Nursing practice is a very physical business. The work that most nurses do involves the use of their bodies as the primary tool of their work. Nurses take their physical selves to patients in order to carry out that work, the body of the nurse is often in direct contact with the bodies of patients that they care for. This thesis is about what I have called the �invisible bodies of nursing�, and I describe these throughout the body of the thesis. The physical body of the nurse, the body of practice, and the body of knowledge. The physical body of the nurse is absent in most nursing literature, it is sometimes inferred but seldom discussed. My contention is that the physical body of the nurse is invisible because it is tacit. Much nursing practice is invisible because it is perceived by many nurses to be inarticulable and is carried out within a private discourse of nursing, silently and secretly. Nursing knowledge is invisible because it is not seen as being valid or authoritative or sanctioned as a legitimate discourse by the dominant discourse. I approach these issues through an evolving �specular� lens. Luce Irigaray�s philosophy of the feminine and her deconstructing and reconstructing of psychoanalytic structures for women inform my work. Michel Foucault�s genealogical approach to analysing discourses is a powerful tool for exploring the history of the creation of the nurse and offers critical insights in to how nursing is perceived today. Maurice Merleau-Ponty�s phenomenology provides the flesh for my discussions about the embodied practice of nurses as beings in the world. Nursing�s struggle for recognition is ongoing. I discuss strategies that nurses could use to make themselves more �visible� in healthcare structures. The exploration of the embodied self of the nurse and through this the embodied knowledge of nursing is nascent. I hope to provide for nurses some food for both thought and discussion.

Nursing practice is a very physical business. The work that most nurses do involves the use of their bodies as the primary tool of their work. Nurses take their physical selves to patients in order to carry out that work, the body of the nurse is often in direct contact with the bodies of patients that they care for. This thesis is about what I have called the �invisible bodies of nursing�, and I describe these throughout the body of the thesis. The physical body of the nurse, the body of practice, and the body of knowledge. The physical body of the nurse is absent in most nursing literature, it is sometimes inferred but seldom discussed. My contention is that the physical body of the nurse is invisible because it is tacit. Much nursing practice is invisible because it is perceived by many nurses to be inarticulable and is carried out within a private discourse of nursing, silently and secretly. Nursing knowledge is invisible because it is not seen as being valid or authoritative or sanctioned as a legitimate discourse by the dominant discourse. I approach these issues through an evolving �specular� lens. Luce Irigaray�s philosophy of the feminine and her deconstructing and reconstructing of psychoanalytic structures for women inform my work. Michel Foucault�s genealogical approach to analysing discourses is a powerful tool for exploring the history of the creation of the nurse and offers critical insights in to how nursing is perceived today. Maurice Merleau-Ponty�s phenomenology provides the flesh for my discussions about the embodied practice of nurses as beings in the world. Nursing�s struggle for recognition is ongoing. I discuss strategies that nurses could use to make themselves more �visible� in healthcare structures. The exploration of the embodied self of the nurse and through this the embodied knowledge of nursing is nascent. I hope to provide for nurses some food for both thought and discussion.

En régime néolibéral mondialisé, l'appartenance à un groupe professionnel n'est plus une protection assurant à l'ensemble des membres, prestige social et revenus confortables. C'est ce que montre la série de 31 entretiens biographiques menés auprès d’une trentaine de médecins originaires d'Afrique de l'Ouest francophone (MoAO) entre 2009 et 2015. La catégorie MoAO, construite pour les besoins de l’étude, renvoie à des médecins nés dans un pays francophone d’Afrique au Sud du Sahara, qui y ont suivi une partie de leur formation (primaire, secondaire et universitaire), qui ont migré temporairement ou de façon définitive dans un autre pays soit pour acquérir une formation initiale en médecine, soit pour se spécialiser. Les MoAO sont traités ici en cas d’étude fondée sur une approche transnationalisée. Ils permettent de mettre en évidence la complexité et la multiplicité des évolutions sociales et économiques qui obligent la sociologie des professions médicales à mettre à jour ses outils conceptuels et théoriques. Plusieurs hypothèses sont explorées à cet égard. La professionnalité médicale recouvre des processus imbriqués d'acquisition des savoirs professionnels par la formation, d'individualisation des carrières professionnelles débordant des normes communément considérées. Ainsi sont décrites la forte autonomisation et la diversification des parcours de formation en médecine favorisées par l’internationalisation et la constitution d’un marché international de l'enseignement supérieur. De même, la privatisation galopante de la formation médicale observée en Afrique remet en cause le mythe de la totale autonomie de la profession médicale. Elle accompagne au Bénin et au Sénégal, le désengagement de l’Etat donnant une place de plus en plus importante aux organisations internationales (ONU, OMS, ONG) pour l’élaboration et la mise en œuvre de programmes de santé, aux institutions supranationales (UEMOA, CAMES) pour l’élaboration des curricula de formation et l’accréditation des formations médicales, et des structures privées (cliniques, cabinets médicaux, centres de santé sous gestion d’ONG) pour la fourniture des soins et des services de santé. Un tel contexte est fortement structurant dans les carrières professionnelles et migratoires des praticiens enquêtés. La thèse s’intéresse ensuite aux modes d’insertion professionnelle des MoAO en France. L'Etat français a lui-même transgressé le monopole dont bénéficient les professionnels français et à diplôme français pour l'exercice de la médecine, en organisant le recrutement par les hôpitaux publics de médecins étrangers « non autorisés ». Les MoAO n'en représentent qu'une partie des Praticiens à diplôme hors Union européenne. Mais leur parcours permet d'engager la réflexion nécessaire sur la division du travail médical (entre les Nationaux et les étrangers notamment) et les enjeux en termes de reconnaissance notamment portés par les conflits au travail, et par la migration elle-même. / In the globalized neoliberal regime, belonging to a professional group is no longer a protection that ensures all members, social prestige and comfortable incomes. That is what can be learned from 31 biographical interviews conducted with French-speaking West African physicians (MoAO) between 2009 and 2015. The category MoAO, built for the needs of the study, refers to physicians born in a French-speaking African countries in south of the Sahara where they have attended primary, secondary and university training. Then they have migrated temporarily or permanently to another country to acquire a initial training in medicine, either to specialize. The MoAO are treated as study case. They highlight the complexity and multiplicity of social and economic developments that force the sociology of the medical profession to update its conceptual and theoretical tools. Several hypotheses are explored in this regard. Medical professionalism covers interrelated processes of acquisition of professional knowledge through training and individualization of professional careers, beyond commonly considered standards. Thus, self- construction of curricula and diversification of medical training paths, favored by the internationalization of higher education’s market, are described. Similarly, the rampant privatization of medical training in Africa challenges the myth of the autonomy of the medical profession. In Benin and Senegal, this accompanies the disengagement of the States, giving an increasingly predominant place to international organizations in the elaboration and implementation of health programs, to supranational institutions for the development of training curricula and medical training accreditation, to the private structures for the provision of health care and services. The thesis then focuses on the modes of professional integration of MoAOs in France. The French State itself has violated the monopoly granted to French professionals with a French diploma on te medical work market, by organising the recruitment of "unauthorised" foreign doctors. MoAOs represent only a fraction of the practitioners with a degree from outside the European Union. But their experience allow to initiate a necessary reflection on the division of medical work (between nationals and foreigners in particular), as well as on the recognition issues related to conflicts at work, and to the migration itself.

A presente pesquisa tem como objeto de estudo [re]conhecimento que os usuários de um hospital geral detêm sobre o trabalho do enfermeiro. Seu objetivo geral é discutir o entendimento dos usuários de um hospital geral do Rio de Janeiro sobre o trabalho do enfermeiro, à luz do seu reconhecimento profissional, e seus objetivos específicos são: identificar o [re]conhecimento que os usuários possuem sobre o trabalho do enfermeiro e analisar o [re]conhecimento dos usuários sobre o trabalho dos enfermeiros, buscando aproximações e distanciamentos das competências do enfermeiro. Esta pesquisa apoia-se nas concepções teóricas da psicodinâmica do trabalho desenvolvidas por Dejours, se apropriando mais profundamente, da discussão sobre a dinâmica do reconhecimento, na qual acredita que o reconhecimento pode ser um meio que possibilita a transformação do sofrimento no trabalho em prazer. Com o intuito de respeitar os princípios éticos e a Resolução 196/96, essa pesquisa foi encaminhada ao Comitê de Ética e Pesquisa com Seres Humanos/SR-2/UERJ e obteve parecer favorável com protocolo n 49.3.2012. Trata-se de um estudo exploratório-descritivo de abordagem quantitativa e desenho transversal. A população foram clientes internados nas enfermarias cirúrgicas e clínicas do referido hospital. Para melhor caracterizar o perfil da clientela internada foi utilizado o Sistema de Classificação de Pacientes elaborado por Perroca (1996) que baseia-se nas necessidades individualizadas de cuidado de enfermagem, com o intuito de identificar o grau de dependência que o sujeito apresenta da equipe de enfermagem. Os 65 participantes da pesquisa foram selecionados por meio de uma amostra intencional. O instrumento de coleta de dados utilizado foi um formulário contendo 22 perguntas, sendo 18 fechadas e 04 abertas. As informações foram coletadas no período de agosto a outubro de 2012 e analisadas utilizando-se da estatística descritiva simples. A apresentação dos dados foi através de tabelas e a sua discussão teve quatro tópicos, são eles: Perfil sociodemográfico da população; Experiências hospitalares anteriores; Conhecimento da população sobre o enfermeiro e o seu trabalho; O trabalho do enfermeiro e seu reconhecimento. Os resultados mostraram que o perfil sociodemográfico da população é composta por uma maioria feminina; a faixa etária predominante é de 55 a 64 anos e o grau de escolaridade da população é baixo. Para 75,4% dos sujeitos a atual internação hospitalar não é a primeira. No que se refere ao conhecimento que o participante tem sobre o enfermeiro, constatou-se que eles relatam saber quem é o profissional, qual é o seu grau de escolaridade, porém um número significativo não conhecia a composição da equipe de enfermagem (41,5%), demonstrando ser esse um fato contraditório. No que se refere ao reconhecimento conferido ao enfermeiro e seu trabalho, os participantes consideraram importante tanto o trabalho desenvolvido pelo enfermeiro, como também a sua atuação na equipe de saúde, e declararam a pouca valorização social que é imputada à profissão. As principais formas de reconhecimento atribuídas nesta pesquisa estavam relacionadas a sentimentos afetuosos positivos que a figura do enfermeiro gera e a excelência na prestação de cuidados de enfermagem. / The present research has as object of study the [re]cognition that users of a general hospital have about the work of the nurse. Its general objective is to discuss the understanding of users of a general hospital in Rio de Janeiro about the work of the nurse, in the light of their professional recognition, and its specific objectives are: to identify the [re]cognition that users have on the work of nurse and analyze the [re]cognition of users, seeking approaches and distances of the competence of the nurse. This research is based on the theoretical concepts of the psychodynamics of work developed by Dejours, appropriating more deeply, the discussion on the dynamics of the recognition, in which believes that recognition can be a means that enables the transformation of suffering at work in pleasure. In order to respect the ethical principles and the resolution 196/96, this survey was forwarded to the Ethics Committee and Research with Human Beings/SR-2/UERJ and obtained assent with Protocol number 49.3.2012. This is a descriptive-exploratory study of quantitative approach and cross design. The population were patients hospitalized in clinical and surgical wards of the hospital in question. To better characterize the profile of hospitalized clients, was used the Patient Classification System prepared by Perroca (1996), that is based on individualized nursing care needs, in order to identify the extent of dependence degree that subject features of nursing staff. The 65 participants of the survey were selected through an intentional sample. The data-gathering instrument used was a form containing 22 questions, being 18 closed questions and 04 open questions. The information has been collected in the period from August to October 2012 and analyzed using simple descriptive statistics. The presentation of the data was through tables and their discussion had four topics, they are: Socio-demographic profile of the population; Previous hospital experiences; Knowledge of the population about the nurse and his work; The work of nurses and its recognition. The results showed that the demographic profile of the population is made up of a female majority; the predominant age group is from 55 to 64 years, and the educational level of the population is low. To 75.4% of the subjects the current hospitalization is not the first. With regard to the knowledge that the participants have about the nurse, it was found that they report to know who is professional, which is your level of education, but a significant number did not know the composition of the nursing staff (41.5%), demonstrating that this is a contradictory fact. With regard to the recognition given to the nurse and his work, the participants considered important to both the work done by the nurse, as well as their performance in the health team, and declared the little social value that is attributed to the profession. The main forms of recognition granted in this survey were related to positive affectionate feelings that figure of the nurse raises and excellence in nursing care.

A presente pesquisa tem como objeto de estudo [re]conhecimento que os usuários de um hospital geral detêm sobre o trabalho do enfermeiro. Seu objetivo geral é discutir o entendimento dos usuários de um hospital geral do Rio de Janeiro sobre o trabalho do enfermeiro, à luz do seu reconhecimento profissional, e seus objetivos específicos são: identificar o [re]conhecimento que os usuários possuem sobre o trabalho do enfermeiro e analisar o [re]conhecimento dos usuários sobre o trabalho dos enfermeiros, buscando aproximações e distanciamentos das competências do enfermeiro. Esta pesquisa apoia-se nas concepções teóricas da psicodinâmica do trabalho desenvolvidas por Dejours, se apropriando mais profundamente, da discussão sobre a dinâmica do reconhecimento, na qual acredita que o reconhecimento pode ser um meio que possibilita a transformação do sofrimento no trabalho em prazer. Com o intuito de respeitar os princípios éticos e a Resolução 196/96, essa pesquisa foi encaminhada ao Comitê de Ética e Pesquisa com Seres Humanos/SR-2/UERJ e obteve parecer favorável com protocolo n 49.3.2012. Trata-se de um estudo exploratório-descritivo de abordagem quantitativa e desenho transversal. A população foram clientes internados nas enfermarias cirúrgicas e clínicas do referido hospital. Para melhor caracterizar o perfil da clientela internada foi utilizado o Sistema de Classificação de Pacientes elaborado por Perroca (1996) que baseia-se nas necessidades individualizadas de cuidado de enfermagem, com o intuito de identificar o grau de dependência que o sujeito apresenta da equipe de enfermagem. Os 65 participantes da pesquisa foram selecionados por meio de uma amostra intencional. O instrumento de coleta de dados utilizado foi um formulário contendo 22 perguntas, sendo 18 fechadas e 04 abertas. As informações foram coletadas no período de agosto a outubro de 2012 e analisadas utilizando-se da estatística descritiva simples. A apresentação dos dados foi através de tabelas e a sua discussão teve quatro tópicos, são eles: Perfil sociodemográfico da população; Experiências hospitalares anteriores; Conhecimento da população sobre o enfermeiro e o seu trabalho; O trabalho do enfermeiro e seu reconhecimento. Os resultados mostraram que o perfil sociodemográfico da população é composta por uma maioria feminina; a faixa etária predominante é de 55 a 64 anos e o grau de escolaridade da população é baixo. Para 75,4% dos sujeitos a atual internação hospitalar não é a primeira. No que se refere ao conhecimento que o participante tem sobre o enfermeiro, constatou-se que eles relatam saber quem é o profissional, qual é o seu grau de escolaridade, porém um número significativo não conhecia a composição da equipe de enfermagem (41,5%), demonstrando ser esse um fato contraditório. No que se refere ao reconhecimento conferido ao enfermeiro e seu trabalho, os participantes consideraram importante tanto o trabalho desenvolvido pelo enfermeiro, como também a sua atuação na equipe de saúde, e declararam a pouca valorização social que é imputada à profissão. As principais formas de reconhecimento atribuídas nesta pesquisa estavam relacionadas a sentimentos afetuosos positivos que a figura do enfermeiro gera e a excelência na prestação de cuidados de enfermagem. / The present research has as object of study the [re]cognition that users of a general hospital have about the work of the nurse. Its general objective is to discuss the understanding of users of a general hospital in Rio de Janeiro about the work of the nurse, in the light of their professional recognition, and its specific objectives are: to identify the [re]cognition that users have on the work of nurse and analyze the [re]cognition of users, seeking approaches and distances of the competence of the nurse. This research is based on the theoretical concepts of the psychodynamics of work developed by Dejours, appropriating more deeply, the discussion on the dynamics of the recognition, in which believes that recognition can be a means that enables the transformation of suffering at work in pleasure. In order to respect the ethical principles and the resolution 196/96, this survey was forwarded to the Ethics Committee and Research with Human Beings/SR-2/UERJ and obtained assent with Protocol number 49.3.2012. This is a descriptive-exploratory study of quantitative approach and cross design. The population were patients hospitalized in clinical and surgical wards of the hospital in question. To better characterize the profile of hospitalized clients, was used the Patient Classification System prepared by Perroca (1996), that is based on individualized nursing care needs, in order to identify the extent of dependence degree that subject features of nursing staff. The 65 participants of the survey were selected through an intentional sample. The data-gathering instrument used was a form containing 22 questions, being 18 closed questions and 04 open questions. The information has been collected in the period from August to October 2012 and analyzed using simple descriptive statistics. The presentation of the data was through tables and their discussion had four topics, they are: Socio-demographic profile of the population; Previous hospital experiences; Knowledge of the population about the nurse and his work; The work of nurses and its recognition. The results showed that the demographic profile of the population is made up of a female majority; the predominant age group is from 55 to 64 years, and the educational level of the population is low. To 75.4% of the subjects the current hospitalization is not the first. With regard to the knowledge that the participants have about the nurse, it was found that they report to know who is professional, which is your level of education, but a significant number did not know the composition of the nursing staff (41.5%), demonstrating that this is a contradictory fact. With regard to the recognition given to the nurse and his work, the participants considered important to both the work done by the nurse, as well as their performance in the health team, and declared the little social value that is attributed to the profession. The main forms of recognition granted in this survey were related to positive affectionate feelings that figure of the nurse raises and excellence in nursing care.

Este estudo tem por objeto a compreensão do reconhecimento profissional e social do Agente Comunitário de Saúde (ACS) destacando-se as influências das relações sociais impostas, mas que ao mesmo tempo trazem para o cenário o fruto destas relações, a desigualdade social, que remete ao conceito de classes sociais nas relações entre Estratégia de Saúde da Família (ESF) e favela. O objetivo geral é estudar e analisar a percepção dos ACS na Estratégia de Saúde da Família das áreas programáticas (AP) 2.1, 3.1 e 5.2 do município do Rio de Janeiro acerca do seu reconhecimento social e profissional a partir das categorias de reconhecimento e classe social. O estudo é desenvolvido por meio de uma abordagem qualitativa, com base nas narrativas do trabalho, reconhecimento, classe social e gênero, com organização e análise segundo a metodologia do Discurso do Sujeito Coletivo. Os campos de pesquisas utilizados foram às áreas programáticas (A.P.) 2.2, 3.1 e 5.2. Os resultados geraram dois eixos temáticos: Percepção do que levou este trabalhador a ser ACS; Falta de reconhecimento e valorização. O fato de estar desempregado ou inserido em formas de subemprego surgiu como a maior motivação para ser tornar ACS; A divulgação do processo seletivo público leva o ACS a acreditar que será contratado por um estatuto, gerando a expectativa em ser funcionário público e ter garantias trabalhistas sólidas, afastando a possibilidade de voltar a estar desempregado. Na segunda categoria, as questões destacadas incluem: A ACS é morador de uma favela e pertence à classe trabalhadora. A grande maioria destes trabalhadores são mulheres, que precisam estar perto de casa para exercer seu papel também como educadora dos filhos, mas também para aumentar sua renda ou até mesmo exercer seu papel como provedora de uma família inteira, o que também possui determinação de classe social. O ACS se percebe desvalorizado como mediador no trabalho educativo. Esta desvalorização denota a compreensão do trabalho do ACS como de baixa complexidade. A questão salarial também é um fato ao qual o ACS atribui sua desvalorização como trabalhador, e retrata um pertencimento econômico a uma determinada classe social, a classe explorada pelo capital. Conclui-se que o que a inserção de trabalhadores comunitários, via seleção e contratação de ACS na atenção básica aproveita as redes sociais de integração pré-formadas nas comunidades para inserir e dar eficácia às ações de saúde. O atual contexto de trabalho do ACS representa um modo de produção da saúde que aliena este trabalhador, destituindo-o do seu processo de trabalho e reforçando a estrutura de classes presente na sociedade, interferindo no reconhecimento social e profissional do ACS. / This study aims the understanding of social and professional recognition of Community Health Agent (CHA) highlighting the influences of social relations imposed, wich, at the same time, bring to the stage the outputs of these relations: social inequality, refered to the concepts of social classes and relationship between health services and the slums (favelas). The overall goal is to study and analyze the perception of CHA in the Family Health Strategy in three program areas (PA) of Rio de Janeiro city on their social and professional recognition based on the categories of recognition and social class. The study is developed through a qualitative approach, based on the narratives of labour, recognition, social class and gender, organization and analysis according to the Methodology of the Collective Subject Discourse. The results generated two main themes: Perception of what led this subject to become a CHA; Lack of recognition and appreciation. The fact of being unemployed or inserted in forms of underemployment emerged as the biggest motivation for becoming CHA; disclosure of public selection process leads these workers to believe that the CHA will be hired by statute, creating the expectation of being a public servant and have labor rights solid, eliminating the possibility of returning to being unemployed. In the second category, the issues highlighted include: CHA is a slum dweller and belongs to working class. The vast majority of these workers are women, who need to be close to home to play its role as educator of children, but also to increase their income or even execer its role as a provider of an entire family, which also have determination of social class. The CHA is perceived as undervalued mediator in educational work. This devaluation denotes the understanding of the CHA work as one of low complexity. The salary issue is also a fact to which ACS assigns its devaluation as a worker, and portrays an economic belonging to a certain social class, the class exploited by capital. It follows that the insertion of community workers, via selection and hiring of CHA in primary care units uses social networks preformed in communities to give effect to the health actions. The current work context of the ACS represents a mode of production that alienates this health worker, depriving him of his working process and reinforcing the class structure in this society, interfering with their social and professional recognition.

Este estudo tem por objeto a compreensão do reconhecimento profissional e social do Agente Comunitário de Saúde (ACS) destacando-se as influências das relações sociais impostas, mas que ao mesmo tempo trazem para o cenário o fruto destas relações, a desigualdade social, que remete ao conceito de classes sociais nas relações entre Estratégia de Saúde da Família (ESF) e favela. O objetivo geral é estudar e analisar a percepção dos ACS na Estratégia de Saúde da Família das áreas programáticas (AP) 2.1, 3.1 e 5.2 do município do Rio de Janeiro acerca do seu reconhecimento social e profissional a partir das categorias de reconhecimento e classe social. O estudo é desenvolvido por meio de uma abordagem qualitativa, com base nas narrativas do trabalho, reconhecimento, classe social e gênero, com organização e análise segundo a metodologia do Discurso do Sujeito Coletivo. Os campos de pesquisas utilizados foram às áreas programáticas (A.P.) 2.2, 3.1 e 5.2. Os resultados geraram dois eixos temáticos: Percepção do que levou este trabalhador a ser ACS; Falta de reconhecimento e valorização. O fato de estar desempregado ou inserido em formas de subemprego surgiu como a maior motivação para ser tornar ACS; A divulgação do processo seletivo público leva o ACS a acreditar que será contratado por um estatuto, gerando a expectativa em ser funcionário público e ter garantias trabalhistas sólidas, afastando a possibilidade de voltar a estar desempregado. Na segunda categoria, as questões destacadas incluem: A ACS é morador de uma favela e pertence à classe trabalhadora. A grande maioria destes trabalhadores são mulheres, que precisam estar perto de casa para exercer seu papel também como educadora dos filhos, mas também para aumentar sua renda ou até mesmo exercer seu papel como provedora de uma família inteira, o que também possui determinação de classe social. O ACS se percebe desvalorizado como mediador no trabalho educativo. Esta desvalorização denota a compreensão do trabalho do ACS como de baixa complexidade. A questão salarial também é um fato ao qual o ACS atribui sua desvalorização como trabalhador, e retrata um pertencimento econômico a uma determinada classe social, a classe explorada pelo capital. Conclui-se que o que a inserção de trabalhadores comunitários, via seleção e contratação de ACS na atenção básica aproveita as redes sociais de integração pré-formadas nas comunidades para inserir e dar eficácia às ações de saúde. O atual contexto de trabalho do ACS representa um modo de produção da saúde que aliena este trabalhador, destituindo-o do seu processo de trabalho e reforçando a estrutura de classes presente na sociedade, interferindo no reconhecimento social e profissional do ACS. / This study aims the understanding of social and professional recognition of Community Health Agent (CHA) highlighting the influences of social relations imposed, wich, at the same time, bring to the stage the outputs of these relations: social inequality, refered to the concepts of social classes and relationship between health services and the slums (favelas). The overall goal is to study and analyze the perception of CHA in the Family Health Strategy in three program areas (PA) of Rio de Janeiro city on their social and professional recognition based on the categories of recognition and social class. The study is developed through a qualitative approach, based on the narratives of labour, recognition, social class and gender, organization and analysis according to the Methodology of the Collective Subject Discourse. The results generated two main themes: Perception of what led this subject to become a CHA; Lack of recognition and appreciation. The fact of being unemployed or inserted in forms of underemployment emerged as the biggest motivation for becoming CHA; disclosure of public selection process leads these workers to believe that the CHA will be hired by statute, creating the expectation of being a public servant and have labor rights solid, eliminating the possibility of returning to being unemployed. In the second category, the issues highlighted include: CHA is a slum dweller and belongs to working class. The vast majority of these workers are women, who need to be close to home to play its role as educator of children, but also to increase their income or even execer its role as a provider of an entire family, which also have determination of social class. The CHA is perceived as undervalued mediator in educational work. This devaluation denotes the understanding of the CHA work as one of low complexity. The salary issue is also a fact to which ACS assigns its devaluation as a worker, and portrays an economic belonging to a certain social class, the class exploited by capital. It follows that the insertion of community workers, via selection and hiring of CHA in primary care units uses social networks preformed in communities to give effect to the health actions. The current work context of the ACS represents a mode of production that alienates this health worker, depriving him of his working process and reinforcing the class structure in this society, interfering with their social and professional recognition.

Lazarus and Folkman's (1984) transactional stress-strain-coping theory provides the theoretical background for the present thesis. This theory proposes that strain (i.e., burnout) occurs when demands (i.e., work stressors) exceed coping resources (e.g., social support). The current thesis explores the influence of social support on the stress-burnout relationship in nurses. A sample of Australian nurses working across three public hospitals in Brisbane's metropolitan district were recruited to investigate the nature and level of burnout experienced by nurses. Burnout is characterised by emotional exhaustion, depersonalisation and reduced personal accomplishment. The present research addresses gaps in the empirical literature by investigating the key work stressors experienced by Australian nurses and by establishing nurses' referent levels of work stress, social support, and burnout. In addition, the research explores the complex relationships between work stress, social support and burnout. The majority of nursing studies have failed to consider how support from within the nurses' work environment mitigates burnout. The present research builds upon previous nursing literature by examining the "main&qout; and "buffering" effect hypotheses. Studies have consistently found support for the main effect model, however the hypothesis that social support buffers the negative effects of stress has resulted in highly conflicting findings. Some theorists (Cohen & Wills, 1985; Cutrona & Russell, 1990) propose that the buffering effects of social support will only be found if there is an adequate match between the needs elicited by the stressful event and the type of support an individual receives. The present study extends the stress or support matching theory by exploring the matching between specific types of stressors to specific types (i.e., emotional and instrumental) and sources (i.e.,supervisor and coworkers) of support. Cutrona (1990) suggests that the controllability of a stressor is the primary dimension in determining an appropriate match between stressors and types of support. Cutrona proposes that controllable stressful events elicit needs for instrumental support and uncontrollable events elicit needs for emotional support. Heeding Cutrona's advice, independent raters classified nurses' work stressors as controllable or uncontrollable stressful events prior to investigating the stressor-support matching theory. Three sequential studies were undertaken to explore the variables of interest to this research program. In Study 1, focus groups were conducted with 68 nurses (11 males, 34 females) from two public hospitals. The qualitative data was subjected to content analysis. The findings revealed that Australian nurses are exposed to a range of job-specific stressors (i.e., Job Conditions, Job Uncertainty, Interpersonal Conflict and a Lack of Professional Recognition and Support) and generic role stressors (i.e., Role Overload, Role Conflict and Role Ambiguity). The findings prompted the research to utilise Wolfgang's (1988) Health Professions Stress Inventory to measure nurses' job-specific stressors and Osipow and Spokane's (1987) Occupational Roles Questionnaire to measure nurses' role stressors in Study 2. The findings from Study 1 also confirmed that the way nurses perceive work support is consistent with current social support literature. Nurses indicated that their two main sources of support were their coworkers and their supervisor. Furthermore, nurses discussed social support from a multidimensional perspective, recognising different types of support that were broadly classified as emotional and instrumental support. Based on these findings, the researcher developed a work support measure specifically for the purpose of this research. Items were taken from established social support scales and were slightly modified to ensure that they were contextually relevant to nurses. In Study 2, 273 nurses (38 males, 235 females) completed a multi-measure questionnaire. While there was sufficient research evidence to indicate that the Occupational Roles Questionnaire (Osipow & Spokane, 1987) and the Maslach Burnout Inventory (Maslach, Jackson, & Leiter, 1996) possess adequate levels of reliability and validity, less was known about Wolfgang's Health Professions Stress Inventory and the work support scales designed for this research program. Factor analysis of the Health Professions Stress Inventory revealed a four-factor solution: Lack of Professional Recognition and Support, Patient Care Uncertainty, Job Conditions, and Interpersonal Conflict. Cronbach's coefficient alphas ranged from .62 to .83. Factor analysis of the Coworker Support Scale revealed a two-factor solution, representing emotional and instrumental support. Cronbach's coefficient alphas for the Emotional Coworker Support and Instrumental Coworker Support were .92 and .88 respectively. Contrary to expectations, factor analysis of the Supervisor Support Scale revealed a one-factor solution. It was therefore deemed appropriate to examine Supervisor Support as a unidimensional construct in subsequent analyses. Cronbach's coefficient alpha for the Supervisor Support scale was .96. Overall, the results from Study 2 provided supporting evidence to suggest that the measures used in the current research program were psychometrically sound. In Study 3, the data collected in Study 2 was subjected to further statistical analysis. The findings from Study 3 indicated that overall, the sample of Australian nurses reported low to moderate levels of work stress, moderate levels of work support and moderately high levels of burnout. For Emotional Exhaustion, predictor variables accounted for 42.2% of the total variance. Sociodemographic factors explained a small but significant proportion of the variance (2.7%). Work stressors however, were the main predictors of Emotional Exhaustion, explaining 41.5% of the total variance. Role Overload, Job Conditions and Role Conflict were the main determinants of Emotional Exhaustion, with Role Overload explaining most of the variance. For Depersonalisation, the predictor variables accounted for 34.2% of the total variance. Sociodemographic factors (11.5%) and work stressors (33.6%) both explained a significant proportion of the variance. Role Conflict and Patient Care Uncertainty were the main determinants of Depersonalisation, with Role Conflict explaining most of the variance. For Personal Accomplishment, Role Conflict and Role Ambiguity explained 20.5% of the total variance, with Role Conflict explaining most of the variance. Sociodemographic factors and job-specific stressors were not significant Predictors of Personal Accomplishment. Evidence for main effects of work support on burnout were limited. There was no evidence to suggest that work support had significant main effects on Emotional Exhaustion. Supervisor Support had a small, but significant main effect on Depersonalisation (â = -.15, p < .05) and Personal Accomplishment (â = -.24, p < .01). There was no evidence of main effects for Emotional and Instrumental Coworker Support. Furthermore, the present research found no significant evidence to support the buffering effect of work support on burnout. Theoretical and practical implications of these findings are discussed.

Tant l’Union européenne (UE) que le Marché Commun du Sud (MERCOSUR) ont construit différentes politiques publiques pour la reconnaissance des diplômes à des fins académiques ou à des fins professionnelles. Ces politiques ont pour but principal de faciliter la mobilité des diplômés respectifs dans les pays membres qui composent chaque région.En dépit du fait qu’il s’agit de processus d’intégration régionale très différents, la construction des politiques de reconnaissance académique-professionnelle présente plusieurs similitudes. Les deux politiques se sont dédoublées dans un axe académique et un autre axe professionnel, comme s’il s’agissait de secteurs complétement éloignés l’un de l’autre. Conséquemment, nous avons analysé quatre enjeux dans ce travail : d’abord, le processus que lance la Commission européenne (CE) au début des années 1970 avec les directives sectorielles pour les « professions réglementées » et, qui après différents changements, culmine dans les Directives 2005/36/CE et 2013/55/UE. Deuxièmement, le processus qui se développe principalement à partir de la mise en œuvre du Programme Erasmus en 1986, et qui techniquement pose les bases pour que soit lancé de façon intergouvernementale en 1999 le « processus de Bologne ». Troisièmement, en 1998, le MERCOSUR décide de construire un premier instrument expérimental d’accréditation des cursus universitaires au niveau régional (le MEXA), qui suite à différents changements, est devenu un dispositif permanent : l’ARCUSUR. Finalement, les Ministères des affaires étrangères des pays membres du MERCOSUR ont avancé avec un protocole concernant le secteur des services de la région et, suite à différentes négociations, le Conseil du Marché Commun a permis la pratique professionnelle temporaire à partir d’un autre dispositif : la Décision 25/2003.Ce divorce entre reconnaissance académique et professionnelle nous a invité, d’un côté, à questionner les rapports contemporains entre l’État ou la CE et les différentes associations professionnelles, l’université et la construction des diverses politiques européennes ou du MERCOSUR. Et, d’un autre côté, à analyser la place de l’État et de la CE dans cette construction et les rapports avec les normes ou « recommandations » provenant des organisations internationales. / Both the European Union (EU) and the Southern Common Market (MERCOSUR) have constructed different public policies for the recognition of diplomas for either academic or professional purposes. The aim of these policies is to facilitate the mobility of its respective graduates within the countries members of each region.Despite the fact that they are two different regional integration processes, the construction of academic and professional recognition policies have several similarities. The two policies were spread out in two axis, an academic one and a professional one, as if they were fully separated areas from each other. Hence, we analyzed four issues in this work. First, the process that launches the European Commission (EC) in the early 1970s with the sectorial directives for the “regulated professions” and which, after various changes, culminating in Directives 2005/36/EC and 2013/55/EU. Second, the process initiated with the Erasmus Program’s implementation in 1986. This program provides the technical support for the intergovernmental launch the “Bologna process” in 1999. Third, in 1998 MERCOSUR decided to build a first experimental accreditation instrument of academic programs at the regional level (MEXA). After several changes, it has become a permanent device: the ARCUSUR. Finally, the Ministries of Foreign Affairs of MERCOSUR members have made some progress in implementing a protocol for the regional services sector and followed by different negotiations, the Council of the Common Market allowed the temporary professional practice from another device: Decision 25/2003. This dissociation between academic and professional recognition invited us to analyze two distinctive phenomenons. On the one hand, is to question the contemporary relations among the State or the EC and the different professional associations, the university and the construction of the divers European or MERCOSUR policies. And on the other hand, is to analyze the role of the State and the EC in the construction and the relation with normative or “recommendations” from international organizations.