Aim: This study explores what type of information patients and nurses share with, or provide to, each other, and whether or not the information received was relevant and sufficient for their needs. Background: Information exchange, as part of shared decision-making, is advocated in policy and practice throughout the healthcare sector. Much of the literature on information exchange relates to one-to-one consultations with consultants or GPs. To date, no studies have explored information exchange between patients and nurses in ward settings. Nursing literature on patients’ information needs focuses on one-way information provision from nurses to patients, rather than on two-way information exchange between patients and nurses. Methods: Interactions between patients and nurses were observed and audio-recorded using a remotely controlled audio-recording system. Semi-structured individual face-to-face interviews were then conducted to clarify and add to the observation data. A multiple case study design was used for this study: each case comprised one patient, the nurses caring for that patient, and the interactions between them. A pilot study was undertaken to inform the methods for recruitment and data collection for the main study. Results: The pilot study comprised five cases (patients n=5, nurses n=3). Changes to the recruitment strategy for the main study included surgical patients being invited to participate in the same way as medical patients. There were no difficulties with the data collection methods. The main study comprised nineteen cases (patients n=19, nurses n=22). Information exchange seemed unfamiliar to ward-based nurses. The findings show that information exchange may not be a one-off event but a complex series of interactions. Patients did not distinguish between clinical and non-clinical information in the same way as nurses. Primary reasons for patients’ hospital admission were not discussed and nurses did not share information about nursing interventions. The relevance for patients and nurses differed; patients generally wanted information for reducing anxiety and socialization; nurses wanted information for assessment and care planning. In terms of sufficiency, observation sessions highlighted that insufficient information was provided, often due to lost opportunities and paternalistic practice. However, the majority of patients and nurses perceived that they had exchanged sufficient information. Conclusion: This multiple case study provides insights into the type, relevance and sufficiency of information for patients and nurses in ward settings. In ward settings, information exchange as conceptualised by Charles et al. (1997 and 1999) may be difficult to achieve due to the complexity of patient/nurse interactions. Therefore, there are implications for policy makers as policies are not context specific. However, information exchange may be helpful for reducing patients’ anxieties. The concepts of shared decision-making and information exchange are not part of ward-based cultures and philosophies, which suggests implications for patient and nurse education. Research on information exchange between patients and nurses in other ward contexts may contribute to further understanding of information exchange in ward settings.

The thesis focuses on multilingual communication in healthcare centres in Prague. One of its main objectives is to compare and contrast the situation in the public- and the private sector. The theoretical part of the thesis presents interpreting in healthcare settings as one of the most important and most frequent types of community interpreting. The authors focus mainly on the current state of research in diverse world regions, and subsequently analyse the specific aspects of interpreting situations in the setting in question. An integral constituent of the theoretical part of the thesis is a global overview of the current situation in terms of quantity of foreign patients in Prague hospitals, including selected relevant demographic data. In conclusion of the theoretical part, the authors briefly elaborate on the phenomenon of medical tourism. The empirical part of the thesis is based on a questionnaire survey carried out among hospital employees in Prague, the aim of which was to analyse the current situation in terms of communication with foreign country nationals and to compare and contrast the public- and the private sector in this respect. The main focus of the research is to find out how the respondents perceive the situation and whether they are satisfied with it and to what extent this is...

Sur la scène de l’insertion se réactiveraient et se déploieraient les souffrances d’exclusion de certains jeunes, « souffrances narcissiques et identitaires » (R. Roussillon) qui révéleraient un « collapsus topique » (C. Janin) entre les « espaces du lien inter et trans-subjectif et l’espace intra-psychique » (R. Kaës).Le clinicien est alors invité à proposer des dispositifs cliniques susceptibles de libérer la scène de l’insertion des effets mortifères de la répétition traumatique.A partir d’un travail clinique de 20 ans au sein des Missions Locales pour l’insertion des jeunes, qui accueillent tous les ans plus de 1.2 millions de jeunes en France, l’auteur propose la mise en place de dispositifs orioplastiques au sein de ces institutions. Il emprunte à la plasticienne A.Stella la notion d’ « orioplastie », qui associe le grec orio (limite) et plastie, du grec ancien plassein (façonner, mouler), aux origines d’une qualité, la plasticité, la malléabilité. Il étudie trois dispositifs étroitement articulés, un dispositif individuel et deux groupaux et tend à dégager à la fois leurs caractéristiques, en matière d’espace et de temps, qui leur conféreraient une qualité de « medium malléable » (R. Roussillon, M. Milner) et les processus qu’ils permettraient de déployer en matière de « double travail psychique de liaison » (C. Vacheret), en référence à la « double limite » d’ A. Green.Il ouvre ainsi la question d’une éventuelle nouvelle étape de la psychiatrie publique, qui consisterait à se déployer dans les institutions du social et de l’insertion, afin de contribuer à une meilleure prise en compte des questions de la précarité et de l’exclusion, et pose les questions des conditions d’exercice et des limites de ce travail. / The social and professional integration process appears to reactivate exclusion related psychological troubles, defined as the « narcissistic disturbances of the sense of identity » (R. Roussillon) revealing a « topical collapse » (C. Janin) between the « the inter- and trans-subjective and the intra-psychic spaces » (R. Kaës). The role of the clinical psychologist is to propose clinical settings capable of ridding this process of the negative effects of traumatic repetition.The author, based on 20 years of clinical experience in Missions Locales, social structures for reintegration which welcome more than 1.2 million young people in France every year, proposes the deployment in these institutions of orioplastic settings. The notion of « orioplasty » is borrowed from the artist A.Stella who derives the terms from the Greek words orio (limit) and plassein (to shape or mold). The study of three tightly linked protocols, one for individuals and two for groups, simultaneously highlights their characteristics involving space and time, conferring them with the quality of a « pliable medium » (R. Roussillon, M. Milner), and the processes, both psychological and social, involving a « dual mental linking process » (C. Vacheret), in reference to the « double limit » of A. Green, that they permit to establish.Thus, the author raises the question of a new stage in public sector psychiatry which would consist of going into the institutions of social integration in order to better take into account the problems of social insecurity and exclusion, and addresses the question of the conditions and the limits involved in this new approach.

O presente trabalho apresenta uma análise crítica, mas comprometida, da desconstrução manicomial e da reforma psiquiátrica brasileira, à luz das contribuições teóricas de Nise da Silveira e D.W. Winnicott. Constata que neste movimento convivem a busca de transformações radicais, em dimensões sociais, e uma relativa pobreza na criação de novos dispositivos de caráter eminentemente clínico, o que permite apontar uma importante limitação, vale dizer, que o reconhecimento da importância da dimensão social não se faz acompanhar da suficiente consideração da subjetividade em termos sensíveis e emocionais. Configura-se, assim, situação problemática, que pode ser superada pela via da proposição de enquadres clínicos diferenciados, desde que estes sejam potencialmente capazes de permitir uma articulação produtiva entre dimensões subjetivas sociais e afetivo-emocionais / It is showed trhough in this movement, the search for extreme transformation in social dimensions coexists with some relative poverty to create new mechanisms of clinical feature, which allows us to point out an important limitation, that social importance recognition is not followed by enough consideration of subjectivity in sensitive and emotional terms. It is then formed a problematic situation that may be overcome by the proposition of differentiated clinical settings, as long as they are potentially facilitate a productive articulation between social, subjective and affective-emotional dimensions

Esse estudo apresenta o desenvolvimento de práticas psicológicas no contexto institucional. Trata-se de intervenção psicoterápica em grupo com as cuidadoras de crianças em acolhimento institucional de abrigos, por dois anos, desenvolvida no contexto da instituição. Ao realizarmos nosso estudo anterior de Mestrado, identificamos acentuado sofrimento psíquico manifestado pela equipe de cuidadoras, no qual percebemos importantes identificações da equipe com as angústias emergentes nas crianças abrigadas. Iniciamos, em março de 2006, encontros psicoterápicos grupais e semanais com as cuidadoras desse abrigo até o mês de março de 2008. Aplicamos com o grupo, no início e na finalização dos encontros, o Procedimento Desenhos-Estórias com Tema, para compreendermos a dinâmica psíquica das participantes atrelada ao relacionamento com crianças em acolhimento, e também para nos auxiliar a avaliar a intervenção realizada. Adotamos a perspectiva winnicottiana para a noção de saúde. Esta experiência nos revelou que a partir do momento em que as cuidadoras alcançaram melhor contato emocional com a interioridade puderam conter grande parte do sofrimento psíquico, apresentando-se de forma mais viva para o contato com a realidade externa e ampliando os contatos afetivos. A equipe de cuidadoras apresentou melhor contato com os próprios afetos e demonstrou avanços na capacidade de discriminação das crianças em acolhimento, o que facilitou os relacionamentos no contexto institucional. Percebemos mudanças na realidade subjetiva da equipe, embora permanecesse a mesma realidade social do contexto, o que nos possibilitou também considerar a eficácia da intervenção psicológica com o grupo de cuidadoras. Portanto, propomos esta intervenção como enquadre clínico diferenciado para atendimento de cuidadoras em abrigos / This study presents the development of the psychological practice within the institutional context. It is the psychotherapeutic group intervention with the children\'s caregivers in institutional shelters, for two years, developed within the context of the shelters. In our previous study for the Master\'s Degree, we identify intense psychic suffering manifested by the team of caregivers, in which we perceive important identifications between the team and the state of anguish the sheltered children are found. In March, 2006, we begin weekly psychotherapeutic gatherings with the caregivers of this shelter, until up the year 2008. Within the group, and at the beginning and the end of each gathering, we apply the Drawing- And-Story Procedure with Theme, to understand the psychic dynamics of the participants in relation with the sheltered children, and also, to help us evaluate the applied intervention. We adopt the Winnicottian Perspective for the notion of health. The experiment reveals, from the very moment the caregivers reach a better emotional contact, with the interiority, that they are able to hold back a great part of the psychic suffering, taking a more lively approach in contacting the exterior reality, expanding the affective contacts. The team of caregivers presents a better contact with their own affections; also, presents improvement in the capacity to discriminate the children under the shelter, which facilitates the relationship in the institutional context. We perceive a change in the subjective reality of the team of caregivers, even though the social reality of the context remains unchanged, and this allows us to consider the efficiency of the psychological intervention with the team of caregivers. Thus, we propose this intervention as differentiated clinical setting to aid caregivers in shelters

Made available in DSpace on 2016-04-04T18:29:40Z (GMT). No. of bitstreams: 1 Diana Pancini Ribeiro.pdf: 3595414 bytes, checksum: 5704fc4a088f97a32ba1eaab61e87cbe (MD5) Previous issue date: 2008-02-11 / This research broaches the clinical and developing potential of the transitional use of the Thematic Story-drawing Procedure in early interviews held by undergraduate students in group supervision meetings, meant as activity which articulates knowledge transmission and holding. It is inserted, therefore, into a particular moment of the psychologist s academic development, which takes effect by means of the clinical care given to children, in the context of the psychodiagnosis. The research at issue, based on the discarding of the positivist view and the adoption of an epistemological paradigm which favors intersubjectivity, is structured according to a complex architecture, to the extent that clinical care and supervision are viewed as inseparable practices. 16 reports on the use of the Procedure, drawn up during a two-month period, along of which 16 undergraduates made twenty-four complete psychodiagnoses, were psychoanalytically evaluated, in close dialogue with the Winnicottian thought. Two of such reports are fully presented in the research. The analyses, on the whole, allow us to conclude that the transitional use of the Thematic Story-drawing Procedure seems to be heuristically important since it favors meaningful emotional communications among all the people involved in the interaction, in the contexts of the care provided for the children and the supervision provided for the students. / Este trabalho investiga o potencial cl?nico e formativo do uso transicional do Procedimento de Desenhos-Est?rias com Tema em primeiras entrevistas realizadas por alunos de gradua??o e em reuni?es de supervis?o grupal, concebida como atividade que articula transmiss?o de conhecimento e holding. Insere-se, portanto, em um particular momento da forma??o do psic?logo, que se realiza por meio do atendimento cl?nico a crian?as, no contexto do psicodiagn?stico. Pensada a partir do abandono de uma vis?o positivista e da ado??o de um paradigma epistemol?gico, que privilegia a intersubjetividade, a pesquisa se estrutura segundo arquitetura complexa, na medida em que entende o atendimento cl?nico e a supervis?o como pr?ticas indissoci?veis. Foram psicanaliticamente examinadas, em pr?xima interlocu??o com o pensamento winnicottiano, dezesseis narrativas do uso do Procedimento, elaboradas num per?odo de dois meses letivos, ao longo dos quais dezesseis alunos realizaram vinte e quatro psicodiagn?sticos completos. Duas narrativas s?o detalhadamente apresentadas na tese. O conjunto das an?lises permite afirmar que o uso transicional do Procedimento de Desenhos-Est?rias com Tema revela-se heuristicamente valioso por favorecer comunica??es emocionais significativas, entre todos os envolvidos, nos contextos do atendimento e da supervis?o.

Esse estudo apresenta o desenvolvimento de práticas psicológicas no contexto institucional. Trata-se de intervenção psicoterápica em grupo com as cuidadoras de crianças em acolhimento institucional de abrigos, por dois anos, desenvolvida no contexto da instituição. Ao realizarmos nosso estudo anterior de Mestrado, identificamos acentuado sofrimento psíquico manifestado pela equipe de cuidadoras, no qual percebemos importantes identificações da equipe com as angústias emergentes nas crianças abrigadas. Iniciamos, em março de 2006, encontros psicoterápicos grupais e semanais com as cuidadoras desse abrigo até o mês de março de 2008. Aplicamos com o grupo, no início e na finalização dos encontros, o Procedimento Desenhos-Estórias com Tema, para compreendermos a dinâmica psíquica das participantes atrelada ao relacionamento com crianças em acolhimento, e também para nos auxiliar a avaliar a intervenção realizada. Adotamos a perspectiva winnicottiana para a noção de saúde. Esta experiência nos revelou que a partir do momento em que as cuidadoras alcançaram melhor contato emocional com a interioridade puderam conter grande parte do sofrimento psíquico, apresentando-se de forma mais viva para o contato com a realidade externa e ampliando os contatos afetivos. A equipe de cuidadoras apresentou melhor contato com os próprios afetos e demonstrou avanços na capacidade de discriminação das crianças em acolhimento, o que facilitou os relacionamentos no contexto institucional. Percebemos mudanças na realidade subjetiva da equipe, embora permanecesse a mesma realidade social do contexto, o que nos possibilitou também considerar a eficácia da intervenção psicológica com o grupo de cuidadoras. Portanto, propomos esta intervenção como enquadre clínico diferenciado para atendimento de cuidadoras em abrigos / This study presents the development of the psychological practice within the institutional context. It is the psychotherapeutic group intervention with the children\'s caregivers in institutional shelters, for two years, developed within the context of the shelters. In our previous study for the Master\'s Degree, we identify intense psychic suffering manifested by the team of caregivers, in which we perceive important identifications between the team and the state of anguish the sheltered children are found. In March, 2006, we begin weekly psychotherapeutic gatherings with the caregivers of this shelter, until up the year 2008. Within the group, and at the beginning and the end of each gathering, we apply the Drawing- And-Story Procedure with Theme, to understand the psychic dynamics of the participants in relation with the sheltered children, and also, to help us evaluate the applied intervention. We adopt the Winnicottian Perspective for the notion of health. The experiment reveals, from the very moment the caregivers reach a better emotional contact, with the interiority, that they are able to hold back a great part of the psychic suffering, taking a more lively approach in contacting the exterior reality, expanding the affective contacts. The team of caregivers presents a better contact with their own affections; also, presents improvement in the capacity to discriminate the children under the shelter, which facilitates the relationship in the institutional context. We perceive a change in the subjective reality of the team of caregivers, even though the social reality of the context remains unchanged, and this allows us to consider the efficiency of the psychological intervention with the team of caregivers. Thus, we propose this intervention as differentiated clinical setting to aid caregivers in shelters

This thesis studies the problem of combining a poem with music in nineteenth-century Lieder so that the music enhances the poetry rather than detracting from it. Eight settings of Goethe's poem "Kennst du das Land," from his novel Wilhelm Meisters Lehrjahr, are compared. Settings by Johann Friedrich Reichardt, Beethoven, Schubert, Schumann, Liszt, Tchaikowsky, and Wolf are analyzed, after initial treatment of the literary aspects of the poem. The degree of musico-poetic synthesis varies in these settings, and it becomes evident that total fusion of poetry and music is not possible. However, the settings by Schumann and Wolf achieve strong balance of word and tone.

Made available in DSpace on 2016-04-27T16:32:37Z (GMT). No. of bitstreams: 1 Jose Luiz Germano Martins.pdf: 7399670 bytes, checksum: f232372788ff6f44dcc45214d078f7b8 (MD5) Previous issue date: 2012-02-27 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / Understanding the school space as multiple, heterogeneous, and that relationships between students are not only based on educational´s criteria of educational performance and behavior, this study investigated the social relations among elementary students focusing on those that designated by the school as those with poor academic performance in public schools in two different networks , considering that different processes could occur school exclusion given the different forms of organization that these systems could provide. To this end, we selected two classes of second grade of elementary education at two different public schools in which the selection occurred because it is public schools, well organized, with a good position for observation, located in a neighborhood with good human development index. The choice of second grade students of elementary school was due these students already have a school career with "negative mark" root, but had not established as definitive yet. As procedures for data collection was initially used sociometric testing and observations. The first served for the analysis of social relations among all students in the class (rejection rates and acceptance), using three indicators: groups of study, leisure and friendship that made it possible to place students in the social context of school . The test also served to define the students who were the object of observation, made during a school year, in different social spaces on school (classroom, lobby, recreational, outgoing, free activities, etc), creatinging comparative scenes situations of interaction. The theoretical references were used; Goffman for understanding how the marks interfere with social relationships developed; Dubet, especially with regard to the "strategic logic" to analyze the various initiatives of the students in order to locate themselves at school; Elijah whose concept of configuration possible to analyze the different groups formed in various social situations. The main findings can be summarized as follows: a negative mark of poor academic performance is not as essential in all activities among the students, while a student looking to use different strategies to cope with his colleagues, the other is isolated almost of all activities, which seems to show that their difficulties in social relationships with classmates are much more complex problems than the low income, social class settings, including low-income students, change significantly according to the activities involved. In this sense, one can conclude that the influence of low-income school in the relations between students plays a secondary role, except those specifically as academic. The results were pointing to the fact that the criteria of the activities are more important than the brand that carries the student, since, varying with the study sites and personal strategies for each student, the results of more or less accepted or rejection, also change / Entendendo o espaço escolar como sendo múltiplo e heterogêneo e que as relações entre alunos não se constituem somente com base nos critérios pedagógicos de rendimento e comportamento, o presente trabalho investiga as relações sociais estabelecidas entre alunos do ensino fundamental, com foco naqueles que são designados pela escola como os que apresentam baixo rendimento escolar, em duas escolas públicas de redes diferentes. São averiguados que critérios e que aspectos são privilegiados por esses alunos para o estabelecimento dessas relações sociais, nos diferentes espaços e em distintas atividades desenvolvidas no ambiente escolar, procurando investigar a relação entre baixo rendimento escolar de alunos do ensino fundamental e as interações sociais estabelecidas entre eles e os demais alunos da escola. Para tanto, foram selecionadas duas classes da 2ª série do ensino fundamental de duas escolas públicas distintas. A escolha dessas escolas se deu por tratar-se de escolas públicas, bem organizadas, com uma boa situação de observação, localizadas num bairro de classe média/alta. Além disso, poderiam ser encontradas influências diversas nos processos de exclusão escolar, uma vez que as redes públicas são diferentes. Mediante essa necessidade, foram escolhidas salas da 2ª série do ensino fundamental, pois se presume que esses alunos já possuam uma trajetória escolar que permite verificar se alguns desses alunos já têm algum tipo de marca negativa sedimentada, que os inclua no rol dos alunos com baixo rendimento escolar. Como procedimentos de coleta de dados foi inicialmente utilizado o teste sociométrico que serviu para a análise das relações sociais entre todos os alunos da classe (índices de rejeição e de aceitação), por meio de três indicadores: agrupamentos de estudo, de lazer e de amizade, assim como para a definição dos alunos que foram objeto de observação, realizada no decorrer de um ano letivo, nos diferentes espaços sociais da escola (sala de aula, entrada, recreio, saída, atividades livres, etc.), com a criação de cenas comparativas de situações de interação. Para entender as marcas que tais alunos possam adquirir, o referencial de Goffman é fundamental, para a compreensão de como as marcas sociais interferem nas relações desenvolvidas. Da mesma forma que Dubet propicia estudar a escola na perspectiva de espaço social multifacetado e desinstitucionalizado, em que os alunos são obrigados, em cada experiência social vivida, a incorporar aquilo que este autor denomina como lógicas da ação: a integração, a estratégia e a subjetivação . Finalmente, é utilizado o conceito de configuração de Elias, por se tratar de uma rede de interdependências que liga os homens, formando um nexo, uma estrutura de pessoas mutuamente orientadas e dependentes.Cada um desses autores possibilita, com sua teoria, a análise do coletado nas pesquisas de campo, por meio dos instrumentos de pesquisa já citados e suas representações, tanto nos diferentes tipos de sociogramas elaborados, como nas observações nos espaços escolares. Foram encontrados resultados que apontam para o fato de que os critérios das atividades realizadas são mais importantes que a marca que o aluno carrega, uma vez que, variando com os locais estudados e as estratégias pessoais de cada aluno, os resultados de maior ou menor aceitação ou rejeição, também se modificam

University officials have identified a problem among secondary preservice teachers (SPTs) who have expressed reluctance to teach in local urban schools. The purpose of this qualitative case study was to explore the perceptions of SPTs regarding their preparation for and experiences with teaching in urban school settings. Vygotsky's zone of proximal development and Bruner's concept of scaffolding served as the conceptual frameworks that guided this study. Data were collected from 11 SPTs who completed the requirements of their field service experiences in urban schools. Data collection consisted of individual interviews, one focus group interview, and field observations. Findings showed that SPTs desire to make a difference in urban schools, lack confidence in managing culturally diverse classrooms, and desire more faculty guidance in working with diverse populations. SPTs asserted that they need more research-based teaching strategies and urban field experiences. Implications for social change include more collaboration among university faculty, urban school principals, mentor teachers, and community organizations. Findings may be used to prepare SPTs to serve culturally diverse populations, which may improve students' academic achievement in urban classrooms.