Esta dissertação é resultado de uma pesquisa-intervenção cuja produção de dados ocorreu com o Grupo Condutor Regional da Rede Cegonha (GCR) no DRS III de Araraquara - SP, parte do Projeto de Pesquisa para o Sistema Único de Saúde (PPSUS): O processo de implantação da rede de atenção à saúde materno infantil no DRS III de Araraquara: a atenção básica como ordenadora da atenção em rede. Nosso objetivo foi compreender este coletivo como espaço de Educação Permanente em Saúde (EPS) para a institucionalização dessa Rede, e também caracterizar a EPS no território de abrangência deste DRS, compreender suas fragilidades-potencialidades e também os processos de EPS produzidos no interior do GCR para a implementação da Rede Cegonha (RC), diante de desafios como a redução da morbimortalidade materno infantil e o atendimento integral e humanizado a mulheres e crianças. Esta pesquisa qualitativa compreendeu a análise de documentos e a pesquisa-intervenção, utilizando método cartográfico, e a produção dos dados ocorreu no ano de 2014 com os integrantes do GCR e outros pesquisadores PPSUS. As análises tiveram como referenciais o Processo de Trabalho em Saúde e conceitos do movimento institucionalista, das correntes da Análise Institucional e da Esquizoanálise. Esta pesquisa de cunho cartográfico explorou o contexto sócio-histórico da EPS e da RC no DRS III e paisagens que compõem o mapa do aprendizado no que chamamos Rede-rizoma, entremeadas por análises de implicações e aprendizados na experiência, tanto de construção da pesquisa como da RC. Nos planos do rizoma houve momentos de aprendizado significativo, ecos nos municípios, interferências da pesquisa-intervenção, dentre outros componentes de tessitura da rede que envolveram seus atores, seus pontos de conexão, de tensão, de apoio. Nesse emaranhado quente e frio, interessou-nos explorar as singularidades do encontro e os movimentos de forças instituintes e do instituído com o compromisso de entender a EPS como ferramenta de trabalho para a institucionalização da RC. Percebemos a existência de microprocessos de institucionalização disparados no cotidiano do GCR, caracteristicamente paralisantes e mobilizadores, como a importância da participação social, ainda tímida, as tensões com a imobilidade municipal, as fragilidades-potencialidades dos recursos humanos e financeiros, e também resultados que refletem em alargamento e participação de novos atores, cooperação intermunicipal, fortalecimento dos Grupos Condutores Municipais da rede cegonha e uma gestão estadual disposta a deflagrar processos de formação participativos. Trata-se de movimentos que se revelaram em implicações de múltiplas bifurcações e em processos de EPS que se fazem de forma mutante, conformando a rede-rizoma / This dissertation resulted from a intervention-research which data production took place with the Regional Conductor Group of the Stork Network (GCR) in the DRS III of Araraquara - SP, part of the research project for the National Health System (PPSUS): The maternal and child health care network deployment process in the DRS III Araraquara: primary health care ordering the network care. Our purpose was to understand this collective as a Permanent Education in Health (EPS) space for the institutionalization of this Network, and also characterize the EPS in the DRS territory, understand their fragilities-potentialities and also the EPS processes produced inside the GCR for the implementation of RC, in face of challenges such as reducing child and maternal mortality and the comprehensive and humanized assistance to women and children. This qualitative research included the analysis of documents and the intervention-research using cartographic method which data production occurred in 2014, with members of the GCR and other PPSUS researchers. The analysis had as referential, the Work Process in Health and concepts of the Institutionalist Movement, from Institutional Analysis and Schizoanalysis currents. This cartographic research explored the EPS and RC socio-historical contexts in the DRS III and some landscapes that make up the learning map in what we call Net-rhizome, permeated by implication analysis and learning experience, both from research and RC construction. In the rhizome plans there were moments of meaningful learning, echoes in the municipalities, research-intervention interferences, among other weaving network components involving its actors, its connection, tension and support points. In this hot and cold tangle, we were interested in explore the uniqueness of the meeting and the movement of instituting forces and the instituted with the commitment to understanding the EPS as a tool for the RC institutionalization. We realized the existence of institutionalization microprocesses triggered in the GCR characteristically paralyzing and mobilizers, as the importance of social participation, even timid, tensions with municipal immobility, the fragilities-potentialities, human and financial resources, as well as results that reflect in enlargement and new actors participation, inter-municipal cooperation, strengthening of Municipal Conductor Groups and a state management willing to trigger participatory educational processes. Movements that have proven in multiple bifurcation implications and EPS processes in mutant forms conforming the net-rhizome

This study aims to rethink the hegemonic speeches within capitalism emergency policies - linked to social assistance in the past 30 years of democratic government - hence these are the practices that when displaced from an effective commitment of aiding people that produce, instead of the promotion of the Human Rights, an exercise of monitoring of the legal order through a wide range of population statistical control and social risks prevention guided knowledge-practices. Thus, it is intended to discuss the practices developed in the contemporary, that on the behalf of the Human Rights promotion within a social aid public policies system, legitimate practices of knowledge/power to actualize the legal order as the controller of the bodies and population, including through the profession of psychology. Thus, the analysis of this problem will be performed by scenarios that are described by excerpts taken from field jornals and discussed by the French institutional analysis tools. Such cut-outs allowed rethink the possible accommodations, immobilities, concerns, resistances that occurred in contact with people assisted in the Specialized Reference Center for Social Assistance (CREAS). In this sense, the works of Michel Foucault and René Lourau emerge as an important theoretical framework to discuss the issues that concern the day-by-day operations. Notions such as governability, biopolitics, and implication developed in important works of these authors has served for a critical reading of the institutional practice and its modus operandi upon the individuals and their subjection modes. / Neste estudo pretende-se repensar os discursos hegemônicos no âmbito das políticas emergenciais do capitalismo – ligadas a assistência social nos últimos 30 anos de governo democrático - afinal são essas práticas que ao serem deslocadas de um compromisso efetivo com o atendimento as pessoas, que produzem ao invés da promoção dos direitos humanos, um exercício de vigilância do ordenamento legal através de uma série de saberes-práticas pautadas no controle estatístico das populações e prevenção de riscos socais. Dessa forma, será possível problematizar as práticas desenvolvidas no contemporâneo, que em nome da promoção de direitos humanos, dentro de um sistema de políticas públicas da assistência social, legitimam, através do ofício da Psicologia, práticas de saber/poder que efetivam o papel do ordenamento legal como controlador dos corpos e da população, portanto, no papel do exercício de uma biopolitica. Assim, a análise dessa problemática será realizada por cenários que serão descritos através de recortes extraídos de diários de campo e discutidos através de ferramentas da análise institucional francesa. Tais recortes possibilitaram repensar as possíveis acomodações, imobilidades, inquietudes e resistências que ocorriam no contato com as pessoas atendidas no Centro de Referência Especializado em Assistência Social (CREAS). Nesse sentido, as obras de Michel Foucault e René Lourau surgem como importante arcabouço teórico para problematizar essas questões que tangem o dia-a-dia da instituição. Noções como governamentalidade, biopolitíca e implicação desenvolvidas em importantes obras destes autores tem servido para uma leitura crítica da prática institucional e seus modos de operacionalização sobre as pessoas e seus modos de subjetivação.

Orientador: Solange L'Abbate / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-18T01:40:18Z (GMT). No. of bitstreams: 1 Sol_NuncioAntonioAraujo_D.pdf: 30048278 bytes, checksum: 049f92b5a39004870d7b6253fa32095e (MD5) Previous issue date: 2011 / Résumé: Cette thèse a comme objectif général sauver, à travers l'Analyse Institutionnelle Socio-Historique, le processus de constitution de la Médecine Générale et Communautaire (MGC) brésilienne à partir de quelques expériences municipales. Important faire ressortir la forte implication de l'auteur avec ce travail être ex-residente de médecine générale communautaire de l'Hôpital Monsenhor Horta dans Mariana/MG. La MCG au Brésil présente de multiples et complexes influences sociales, politiques et culturelles, caractérisée par des éléments idéologiques et conceptuels divers et beaucoup de fois conflictuelles, originaires, au un premiers moments, de scénarios internationaux qui, à accosteront au Brésil, souffrent un processus assimilation " tropicalizada ", lié au choc entre La normatization d'état et de fondations internationales et sa il accomplit de la mise en oeuvre à partir des réalités locales où ils ont été implantés. Nous pourrions supposer l'existence d'un modèle brésilien de MGC? Ainsi, l'hypothèse centrale de ce travail est ce dont MGC au Brésil a présenté des caractéristiques propres qui la diffèrent du modèle original américain, en prévalant, dans le processus d'implantation et de mise en oeuvre, la flexibilité et les innovations de caractère local. S'analyse la mise en oeuvre de la Médecine Générale Communautaire au Brésil dans les décennies de 70 à 90, en élaborant une possible genèse conceptuelle et sociale de MGC à travers l'analyse de trois expériences dans MGC - les Du Centre de Santé-École Murialdo et de Grupo Hospitalier Conceição les deux à Porto Alegre /RS et encore opérant, et ce de l'Hôpital Monsenhor Horta dans Mariana/MG, interrompue en 1984. Il s'agit d'une étude de nature qualitative, de fond simultanément théorique ET empirique, sur base d'entrevues et de recherche documentaire. Des résultats montrent que les trois expériences analysées présentent des différences importantes, tant nous leurs processus d'implantation qu'aussi nous leurs liens institutionnels, politiques et idéologiques. Se détache aussi la variété des expériences concernant la formation de médecins résidants dans le secteur de MGC / Resumo: Esta tese tem como objetivo geral resgatar, através da Análise Institucional Sócio-Histórica, o processo de constituição da Medicina Geral e Comunitária (MGC) brasileira a partir de algumas experiências municipais. É importante salientar a forte implicação do pesquisador com este trabalho por ser ex-residente de medicina geral comunitária do Hospital Monsenhor Horta em Mariana/MG. A MCG no Brasil apresenta múltiplas e complexas influências sociais, políticas e culturais, caracterizada por elementos ideológicos e conceituais diversos e muitas vezes conflituosos, oriundos, num primeiro momento, de cenários internacionais que, ao aportarem no Brasil, sofrem um processo de assimilação "tropicalizada", decorrente do embate entre a normatização estatal e de fundações internacionais e sua efetiva implementação a partir das realidades locais onde foram implantadas. Poderíamos, então, supor a existência de um modelo brasileiro de MGC? Assim, a hipótese central deste trabalho é a de que a MGC no Brasil apresentou características próprias que a diferem do modelo original americano, prevalecendo, no processo de implantação e implementação, a flexibilidade e as inovações de caráter local. Foi analisada a trajetória da Medicina Geral Comunitária no Brasil nas décadas de 70 a 90, elaborando uma possível gênese conceitual e social da MGC através da análise de três experiências em MGC - o do Centro de Saúde-Escola Murialdo e do Grupo Hospitalar Conceição ambos em Porto Alegre/RS e ainda atuantes, e a do Hospital Mons. Horta em Mariana/MG, interrompido em 1984. Trata-se de um estudo de natureza qualitativa, de fundo simultaneamente teórico e empírico, com base em entrevistas semi-estruturadas e pesquisa documental. Os resultados mostram que as três experiências analisadas apresentam diferenças relevantes, tanto nos seus processos de implantação como também nos seus vínculos institucionais, políticos e ideológicos. Destaca-se também a variedade das experiências em relação à formação de médicos residentes na área de MGC / Abstract: This dissertation aims at rescuing, by Socio-Historical Institutional Analysis, the process of constitution of Brazilian General Medicine Community (GMC) from some municipal experiences. It is important to point out the strong implication between the researcher and this study, since he was a former-resident of GMC of Monsenhor Horta Hospital in Mariana/MG. The GMC in Brazil presents multiple and complex social, cultural and political influences, it is also characterized by diverse ideological and conceptual elements and many times conflictive, deriving, at the first moment, from international settings that, when arriving in Brazil, suffered from a process called "tropical like" assimilation, resulting from the shock between the state normalization and international foundations and its effective implementation through the local realities where they were implanted. So, could we suppose the existence of a Brazilian model of GMC? Thus, the central hypothesis of this work would be that the GMC in Brazil presented proper characteristics that differ from the American original model, prevailing, in the process of implantation and implementation, the flexibility and the innovations of local feature. The study analyzed the implementation of Brazilian General Medicine Community in the decades of 70 the 90, elaborating possible conceptual and social genesis of the GMC through the analysis of three different experiences in GMC - Center of Murialdo Health-School and the Conceição Hospital Group, both still operating in Porto Alegre /RS and Mons. Horta Hospital in Mariana/MG, interrupted in 1984. This is a qualitative study of theoretical and empirical background simultaneously, based on semi-structured interviews and desk research. Results point out that the three experiences show relevant differences not only in their insertion processes but also in their institutional, political and ideological bonds. The research also highlights the variety of experiences for the training of medical residents in the area of GMC in Brazil / Doutorado / Ciências Sociais em Saúde / Doutor em Saude Coletiva

O objetivo desta pesquisa é analisar, a partir do referencial da Análise Institucional, a experiência do Clube dos Saberes (CS), um dispositivo que fez parte de uma intervenção institucional, num hospital psiquiátrico privado da cidade de São Paulo, entre os anos 2001 e 2005. O Hospital é uma instituição biforme, com uma organização hierárquica-piramidal e características manicomiais. O CS é uma rede de relacionamentos formada pela troca de saberes e de experiências entre as pessoas de um coletivo, que se organiza democraticamente e visa tanto o crescimento pessoal e individual quanto do próprio coletivo. Ele é proposto ao Hospital como possibilidade de superação da crise enfrentada através da inoculação de uma nova cultura de tratamento, de novas formas relacionamento, de novos modos de funcionamento e organização. A pesquisa envolveu, num primeiro momento, a reconstituição da história dessa experiência a partir da memória da pesquisadora-participante e de registros escritos e, num segundo momento, a seleção de trechos dessa história que possuíam a qualidade de analisador. A análise mostrou que apesar do CS representar uma esperança de mudança e de superação da crise do hospital, ele sofreu resistências por parte da equipe e enfrentou diversos obstáculos: participação pouco expressiva dos trabalhadores do hospital no desenvolvimento do CS; apreensão distorcida ou limitada do projeto; baixa efetividade das parcerias firmadas; persistência e recrudescimento das características manicomiais do hospital; predomínio da organização sobre a clínica e maior atenção à saúde financeira do hospital do que à saúde de seus agentes (pacientes e trabalhadores). Por fim, consideramos que o desenvolvimento do CS foi significativamente prejudicado pela falta de espaços de análise da instituição e de sua alienação. / The object of this research is to analyze, using institutional analysis as a reference, the experience of the Clube dos Saberes, ( Club of knowledge ) or CS, the instrument of an institutional intervention in a private psychiatric hospital in the city of São Paulo between the years of 2001 and 2005. The hospital is a two pronged institution, which has a hierarchicalpyramidal organization with characteristics of an asylum. The CS is a network of relationships formed by the exchange of knowledge and experiences between a collective, that organizes democratically and aims for a personal and individual growth as well as the growth of the collective. This instrument is offered to the hospital as a possibility of overcoming a crisis through the inoculation of a new culture of treatment, of new forms of relationship, of new ways of functioning and organization. The research involved, at first, rebuilding the history of this experience through the memory of the participant-researcher, and through written records, later there was the selection of passages of this history that had the quality of analyzer. The analysis showed that although of the CS represented a hope of change and a chance of overcoming the crisis in the hospital, it suffered resistance from the part of the team and it faced several obstacles: a participation of small significance from the staff in the development of the CS; limited or distorted apprehension of the project; low effectiveness of the established partnerships; the persistence and aggravation of the characteristics of the hospital as an asylum; The predominance of the organization in detriment of the clinic and a greater attention to the financial health of the hospital then the health of its agents ( staff and patients ). In conclusion we find that the development of the CS was significantly hindered by the lack of a space for an institutional analysis and its own alienation.

Partindo das considerações de que os termos sujeito e subjetividade permeiam o discurso psicanalítico contemporâneo e de que são, direta e indiretamente, atribuídos a Freud a despeito de ele próprio nunca tê-los conceituado, esta pesquisa tem como objetivo caracterizar um perfil de sujeito a partir do discurso freudiano. O trabalho orientou-se pela metodologia da Análise Institucional do Discurso, uma analítica do domínio subjetivo que toma o discurso em seu caráter de ato e acontecimento. Primeiramente se realizou um estudo de As técnicas de si, de Michel Foucault, de modo a permitir o circunstanciamento da psicanálise como uma técnica que produz um si, um sujeito este circunstanciamento permitiu, então, tomar sujeito e subjetividade na qualidade de produções histórica, geográfica e analiticamente contextualizadas, não como formas de imanência ou transcendência. A partir desse pressuposto, elaborou-se uma análise institucional do discurso de O mal-estar na civilização que privilegiou não apenas seu conteúdo, mas principalmente seu modo de produção, colocando em relevo o contexto presente no texto, as interlocuções que se criam, os lugares atribuídos e ocupados, as expectativas assim mobilizadas, as estratégias discursivas utilizadas, os jogos de poder e verdade exercidos, bem como os efeitos de reconhecimento e desconhecimento então facultados. Esta análise mostrou que Freud exerce uma perspectiva de interioridade, pois o mal-estar que acomete a civilização é compreendido em analogia à concepção psicanalítica de desenvolvimento individual, explicando, em suma, a cultura pelo prisma do indivíduo; evidenciou que as teorizações sobre a vida instintiva são a principal sustentação do discurso sobre o mal-estar da civilização; apontou como as estratégias discursivas utilizadas por Freud promovem a subjetivação, por parte do leitor, daquilo que seu discurso produz como verdade; e que o conceito de indivíduo é ocasião de exercício daquela perspectiva de interioridade e de atualização dos pressupostos teóricos. Com base nisso, pôde-se caracterizar um sujeito universal; psicologizado; determinado sobretudo pelos movimentos da sexualidade e da agressividade; cuja tônica recai sobre o dito mundo interno; dotado de origens e propósitos concernentes à vida instintiva; e cujo perfil é delimitado pela tarefa de administração dos instintos, isto é, cujo perfil se dá entre os imperativos superegóicos de renúncia e a margem de liberdade de que dispõe para satisfazer as exigências do princípio de prazer. Observou-se também, na esteira do pontuado por Guirado (2010), que em geral Freud naturaliza os termos do discurso teórico, fazendo de sua universalização a condição e o limite para se pensar o domínio subjetivo e a singularidade; diferentemente de Foucault, que compreende esse domínio em referência às relações de poder e saber, de forma contextualizada. Do ponto de vista da análise institucional do discurso freudiano, concluiu-se, finalmente, que o si ao qual a técnica psicanalítica dá lastro é efeito da perspectiva exercida por Freud, que promove o reconhecimento da interioridade instintiva como crivo da civilização, de um modo de vida e de si mesmo / From the considerations that the terms \"subject\" and \"subjectivity\" permeate the contemporary psychoanalytic discourse and that are directly and indirectly attributed to Freud despite himself never have them conceptualized, this research aims to characterize a profile of \"subject\" derived from the Freudian discourse. The work was guided by the methodology of Institutional Analysis of Discourse, an analytic of the subjective domain which takes the discourse in his character of act and event. First, a study was conducted of the Technologies of the self, of Michel Foucault, to circumstantiate psychoanalysis as a technology that produces a \"self\", a \"subject\" this circumstantiality allowed, then, take \"subject\" and \"subjectivity\" as productions historical, geographic and analytically contextualized, not as forms of immanence or transcendence. From this assumption, we drew up an institutional analysis of discourse of Civilization and its discontents that focused not only its content, but primarily their mode of production, putting in relief the context present in the text, the interlocutions that are created, the assigned and occupied places, the expectations then mobilized, the discursive strategies used, the games of power and truth exercised, and the effects of recognition and disowning then provided. This analysis showed that Freud exerts a perspective of interiority, because the discontents that affects the civilization is understood in analogy to the psychoanalytic conception of individual development, explaining, in short, the culture through the individual prism; It showed that the theories on the instinctual life are the main support of the discourse about civilization and its discontents; it pointed out how the discursive strategies used by Freud promotes the subjectivation, on the part of the reader, of what his discourse produces as truth; and that the concept of \"individual\" is the opportunity to exercise that perspective of interiority and update the theoretical assumptions. Based on this, it was possible to characterize a subject that is universal; psychologized; determined mainly by sexuality and aggression movements; whose tonic lies on the called interior world; endowed with origins and purposes concerning instinctual life; and whose profile is delimited by the administration task of instincts, that is, whose profile constitutes between the superegoic imperatives of waiver and the margin of freedom that has to satisfy the requirements of the pleasure principle. It was also observed, in the wake of punctuated by Guirado (2010), which generally Freud naturalizes the terms of theoretical discourse, making it universalization the condition and the limit to think about the subjective domain and singularity; unlike Foucault, which understands this domain in reference to the relations of power and knowledge, in a contextualized way. From the perspective of institutional analysis of the Freudian discourse, it was concluded, finally, that the self to which the psychoanalytic technology gives ballast is an effect of the perspective exerted by Freud, which promotes the recognition of the instinctive interiority as a lens of the civilization, of a way of life and of yourself

Orientador: Solange L'Abbate / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-25T09:31:16Z (GMT). No. of bitstreams: 1 Vivot_ClaudiaCristiane_M.pdf: 1742438 bytes, checksum: a6d24f89393f18ab5da4a51e74d5fc9a (MD5) Previous issue date: 2014 / Resumo: A Secretaria Municipal de Saúde de Sorocaba/SP, por meio da Diretoria de Área da Assistência e Educação em Saúde, responsável pelo direcionamento do modelo de atenção à saúde e gestão das Unidades Básicas de Saúde, vem adotando diferentes estratégias de trabalho para o fortalecimento da Atenção Básica em Saúde em seu território. Em 2010, foram criados seis Colegiados de Gestão, compostos por cinco Unidades Básicas de Saúde cada. Foram constituídos também três Núcleos Técnicos, compostos por profissionais do nível central designados para apoiar a gestão das Unidades Básicas de Saúde. Nesse novo formato, houve uma revisão do papel dos apoiadores técnicos e a implementação de reuniões com coordenadores das Unidades Básicas de Saúde. A adesão dos técnicos da Diretoria de Área da Educação em Saúde a este modelo organizacional não ocorreu de modo homogêneo em todos os Colegiados. Nos Colegiados Leste e Centro Sul, as diferentes estratégias de trabalho foram discutidas em reuniões periódicas orientadas pelos princípios da Política Nacional de Educação Permanente em Saúde. Assumiu-se a premissa de que o desenvolvimento técnico-científico e ético dos coordenadores das Unidades Básicas de Saúde favoreceria o fortalecimento da Política Nacional de Atenção Básica. O objetivo geral dessa investigação de caráter qualitativo foi analisar essas reuniões, ocorridas de junho de 2010 a dezembro de 2012, como espaços de discussão de práticas relativas à qualificação da gestão e seus possíveis desdobramentos em relação aos coordenadores das Unidades Básicas de Saúde. As informações foram obtidas a partir da leitura das Atas das reuniões, dos relatos da autora que atuou como uma das apoiadoras dos referidos colegiados, complementadas por entrevistas semiestruturadas com os coordenadores das Unidades Básicas de Saúde e com os diretores da Diretoria de Área da Assistência e Educação em Saúde, que atuaram de 1998 a 2012. A análise das informações levou em conta os pressupostos da Educação Permanente, baseou-se no referencial teórico-metodológico da Análise Institucional, sobretudo os conceitos de instituição, implicação e analisador. Os resultados da investigação apontaram que nestes Colegiados de Gestão Leste e Centro Sul houve um expressivo avanço na construção coletiva de conhecimentos e ações voltadas ao enfrentamento dos problemas do cotidiano do trabalho, resultando numa maior aproximação entre a gestão e a assistência. Evidenciou-se também um aumento do vínculo entre os próprios coordenadores e entre estes e os apoiadores, construindo uma nova intersubjetividade. Esta investigação pretende contribuir para a institucionalização e difusão dessa estratégia de caráter inovador e estimular movimentos semelhantes em outros equipamentos das Secretarias Municipais de Saúde, buscando sempre o aprimoramento do Sistema Único de Saúde / Abstract: The Municipal Health Department of Sorocaba, SP, Brazil, through its Division for Health Treatment and Education, is responsible for managing the model of treatment dispensed at basic health units. In effect, the department has adopted different working strategies for strengthening primary health care in the municipality. In 2010, six management teams were set up, each one responsible for five basic health units. Three technical groups were also implemented, comprised of middle-level professionals assigned to back up the management of basic health units. With this new format the role of technical backers was revised and meetings were held with coordinators of basic health units. Acceptance of this model by technicians in the Division for Health Treatment and Education was far from homogeneous among the teams. In the eastern and south-central teams the different working strategies were discussed at periodic meetings, based on the principles found in the Brazilian National Policy for Continuing Education in Health. The premise was accepted that the technical, scientific and ethical training of the coordinators of basic health units favored the strengthening of the National Primary Care Policy. The overall objective of this qualitative investigation was to analyze these meetings, which were held between June 2010 and December 2012, as spaces for discussing practices related to training in management and the possible results for coordinators of basic health units. The information was obtained from the minutes of these meetings and from reports by the author, who served as one of the backers of the above-mentioned teams. The information was completed with semi-structured interviews with coordinators of basic health units and with persons who had served as supervisors of the Division for Health Treatment and Education between 1998 and 2012. The analysis of the information took into account the premises of continuing education and the theoretical and methodological framework of institutional analysis, especially the concepts of institution, implication, and analyzer. Research results showed that there was a significant advance in the collective construction of knowledge and actions in the eastern and south-central teams, aimed at addressing everyday problems of work. This resulted in a closer relationship between management and treatment. Closer ties also resulted among the members themselves and between them and the backers, which led to new intersubjectivity. This study is intended as a contribution to the institutionalization and dissemination of this innovative strategy. The authors also hope that it will encourage similar movements in other areas of municipal health departments in the improvement of the Brazilian Federal Health System / Mestrado / Ciências Sociais em Saúde / Mestra em Saúde Coletiva

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2015-12-08T11:19:18Z No. of bitstreams: 1 Marcela Pimenta Muniz.pdf: 1029684 bytes, checksum: 11cf85fe468e4bbf122711a2f0fb3dd7 (MD5) / Made available in DSpace on 2015-12-08T11:19:18Z (GMT). No. of bitstreams: 1 Marcela Pimenta Muniz.pdf: 1029684 bytes, checksum: 11cf85fe468e4bbf122711a2f0fb3dd7 (MD5) Previous issue date: 2011 / Mestrado Acadêmico em Ciências do Cuidado em Saúde / A presente pesquisa surgiu a partir da minha inquietação referente aos processos educativos permanentes junto à equipe de enfermagem que tem se desenhado no contexto do hospital psiquiátrico. A literatura do campo da enfermagem psiquiátrica, com foco no cuidado em saúde mental, descreve que a realidade da enfermagem ainda é incipiente no que diz respeito a compreender/modificar o processo de trabalho. O objeto de estudo foi a institucionalização da educação permanente da equipe de enfermagem no contexto de um hospital psiquiátrico. Essa dissertação teve como objetivo descrever os processos educativos permanentes para a equipe de enfermagem que ocorrem em um hospital psiquiátrico, identificando as lacunas e as potencialidades destes processos educativos para a equipe de enfermagem. Foi desenvolvida uma pesquisa de abordagem qualitativa, do tipo exploratório, com base no referencial teórico-metodológico da Análise Institucional. A coleta de dados foi realizada por meio de observação participante e de grupo focal. Os dados foram analisados com base na Análise Institucional e nos preceitos da Reforma Psiquiátrica. Apresenta-se como resultado a elaboração de uma cartografia a respeito dos processos educativos em enfermagem no cotidiano do hospital psiquiátrico. De acordo com as demandas da Reforma Psiquiátrica, o papel dos serviços de saúde deve ser o de garantir a visão do portador de sofrimento psíquico como cidadão, onde o tratamento não deve servir de tutela, mas sim de libertação. Para isso, é necessário que as equipes de enfermagem participem de espaços educativos onde possam refletir a respeito das novas práticas de cuidar no campo psicossocial, onde possam falar e ouvir sobre as implicações da Reforma Psiquiátrica para as equipes de enfermagem e onde possam refazer constantemente os atravessamentos individuais e coletivos dessas equipes sobre o indivíduo psicótico. Concluiu-se que a educação permanente em enfermagem deve ter como principal mote o desempenho de um cuidado como prática social. Deve propiciar que os profissionais de enfermagem busquem abordar o portador de sofrimento psíquico através da responsabilidade com o cuidado humano, com agenciamentos intra-equipe e extra-setor saúde, acompanhando esses portadores em seu dia a dia, isto é, na vida, respeitando-o em suas especificidades, em suas peculiares escolhas e apostando – ainda que provisoriamente – em vê-los usufruindo de um convívio social. Assim, as ações educativas em serviço devem servir para desenvolver novas formas de compreender e interpretar a realidade, questionar, discordar, propor soluções, favorecer a reflexão em favor da sociedade. / The theme of this research came from the inquietude caused by the work as nurse and refers to the educative processes developed with the nursing team in the context of the psychiatric hospital. The literature in the psychiatric nursing field, with focus on the care in mental health, describes that the reality of nursing is still beginner as regards to understand/modify the work process. The object of study was the institutionalization of the permanent education of the nursing team in the context of the psychiatric hospital. This dissertation aimed to describe the permanent educative processes for the nursing team that occur in a psychiatric hospital, identifying the gaps and the potentialities of these educative processes for the nursing team. A qualitative and exploratory research was developed on the basis of the theoretical-methodological framework of the institutional analysis. The data collection was performed by participant observation and focus group. The data were analyzed on the basis of the institutional analysis and in the precepts of the Psychiatric Reform. It presents as a result the elaboration of the cartography about of the educative processes in nursing in the daily of psychiatric hospital. In accordance with the demands of the Psychiatric Reform, the role of health services should be to ensure the vision of the psychic suffering patient as a citizen, where the treatment should not be used for authority, but liberation. For this reason, it’s necessary that the nursing teams participate in educative places where can reflect about the new practices of care in the psychossocial field, where can talk and hear about the implications of the Psychiatric Reform to the nursing teams and where they can remake constantly the individual and collectives relations of those teams on the psychotic individual. It was concluded that the permanent education in nursing must have as main subject the performance of the care as a social practice. It must provide that the nursing professionals seek to address the psychic suffering patients through the responsibility with the human care, with intra-team and extra-health sector arrangements, accompanying those patients in their daily, that is, in the life, respecting them in their specificities, in their peculiar choices and betting - even provisionally - to see them enjoying a social life. Thus, the educative actions in service should serve to develop new ways of understanding and interpreting the reality, to question, disagree, propose solutions, encourage the reflection in the society.

Decentralized development approaches have in recent years gained wide acceptance in policy circles. In India the national and the state governments have for a long time undertaken the primary responsibility for water management. In recent years however, there has been a clear shift of policy towards increased reliance on the local communities. This thesis deals with the capacity of rural communities in India to manage their water resources in a sustainable way. Through a case study of water management in a South Indian village opportunities and barriers for rural communities in India to manage their water resources in a sustainable way is analysed. The thesis deals with both formal and informal institutions involved in the water management.Factors that can promote and obstruct locals’ contribution in water management are discussed. Also the role of external actors such as NGOs, the Panchayats and the government is dealt with, and how they may facilitate a development towards sustainability and increased locals’ contribution in order to achieve a sustainable community bases water management. Theories on collective action and the commons have been used in the analysis. These theories deal with how to get people to cooperate regarding the management of common resources such as water in order to achieve higher collective benefits. The study is primarily based on 66 semistructured qualitative interviews with local water users in a village in Andhra Pradesh. / Decentralized development approaches have in recent years gained wide acceptance in policy circles. In India the national and the state governments have for a long time undertaken the primary responsibility for water management. In recent years however, there has been a clear shift of policy towards increased reliance on the local communities. This thesis deals with the capacity of rural communities in India to manage their water resources in a sustainable way. Through a case study of water management in a South Indian village opportunities and barriers for rural communities in India to manage their water resources in a sustainable way is analysed. The thesis deals with both formal and informal institutions involved in the water management.Factors that can promote and obstruct locals’ contribution in water management are discussed. Also the role of external actors such as NGOs, the Panchayats and the government is dealt with, and how they may facilitate a development towards sustainability and increased locals’ contribution in order to achieve a sustainable community bases water management. Theories on collective action and the commons have been used in the analysis. These theories deal with how to get people to cooperate regarding the management of common resources such as water in order to achieve higher collective benefits. The study is primarily based on 66 semistructured qualitative interviews with local water users in a village in Andhra Pradesh. / The ISRN in the pdf-file is incorrect. The correct ISRN is shown below.

L'objet de la thèse est constitué de l'accueil dans le champ du travail social. Il est le premier temps de la rencontre entre l'individu et les travailleurs sociaux.Le terme d'accueil est couramment utilisé dans le jargon professionnel, aussi bien dans les activités de travail quotidiennes que dans le champ de la formation professionnelle. Sa dimension polymorphe complexifie son appréhension. L'apparente banalité qu'il revêt en fait un objet de recherche d'autant plus délicat à saisir. Il se met en œuvre à travers différentes missions et dimensions. Associé intrinsèquement à l'entrée en relation, il est d'abord un espace d'accueil et interroge les dimensions spatiale, temporelle et organisationnelle. Il se formalise à travers des documents écrits à usage professionnel. Il se met en œuvre à travers les politiques publiques et devient un objet évaluable en termes de qualité de l'accueil proposé et reçu.L'accueil ,comme activité de travail, fait l'objet de nombreuses études ou rapports. Paradoxalement, plus cette activité est décrite plus elle apparaît insaisissable. En m'appuyant sur une démarche à la fois socio-historique et socio -clinique, je confronte les éléments du passé constituant les métiers du travail social et recherche l‘origine de l'accueil dans les pratiques professionnelles au fil du temps. Je les mets en miroir avec les réalités actuelles du travail social. J'utilise mon propre parcours professionnel et l'analyse de mon implication pour saisir plus globalement les implications professionnelles à l'œuvre aujourd'hui. Je m'appuie sur la sociologie du travail social. L'emploi générique de l'accueil démontre une utilisation peu étayée théoriquement et des pratiques professionnelles diverses et variées, voire complexes. Repéré comme fondement historique de l'acte d'intervention en travail social, l'accueil s'enracine dans les mouvements hygiénistes et de santé, mêlant valeurs caritatives, religieuses et républicaines.Si l'accueil est le moment de la rencontre entre l'accueilli et l'accueillant. Il demande par conséquent à mobiliser des savoirs pratiques pour entrer en relation. Il s'étaye sur le ressenti, les valeurs de professionnels aux origines sociales et culturelles diverses et variées. Il se pratique au quotidien. Si les travailleurs sociaux sont historiquement concernés par l'entrée en relation d'aide avec les personnes, d'autres salariés issus de métiers différents partagent aujourd'hui cette tâche, voire les remplacent pour recevoir la première demande de l ‘usager. Accueillir « l'autre » demeurerait un acte « quasi liturgique » pour les salariés du travail social et plus globalement de l ‘action sociale.Dans ces allers-retours entre passé et présent, les Centres Communaux d'Action Sociale (CCAS) apparaissent historiquement comme faisant partie des premières structures publiques qui ont pour mission d'accueillir et de venir en aide aux publics les plus démunis, ceci depuis la Révolution française. Ils se nommaient alors « bureau de bienfaisance ». J'ai ainsi fait le choix de mettre en œuvre un dispositif de recherche de type socio-clinique en CCAS pour dévoiler la complexité de cette mission, au regard du service public. Les travailleurs sociaux, animateurs, agents administratifs mobilisés et divisés autour de l'entrée en relation avec un public toujours plus fragilisé montrent les aspects cachés de leur professionnalité. L'accueil au quotidien est déjà une entrée dans la relation d'aide particulière et difficilement généralisable. L'accueil apparaît progressivement comme un analyseur des implications professionnelles, des logiques de métiers et des postures à l'œuvre dans le champ du travail social. / The thesis considers client reception in the field of social work. It is the initial phase when the individual and social workers meet.The term "reception" is commonly used in professional jargon, both for routine tasks and in the field of vocational training. Its multi-faceted dimension makes it more complex to understand. Its apparent banality makes it a research subject that is all the more difficult to grasp. It comes into play through different missions and dimensions. Intrinsically associated to entering into a relationship, it is first a reception area and questions the organisational, time and space dimensions. It is formalised through documents written for professional use. It is implemented through public policies and becomes an aspect that can be assessed in terms of the quality of the reception proposed and received.Client reception, as a work activity, has been the subject of many studies or reports. Paradoxically, the more that is written about this activity, the harder it seems to grasp. Using a both socio-historical and socio-clinical approach, I consider the aspects that shaped the social work profession in the past and I research the origins of client reception in professional practices over time. I mirror them with the current realities of social work. I fall back on my own professional career and analyse my involvement to more globally understand the professional implications in play today. I draw on the sociology of social work. The generic usage of client reception displays a use that is poorly substantiated theoretically and diverse and varied, or even complex professional practices. Recognized as a historical basis for intervention in social work, client reception is rooted in health and hygienic mechanisms, mixing republication, religious and charitable values.If client reception is the moment of meeting between the person seeking social support and the receptor, it therefore calls for practical expertise to be brought into play in order to enter into a relationship. It is substantiated by the feelings and professional values of the different and varied cultural and social origins. It is used in daily life. If social workers are traditionally concerned about entering into a relationship to help people, other members of different professions today share this task, or even replace the former as they receive the first request of the user. Receiving “the other” would remain a "nearly liturgical" act for social work employees and more globally those involved in social action.In this toing and froing between past and present, the Social Action Community Centres (CCAS)) traditionally appear as being part of the initial public structures whose mission has been to be the point of entry and come to the help of the most destitute ever since the French Revolution. They were then known as a “relief committee”. I have thus chosen to implement a socio-clinical research mechanism in CCAS to reveal the complexity of this mission as regards serving the public. The social workers, facilitators and administrative staff engaged and involved in entering into a relation with a ever more fragile general public show the hidden aspects of their professionalism. Client reception in daily life is already a point of entry into the specific support relationship and which is hard to generalize. Client reception is progressively emerging as an analyser of professional of professional implications, work rationale and attitudes to work in the field of social work.

Urban areas play important role in relation to potential risks and impacts of climate change. Adaptation experience is accumulating in the public and private sector across the world. This diploma thesis evaluates current creation of adaptation strategies in cities of the Czech Republic with the use of institutional analysis by the IAD framework. The aim of the thesis is to identify the most common constraints on the adaptation strategies making process and to suggest possible solutions. Data collection method is based on in-depth interviews with stakeholders in the cities of Pilsen, Prague and Brno. Identified constraints include lack of policy support, different level of experiences with creation of conceptual documents and problem with funds for adaptation action. As a solution deepen partnership between self-government and non-profit institutions and deepen cooperation between politics and civil servants with focus on information exchange is needed. In addition conceptual characterization of problems in cities together with their identification, which can helps to obtain funding for implementation of adaptation actions (e.g. through the LIFE programme) is recommended.