O adoecimento por tuberculose é um processo subjetivo e interpenetrado por saberes, discursos e práticas, produzidos histórico-culturalmente na vida social e nutridos em um interdiscurso (sobre a doença e o doente), que afeta o modo como o sujeito significa a sua experiência. Neste estudo, sustentamo-nos no arcabouço teórico-metodológico da análise de discurso de matriz francesa, que busca a compreensão dos processos de produção de sentidos, na relação da língua com sua exterioridade histórica e social. Partindo do pressuposto de que há uma constituição linguístico-histórica do sujeito discursivo, o estudo objetivou investigar como os discursos sobre a tuberculose afetam a (des)construção identitária do sujeito, que perpassa as constituições subjetivas em seu processo de adoecimento. Utilizando a abordagem qualitativa, foram realizadas dezesseis entrevistas registradas em áudio, no período de agosto a outubro de 2009, com sujeitos em tratamento de tuberculose em um hospital público do município de João Pessoa, Estado da Paraíba. O corpus de análise foi constituído pelas entrevistas transcritas mais as produções artísticas dos participantes como representações de seu processo de adoecimento. No gerenciamento do material de linguagem bruto, utilizou-se o Software Atlas.ti, que nos auxiliou no processo anterior às análises discursivas. O projeto deste estudo foi submetido à apreciação de um Comitê de Ética em Pesquisa, de acordo com as orientações da Resolução 196/96 do Conselho Nacional de Saúde. Ao relacionar a tuberculose a comportamentos excessivos, alcoolismo, fraqueza, vida urbana e drogadição, os sentidos produzidos pelos sujeitos entrevistados foram regidos por formações ideológicas que identificam a tuberculose como situação de desaprovação social. Observamos que as formações imaginárias, que remetem ao lugar desse sujeito doente como usuário do sistema de saúde produzem o seu apagamento, a sua interdição. Concluímos que a ênfase no simbólico, mediante os símbolos de estigma, que acentuam a visibilidade do doente de tuberculose como desviante ou sujeito \"especial\" é o mecanismo mais importante de manutenção da estigmatização da doença e do doente. / The tuberculosis illness is a subjective process pervaded by knowledge, discourses and practices produced historic-culturally in the social life and nurtured in an interdiscourse (about the illness and the patient), that affects how the subject interprets his experience. In this study we follow the French theoretical and methodological framework of discourse analysis matrix that strives to understand the meaning production processes in the language relationship with its historic and social exteriority. Assuming that there is linguistic-historical constitution of the discursive subject, the study aimed to investigate how the tuberculosis discourses affect the subject´s identity (de)construction that goes beyond the subjective constitutions in his disease process. Sixteen audio taped interviews using the qualitative approach were conducted with tuberculosis treatment subjects in a City of João Pessoa, Paraíba, public hospital, during the August - October 2009 period. The corpus of analysis consists of the transcribed interviews plus the participants\' artistic productions as representations of their illness. The Atlas.ti Software was utilized in the raw language material management which helped in the process prior to discourse analyses. The study design was submitted for assessment to a Committee for Research Ethics. By linking tuberculosis to excessive behaviors, alcoholism, weakness, urban life and drug addiction, the meanings produced by the interviewees were governed by ideological formations that identify tuberculosis as a situation of social disapproval. It was observed that the imaginary formations, which refer to the place of that sick person as user of the health system produced its effacement, its isolation. We conclude that the emphasis on the symbolic, by means of the symbols of stigma that accentuate the TB patient visibility as a \"deviant\" or special subject, is the most important mechanism in maintaining the stigmatization of the disease and the patient.

A hansenÃase à uma doenÃa estigmatizada de alto poder incapacitante atribuÃdo em parte aos episÃdios reacionais hansÃnicos. A relevÃncia do tema consiste na premÃncia em diagnosticar e tratar os episÃdios reacionais hansÃnicos, eventos inflamatÃrios agudos no curso de uma doenÃa crÃnica, que pode acometer os indivÃduos antes da hansenÃase, durante o tratamento e apÃs a alta. Tem-se como objetivo compreender a vivÃncia dos corpos com episÃdio reacional hansÃnico no Ãmbito individual, familiar e comunitÃrio. Parte-se do pressuposto que os episÃdios reacionais marcam a vida das pessoas contribuindo para o estigma e o isolamento social. Constituindo-se numa investigaÃÃo de carÃter qualitativo, desenvolvida à luz da fenomenologia existencial, este estudo teve como cenÃrio o centro de referÃncia em hansenÃase no municÃpio de Floriano no PiauÃ. Foram realizadas nove entrevistas fenomenolÃgicas, em abril de 2012, sendo quatro com mulheres e cinco com homens que vivem ou viveram tal experiÃncia. Para desvelar o fenÃmeno da vivÃncia com episÃdios reacionais, elaborou-se a questÃo norteadora: âComo à para vocà ter tido hansenÃase e apresentado episÃdio reacionalâ (considerando a sua vida pessoal, familiar e comunitÃria)? Desse modo, as falas dos sujeitos-colaboradores foram analisadas na perspectiva dos estudiosos da fenomenologia existencial. A anÃlise das descriÃÃes permitiu identificar as unidades temÃticas: corpos doÃdos â a descoberta da hansenÃase; corpos rachados â vivÃncia e transformaÃÃo do corpo com episÃdio reacional hansÃnico; corpos quebrados â a incerteza da cura pela sequela; corpos ressignificados â mudanÃa na vida apÃs o episÃdio reacional hansÃnico; corpos sentidos â vivÃncia na famÃlia e comunidade; corpos disciplinados â vivÃncia no serviÃo de saÃde. A compreensÃo do fenÃmeno culminou com o pressuposto elaborado, possibilitando desvelar algumas facetas que significam para os sujeitos-colaboradores transformaÃÃes no seu mundo, ocasionadas pela manutenÃÃo dos episÃdios reacionais, pelas incapacidades fÃsicas instaladas e pelas limitaÃÃes funcionais repercutidas nas atividades laborais e nos aspectos socioeconÃmicos da existÃncia mundana, fortalecendo, assim, o estigma social que permeia a hansenÃase/episÃdios reacionais. Revelou tambÃm a autonomia do cuidado de si enfatizado pelo conhecimento da doenÃa e pelas suas implicaÃÃes; o apoio familiar e comunitÃrio indispensÃvel no modo de lidar com o adoecer e a possibilidade de ressignificar os encontros produtores de vida entre profissionais de saÃde e pessoas acometidas pela hansenÃase/episÃdios reacionais, considerando-se os saberes e as prÃticas existencialmente construÃdas. / Leprosy is a stigmatized high power incapacitating disease which is partly attributed to leprosy reactional states. The relevance of this theme is the urgent need to diagnose and treat leprosy reaction episodes, acute inflammatory events in the course of a chronic, disease that can affect individuals of leprosy before, during treatment and after discharge. It aims to understand the experience of bodies with reactive episode of leprosy at the individual, family and community ambits. This is on the assumption that the reactive episodes mark the lives of people contributing to stigma and social isolation. It is a qualitative research, developed at the light of existential phenomenology. This study was set at the reference center for leprosy in the city of Floriano in PiauÃ. There were nine phenomenological interviews, in April 2012, with four women and five men who had or have lived such experience. To reveal the phenomenon of living with leprosy reactions, we were led to question: "What is it like, for you to have leprosy and the reactional episode presented" (considering their personal, family and community)? Thus, the subjectsâ speeches were analyzed from the perspective of scholars of existential phenomenology. The analysis of descriptions led us to identify the thematic units: aching bodies - the discovery of leprosy; cracked bodies - and body transformation experience; broken bodies - the uncertainty of cure due to sequels; re-signified bodies - life changes after leprosy reaction episodes; body senses - experience in family and community; disciplined bodies - experience in the health care service. The understanding of the phenomenon culminated with the drawn assumption, allowing us to reveal some facets that mean for subject-transformations and changes in their lives, occasioned by the maintenance of leprosy reaction episodes, installed by physical disabilities and functional limitations reflected in the labor activities and Socioeconomic aspects of mundane existence, thus strengthening the social stigma that permeates leprosy / leprosy reaction episodes. It also revealed the autonomy of self-care emphasized by the knowledge of the disease and its implications, the family and community support needed in order to deal with the sickness, and the ability to reframe life producing encounters between health professionals and people affected by leprosy; considering the knowledge and practices existentially built.

Segundo a Organização Mundial de Saúde a esquizofrenia é um transtorno incapacitante de curso crônico caracterizado pela presença de alucinações e delírios. Alguns trabalhos apontam que o uso de maconha em pessoas com diagnóstico de esquizofrenia pode agravar os sintomas positivos da doença enquanto age positivamente sobre os sintomas negativos. Estudos qualitativos têm surgido na área com o objetivo de compreender os significados que pessoas com diagnóstico de esquizofrenia atribuem ao uso da substância. Esses estudos trazem que essas pessoas possuem uma visão positiva a respeito do uso, que este proporcionaria a elas um estado de relaxamento e alívio de suas tensões, além de relatarem aumento de criatividade e o uso da maconha como forma de atingir um estado espiritual mais elevado, assumindo um caráter de automedicação. Nesse sentido o presente trabalho teve como objetivo conhecer os significados que pessoas com esquizofrenia atribuem ao uso de maconha. Para isso, foi realizado estudo qualitativo, com referencial metodológico clínico-qualitativo. Os participantes foram selecionados em um serviço público de saúde mental especializado em álcool e drogas do interior de São Paulo. Como instrumento de coleta de dados, utilizou-se um roteiro de entrevista semiestruturada. Os critérios de inclusão no estudo foram: estar em atendimento, ou ser oriundo do serviço selecionado; ter diagnóstico de esquizofrenia segundo a CID-10; fazer uso de maconha ou ter feito uso no ano anterior a entrevista; ter mais que 18 anos e não fazer uso de outra droga ilícita, como cocaína ou crack. Foram realizadas um total de 10 entrevistas. Os participantes da pesquisa eram todos do sexo masculino e tinham em média 28 anos de idade. Foram levantadas quatro categorias a partir da análise das entrevistas: a) Percepções a respeito do adoecimento, onde os participantes relatam o preconceito e estigma que envolve o diagnóstico e como alguns sintomas da esquizofrenia os incapacitam para atividades cotidianas; b) Uso de maconha, este iniciado, em sua maioria, na adolescência e sempre na companhia de amigos; c) Esquizofrenia e maconha, onde discursos relacionados sobre aumento de criatividade, capacidade de organizar o pensamento, vivências de espiritualidade e melhora na qualidade do sono se fizeram presentes e d) Tratamento, onde a busca pelo tratamento partia sempre de algum familiar. É importante conhecermos a visão dessas pessoas a respeito do uso de maconha para compreendermos o que sustenta a manutenção deste, além de fornecer novos elementos na construção de um olhar crítico sobre este fenômeno. / According to the World Health Organization schizophrenia is a disabling disorder of chronic course characterized by the presence of hallucinations and delusions. Some studies suggest that the use of marijuana in people diagnosed with schizophrenia may exacerbate the positive symptoms of the disease while it acts positively on the negative symptoms. Qualitative studies have emerged in the area with the goal of understanding the meanings that people diagnosed with schizophrenia attribute to the use of the substance. These studies bring those people have a positive vision regarding the usage, that this would provide them a state of relaxation and relief of the tension, as well as reporting an increase of creativity and the use of marijuana as a way to achieve a spiritual state higher, assuming a character of \"medication\". In this sense, the objective of this study was to understand the meanings that people with schizophrenia attributed to marijuana use. For this reason, a qualitative study was carried out, with a methodological clinical-qualitative. The participants were selected in a public service of mental health who specializes in alcohol and drug use in the interior of São Paulo. As an instrument of data collection, we used a script of semi-structured interview. Inclusion criteria were: being in service, or be from the selected service; have a diagnosis of schizophrenia according to ICD-10; make use of marijuana or having used the year before the interview; have more than 18 years and not make use of other illicit drugs such as cocaine or crack. a total of 10 interviews were conducted. The participants were all male and had an average age of 28. Four categories were raised from the analysis of the interviews: a) Perceptions about the illness, where participants reported prejudice and stigma surrounding the diagnosis and some symptoms of schizophrenia to incapacitate the daily activities; b) Marijuana use, this started, mostly in their teens and always in the company of friends; c) Schizophrenia and cannabis, where speeches related to increased creativity, ability to organize thought, spirituality experiences and improves the quality of sleep were present and d) Treatment, where the search for treatment always started from a family member. It is important to know the vision of these people about marijuana use to understand what supports the maintenance of this, in addition to providing new elements in building a critical look at this phenomenon.

Demographic change as well as pressure from the European Union and national government are forcing organisations to change age-discriminatory Human Resource Management (HRM) approaches. Based on a qualitative analysis of eight British and German organisations, we found that commitment, scope, coverage and implementation of age management differ due to country-specific institutions, particularly government, in nudging employers and unions to preferred age practices. This confirms the path-dependency concept suggested by institutional theory. Nevertheless, we also found that industry-specific factors mediate the implementation of age management, leading to some convergence across countries. This indicates that organisations deviate from the institutional path to implement practices that they deem important. (authors' abstract)

This qualitative research study focuses explicitly on understanding the experiences and perceptions of urban Aboriginal women living with HIV/AIDS. Stigmatizing attitudes and language have serious impacts upon the lives of HIV-positive Aboriginal women. The ways our society presently addresses the women needs to change. With the insights and assistance of four Aboriginal women living with HIV, this project adds to the presently sparse qualitative literature in this research area. Current research indicates that there are many factors associated with urban Aboriginal women being at higher risk for infection and lower physical and mental health, such as race, socio-economic conditions, isolation, oppression and violence, family history, substance abuse, discrimination, and often the responsibilities of childrearing. However, current research analysis and presentation is insufficient, and more in-depth questions arise. Material was collected using semi-structured, open-ended questioning conversations with the participants. Two guiding research questions were asked: 1) What is it like for you, living with HIV right now? and 2) What would you want other people to learn from your experiences? The women’s stories provide an avenue for participants to voice some of their triumphs and challenges about being an Aboriginal woman living with HIV/AIDS. For the community at large, this is also an opportunity to hear first hand, important information such as this. In this work, I have tried to adhere to the tenets of Indigenous methodologies by allowing the life-stories to resonate as holistic representations. Rather than deconstructing the women’s stories through naturalistic analysis (which continues to categorize and to objectify participants), the stories are viewed through a Health Narrative Topography whereby thematic genres such as Restitution, Chaos, and Quest are illuminated, while also being critically aware of some of the limitations to this framework. Three overarching themes are revealed through the women’s stories: 1) the empowerment and resiliency demonstrated by the participants; 2) the need for cultural competency in a society that continues to stigmatize Aboriginal and HIV-positive women; and, 3) the need for a more holistic approach within society when it comes to education, learning, and healing. / Graduate Studies, College of (Okanagan) / Graduate

Since the establishment of the wireless sector, design has been playing a wide range of roles. Specialized literature has been extensively reporting the use of this discipline associated with NPD, focusing on hardware and software development in the mobile communications. On the other hand, evidences of its use to support forecasting are scarce and generic. Finally, formal publications addressing future forecasting from a design perspective in the context of mobile communications have never been reported, leading to a knowledge gap that needs to be addressed. This research investigates the strategic roles, applications and contributions of design and designers for future forecasting in the wireless telecom sector. As a comprehensive discipline, it is used to examine and identify a number of factors that might influence/impact in the development of visionary solutions supporting the design team of traditional handset manufacturers to make better decisions in order to ‘shape’ the future in the wireless industry. Considering these ideas, the aim of this research is to create a ‘design-led future forecasting model for mobile communications’ to assist and support traditional manufacturers’ design team. This PhD study relies on a qualitative methodology comprising a number of data collection and analysis tools (e.g. literature review, case studies analysis, in-depth experts’ interviews, workshops and Grounded Theory). To create the intended framework, extensive secondary and primary data; theoretical and practical inputs were brought together, analysed and combined. The proposed model was evaluated through two rounds of experts’ interviews complemented by two workshops with potential users (e.g. design students) to check and explore its practicalities when applied to design for the future. Finally, this study bridges future forecasting and the wireless telecom through the use of design to address the literature gap. The richness of the developed model provides practical assistance to traditional manufacturer’s design team informing about a broad spectrum of aspects that should be considered when designing for the future in the mobile telecom industry, supporting strategic decision making in different stages of the future-led design process.

Background: Postoperative delirium (POD) is a common neurocognitive disorder in patients undergoing surgical procedures. Delirium is a disorder that is poorly understood, frequently unrecognized and associated with numerous adverse outcomes including longer hospital stays, significantly higher costs and increased morbidity and mortality. While there has been a great deal of research on proposed etiologies, risk factors and outcomes of delirium, few studies have explored the patient’s subjective experience of the phenomenon. Purpose: The purpose of this qualitative descriptive research was to investigate the patient experience of postoperative delirium and measure the distress associated with the experience. The Delirium Symptoms Experience Model (DSEM) provided the theoretical framework in which to understand the postoperative delirium experience. The three specific aims used to guide the investigation were: 1) Identify patient age, gender, race, type and length of surgery, past medical and surgical history, length of admission, delirium subtype (if known), and medications (including anesthetic agents) used in the perioperative period to better characterize the sample and provide context for the qualitative findings; 2) Describe the postoperative patients’ experience of being and feeling delirious; and, 3) Measure the distress associated with the recall of delirium using the Delirium Experience Questionnaire (DEQ) Methods: Ten participants ranging in age from 33-75 years (mean = 66.2 years of age) who experienced postoperative delirium were interviewed. Patients were screened for persistent delirium or cognitive impairment as assessed with the Confusion Assessment Method and the Mini-Cog™ Instruments. Results: Three organizing themes emerged from the content analysis: 1) Altered Perceptions of Reality; 2) Stuck in the Confusion; and, 3) Seeking Reality. The analysis of the quantitative measures and descriptive data demonstrated a high rate of psychological distress associated with delirium recall with 80% participants reporting it caused severe to very severe distress. The anesthetic drug propofol was the common medication prescribed in the perioperative period and given to all ten participants. Conclusion: Understanding this phenomenon from the patients’ perspective may provide a better understanding of the delirium experience and aid in the development of interventions and treatments to improve care and reduce suffering.

My own experiences of disjuncture sparked questions related to how practical nursing education is situated within the larger nursing disciplinary landscape. On acute care nursing units, work relationships are changing between RNs and LPNs as new collaborative care models are introduced, creating ambiguity and confusion with increasingly overlapping scopes of practice. Gaps remain in knowing how RNs and LPNs experience changes in these intra-professional team contexts, and how patient care, nursing work, and nursing education may be influenced by these new collaborative models. This has been the foundation for the journey towards graduate study and this dissertation work. In this dissertation I address the overarching research question: How are registered and practical nurses’ experiences of learning to work together being organized by educational and work contexts? This question consists of two sub-questions: 1) What are the experiences of pre-licensure health professional students and educators learning to work in intra-professional teams? and, 2) How are institutional texts organizing post-licensure nurses’ experiences of learning to practice on intra-professional teams? The first sub-question is addressed using the Joanna Briggs Institute (JBI) qualitative systematic review methodology to reveal what is currently known about how pre-licensure health professional students learn to work on intra-professional teams. The second question is approached using an institutional ethnographic analytic lens to explore how post-licensure nurses’ (RNs and LPNs) work is socially organized via educational, union, health authority, and regulatory texts and how this social organization impacts intra-professional relationships. Taking a plural approach to knowledge construction allows for a multi-perspectival view of RNs and LPNs experiences and the role of educational and work contexts in shaping how they learn to work together. Incorporating methodologies as diverse as a JBI systematic review and institutional ethnography raises methodological tensions. Each has its own philosophical assumptions, reflecting particular strengths and limitations in the production of knowledge. The challenges of employing a plural approach are explored alongside new knowledge and possibilities for exploring and understanding how best to care for patients and educate students within complex, collaborative environments. / Graduate / 2018-08-29

Fertility studies using quantitative methods often present individuals or couples as autonomous decision-makers who make deliberate fertility decisions and have a fairly clear and consistent preference for family size and the timing of parenthood. This study aimed to explore the extent this view reflects experiences by examining how individuals talked about and made sense of parenthood and family. Semi-structured interviews were conducted with thirteen women and twelve men residing in Scotland between February 2009 and May 2010. Respondents were first asked to respond to vignettes of fertility scenarios, designed to elicit discussions around the limits to reproductive autonomy. Using a life grid, respondents were also asked to reflect on their experiences and intentions around the issue of parenthood and family. During the interviews, respondents spoke about the reasons for and against having children, their preferences for and expectations of family size, the timing of parenthood and communicating with their partners in relation to parenthood. Respondents' accounts were analysed reflexively, focusing on the references they drew upon when constructing their accounts and locating the interview as a setting in which these accounts were generated. Respondents' accounts highlighted the tension between the affirmation of personal choice and autonomy in principle and their subscription to a variety of powerful social norms. Respondents’ rhetorical commitment to women’s reproductive autonomy was very strongly articulated in their response to the vignettes. When accounting for their own fertility preferences and decision-making processes respondents referred to a range of social conventions and constraints limiting their choices. Parenthood was described as a normative transition in terms of being ‘natural’ and ‘expected’ in the life course. Respondents, who identified as ‘childfree’ however, presented themselves as being made accountable for making the decision to not have children. A majority of respondents expressed a clear family size preference of two, but in practice respondents qualified this by taking into consideration a variety of biological, material and social circumstances. Respondents saw parenthood as being constrained by the fulfilment of a range of common ‘preconditions’, which included the completion of education, being in secure employment, being in a stable relationship and having material and social resources for raising children; the postponement of parenthood until these preconditions were met was presented by respondents as being ‘responsible’. Further, the varying degrees of communication respondents said they had with their partners around the issue of parenthood, and the nature of that communication, suggested that fertility behaviours were rarely the outcome of explicit, conscious negotiations and joint decision-making by partners. This study demonstrated that fertility decisions are guided by social norms around parenthood and negotiated constantly in response to changing personal and social contexts. The heterogeneity of the sample enabled a rich analysis of the role of gender and age on the differential experiences and expectations expressed in respondent’s’ accounts. This study adds to the small but growing body of literature that highlights the value of applying qualitative research methods to the study of fertility, which is particularly useful in gaining a deeper understanding of fertility as a social process.

Magister Educationis - MEd / South Africa's education system has undergone dramatic changes in the last decade resulting in an increase in the levels of stress reported by educators. Changes, such as the implementation of Inclusive Education as well as the new culture of human rights in schools, have created extra responsibilities for educators. Today, educator’s don't just have to adjust to these changes, but also have to deal with a rise in learners experiencing barriers to learning and a variety of problems displayed by school leaners. This study explored the understandings and experiences of School-Based Support Teams (SBST) of inclusive education in the Western Cape. For the purpose of this study, a qualitative case study design was used. The researcher found it advantageous to use the qualitative research case study design because it enables the researcher to gain an in-depth understanding of the lived experiences of educators. The participants in this study were twenty educators who serve as members of the SBST in a special and public ordinary school. Participants reported that they experienced success in the implementation of Inclusive Education (IE) in their schools. These include established teamwork, increased access and participation, improved teaching practices as well as the provision of assistive devices. Participants reported positive gains during the implementation, they also reported challenges. These include lack of capacity, lack of resources, problem behaviours, unrealistic workloads and lack of support. This study concludes that if the School Based Support Team is critical in the implementation of IE in South Africa, the Department of Education as well as the schools needs to rethink these roles or develop a Human Resource Development Strategy that will empower educators with the knowledge and skills necessary to play the role. Secondly, the Department of Education should seriously consider ways in which educators can be protected from perpetrators. Lastly, based on the lived experiences of the SBST in the study, educators should continue with the good work but be allowed to provide support in ways that work within their capacity and broader socio-cultural contexts.