthy, supposedly ideal standard. Paper 3, an Institutional Ethnography, provides evidence for some of the ways employers and the aforementioned curricula influence how instructors teach. Paper 3 reports that multi-level teaching may not be enough to foster inclusivity, thus suggesting a greater need for stratification by ability rather than age. Additionally, findings outline some ableist teaching practices, which some instructors resisted by drawing on their competence to employ teaching methods respecting exercisers’ agency. Finally, Paper 4 introduces a substantive, grounded theory of age capital, which builds on Bourdieu’s theorizations of cultural capital, as well as Mauss’ habitus and body techniques. Age capital is defined as possessing a gerontological embodied competence, or cognitive and embodied knowledge of the socio-cultural practices throughout one’s life course. Collectively, this thesis provides several recommendations for teaching group exercise in a manner that fosters more inclusive classes for older adults. / Thesis / Doctor of Philosophy (PhD) / The key goals of this research were to understand how fitness instructors’ training might influence how instructors teach in their group exercise classes, learn how and what fitness instructors teach, and identify how instructors’ teaching is (or should be) different with older exercisers. I found that fitness instructors are important to group exercise classes, as they bring people together and teach people how to exercise safely. It is also especially important that instructors have special training to work with older people, but there is a lack of consistency in the training of exercise instructors and instructors received mixed messages about ageism in their training. This could reinforce the idea that older persons lose abilities as they age and result in a one-size fits all way of teaching that fails to include older exercisers’ diverse abilities. This research suggests ways instructors can be better trained to relate to older exercisers.

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Made available in DSpace on 2014-12-17T15:38:32Z (GMT). No. of bitstreams: 1 LucianaFM_TESE.pdf: 854964 bytes, checksum: 132a69f66769754a3d044805d52a783c (MD5) Previous issue date: 2010-06-07 / The Primary Health Care and one of its main strategies, the Family Health Strategy (ESF), are framed as the gateway to the Public Health System (SUS). Thus, most of the incident and prevalent health problems in the population attended should be solved at this level of care, including psychological suffering, and the so-called complaint of nerves. Nerves and nervous denote a complexity that is not always well comprehended by health workers, in such a way that the care to this kind of problem is usually inadequate. In this line of thought, the general objective of this study is to analyze the network of discourses and the care to the psychological suffering, expressed as nerves, in SUS daily Primary Health Care. Besides and more specifically, it aims at identifying the principles and guidelines of the Primary Health Care in mental health; to investigate health workers positioning before psychological suffering and complaints of nerves, and also analyze different actions and practices of care carried out in different Health Units towards complaints like nerves. Institutional Ethnography was the theoreticalmethodological perspective adopted for the work. This approach seeks to understand and analyze the institutional relationships in a particular context considering sociostructural influences and power relations, as well as daily discourses and practices. Based on interviews with health professionals, informal conversations and observations in six Health Units with ESF teams from different sanitary districts in Natal/RN, it was possible to check that the index of complaint of nerves is high. The referral to psychologists and psychiatrists, as well as the prescription of psychotropic drugs appear as the most common intervention at this level of care. In general, the participants complain that they have poor specialized knowledge about the theme of mental health. They face the problem of bad work conditions and the lack of institutional support, which make actions of illnesses prevention and health promotion even more difficult. Besides, there are different ongoing practices such as meetings for hypertensive and aged people, walk, visit, round-table discussions and community therapy. However, not all of these actions are aimed at the care of psychological suffering. It is observed that the Matrix Support, which is a methodological strategy of supervision and follow up forcases of mental health, hasn t been totally implemented in the municipal system, although it is a tool that has been used by psychologists in some Health Units in the city. It was also verified that the health care practices to the problem of nerves strongly depend on the professional s commitment with the PSF guidelines and on mental health policies, in addition to continued support, when available, from other professional who works as matrix supporter / A aten??o b?sica e uma de suas principais estrat?gias, a Estrat?gia Sa?de da Fam?lia (ESF), se configuram como a porta de entrada para o Sistema ?nico de Sa?de (SUS). Dessa maneira, boa parte dos problemas de sa?de incidentes e prevalentes na popula??o dscrita deve ser resolvida nesse n?vel de aten??o, incluindo o sofrimento psicol?gico e a denominada queixa de nervoso. Nervos e nervoso denotam uma complexidade que nem sempre ? bem compreendida pelos trabalhadores de sa?de, de maneira que o cuidado a esse tipo de problema geralmente ? inadequado. O objetivo geral desse trabalho ? analisar a rede de discursos e de cuidados no atendimento ao sofrimento psicol?gico que se expressa como nervos, no cotidiano da aten??o b?sica do SUS. Mais especificamente, identificar os princ?pios e diretrizes da aten??o b?sica em sa?de mental; investigar o posicionamento dos trabalhadores de sa?de diante do sofrimento psicol?gico e das queixas de nervos, e analisar as diferentes a??es e pr?ticas de cuidado realizados nas diferentes Unidades de Sa?de diante de queixas como nervos. A perspectiva te?rico-metodol?gica adotada no trabalho foi a Etnografia Institucional. Essa abordagem busca compreender e analisar as rela??es institucionais em determinado contexto considerando as influ?ncias socioestruturais e as rela??es de poder, bem como as pr?ticas e os discursos cotidianos. Foram realizadas entrevistas com trabalhadores de sa?de, conversas informais e observa??es em seis Unidades de Sa?de com equipes da ESF de diferentes distritos sanit?rios do munic?pio de Natal/RN. Constatou-se o alto ?ndice de queixas de nervos, sendo que o encaminhamento a psic?logos e psiquiatras e a prescri??o de psicotr?picos s?o a forma mais comum de interven??o. Em geral, h? uma falta de conhecimento especializado sobre o tema da sa?de mental, bem como aus?ncia de discuss?es sobre as pol?ticas de sa?de mental. De um lado, as condi??es de trabalho e a falta de apoio institucional dificultam a realiza??o de a??es de preven??o de doen?as e promo??o ? sa?de. Por outro, h? diferentes pr?ticas em andamento tais como reuni?es de hipertensos e idosos, caminhadas, visitas, rodas de conversas e terapia comunit?ria embora nem todas visem o cuidado espec?fico ao sofrimento psicol?gico. O apoio matricial, estrat?gia metodol?gica de supervis?o e acompanhamento de casos de sa?de mental, vem sendo implantado por psic?logos em algumas Unidades de Sa?de do munic?pio, por?m ainda n?o est? totalmente implantado na rede. As pr?ticas de cuidado aos problemas de nervos dependem principalmente do envolvimento do trabalhador com as diretrizes da ESF e das pol?ticas de sa?de mental, al?m do apoio sistem?tico, quando dispon?vel, de outro profissional que funciona como apoiador matricial

Made available in DSpace on 2014-12-17T15:40:38Z (GMT). No. of bitstreams: 1 FatimaRRM_TESE.pdf: 870071 bytes, checksum: 0013fd8d1569e1ed87bf96b26d2cfa3f (MD5) Previous issue date: 2010-02-22 / Conselho Nacional de Desenvolvimento Cient?fico e Tecnol?gico / The practice of medicine related to the gestational processes tend to be organized according to the context and the place of work, being thus dependent of the conditions both social and economical, and of the physical structure and the functionality of the services. The high mortality rate in this process has diminished, since 1986, the study made by the World Health Organization (WHO) as to the technical aspects and the social inequalities that influence this situation in different geographical contexts. This culminated recommendations that proposed the reorientation of the dynamical practice of medicine, with a focus on the safety of maternities. Brazil adopted, in the year 2000, the suggestions of the OMS, emphasizing the humanization as the main reason for these actions. However, this discussion tends to not consider the problems caused by the social inequalities and the epidemiological and social conditionings that define the actions of the Unified Health System (Sistema ?nico de Sa?de SUS). In this area, this research seeks to analyze the practices, cares taken, and the universal symbol that promotes and rewards the assistance to the birth of children by the SUS. Besides the analysis of the public documents that deal with this subject, an ethnographic study was developed in a maternity in Natal/RN, considered a model of humanization after receiving the Galba de Ara?jo prize in 2002. In this stage, the methodological strategies were observed, and the focus of the individual interviews with workers and users of this service. In the analysis of the data, it became evident that the different professional workers and women who gave birth, tend to show concern of the standards the delimit production and reproduction of the practice of medicine, as they favor the absence of a critical posture of the actions destined to the population. Besides this, if became evident that the institutional difficulties associated to the economical, cultural, and political problems also difficult the involvement and the reflection of the workers in favor of assisting changes of the process. There is also a utilization of a perspective prescriptive of humanization in the everyday life of the social workers, without reflection of its meaning. Some workers present, in their statements, a preoccupation with the social and economical aspects that affect the practice of medicine, and with the limitations of the humanization discourse that disarticulates the necessities of those involved in the process of formation, and soon tend to return to the discussion of humanization while a kind practice characterized by the minimization of the interventionist actions. Now the users of the system show themselves before the dynamic of the services, submitting themselves to what is offered while assistance, without questioning and/or reflecting about their usual shortages. Therefore, to think of changes in the know and do of the practice of medicine destined to the birth of children implies reflection on the quotidian production of these practices and of the social contexts that influence the process of assistance in the practice of medicine. Herein it would be possible to predict the appropriation, by different workers concerning their exasperations and necessities, making them active in the pursuit of their rights as citizens / As pr?ticas em sa?de relacionadas ao processo gestacional tendem a se organizar de acordo com o contexto e os espa?os assistenciais, os quais s?o dependentes das condi??es socioecon?micas e da estrutura f?sica e funcional dos servi?os. A elevada morbimortalidade nesse processo desencadeou, desde 1986, a reflex?o pela Organiza??o Mundial de Sa?de (OMS) quanto aos aspectos t?cnicos e ?s iniquidades sociais que influenciam essa situa??o em diferentes contextos, culminando nas recomenda??es que propunham a reorienta??o da din?mica assistencial com foco na maternidade segura. O Brasil adota, no ano 2000, as sugest?es da OMS, enfatizando a humaniza??o como eixo orientador das a??es. Contudo, essa discuss?o tende a desconsiderar os problemas das iniquidades locais e os condicionantes epidemiol?gicos e sociais que definem as a??es no Sistema ?nico de Sa?de (SUS). Nesse sentido, esta pesquisa objetivou analisar as pr?ticas discursivas nas a??es de trabalhadores e usu?rias da Maternidade de Felipe Camar?o em face da organiza??o do cuidado na perspectiva da humaniza??o do parto e do nascimento no contexto institucional de uma maternidade p?blica. Ent?o, al?m da an?lise dos documentos p?blicos que lidam com essa tem?tica, foi desenvolvido um estudo etnogr?fico em uma maternidade em Natal (RN), considerada modelo para a humaniza??o ap?s ter recebido o pr?mio Galba de Ara?jo, em 2002. Nessa etapa, as estrat?gias metodol?gicas foram a observa??o participante, o grupo focal e a pr?tica da entrevista individual com trabalhadores e usu?rias do servi?o. Na an?lise dos dados, evidenciou-se que os diferentes atores, os profissionais e as mulheres em parturi??o, tendem a mostrarem-se alheios aos contextos que delimitam a produ??o e reprodu??o das pr?ticas em sa?de, o que favorece a aus?ncia de uma postura cr?tica diante das a??es destinadas ? popula??o. Al?m disso, ficou evidente que as dificuldades institucionais, associadas ?s quest?es econ?micas, culturais, pol?ticas e de gest?o, tamb?m dificultam o envolvimento e a reflex?o dos trabalhadores em favor de mudan?as assistenciais para o processo. H? tamb?m a utiliza??o de uma perspectiva prescritiva da humaniza??o no fazer cotidiano desses atores sociais, sem uma reflex?o cr?tica acerca do seu significado. Alguns trabalhadores apresentam em seus posicionamentos uma preocupa??o com os aspectos sociais e econ?micos que afetam as pr?ticas em sa?de e com as limita??es do discurso humanizador, que desarticula as necessidades dos envolvidos nesse contexto. Todavia, possivelmente por quest?es culturais e relacionadas ao processo de forma??o, logo tendem a retornar ao discurso da humaniza??o enquanto pr?tica caridosa caracterizada pela minimiza??o das a??es intervencionistas. J? as usu?rias mostram-se passivas diante da din?mica dos servi?os, submetendo-se ao que lhes ? oferecido enquanto assist?ncia, sem questionar e/ou refletir acerca das suas car?ncias usuais. Assim, pensar em mudan?as no saber/fazer em sa?de destinadas ao parto e ao nascimento implica refletir a produ??o cotidiana dessas pr?ticas e os contextos sociais que influenciam o processo assistencial em sa?de. Dessa forma, seria poss?vel antever a apropria??o, pelos diferentes atores, dos seus anseios e necessidades, fazendo-os ativos na busca pelos seus direitos de cidadania

Since 2002, the Canadian state has mandatorily tested applicants for permanent residence for HIV (Human immune deficiency virus). The policy and practices associated with this screening have never been critically scrutinized. Authoritative claims about what happens in the conduct of the immigration medical examination are at odds with the experience of immigrant applicants living with HIV. This is the analytic entry point into this inquiry that is organized within the theoretical and methodological frame offered by institutional ethnography and political activist ethnography. Analysis is connected to broader research literatures and the historical record. The goal of this study is to produce detailed, contextualized understandings of the social and ruling relations that organize the lives of immigrants to Canada living with HIV. These are generated from the material conditions of their lives. An assumption about how organization happens is the social and reflexive production of knowledge in people’s day-to-day lives through which connections between local and extra-local settings are empirically investigable. I investigate the organization of the Canadian immigration process. How is this institutional complex ordered and governed? How is immigration mandatory HIV testing organized, and with what consequences to HIV-positive applicants to Canada? This is a text-mediated organization where all the sites are connected by people’s work and the texts they circulate. The positive result of an immigration HIV test catalyzes the state’s collection of medical data about an applicant. These are entered into state decision-making about the person’s in/admissibility to Canada. I focus on a key component of the immigration process, which is medical examination and HIV testing with this, along with the HIV test counselling practices that happen (or not) there. The reported absence of the latter form of care causes problems and contradictions for people. This investigation adopts the standpoint of these persons to investigate their problems associated with HIV testing. The main empirically supported argument I make is that the Canadian state’s ideological work related to the HIV policy and mandatory screening ushers in a set of institutional practices that are highly problematic for immigrants with HIV. This argument relies on data collected in interviews, focus groups, observations, and analysis of texts organized under Canada’s Immigration and Refugee Protection Act (S.C., 2001, c. 27) and textually mediated, discursively organized concepts that shape people’s practice. Canadian immigration medical policy makers should make use of these findings, as should civil society activists acting on behalf of immigrants to Canada living with HIV. I make nine specific recommendations for future action on HIV and immigration in Canada.

Abstract The disquiet around parent-school relationships is the focus of this study. During transitioning to high school, the boundaries around this relationship changes. Few studies have addressed these changes, particularly from parents’ perspectives. It is parents’ voices which are central to this study. This dissertation uses the standpoint of parents, which is often absent or silent in educational literature and research. Within a critical and constructivist paradigm, and influenced by Institutional Ethnography, two elementary schools (divergent in race, social class, ethnicity and immigrant status) and one high school are the sites for interviews with 14 parents and 13 educators. 11 parents were re-interviewed after their children entered high school. Four questions were addresses: How has parent involvement come to be understood? How is the parent-school relationship experienced by parents and educators? How and why are decisions made around the transition and school choice process? Do parents’ perceptions align/vary from those of educators? Based on historically constructed notions and assumptions, parent involvement is usually understood as a visible and public demonstration of appropriate and caring parenting ignoring interactions outside of the public’s gaze. Illustrated through Parent Council membership, parent involvement is gendered, classed, culturally related and race, ethnic and immigrant status specific. Some parents had more social, cultural, economic and emotional capital to bring to the transition process, while others were marginalized and had to rely on/trust the education system. School and Board policies and procedures were examined and their varied affects on parents’ experiences and choices analysed. Educators assisted in disseminating assumptions around parent-school relationships and contributed to inequitable parent knowledge, partially as a result of too little training. By examining social, economic and cultural positioning of parents within local school communities, positive parent-school relationships can be nurtured, which political pundits and educationalists have failed to accomplish. During transitioning, organization and social discontinuities contributed to parent and school disconnects and constructed borderlands in the parent-child-school relationship. This study evidenced the fragility of the parent-school relationship, especially during this vulnerable time for parents and thus, reflective questions are presented in hope of initiating a crucial conversation in local school communities.

Elderly patients in the Emergency Department (ED) receive a different level of care than younger patients. The ED disproportionately deploys resources to serve the needs of the younger patient population, a decision that appears to be mediated by the acuity of the patient’s condition as defined by the institution. This study will seek to examine the institutional work processes by which this disparity in care is created. By looking at the needs of the elderly as ED patients and based on what they identify as important to them, this ethnographic study will examine the work organization of the nurses, physicians, and administrators in the ED. The goal of the research is, through the examination of the organization of work and the texts that mediate it, to explain the ruling relations through which elderly patients are subjugated as patients in the ED.

Elderly patients in the Emergency Department (ED) receive a different level of care than younger patients. The ED disproportionately deploys resources to serve the needs of the younger patient population, a decision that appears to be mediated by the acuity of the patient’s condition as defined by the institution. This study will seek to examine the institutional work processes by which this disparity in care is created. By looking at the needs of the elderly as ED patients and based on what they identify as important to them, this ethnographic study will examine the work organization of the nurses, physicians, and administrators in the ED. The goal of the research is, through the examination of the organization of work and the texts that mediate it, to explain the ruling relations through which elderly patients are subjugated as patients in the ED.