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Ce travail de thèse trouve son origine dans une intervention menée auprès du collectif d’ergothérapeutes du centre de rééducation François Gallouedec. Il prend pour objet les dilemmes de métier de ces professionnels lorsqu’ils sont confrontés à la question du travail des patients. L’intervention s’est déployée en suivant une méthodologie développementale propre à la clinique de l’activité. Elle a permis aux ergothérapeutes de prendre pour objet d’analyse leur propre travail lors de programmes de restauration fonctionnelle. La littérature sur ces programmes confirme le choix de s’intéresser aux ergothérapeutes comme principaux destinataires des questions professionnelles des patients. Cependant, les recherches dans le domaine tendent à éluder la question du travail des professionnels de santé et à résumer celui des patients au simple retour à l’emploi.C’est justement pourquoi il nous a semblé intéressant de renverser la question en nous intéressant au travail de ceux qui s’intéressent au travail. Nous avons émis l’hypothèse que ce point difficile confrontait les ergothérapeutes du centre François Gallouedec à des dilemmes de métier notamment lors de la réalisation d’un « atelier geste professionnel ». Les résultats de cette recherche montrent toute l’importance de s’intéresser au travail des professionnels de santé, ce qui est fait mais aussi ce qui n’est pas fait ou ce qu’on aurait voulu faire, pour le développement des modèles de prise en charge des patients. Le réel du travail des rééducateurs peut ainsi devenir une ressource dans la mise en place de programmes de rééducation qui souhaitent s’intéresser à la question du travail du patient. / This thesis work originated in an intervention conducted with the collective of occupational therapists of the rehabilitation center François Gallouedec. It focuses on the job dilemmas of these professionals when confronted with the issue of patient’s work.The intervention was deployed following a developmental methodology specific to the clinic of the activity. It allowed occupational therapists to take their own work as an object of analysis during functional restoration programs. The literature on these programs confirms the choice to focus on occupational therapists as the primary addressee for patients' professional issues. However, research in the field tends to evade the question of the work of health professionals and to summarize that of patients simply returning to employment. This is why we felt it necessary to focus on the work of those who are interested in work. We hypothesized that this difficult point confronted the occupational therapists of the François Gallouedec center with job dilemmas, particularly during the realization of a "professional gesture workshop". The results of this research show the importance of taking an interest in the work of health professionals, which is done but also what is not done or what we would have liked to do, for the development of models of patient care. The real work of there educators can thus become a resource in the implementation of rehabilitation programs that wish to be interested in the question of the work of the patient.

[Truncated abstract] Despite significant scientific advances in tracking the complex physiological mechanisms that drive the asthma disease process, worldwide trends in childhood asthma continue to rise. This research sought to describe the relationships between psychosocial stress, psychosocial resources, asthma severity, and health-related outcomes from the standpoints of biopsychosocial and developmental theory. The research consisted of three studies based on a prospective study involving 2573 children from a community-based birth cohort. The cohort has been under active follow-up from birth and this thesis draws on data obtained at the 1, 2, 6, 10 and 13 year follow-ups . . . The final study undertook to describe the mediating influence of specific supportive behaviours provided by family members and peers to adolescents with asthma. Ninety-nine adolescents participating in the 13 year follow-up of the community cohort study completed a semi-structured interview adapted from the Diabetes Social Support Interview (La Greca et al., 1995) to assess supportive behaviours and the KINDL (Ravens-Sieberer & Bullinger, 1998) to assess QOL. It was predicted that illness-specific support would mediate the relationship between family dysfunction and quality of life. Qualitative analyses identified parents as important sources of tangible support, peers as important sources of companionship and emotional support, and siblings bridging the two, by providing tangible, companionship and emotional support to the adolescent. Mediator analyses found that specific parent behaviours perceived as unsupportive by the adolescent mediated the relationship between family dysfunction and self-oriented quality of life. Clinical implications support the integration of medical and psychological expertise in the treatment of asthma. Future research directions are also discussed.

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Made available in DSpace on 2016-08-03T16:34:26Z (GMT). No. of bitstreams: 1 LUANA YEHIA DE LA BARRA.pdf: 647369 bytes, checksum: 5ed787f9c3f80662f9156a0374495f95 (MD5) Previous issue date: 2006-02-08 / The biopsychosocial approach is very important for physical therapists to enabling them to act with human beings, in a global way, not only focusing their attention only on the pathology, but also on the ill person as a whole. The comprehension of the profession and the concepts of health illness, and patient, are also needed for the physical therapists to consider their intervention on a more extended basis than only on the rehabilitation one. The purpose of this study is to investigate the comprehension of the last year´s Physical therapy students from a private University in São Paulo about health illness, patient, Physical therapy and the relationship between physical therapist and their patients, associating the understanding to the existent health models. In order to achieve these objectives it uses authors of the Health Psychology who defend the biopsychosocial approach, and also authors of Physical therapy and Medicine who write about the models for graduation curriculae of health professionals. Ten semi-structured interviews were led with students, asking about the subjects of the study. The results were analyzed qualitatively, using the construction of analysis categories to answer the objectives of the research. In conclusion, the students noticed some phsychological and social aspects of patients, but not in a clear way and in most of the students, this knowledge was adquired outside the University. Eventhough, the topics on humanities are included in their course, but at the time of the graduation, students don´t reach the objectives of a human comprehension of patient, and oscillate between the biomedical and biopsychosocial model / A visão biopsicossocial de homem é de fundamental importância para que os fisioterapeutas sejam capazes de atuar com seus pacientes, de forma global, sem focar a atenção apenas à doença, mas sim à pessoa doente. A compreensão acerca da profissão e dos conceitos de saúde-doença e paciente, também se faz necessária para que esses profissionais possam considerar sua intervenção num âmbito mais amplo do que a reabilitação. O objetivo deste trabalho é investigar a compreensão que os alunos do último ano de Fisioterapia de uma Universidade privada de São Paulo têm sobre saúde-doença, paciente, Fisioterapia e relacionamento fisioterapeuta-paciente e como associam estas compreensões aos modelos de saúde existentes. Para isso toma por base autores da Psicologia da Saúde que defendem uma visão biopsicossocial de homem, assim como autores da Fisioterapia e Medicina que escrevem sobre os modelos adotados nos currículos de formação dos profissionais da saúde. Foram realizadas 10 entrevistas semi-dirigidas com os alunos, apresentando questões a respeito dos temas em questão. Os resultados foram analisados de forma qualitativa através da construção de categorias de análise visando responder aos objetivos da pesquisa. Conclui-se que os alunos percebem alguns aspectos psicológicos e sociais do paciente, mas não de forma clara e, na maioria dos casos, este conhecimento se dá através de conhecimentos que não foram adquiridos na Universidade. Esta, apesar de fornecer os conteúdos para a formação mais humana do fisioterapeuta, não alcança os objetivos ao final do curso, já que os alunos oscilam entre os modelos biomédico e biopsicossocial

This study is aimed at exploring the impact of secondary trauma on the child. A shortcoming has been identified in practice because of the lack of trained social workers and therapists in the field of secondary trauma and children and applying effective therapeutic intervention. The goal of this study was to explore and determine the impact of trauma on the child as the secondary victim in the emergency room of the hospital. In order to reach the required goal, a number of objectives were set. By means of a literature study and consultation with experts in the field of trauma, a theoretical framework was set up with regard to the following: secondary trauma as phenomenon; the child in the middle childhood as part of life; trauma debriefing and the child. An empirical study where semi-structured interviews and participatory observation were used as the methods of data collection was undertaken, to assess the impact of trauma on the child, as the secondary victim in the emergency room of the hospital. The following aspects were handled specifically: 1. the experience of trauma by the child 2. fears and anxiety 3. re-experiencing the event through thoughts 4. sensation, communication and play 5. increase in sensitivity through sight, noises and smell 6. avoidance of memories, thoughts and feelings towards the trauma and then the search for closure Individual semi-structured interviews were used with ten respondents. Applied research was undertaken as the researcher aimed at establishing solutions for problems that occur in the emergency room of the hospital. The researcher used a qualitative research approach. Considering that in this study a relatively unknown field was researched, a phenomenological strategy within an exploratory study was used to explore, understand and interpret the research question, which is not well known. The research question formulated for this study was: “What is the effect of trauma on the child as the secondary victim?” Empirical data, which was obtained by using a semi-structured interview schedule and participatory observation, revealed the following: 1. The secondary traumatized child is the individual that’s been exposed to the trauma by either witnessing the event or through the relationship with the victim. 2. The following phases of trauma were identified through the study of the secondary traumatized child: i. PHASE 1 : Biological impact phase ii. PHASE 2 : Reaction phase iii. PHASE 3 : Avoidance phase iv. PHASE 4 : Reintegration and recovery of homeostasis 3. Role of social support systems for the adaptation of the psycho-social functioning of the victim. 4. External factors that might influence the traumatized child. The study revealed information on the child as the secondary traumatized victim in the emergency room of the hospital, which holds further research possibilities. The desired information was acquired and can be used in further studies and the development of a trauma-debriefing programme. / Dissertation (MSW (Social Health Care))--University of Pretoria, 2006. / Social Work and Criminology / MSW (Social Health Care) / Unrestricted

Bipolêre versteuring is ‘n kroniese, herhalende en ernstige siekte met ‘n voorkoms van 1 % wêreldwyd. Pasiënte kan psigoties word, selfmoordideasie hê en ook soms aggressief raak. Dikwels moet hulle gehospitaliseer word - ook teen hulle wil, want hulle mag soms geen insig toon nie. Pasiënte mag presenteer met ‘n ko-morbiede toestand, byvoorbeeld substansmisbruik of ‘n persoonlikheidsversteuring. Dit gebeur dikwels dat hulle nie hulle toegewysde rolle, byvoorbeeld dié van gade, broodwinner, ouer of volwasse kind, kan vervul nie. Versorgers van pasiënte gediagnoseer met bipolêre versteuring, word eweneens beïnvloed deur die siekte en die gepaardgaande stigma daarvan. Dit kan vir hulle baie moeilik wees wanneer hulle die verantwoordelikhede en rolle van die pasiënt moet oorneem. Beskou vanuit die oogpunt van ‘n ekologiese sisteemperspektief is die aard van hierdie impak op die maatskaplike funksionering van die versorgers relevant vir maatskaplike werk in die geestesgesondheidsveld. Die verkenning van hierdie impak en die ontwikkeling van ‘n intervensie om die impak aan te spreek het dus die rasionaal van hierdie studie gevorm. Die geïntegreerde biopsigososiale model, binne ‘n ekologiese sisteem perspektief, word aangewend by die psigiatriese instelling waar die navorser werk. Hierdie benadering het dus ook gedien as die vertrekpunt vir die betrokke studie. Die gemengde-metode navorsingsbenadering is tydens hierdie studie benut ten einde ‘n uitgebreide analise van die navorsingsprobleem te verskaf. Die voorgenome studie het binne die kategorie van toegepaste navorsing geval, want die doel daarvan was om ‘n program te ontwikkel om hulp te verleen aan versorgers van individue gediagnoseer met bipolêre versteuring. Die navorser het haar navorsing gerig aan die hand van Rothman en Thomas (1994) se intervensie ontwerp en ontwikkelingsmodel (D&D) deur gebruik te maak van kwalitatiewe en kwantitatiewe metodes. Na afloop van die analise van die kwalitatiewe data, is ‘n unieke psigo-maatskaplike opvoedkundige program, die SEE-SAW program, ontwikkel en toe geïmplementeer. Die konsep van balans versus wanbalans binne die sisteem is essensieel; die navorser se program het ten doel gehad om beter balans binne die sisteem van die pasiënt en versorger te bewerkstellig. Die gevolgtrekkings het duidelik getoon dat die versorger van die bipolêre pasiënt blootgestel is aan ‘n wye spectrum van behoeftes en uitdagings, maar dat intervensies soos die SEE-SAW program van groot waarde mag wees. / Bipolar disorder (BD) is a chronic, recurrent, serious illness that occurs in 1 % of people globally. Patients might become psychotic, suicidal and sometimes violent. They often need to be hospitalised, even against their will because they may have no insight. Patients may have a comorbid condition such as substance abuse or a personality disorder. They are frequently unable to fulfil their assigned roles of spouse, breadwinner, parent or adult child. Caregivers of patients diagnosed with BD are also affected by the illness and the associated stigma. It becomes very difficult for them when they have to take over the responsibilities and roles of the patient. The nature of this impact on the social functioning of the caregivers, understood from an ecological systems perspective, is relevant for social work in the mental health care field. Discovering more about this impact and developing an intervention to curb it therefore formed the rationale for this study. The integrated biopsychosocial model, within an ecological systems perspective, is being used at the psychiatric institution where the researcher works. This approach therefore also served as the point of departure from which this research was conducted. A mixed methods research approach was utilised to provide a comprehensive analysis of the research problem. The proposed study fell into the category of applied research, due to its aim of designing a programme to assist caregivers of people diagnosed with BD. The researcher directed the study according to Rothman and Thomas’s (1994) intervention design and development model (D&D), using qualitative and quantitative methods. After the analysis of the qualitative data a unique psychosocial educational programme, the SEE-SAW programme, was developed and then implemented. The concept of equilibrium versus disequilibrium in the system is central; the researcher’s programme therefore strove towards better equilibrium within the system of patient and caregiver. From the conclusions it is apparent that the caregiver of the BD patient is exposed to a wide spectrum of needs and challenges, but that interventions such as the SEE-SAW programme may be very helpful. / Thesis (PhD)--University of Pretoria, 2014. / Social Work and Criminology / PhD (Social Work) / Unrestricted