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241	"MINDING THE HEART": fattori di rischio psicosociale e motivazione al cambiamento tra pazienti in riabilitazione cardiologica / MINDING THE HEART: PSYCHOSOCIAL RISK FACTORS & MOTIVATION TOCHANGE IN CARDIAC REHABILITATION PATIENTS PIETRABISSA, GIADA 17 March 2016 (has links) Il presente lavoro di tesi è stato condotto in ambito psicocardiologico, e riguarda l’indagine delle determinanti psicosociali potenzialmente coinvolte nell’eziopatogenesi, digressione e prognosi delle malattie cardiache. Più studi preliminari sono stati condotti a fini esplorativi, e solo le varabili risultate caratteristiche del campione mantenute in indagini successive. Dopo aver indagato il ruolo del benessere psicologico nell’influenzare la Capacità Funzionale dei pazienti, uno degli indicatori di esito di maggiore importanza in Riabilitazione Cardiologica (RC) (studio 1), si è proceduto a verificare quali tra le variabili cognitive e psicologiche tradizionalmente associate alle malattie cardiache caratterizzasse lo specifico campione, condizionandone Qualità della Vita (QdV) e benessere psicologico (studio 2). Esclusa l’influenza delle variabili cognitive sullo stato emotivo dei soggetti, si è, poi, approfondito il ruolo delle variabili psicologiche nel determinarne la QdV percepita dei degenti (studio 3). Obiettivo del quarto studio è, infine, valutare efficacia ed efficienza dell’aggiunta di tecniche e principi propri del Colloquio Motivazionale (CM) al trattamento psicologico standard (Terapia Breve Strategica, TBS), al di la del solo trattamento breve strategico, nell’incrementare autoefficacia percepita, disponibilità al cambiamento ed aderenza al trattamento riabilitativo nel malati di cuore. Un esempio dell’uso di tale stile comunicativo viene, inoltre, proposto mediante caso clinico (studio 5). / The general aim of this thesis is to seek evidence on how to achieve long-term maintenance of lifestyle changes in a sample of obese inpatients with heart diseases referred to Cardiac Rehabilitation by investigating the influence of selected variables on their physical and psychological status, as well as by examining the efficacy and effectiveness of a motivational-based intervention. Study 1 is aimed at evaluating whether psychological well-being represents an independent predictor of Exercise Capacity. Study 2 focuses on investigating the influence of cognitive abilities and established psychosocial risk factors on the sample’s subjective Quality of life (QoL) and well-being. Since no effect of different levels of cognitive impairments on the expression of psychological distress among the study participants has been identified, in study 3 the effect of emotional impairments on QoL has been further explored. To conclude, the MOTIV-HEART study (study 4) is aimed at testing the incremental efficacy of a brief strategic treatment including motivational components (BST + MI) in improving physical and psychological outcomes over and beyond the stand-alone brief strategic treatment (BST) and whether results will be maintained/increased at 3-month follow-up. An example of this style of communication is also presented through a case study (study 5). M-PSI/08: PSICOLOGIA CLINICA
242	Merging Task-Centered Social Work and Motivational Interviewing in Outpatient Medication Assisted Substance Abuse Treatment: Model Development for Social Work Practice Fassler, Andreas 01 January 2007 (has links) To advance social work practice and decrease the research practice gap, this dissertation followed a model development paradigm consisting of several phases. Based on the task-centered model of social work practice and motivational interviewing, a new combined model was construed. The two underlying models were analyzed and synthesized, using technical eclecticism as the integrative approach. The resulting combined model was described by guidelines and manualized. To test the combined model in an applied setting, a study was designed in collaboration with social workers at a substance abuse counseling center. There, the combined model intervention was implemented in an outpatient medication assisted treatment program dispensing methadone and buprenorphine to a mainly African-American population. The agency program aimed at detoxification, but also provided methadone maintenance. It offered additional groups and acupuncture. Ten clients and four social work practitioners participated in the intervention study. The study used a mixed-method approach in data collection and analysis. Client practitioner verbal interaction was recorded using digital audio recording. The digital audio files were loaded directly into Atlas.ti software to be used for analysis. Qualitative data analysis with Atlas.ti was performed for two research tasks, a) assessing implementation fidelity of the manual based intervention and b) exploring model development aspects to improve model guidelines. Treatment fidelity was analyzed through deductive coding and frequency counts. Model development analysis was performed similar to a grounded theory model and used content analysis and constant comparison methodologies. Addiction Severity Index and Readiness Ruler, urine drug screens, problem change, and task accomplishment ratings were used as quantitative outcome measures to produce time series data in order to chart individual case progress in a single system design. After testing the intervention, a focus group with participating practitioners was conducted. Overall beneficence with clients improving and progressing successfully in the program was found. The integration of the underlying models was deemed successful. Their elements were found to be complementary and intricately linked. Crucial for successful implementation is that the program environment supports and accepts client choices. Model guidelines were reviewed and improved for further field testing. social work practice model motivational interviewing treatment fidelity model development intervention research Mixed-method Methadone maintenance substance abuse medication assisted treatment task-centered model Adult population Readiness Ruler Addiction Severity Index Manual based Model guidelines Atlas.ti software Time series single system design Theory integration Outpatient applied research qualitative digital audio recording Social and Behavioral Sciences Social Work
243	A Systematic Review of Intervention Efforts to Reduce Indoor Tanning Turrisi, Rob, Hillhouse, Joel J., Mallett, Kimberly, Stapleton, Jerod L., Robinson, June K. 01 January 2012 (has links) This chapter reviews the literature examining interventions to reduce indoor tanning (IT). The first objective was to highlight programs that show promise for large scale dissemination. The second objective was to promote criteria and standards for future intervention research efforts. The scope of interest for this review includes universal (for everyone in the population), selective (for those in the population who are at a greater risk), and indicated (for those who already are experiencing conditions that identify them as at risk) programs. The evaluation of the interventions resulted in three levels of evidence: (1) most promising, (2) emerging, and (3) mixed. For an intervention to be considered “most promising”, it was required that ten criteria be met through examination of research findings in published reports consistent with Flay and colleagues (Prev Sci 6(3):151–175, 2005). Interventions that were classified as “emerging” met most of the criteria. Finally, interventions classified as “mixed” did not reach threshold on more than two criteria that were deemed critical. The results revealed that there was very limited research on IT interventions that meet all the evaluation criteria. Only one intervention approach met all of the criteria (Appearance Booklet) (Hillhouse and Turrisi, Behav Med 25(4):395–409, 2002; Hillhouse et al., Cancer 113(11):3257–3266, 2008). Although the number of published papers in the IT area has increased dramatically over the past decade, these efforts have yet to translate into rigorously conducted intervention trials. The review points to important issues that need to be addressed in future research on the prevention of IT. Keywords appearance booklet Brian Flay cancer Research dermatology effects of radiation radiation protection evidence Frederick Gibbons health promotion and disease prevention health psychology indoor tanning interventions Jerod Stapleton Joel Hillhouse June Robinson Karen Mallett motivational interviewing popular science in medicine and health review Robert Turrisi UV photo young adults Community and Behavioral Health Behavior and Behavior Mechanisms Community Health and Preventive Medicine Dermatology
244	Communautés de pratique interprofessionnelles sur l’entretien motivationnel pour faciliter la transformation des pratiques de counseling en soins primaires : une recherche-action participative Langlois, Sophie 07 1900 (has links) Cette étude avait pour but de faciliter et décrire la transformation des pratiques de counseling des cliniciens de soins primaires (SP) qui ont participé à une communauté de pratique interprofessionnelle sur l’entretien motivationnel (CPI-EM). Réalisé au moyen d’un devis qualitatif, cette recherche-action participative (RAP) (Kemmis et McTaggart, 2005, Kemmis et al., 2014) a permis de rassembler 16 cliniciens de SP (infirmières cliniciennes, nutritionnistes, kinésiologues, médecins de famille et psychologue). Ces derniers ont été répartis en quatre CPI-EM qui ont évolué parallèlement au cours de sept rencontres sur une période de dix mois. Des données qualitatives ont été colligées dans le journal de bord de la doctorante tout au long de l’étude. L’observation participante des CPI-EM a été menée notamment selon la démarche du groupe de codéveloppement professionnel (GCP) (voir Article I). Des groupes de discussion focalisée ont aussi été animés lors de la dernière rencontre des CPI-EM. L’observation non-participante de consultations infirmière/patient, suivie d’entrevues individuelles semi- structurées auprès des participants observés ont conclu la collecte de données. L’approche générale inductive décrite par Thomas (2006) a guidé l’analyse des données. Les résultats révèlent deux types de processus impliqués dans l’apprentissage de l’EM chez les cliniciens participants (voir Article II et Article III). D’une part, ces derniers ont cheminé au cours de processus d’appropriation caractérisés par un changement paradigmatique passant d’une perception de leur rôle professionnel d’experts à celui de guides en santé. Leurs traits personnels, leurs expériences cliniques et la perpétuation d’une culture de soins centrés sur les cliniciens plutôt que sur les patients ont influencé leur parcours de formation. D’autre part, ils ont franchi quatre processus impliqués dans l’implantation de l’EM en SP: l’ambivalence, l’introspection, l’expérimentation et la mobilisation. Leurs traits personnels, leur perception de l’EM comme priorité clinique, ainsi que le soutien organisationnel ont constitué les facteurs d’influence de ces processus. À la lumière des résultats, un programme de formation à l’EM est proposé pour accompagner de manière humaniste et motivationnelle la transformation des pratiques de counseling en SP. La facilitation externe de CPI-EM mobilisant une variété de techniques d’enseignement est ainsi suggérée (voir Article IV). Comme retombées, l'amélioration des pratiques collaboratives, de la satisfaction professionnelle, de la santé psychologique au travail et du leadership clinique a été documentée (voir Article V). L'autonomisation (« empowerment ») des infirmières a également été rapportée, qui aurait à son tour bonifiée la satisfaction des patients à l’égard de la pratique des infirmières participantes basée sur l’EM. Cette étude décrit la contribution de la CPI à faciliter l’appropriation de l’EM et son implantation en SP. Le programme de formation a soutenu les changements paradigmatiques et comportementaux ciblés pour et par les cliniciens participants, notamment grâce à la facilitation externe de communautés de pratique et le contexte interdisciplinaire de la RAP. En plus de l’amélioration des pratiques de counseling, diverses retombées ont été documentées attestant du potentiel de cette approche. / This research aimed to facilitate and describe the transformation of the counselling practices of primary care clinicians who participated in an interprofessional community of practice on motivational interviewing (ICP-MI). Using a qualitative design, this participatory action research (Kemmis and McTaggart, 2005, Kemmis et al., 2014) brought together 16 primary care clinicians (nurses, nutritionists, kinesiologists, family physicians and a psychologist). They were divided into four ICP-MIs that have progressed in parallel during seven meetings spread over a period of ten months. Qualitative data has been collected through the research journal of the doctoral student during the study. The participant observation of ICP-MI meetings was conducted partly using the six-step approach of the professional co-development group (see Article I). Focus groups were also facilitated at the last meeting of each ICP-MI. The non-participant observation of the nurse/patient consultations followed by semi-structured individual interviews with observed participants concluded the data collection. The inductive general approach described by Thomas (2006) guided the research activities related to data analysis. The results revealed two types of processes involved in MI learning among the participating clinicians (see Article II and Article III). On the one hand, they have developed through processes of MI appropriation as the clinicians underwent a paradigmatic shift from a perception of their professional role as health experts to that of health guides. Their personal traits, their clinical background, and the perpetuation of a culture of clinician-centred rather than patient-centred care have influenced these processes. On the other hand, they followed four processes involved in MI implementation in primary care: ambivalence, introspection, experimentation, and mobilization. The clinicians’ personal traits, their perception of MI as a clinical priority as well as organizational support constituted the factors of influence of these processes. Therefore, a training program on MI was developed to support in a humanistic and motivational way the 6 transformation of counselling practices in primary care. The external facilitation of ICP-MI using a variety of training activities is thus suggested (see Article IV). The improvement of collaborative practices, professional satisfaction, psychological health at work and clinical leadership has been documented as a benefit (see Article V). Nurse empowerment has also been reported, which in turn has enhanced patient satisfaction with primary care nursing practice based on MI. This research describes the contribution of ICP to facilitate MI appropriation and its implementation in primary care. The training program facilitated the paradigmatic and behavioural changes targeted for and by the participating clinicians, especially through external facilitation of communities of practice and the interdisciplinary context of this participatory study. In addition to improving counselling practices, various benefits have been documented supporting the potential of this approach. Entretien motivationnel Communauté de pratique Formation continue interprofessionnelle Formation infirmière Application des connaissances Implantation d’innovations en santé Soins primaires Counseling Maladies chroniques Recherche-action Motivational Interviewing Community of Practice Interprofessional Continuing Education Nursing Education Knowledge Translation Implementation Science Primary Care Counseling Chronic Disease Action Research
245	Narratives of governing : rationalization, responsibility and resistance in social work Lauri, Marcus January 2016 (has links) For many years, Sweden has had a reputation for having a comprehensive and women friendly welfare state. However, as in many other European countries during the past few decades, the organization and governing of welfare has undergone profound changes. Through interviews with social workers and the application of theories of governmentality, this thesis analyzes the expressions and consequences of such current organization and governing. One result is that the introduction of meticulous documentation practices of social workers contact with clients, regulate their interaction and constitute a control over both client and social worker. Another result is that the current organization fragments labor and awards more authority to managers, which functions to produce loyalty to the organization and management, rather than clients. This is expressed in demands not to voice protest, as it is said to create a bad mood. It is also expressed in demands to spend as little as possible on clients; short duration of treatment, preference for outpatient treatment and by making it difficult to receive financial support. This austerity is legitimized through the intermeshing of different ideals; budget awareness, evidence that supports short and outpatient treatment and that clients in order to change their course of life should to be allowed or coerced into taking individual responsibility. Another important finding is that the current governing and organization of social work produce distance and detachment, and thus discourage caring subjects. This is a complex process in which an assemblage of different techniques and rationalities undermines the cultivation of a relationship between social worker and client. 1) The ideal of evidence-based practice favors rigid methods over a flexible and holistic approach. 2) Ideals of rationality, closely connected to notions of masculinity and professionalism, value objectivity and devalue and deter the surfacing of emotions. 3) Meticulous practices of documentation reduce the amount of time available to meet clients. 4) Ideals and particular methods designed to promote individual responsibility in clients legitimize social workers distancing themselves from clients’ dependency and needs. 5) A division of labor, in either assessment or treatment, reduces time spent with clients for those who work with assessment and ultimately engage in the rationing of resources. 6) Standardized digital templates, installed to aid in assessments, regulate and proceduralize interactions with the client. 7) Austerity, heavy workloads, individualized responsibility and stress further accentuate distance, as detachment becomes a means to cope with arduous working conditions. The transformation of social work described above produces alienation and a fragmentation of social workers’ collective subjects. Simultaneously, an ethos of caring makes some social workers work extra hard to provide for clients, which ultimately covers for flaws in the system. Although such an ethos of caring allows for the further exploitation of social workers, it is also understood as a means of resistance, which in turn also forms the basis for organized resistance. / Sverige har ett internationellt rykte för att ha en omfattande och kvinnovänlig välfärd. Även om riktigheten i en sådan uppfattning sedan länge ifrågasatts har på senare år, likt i många andra Europeiska länder, det svenska välfärdssystemet genomgått en omfattande förändring i avseende på dess räckvidd, men också dess organisering och styrning. Fokus för denna studie är just denna organisering och styrning, och mer specifikt, hur detta påverkar ett av välfärdens kanske mest centrala område: socialt arbete. Genom att intervjua socialarbetare undersöks i denna studie uttryck för och konsekvenser av en sådan förändring, bland annat genom att undersöka hur könsbundna föreställningar och förväntningar är sammanflätade med det sociala arbetets organisering och styrning. I studien konstateras att socialarbetare erfar att deras arbete genomgått omfattande förändringar, vilket kopplas ihop med både organiseringen och styrningen av det sociala arbetet. Detta uttrycks både i de ideal som kringgärdar arbetet men också i dominerande arbetssätt. En sådan förändring är införandet av omfattande dokumentationsprocedurer av socialarbetarens arbete och kontakt med klienter, vilket medför att kontakten med klienterna blir ytligare. Dokumentationsprocedurerna utgör också en sorts kontroll av både klienterna och socialarbetarna själva. En annan förändring som konstateras är att nya organisationsmodeller och en förändrad ledarskapskultur skapar förväntningar på socialarbetarna att vara lojala med organisationen och ledningen snarare än klienterna. Bland annat utrycks detta genom förväntningar att inte protestera och skapa dålig stämning på arbetsplatsen, men också genom uttalade krav att spendera så lite resurser som möjligt på klienterna; korta behandlingstider, öppenvårdsalternativ och orimligt hårda krav för att få ekonomiskt bistånd. Detta legitimeras genom sammanväxningen av flera olika ideal; budgetmedvetenhet, att klienter inte mår bra av långa institutionsvistelser, men också att klienterna ska tillåtas eller bör tvingas att klara att sig själva. Ett av studiens huvudresultat är att den nuvarande organiseringen och styrningen av socialt arbete skapar avstånd och likgiltighet. Genom flera sammankopplade ideal och arbetssätt styrs dagens socialarbetare till att bry sig mindre om de klienter de möter. På så sätt undermineras förutsättningarna för framväxten av en djup relation mellan socialarbetare och klient; 1) Idealet och kravet att socialarbetare ska arbeta utifrån evidens, det vill säga metoder och förhållningssätt som i speciellt utformade utvärderingsmodeller visat sig ha effekt, gör att väl strukturerade och rigida metoder ges företräde. Denna instrumentalisering underminerar ett flexibelt, relationsorienterat och helhetsfokuserat sätt att arbeta. Dessutom gör evidensidealets fokus på enskilda individer och avgränsade utvärderingstider att mer samhällsinriktat kritiskt och långsiktigt inriktat arbete undermineras. 2) Ett rationalitetsideal, tätt sammanbundet med föreställningar om professionalitet och maskulinitet, värderar objektivitet och förmågan att frikoppla socialarbetarens egna känslor från sitt arbete. Detta maskuliniserade professionsideal innebär att empati och solidaritet med klienten undergrävs. 3) Omfattande krav på olika former av dokumentation av det sociala arbetet gör att tiden som socialarbetaren har till sitt förfogande för att besöka och att ha möten med klienten blir knapp. 4) Ett allmänt samhällsideal kring individuellt ansvar och en särskild arbetsmetod (motiverande samtal) som många socialarbetare förväntas lära sig, framhäver klientens eget ansvar för och vilja till förändring. Detta legitimerar ett avståndstagande från klientens behov av hjälp och stöd enligt logiken ”du måste klara detta själv”. 5) En vanligt förekommande uppdelning av socialarbetarnas arbetsuppgifter i en så kallad beställar-utförarmodell gör att vissa socialsekreterare arbetar med hjälp och stöd, medan andra arbetar med bedömningar av klienters behov. De senare, som också har inflytande över resurstilldelning, blir med en sådan organisering av arbetet alltmer frikopplade från den stödjande och hjälpande verksamheten och kontakten med klienten. 6) Standardiserade digitala bedömningsinstrument, skapade för att på ett likvärdigt sätt bedöma klienters behov och dokumentera det sociala arbetet, reglerar och instrumentaliserar kontakten med klienter. 7) Tunga arbetsbördor, individualiserat ansvar och stress, bidrar ytterligare till att skapa avstånd och likgiltighet eftersom det för vissa utgör ett sätt att genomleva en ohållbar arbetssituation. En allmän åtstramning av socialtjänstens resurstilldelning förstås som en viktig orsak till behovet av att skapa ovan distansmekanismer. Men distansen hänger också ihop med en tendens till ett återupplivande av en tidigare dominerande förståelse av marginalisering och sociala problem; där människors nöd ses som ett utslag av dålig karaktär och ett resultat av dåliga individuella val. De förändringar av det sociala arbetets premisser som beskrivits ovan gör att socialarbetarna alltmer görs främmande inför sitt arbete – de alieneras. Detta främmandegörande uttrycks genom att inte kunna identifiera sig med arbetet självt, sina kollegor eller med sig själv. Ett sådant främmandegörande underminerar, eller fragmentiserar, både relationen till klienten, men också en känsla av gemenskap med andra socialarbetare. En gemenskap som kan utgöra ett ”vi” och ligga till grund för att ställa krav, protestera och göra motstånd mot avhumaniserande ideal och reformer. På så vis är främmandegörandet inte bara en konsekvens av dagens organisering och styrning, utan också något som fyller en viktig funktion för en sådan styrning och organisering, och genomförandet av en allmän åtstramning i socialpolitiken. Samtidigt som dagens organisering och styrning av socialt arbete är främmandegörande, slår vissa socialarbetare knut på sig själva och arbetar extra hårt för att täcka upp för systemets brister och krympande resurser, för att trots det svåra läget ändå försöka ge det stöd som de upplever att klienten behöver. Ett sådant historiskt förankrat femininiserat omsorgsideal, dvs känslor av ansvar och empati inför behövande och en ilska inför oförrätter, utgör därmed på samma gång grund för en fördjupad exploatering av socialarbetarna, och ett vardagligt motstånd mot rådande system. I ett läge när flera upplever att kollegialiteten som grund för motstånd på arbetsplatserna underminerats, utgör ett sådant omsorgsideal samtidigt också grunden för organiserat motstånd utanför arbetsplatsen, bortom chefernas insyn, kontroll och härskartekniker. Medan nuvarande styrningssystem underminerar ett visst sorts motstånd, uppstår samtidigt grunden för nya. Welfare Welfare state neoliberalism neoliberal neo-liberal neo-liberalism new public management NPM new managerialism managerialism public management reform social work social services profession professional EBP evidence-based practice evidence knowledge production paperwork administration performance audit discipline sovereign power self-governing power power/knowledge motivational interviewing MI individualism individual responsibility political the political de-politicized de-politicization governing governmentality governance gender feminism feminist theory Foucault Marx capitalism standardization flexibility budget governing care care-work ethos of care solidarity empathy loyalty division of labor proceduralization instrumentalization mechanization manual based digital template templates de-professionalization proletarization proletarianization Taylorization transition transformation rationalization rationality rational emotions emotional affect alienation detachment distance resistance counter conduct Sweden Swedish model rhizome rhizomatic nomadic narrative narratives discourse critique interviews Välfärd välfärdsstat välfärfärdsstaten nyliberal nyliberalism new public management socialt arbete socialtjänsten socialarbetare svenska modellen styrning styrningsmentalitet kön genus EBP evidensbaserad praktik evidens kunskapsproduktion makt/kunskap administration pappersarbete granskning kontroll disciplin självstyrning motiverande samtal individualism individualisering ansvar individuellt ansvar flexibilitet politik det politiska avpolitisering avprofessionalisering profession professioner professionell förfrämligande Sverige Foucault Marx feminism feministisk teori kapitalism proletarisering taylorisering standardisering manualbaserad rationalisering rationell emotioner känslor avstånd likgiltighet narrativ diskurs kritik intervju intervjuer kapitalism den svenska modellen förändring transformering motstånd mot-makt

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