Made available in DSpace on 2016-04-27T18:12:14Z (GMT). No. of bitstreams: 1 Dissertacao Maria de Fatima.pdf: 927228 bytes, checksum: 15f091b7c8b72f7399a4a829d37c217c (MD5) Previous issue date: 2005-03-31 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This study proposes that the speech therapist be a facilitator element of relationship between mother and baby of high risk, because sensorial involvement is indispensable for the psychical development of the baby and to the emergence of his oral language. The proposal of this study appeared since the evidence that many mothers of premature newborn babies in Newborn and Pediatric Intensive Treatment Unit of Hospital das Clínicas Samuel Libânio de Pouso Alegre/MG , were not able to identify corporal expression of their children and did not achieved the sensorial involvement during clinical evolution and qualification of babies to exclusive oral alimentation. In this manner, the proposal of this work is the investigation of mediation as a tool of facilitator intervention of the relationship mother and baby of high risk through technical instruments relationed with newborn care, and the shelter of mother with her anguishes and fears. The technicals tools used in this study were: the correct position of the baby; offering of smell and taste stimulus, the elicitation of alimentation and defense reflections, Nutritive Suction through sounding lead-finger technique; the No Nutritive Suction, the offering of pleasant touch, gentle opening of incubator porthole and the luminosity control through black using. Along the study it was evident that the speech therapy mediation fortifies the trust of mother in herself, and in an ability to become available to her child and recognize him as a love object that demands care, reflecting in the sensorial involvement offered by her. The technical instruments, in this context, become near mother and baby and contribute to the mother´s interest and her participation in the work of assistance the babies alimentation and cares relationed with hearing / Este trabalho propõe que o fonoaudiólogo se insira como elemento facilitador da relação mãe-bebê de alto risco, porque o envolvimento sensorial é imprescindível para o desenvolvimento psíquico do bebê e emergência de sua linguagem oral. Esta proposta surgiu a partir da constatação de que muitas mães de recém-nascidos prematuros, internados na UTI Neonatal e Pediátrica do Hospital das Clínicas Samuel Libânio , de Pouso Alegre/MG, não conseguiam identificar a expressão corporal dos filhos e, inclusive, envolver-se sensorialmente com eles durante a evolução clínica e a capacitação dos bebês para alimentação oral exclusiva. O objetivo deste trabalho é estudar a mediação fonoaudiológica como uma forma de intervenção facilitadora da relação mãe-bebê de alto risco, através do uso dos recursos técnicos fonoaudiológicos voltados para os cuidados neonatais, e do acolhimento à mãe em suas angústias e receios. Os recursos técnicos utilizados nesta pesquisa foram: o posicionamento correto do bebê; o oferecimento de estímulos odoríferos e gustativos, a elicitação de reflexos de alimentação e de defesa, Sucção Nutritiva através de técnica sonda-dedo, a Sucção-Não-Nutritiva, oferecimento do toque prazeroso, abertura suave da portinhola da incubadora e o controle de luminosidade, através do uso do black. Ao longo da pesquisa ficou evidente que a mediação fonoaudiológica fortalece a confiança da mãe em si e em sua capacidade de se disponibilizar ao filho e reconhecê-lo como objeto de amor que demanda seus cuidados, repercutindo no envolvimento sensorial oferecido por ela. Os recursos técnicos, neste contexto, aproximam mãe-bebê e contribuem para que a mãe tenha interesse e participe do trabalho fonoaudiológico de assistência à alimentação e de cuidados quanto à audição

Made available in DSpace on 2016-04-28T20:40:07Z (GMT). No. of bitstreams: 1 Julieta Jerusalinsky.pdf: 1960391 bytes, checksum: e621fe1c2f5a9c553f5e4df87d97be29 (MD5) Previous issue date: 2009-06-26 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This thesis approaches the production of the inscriptions that constitute the psychism in mother-baby ties. The text is present within the field of fundamental psychopathology and theoretical-clinical psychoanalysis. The author posits that the inscription of the letter a concept employed by Jacques Lacan to situate psychic inscriptions depends on the mother's involvement in the baby's economy of jouissance. The transmission of the inscription does not take place through the direct presence of a code, but rather through a succession of enigmatic effects on the baby's ties with his mother. She is an embodied mOther, in view of which the subject must emerge on the border between jouissance and knowledge, body and language. On the basis of the given-to-be-seen on the baby's body, the mother formulates the supposition of the knowledge of which the baby is a tributary. It is knowledge of the mother's desire and is enigmatic to the mother herself, but the baby becomes involved in it. The givento- be-seen on the baby's body takes on the character of a formation of the unconscious. The mother's psychism operates there as an initially prosthetic psychic apparatus for the baby to function physically. The baby s economy of jouissance is thus bound to its mother's knowing. The earliest roots of psychic constitution thus reveal the lack of correspondence between body and subject. Through her care, the mother "embroiders" the letter on the baby's body as she occupies herself with his economy of jouissance, by being affected by what affects him. She thus links the baby's physical functioning to a language structure by which he inadvertently becomes involved in the tie with the mOther. From then on, the tie is indispensable in his circuit of satisfaction. For this reason, the baby is also affected by the sounds and lalangue through which the mother's jouissance emerges in the act of enunciation. When the baby becomes emotionally involved in the games that constitute the subject, the mother attributes their authorship to him, and the knowledge of this playing permanently transits with him through the positions of object and subject. She presumes that he is the subject that knows about playing. At the same time, when she makes the baby an object of jouissance, she herself obtains jouissance by transitively identifying with the jouissance of the baby's passivity. Therefore, the jouissance involved in the tie between mother and baby is not reduced to either the anxiety of insufficiency nor to the measure of phallic strength, nor even to the masochistic jouissance of the mater dolorosa. Through jouissance located beyond the phallic, a creation can be produced, a child can be raised. The raising of the child indicates the transitivist dimension of the earliest roots of the tie between mother and baby. If motherhood can make room for an act that, for a woman, is creative, the child, in turn, has a way to be creative when playing. The relationship between mother and baby is limited neither to phallic jouissance nor to the search for complementarity with the jouissance of the mOther, but it can open the way to an Other jouissance, a supplementary creation, which, even if it makes use of the paternal function, does not stop at the Oedipus complex. In view of the mental suffering involved when a baby painfully gives-to-be-seen on his body, the clinician intervenes, not by observing but by reading, which can decipher. Operating on the basis of the key to the code, the letter, which insists on symptomatic repetition, the clinician opens the way to supplementary creations / A tese aborda a produção das inscrições constituintes do psiquismo no laço mãe-bebê sob o marco acadêmico de pesquisa em Psicopatologia Fundamental e teórico-clínico da psicanálise. Considera que a inscrição da letra conceito utilizado por Jacques Lacan para situar as inscrições psíquicas depende da implicação materna na economia de gozo do bebê. Sua transmissão não ocorre pela via direta de um código, mas por uma sucessão de efeitos enigmáticos no laço com a mãe, enquanto Outro encarnado, diante dos quais o sujeito precisará advir, no litoral entre gozo e saber, corpo e linguagem. A partir do dado a ver no corpo do bebê, a mãe formula a suposição de um saber do qual este seria tributário: saber sobre o desejo materno que, à própria mãe, resulta enigmático, mas em relação ao qual o bebê fica implicado. Assim, o dado a ver no corpo do bebê assume o caráter de formação do inconsciente. O psiquismo materno opera aí como um aparelho psíquico inicialmente protético para o funcionamento corporal do bebê, que passa a ter sua economia de gozo atrelada ao saber materno. Os primórdios da constituição psíquica, portanto, deixam em relevo a não correspondência entre corpo e sujeito. A mãe realiza em seus cuidados o "bordado" da letra ao corpo do bebê, ao ocupar-se de sua economia de gozo, ao afetar-se pelo que o afeta. Assim, parasita o funcionamento corporal do bebê com uma estrutura "linguageira" pela qual este, inadvertidamente, se engaja no laço com o Outro a partir daí imprescindível em seu circuito de satisfação. Por isso o bebê também é afetado pela prosódia e alíngua pelas quais comparece o gozo materno no ato da enunciação. Quando o bebê se engaja "gozozamente" nos jogos constituintes do sujeito, a mãe passa a atribuir-lhe a autoria, o saber, sobre esse brincar, transitando permanentemente com ele pelas posições de objeto e sujeito. Ela o supõe sujeito que sabe do brincar; ao mesmo tempo, quando o faz objeto de gozo, goza identificando-se transitivamente ao gozo da passividade do bebê. Portanto, o gozo implicado no laço mãe-bebê não está reduzido nem à angústia da insuficiência nem à medida da potencia fálica. Tampouco ao gozo masoquista da mater dolorosa. Por meio de um gozo situado para além do fálico, pode-se produzir uma criação: a criação da criança aponta a dimensão transitivista dos primórdios do laço mãe-bebê. Se a maternidade pode dar lugar a um ato criativo para uma mulher, por sua vez, a criança tem aí uma brecha para vir a ser criadora no brincar. A relação mãe-bebê não se limita nem ao gozo fálico nem à busca da complementaridade com o gozo do Outro, mas pode dar acesso a um gozo Outro, a uma criação suplementar, que, mesmo se servindo da função paterna, não se detém no complexo de Édipo. Diante do pathos que o bebê em sofrimento dá a ver em seu corpo, o clínico intervém, não por uma observação, mas por uma leitura que possibilita uma decifração. Operando a partir da cifra, da letra que insiste na repetição sintomática, abre lugar para criações suplementares

Background: A key innovation in the provision of inpatient services to facilitate the care and treatment of women with severe postnatal mental illness was the introduction of joint mother and baby psychiatric hospitalisations, where both the mother and baby are admitted to hospital together. This study examined the history of the practice of joint mother and baby admissions across the UK and critically explored the processes relevant to the diffusion of joint admissions and patterns of service development to identify the possible and probable causes for significant differences in service provision across the United Kingdom (UK). Aims: The study examined the documented history of the development of practice of joint mother and baby psychiatric hospital admissions across the UK and in doing so, a) Identified the pattern of service and practice development and the likely reasons for the pattern of the chronology. b) Identified the processes involved in the diffusion of joint mother and baby admissions in the UK, and explored why the practice was sustained (or not). c) Contributed new information to the continued development of innovation diffusion theory and research, and its application to health care service and practice development. Methods: A historical method was used in the study and was reported through the use of historical narrative and analysis. Data was collated from primary and secondary sources of documented evidence which was used to inform the history of joint mother and baby admissions across the UK. Data was analysed using the theoretical framework of diffusion of innovation (Rogers, 2003). Findings: Two versions of the same innovation were identified: joint admissions to side rooms of general adult psychiatric wards or annexed areas of the wards and joint admissions to specialist mother and baby units. Neither version of the practice followed the normal S-curve pattern of adoption in terms of frequency and rate of adoption. After a period of approximately 63 years there are 24 facilities for the provision of joint admissions in the NHS in the UK. The main influencers to the adoption of the practice was perception of risk, social networks internal and external to the NHS, the presence of clinical and political champions to drive the adoption and implementation of the innovation and policy entrepreneurship by clinicians working in the clinical field of perinatal mental health. The development of specific policy, guidelines and in Scotland, legislation, has resulted in a move during the last decade from joint admissions being diffused naturally to side room admissions being actively withdrawn and specialist psychiatric mother and baby units actively being disseminated. There is strong evidence that the diffusion process for specialist mother and baby units is still in motion at the time of reporting. Conclusion: Two competing versions of the same innovation had unusual patterns of diffusion. The influencers identified as relevant to the diffusion patterns of each version of the innovation were essentially the same influencers but they were used in different ways to affect change: rejection of one version of the innovation in favour of adoption of the other. The main influencers on the diffusion of joint admissions changed over the time line of the adoption pattern. Barriers to diffusion included the absence of evidence of effectiveness, the absence of economic evaluation, the position in service divisions of perinatal mental health as a field of practice and the absence of succession planning across professional groups. Recommendations are made for future research.

In this thesis the intricacies of service user and staff perceptions of psychological interventions for mental health difficulties were explored. Expanding upon this theme, mothers and staff on a Mother and Baby Unit (MBU) were asked about their views regarding the acceptability and feasibility of the implementation of a parenting intervention, Baby Triple P Positive Parenting Programme (Baby TP). This investigation is presented as four papers: a literature review, two empirical papers (a & b) and, a critical review and personal reflection of the research process.The literature review, a meta-synthesis of qualitative studies, explores service user and staff perceptions of psychological interventions for mental health difficulties. Twenty-eight studies were synthesised to develop comprehensive understanding of subtle, specific and overlapping elements involved in the implementation of psychological intervention. Guided by Noblit and Hare’s (1988) approach, 11 over-arching themes and 25 sub-ordinate themes emerged from the synthesis. Findings provide a detailed description of the concepts pertinent to both service users and staff. Implications are identified for service managers and clinicians in obtaining optimum efficiency and outcomes of psychological intervention. The empirical study is a Q-methodological investigation into service user and staff perceptions of the acceptability and feasibility of a parenting intervention, Baby TP, on a MBU. This study is split into two population-specific papers. Overall five main factors were identified (service users: three; staff: two), which provides new insights into the acceptable and feasible elements of a parenting intervention within this specialist setting. The findings highlight a positive consensus as to the acceptability and feasibility of Baby TP in a MBU setting alongside a number of identified needs pertinent to service users, staff and the setting. Clinical implications and recommendations are provided to address identified areas of need for both populations within this setting. The third paper is a critical review of the thesis illustrated through personal reflections of the research process.

Die doel van hierdie studie is die ontwikkeling van 'n ouerleidingsprogram vir moeders wat hul premature babas in 'n kangaroemoedersorgprogram versorg. Die program het ten doel om die moeders in die onmiddelikke versorging, sowel as die toekomstige begeleiding van hut kinders, toe te rus. 'n Literatuuroorsig word gegee van prematuriteit as fenomeen en van kangaroemoedersorg (KMS) as versorgingswyse, met spesifieke verwysing na die toepassing daarvan in Kalafonghospitaal. Die grondslae van ouerteiding word uit die literatuur opgesom en riglyne word ook gestef vir die samestelling van 'n ouerfeidingprogram. Die kwalitatiewe navorsingsmetode word gebruik om die inhoud van die ouerfeidingsprogram te bepaal en om ondersoek in te stel na die mees geskikte aanbiedingswyses. Die verslag word afgesluit met riglyne vir die samestelling van 'n prakties-toepasbare ouerleidingsprogram waarin inhoudsmoontlikhede, idees vir aanbieding en wyses vir die bepaling van gestelde uitkomste uiteengesit word. / The aim of this study is the development of parental guidance for mothers who take care of their premature babies in a programme of Kangaroo Mother Care. The programme aims to equip mothers for immediate and future care of their children. A literature review of prematurity as phenomenon and of kangaroo mother care as care method is presented with specifK: reference to the way it is applied in Kalafong-hospital. The basics of parental care are summated from literature and guidelines are set to design a parental guidance programme. The qualitative research method is put into operation to determine the content of the parental guidance programme and to investigate the most appropriate method of presentation. The report is concluded with guidelines for setting up a practical and applicable parental guidance programme in which subject possibilities, ideas for presentation and means for determining set outcomes are explained. / Educational Studies / M.Ed.(Spesialisering in voorligting)

Made available in DSpace on 2016-04-28T20:39:52Z (GMT). No. of bitstreams: 1 Eliana Lemos Pommee.pdf: 2255341 bytes, checksum: f90be9be89cace551070f817d6e6bf41 (MD5) Previous issue date: 2008-08-14 / This study focus the binding behaviors between mother and baby in puerperal women, who has delivered her babies in the Labor Center of Amparo Maternal, in the city of São Paulo. His main goal is to describe the manifestations of binding behavior between mother and baby in the first time they're together after the labor and to analyse the function of holding in promoting this bind. The term holding is used as a context of caring and support the mother gives to her newborn baby, as well as the mother's family gives to herself. The psychoanalytical concepts about the puerperal-pregnant cycle(Winnicot,Maldonado,Szejer),the baby's contemporary theorists(Stern, Lichtenberg) and the body-mind approach of Wilhelm Reich in the prevention of health are the theoretical basis of this study. The data was obtained through video recording the mother-baby relationship and through semi directed clinic interviews with the puerperals.From the results, two different groups of mothers aroused, in respect to the holding, in two situations : From the interaction mother-baby, and from the interaction of the mother with her family. The study points out to the very important function of the family holding throughout pregnancy and how having holding after the labor promotes the binding between mother and the baby. This study contributes to the comprehension of the psychological assistance as a path to promote the biding, therefore widing the universe of interference in the pregnant-puerperal cycle to the families / Este estudo trata das manifestações de comportamento de vínculo mãe-bebê em puérperas que tiveram seus bebês em Centro de Parto no Amparo Maternal, na cidade de São Paulo. Têve como objetivos: descrever as manifestações de comportamento de vínculo mãe-bebê no primeiro encontro após o parto e analisar a função do holding na promoção do vínculo. O termo holding é utilizado como contexto de acolhimento, suporte e cuidados tanto da mãe para com o recém nascido, como da família em relação à mãe. Os referenciais teóricos utilizados são os conceitos psicanalíticos sobre o ciclo grávido puerperal (Winnicot, Maldonado, Szejer) os teóricos contemporâneos do bebê (Stern, Lichtenberg) e a abordagem psicorporal de prevenção em saúde de Wilhelm Reich. Para obtenção dos dados foram utilizadas gravações em vídeo da relação mãe-bebê e entrevista clínica semidirigida com as puérperas. Dos resultados emergiram dois grupos de mães heterogêneos com relação ao holding, em duas situações: de interação mãe-bebê e interação da mãe com o ambiente familiar. O estudo aponta para a importante função do holding que a família oferece à mulher durante a gestação e a perspectiva de obter holding durante o pós-parto na promoção do vínculo mãe bebê. Este estudo contribui na compreensão da importância da assistência psicológica como forma de promoção de vínculo, ampliando o universo de intervenção no ciclo grávido-puerperal para as famílias

Die doel van hierdie studie is die ontwikkeling van 'n ouerleidingsprogram vir moeders wat hul premature babas in 'n kangaroemoedersorgprogram versorg. Die program het ten doel om die moeders in die onmiddelikke versorging, sowel as die toekomstige begeleiding van hut kinders, toe te rus. 'n Literatuuroorsig word gegee van prematuriteit as fenomeen en van kangaroemoedersorg (KMS) as versorgingswyse, met spesifieke verwysing na die toepassing daarvan in Kalafonghospitaal. Die grondslae van ouerteiding word uit die literatuur opgesom en riglyne word ook gestef vir die samestelling van 'n ouerfeidingprogram. Die kwalitatiewe navorsingsmetode word gebruik om die inhoud van die ouerfeidingsprogram te bepaal en om ondersoek in te stel na die mees geskikte aanbiedingswyses. Die verslag word afgesluit met riglyne vir die samestelling van 'n prakties-toepasbare ouerleidingsprogram waarin inhoudsmoontlikhede, idees vir aanbieding en wyses vir die bepaling van gestelde uitkomste uiteengesit word. / The aim of this study is the development of parental guidance for mothers who take care of their premature babies in a programme of Kangaroo Mother Care. The programme aims to equip mothers for immediate and future care of their children. A literature review of prematurity as phenomenon and of kangaroo mother care as care method is presented with specifK: reference to the way it is applied in Kalafong-hospital. The basics of parental care are summated from literature and guidelines are set to design a parental guidance programme. The qualitative research method is put into operation to determine the content of the parental guidance programme and to investigate the most appropriate method of presentation. The report is concluded with guidelines for setting up a practical and applicable parental guidance programme in which subject possibilities, ideas for presentation and means for determining set outcomes are explained. / Educational Studies / M.Ed.(Spesialisering in voorligting)