Many children with life-limiting health conditions in pediatric palliative care have cognitive impairments or intellectual disabilities (ID). They are confronted with their own death and need adapted psychosocial support. The assumption that children with ID might not understand death and dying can lead to limited support. Little is known about psychosocial support in pediatric palliative care around death, dying, and grief for this population. The study aimed to capture professionals' experiences in supporting children with ID in pediatric palliative care around topics of death, dying, and grief. Seven professionals who worked in pediatric palliative care in Germany were interviewed utilizing a qualitative research approach with semi-structured interviews. Inductive thematic analysis was used, and three major themes were identified: Communication about death and dying involves both verbal and non-verbal means, Child-centered interventions are employed to enhance the child's well-being, and Personal factors of involved individuals influence the support provision. The provided support was highly individualized to children's needs. Communication difficulties were identified as a challenge for professionals when providing psychosocial support for children with ID. Children's health condition and functioning, parents' beliefs, and professionals' attitudes towards ID and uncertainty about children's needs were identified as crucial factors influencing support provision for children with ID. The need for further research was highlighted.

The level of brutality and violence against children abducted and forcefully conscripted by the Lord¿s Resistance Army (LRA) in northern Uganda pricked the conscience of humanity. The suffering of the people in northern Uganda was described by Jan Egeland, the former United Nations Under- Secretary for Humanitarian Affairs, as ¿the biggest forgotten humanitarian crisis in the world¿. This study is primarily concerned with the plight of child soldiers in northern Uganda and how their effective reintegration and rehabilitation (RR) could lead to successful peacebuilding. The study is premised on the hypothesis that ¿the promotion of the RR of former child soldiers by providing psychosocial support based on traditional and indigenous resources may contribute to conditions of peace and stability in northern Uganda.¿ The main contribution of this research is that it explores the relevance of psychosocial support based on the traditional and indigenous resources to the RR of child soldiers and peacebuilding of war-torn societies. Psychosocial support based on traditional and indigenous resources as an element of peacebuilding has been the neglected element of peacebuilding by the liberal peacebuilding interventions in most war-torn societies. For example, while traditional and indigenous resources in northern Uganda have been instrumental in the RR of former child soldiers, most scholars and policy makers have largely paid attention to the usual official government and United Nations structured top-down interventions that emphasize Western approaches of peacebuilding. More so, the official approaches have tended to marginalize the plight of former child soldiers in the reconstruction and peacebuilding of northern Uganda. Yet, failing to pay sufficient attention to effective RR of child soldiers could undermine the peace dividends already achieved in northern Uganda. The study also analyses the limitations of psychosocial support based on traditional and indigenous resources in the RR of former child soldiers. It further examines why Western approaches of psychosocial support in the RR of child soldiers have remained in use in spite of the criticisms levelled against them. The study examines other peacebuilding interventions, both official and unofficial, that have been implemented in northern Uganda. In terms of key findings, the study establishes that traditional and indigenous resources are still popular and have been widely used in northern Uganda in the RR of child soldiers. Majority of former child soldiers who were interviewed observed that they found traditional and indigenous resources more helpful than the Western models of psychosocial support. However, it was also established that there is a significant section of former child soldiers who found Western models more relevant in their RR processes. Based on these findings, the study recommends an integrative and holistic model of psychosocial support that blends good elements from both traditional and indigenous resources and Western approaches with greater emphasis on the former. / Advocates Coalition for Development and Environment (ACODE)

Since the start of the Syrian war, Jordan has received many Syrian refugees with around 650,000 Syrians now residing in the country. As the state has received a lot of help from the international community, funding refugee camps and providing basic necessities, a lot of international humanitarian practitioners have come to Jordan to work alongside Jordanian and Middle Eastern practitioners. The situation therefore has brought practitioners from different academic, professional and geographical backgrounds together to work with people of a different cultural background than their own. Syrians represent a vast diversity in terms of ethnic, religious, linguistic and socio-economic backgrounds. Research have addressed that practitioners’ sensitivity to how cultural complexities may influence social problems can facilitate a better understanding of the client’s path to recovery. The purpose of our study was to increase the knowledge of mental health and psychosocial support practitioners’ understanding and experience of a culturally sensitive social work in Amman, Jordan and discuss how this affects their practice with Syrian refugees. Through qualitative interviews we found that the practitioners’ perception of Arab culture as one and the same makes culture a non-issue in terms of cultural diversity, and that this perception influence the practice with Syrian refugees in a number of ways.

Existe uma tensão extraordinária no sistema humanitário: crises e emergências atingem cada vez mais povos, duram mais e são gradativamente mais complexas. As consequências dos conflitos armados e desastres socioambientais para a saúde mental e bem-estar psicossocial de indivíduos e povos, bem como para a ecologia social e os recursos comunitários significativos, já são reconhecidas e continuamente pesquisadas. Esta tese, a seu turno, explora as práticas e políticas do setor de Saúde Mental em emergências humanitárias e toma como ponto de partida analítico o desenvolvimento das Diretrizes do Comitê Permanente Interagências (IASC) em Saúde Mental e Apoio Psicossocial (SMAPS) em emergências humanitárias, lançadas no ano de 2007, assim como sua subsequente disseminação e configuração de governança, além de sua influência sobre projetos e instituições. As diretrizes IASC representam um marco lógico de importante contribuição para o setor de ajuda humanitária, no entanto, ainda constituem um campo de várias disputas e paradoxos, não só na área das referências teóricas e práticas em SMAPS em emergências humanitárias, como também relativamente à sua inserção em uma economia-política do setor de ajuda humanitária paradoxal nos princípios humanitários e éticos. Essa inserção molda as características particulares do funcionamento das Diretrizes e influencia a maneira como se produzem práticas e políticas. Fundamentando-se na pesquisa-ação, nas experiências do autor, o qual atuou como psicólogo na linha de frente em crises humanitárias na Líbia, Gaza, Síria, Timor-Leste e outros contextos, e em entrevistas com atores internacionalmente renomados e responsáveis pela elaboração e gestão de políticas internacionais do setor global de SMAPS, esta tese examina esse processo em detalhe, considerando o desenvolvimento e evolução das Diretrizes IASC de SMAPS e como, atualmente, a área de SMAPS se configura no interior da economia-política do setor humanitário. Mais explicitamente, analisam-se as maneiras como o discurso e a prática do setor de SMAPS são transformados pela estrutura humanitária que ele engendra. Desse modo, e por meio da discussão de todos esses elementos, este trabalho objetiva realizar uma revisão de elementos que influenciam e permitem o desenvolvimento de assistência humanitária seja cooptada em formas particulares que se articulam a interesses não humanitários, moldando substancial e prejudicialmente os projetos de SMAPS em emergências humanitárias ao redor do mundo. / There is extraordinary strain placed on the humanitarian system. Crises and emergencies are occurring more often, affecting more people, and in contexts of increasingly complexity. The impacts of conflict and disaster on mental health as well as on the social ecology and community resources needed for coping and recovery are very well documented. This research explores the politics of mental health and psychosocial programmes in humanitarian settings, and its analytical starting point is the development of the Interagency Standing Committee (IASC) Guidelines on Mental Health and Psychosocial Support (MHPSS) in Emergencies settings launched in the year of 2007. The research explores how the field was developed, its structural governance, trying to explore the political economy configuration of humanitarian organizations providing MHPSS in its discourses, practices and impact. It is demonstrated the MHPSS IASC guidelines unprecedent contribution to the field, however it shows how it is affected by the political economy of aid that it is fundamentally part of. This structural political economy shapes the field and influences the way SMAPS is provided. Using action research, the author\'s own experiences responding to several humanitarian crises for more than 14 years, and interviews with well-known global MHPSS policy makers, this thesis examines this process in detail, considering how the development of the guidelines has developed and evolved, and how the area currently shapes in the political economy of aid. More explicitly, it analyzes the ways in which the discourse and practice of the MHPSS field are transformed by the humanitarian structure it engenders. Despite the field achievements, action research illustrates that this process allows the development of MHPSS response to be co-opted in particular ways that articulate non-humanitarian interests, substantially and harmfully influencing the MHPSS responses.

Made available in DSpace on 2016-03-22T17:27:39Z (GMT). No. of bitstreams: 1 cAMILLA.pdf: 182088 bytes, checksum: 7d4a56422ea83fe44f3803e70f90a6f0 (MD5) Previous issue date: 2006-05-19 / Object: To evaluate the efficacy of a young and lack of experience doula, men and women, on the reduction providing support during labor to young and first time mother. Until now, the majority of studies refer as a doula to a professional and experienced trained woman. Their aims are examined whether a doula altered obstetrical and neonatal outcomes. Methods: 605 primiparous at term which 368 had doula during labor and 237 usual care. The study data were obtained in 1995-1996 at the maternity of São Francisco de Paula´s hospital in Pelotas, RS. We used a questionnaire tested before containing social and demographic information and specific information about the pregnancy and the labor. Results: The duration of the labor for women who had doula was shorter then in the control group (4.8 hours; d.p=4.6 hours versus 6.0 hours; d.p=5.3 hours / p<0.000). In the group of female doula the duration of the labor was 3.6 hours (d.p=3.2 hours) on the other hand, in the male group was 4.5 hours (d.p=4.3 hours). Type of birth, use of forceps, oxytocin administration, smoking during pregnancy, Apgar, newborn´s weight, prenatal care, maternal education and family income didn´t show any significant association with the doula. Conclusions: For this population and setting, labor support from young and lack of experience doula, mainly the female companion, was significantly associated with a shorter labor in primigravidous women. / Objetivos: Avaliar o efeito de doulas inexperientes e jovens, de ambos os sexos, na redução de tempo de trabalho de parto em primíparas jovens. Na literatura, até o presente, as doulas têm sido mulheres maduras e experientes, avaliando-se os efeitos de suas presenças no suporte intra-parto, considerando vários desfechos médicos e psicossociais. Método: Através de ensaio clínico controlado, 605 primíparas foram estudadas, das quais 368 foram acompanhadas por doulas (176 do sexo feminino e 192 do sexo masculino, jovens, inexperientes, estudantes de Medicina e Psicologia), no trabalho de parto. Um grupo de 237 primíparas sem intervenção foi utilizado como controle. A coleta de dados foi realizada nos anos de 1995-1996, na Maternidade do Hospital São Francisco de Paula da Universidade Católica de Pelotas, RS. Mediante um questionário padronizado e testado em estudo piloto, a duração do trabalho de parto foi tomada como desfecho e avaliaram-se dados sócio-demográficos e informações específicas sobre a gestação e o parto. Resultados: A duração média do trabalho de parto para todas as pacientes foi de 4,8 hs (d.p.=4,6 hs). No grupo de doulas femininos foi de 3,6 horas (d.p.=3,2 hs), no grupo de doulas masculinos foi de 4,5 horas (d.p.=4,3 hs) e no grupo controle teve duração média de 6,0 horas (d.p.=5,3 hs) (p<0,000). As variáveis tipo de parto, uso de fórceps, indução, baixo peso ao nascer, pré-natal, escolaridade da mãe, Apgar, fumo durante a gravidez e renda familiar não mostraram associação significativa com o tipo de acompanhante. Conclusão: A presença de doulas jovens e inexperientes, principalmente do sexo feminino, esteve associada a uma menor duração de trabalho de parto em primíparas jovens.

<p>The purpose of this study has been to investigate how psychosocial support for families where a parent suffers from a life threatening illness can be constructed. The intent was also to explore how the child's perspective is protected and what barriers and opportunities there are for family oriented support. The study has a qualitative approach and includes interviews with four social workers. The interviews were analyzed with a systems theory and attachment theory. The conclusions are that the whole family suffers psychological and social pressures when a parent is sick. The psychosocial support is given individually and to the family as a unit to help them deal with their changed life situation and facilitate subsequent grieving. An important aspect of the support is psycho education to parents and children, which aims to increase the understanding of the situation, their individual and each others' reactions. The social workers stress that it’s important to establish contacts in the family’s private network and support agencies in the community.</p><p>It falls under the medical mission to offer support to relatives and it includes a responsibility to inform and support the child based on individual circumstances. However, there seems to exist a variation and uncertainty about its nature and extent. Therefore professionals need to be aware of the importance of highlighting the child’s needs and support families.</p>

<p>Att vårda en närstående person med demens innebär en stor börda för anhörigvårdaren vilket kan resultera i psykisk ohälsa. Stöd är en viktig del för att minska bördan. Syftet med studien var att ur ett omvårdnadsperspektiv belysa anhörigas upplevelse av psykosocial börda och psykosocialt stöd vid vård av en person med demens i hemmet. Studien var en systematisk litteraturstudie som baserades på 15 vetenskapliga artiklar. I resultatet framkom att anhöriga som vårdar en person med demens upplevde en psykisk och fysisk börda. Den tyngsta psykiska bördan uppgavs vara brist på egen tid och att känna sig isolerad från omvärlden. Anhörigvårdarens individuella uppfattning om sig själv och förhållandet till personen med demens påverkade bördan. Informellt socialt stöd visade sig viktigt och minskade risken för depression. Det framkom att socialt stöd och stödgrupper var betydelsefullt för den anhörige. De anhöriga kände att de inte fick det stöd som behövdes från hälso- och sjukvårdpersonal. Därför behövs mer kunskap hos formella vårdgivare för att kunna möta behovet av stöd för anhöriga till en person med demens. Ökad kunskap och förståelse om psykosocial börda ger sjuksköterskan större förutsättningar att kunna ge anhörigvårdaren ett adekvat stöd. Ytterligare forskning krävs för att utvärdera sjuksköterskans roll som psykosocialt stöd.</p>

<p>A randomized intervention study, with the aim to compare the effects of individual psychosocial support provided by (1) oncology nurses specially trained in psychological techniques (INS), or (2) psychologists (IPS), to (3) standard care (SC). Breast cancer patients, living in Uppsala County, and about to start adjuvant treatment at the Department of Oncology, Uppsala, were consecutively included between 1998 and 2000. The patients were assessed seven times during two years by self-administered questionnaires. Study I revealed positive effects of both INS and IPS as compared to SC on global quality of life, side effects, and post-traumatic distress. A lower proportion of patients in the intervention groups had psychosocial support provided in routine care compared with the SC group. In study II the patients reported being highly satisfied with the intervention, irrespective of profession providing the support. However, patients in the INS group reported higher levels of benefit regarding disease-related problems than those in the IPS group. In study III total Health Care costs were lower in the intervention groups and since a gain in quality-adjusted life years (QALY) was seen (mean .1 QALY), the interventions dominated. The costs for the interventions were 44 291- 48 978 SEK. In study IV, daily reporting of anxiety, depression and activity on Visual Analogue Scales (VAS) were completed during two weeks before and after the Hospital Anxiety and Depression Scale (HADS) assessments. A point assessment with the HADS captured the situation better than four weeks assessment on three VAS in the diary. The HADS was considered preferable to the diary. The conclusion is that psychosocial support is beneficial for breast cancer patients and that the intervention delivered by nurses was as effective as that given by psychologists. The costs for the interventions were limited.</p>

The purpose of this study has been to investigate how psychosocial support for families where a parent suffers from a life threatening illness can be constructed. The intent was also to explore how the child's perspective is protected and what barriers and opportunities there are for family oriented support. The study has a qualitative approach and includes interviews with four social workers. The interviews were analyzed with a systems theory and attachment theory. The conclusions are that the whole family suffers psychological and social pressures when a parent is sick. The psychosocial support is given individually and to the family as a unit to help them deal with their changed life situation and facilitate subsequent grieving. An important aspect of the support is psycho education to parents and children, which aims to increase the understanding of the situation, their individual and each others' reactions. The social workers stress that it’s important to establish contacts in the family’s private network and support agencies in the community. It falls under the medical mission to offer support to relatives and it includes a responsibility to inform and support the child based on individual circumstances. However, there seems to exist a variation and uncertainty about its nature and extent. Therefore professionals need to be aware of the importance of highlighting the child’s needs and support families.

Att vårda en närstående person med demens innebär en stor börda för anhörigvårdaren vilket kan resultera i psykisk ohälsa. Stöd är en viktig del för att minska bördan. Syftet med studien var att ur ett omvårdnadsperspektiv belysa anhörigas upplevelse av psykosocial börda och psykosocialt stöd vid vård av en person med demens i hemmet. Studien var en systematisk litteraturstudie som baserades på 15 vetenskapliga artiklar. I resultatet framkom att anhöriga som vårdar en person med demens upplevde en psykisk och fysisk börda. Den tyngsta psykiska bördan uppgavs vara brist på egen tid och att känna sig isolerad från omvärlden. Anhörigvårdarens individuella uppfattning om sig själv och förhållandet till personen med demens påverkade bördan. Informellt socialt stöd visade sig viktigt och minskade risken för depression. Det framkom att socialt stöd och stödgrupper var betydelsefullt för den anhörige. De anhöriga kände att de inte fick det stöd som behövdes från hälso- och sjukvårdpersonal. Därför behövs mer kunskap hos formella vårdgivare för att kunna möta behovet av stöd för anhöriga till en person med demens. Ökad kunskap och förståelse om psykosocial börda ger sjuksköterskan större förutsättningar att kunna ge anhörigvårdaren ett adekvat stöd. Ytterligare forskning krävs för att utvärdera sjuksköterskans roll som psykosocialt stöd.