Dans les services de première ligne des Centres de santé et de services sociaux (CSSS) au Québec, les infirmières sont des acteurs clés des programmes destinés à des populations vulnérables. Ces programmes créent des opportunités pour les infirmières de développer une pratique à l’interface du CSSS et des ressources de la communauté afin d’agir pour réduire la vulnérabilité sociale. Des infirmières commencent d’ailleurs à se mobiliser au-delà de leurs frontières disciplinaires, organisationnelles et sectorielles pour s’engager dans l’environnement de personnes vulnérables, ce que nous désignons ici comme pratique infirmière d’interface. Aucune étude n’a toutefois été repérée en regard de cette pratique infirmière en émergence. Fondée sur une perspective constructiviste et systémique, de même qu’une analyse des conceptions de théoriciennes infirmières sur la pratique, notre recherche doctorale avait pour but de modéliser la pratique infirmière d’interface en contexte de vulnérabilité sociale. Elle a également constitué un cas à partir duquel contribuer aux savoirs théoriques sur le concept de pratique en sciences infirmières. Une étude qualitative exploratoire a été entreprise dans trois CSSS d’une région urbaine. Des entretiens semi-dirigés ont été réalisés avec quinze infirmières. La pratique d’interface de deux infirmières a ensuite fait l’objet d’une année d’observation directe et participante, ce qui a permis de procéder à des entretiens informels avec des gestionnaires ainsi que des membres des équipes interprofessionnelles et communautaires. Une analyse de documents programmatiques et gouvernementaux a complété notre description du contexte de la pratique d’interface. Une analyse thématique amorcée en cours de collecte de données ainsi que la méthode de modélisation systémique de Le Moigne ont permis de soutenir la démarche interprétative et de rendre compte des résultats. Quatre thèmes inter-reliés qualifient la pratique infirmière d’interface. Le premier met en évidence une finalité d’autonomie qui se traduit comme exigence de conformité sociale à l’endroit des personnes vulnérables. Le second porte sur des processus d’engagement relationnels des infirmières pour créer des liens et mettre en relation la clientèle et les acteurs du milieu. Le troisième thème est celui de l’action stratégique de l’infirmière. Enfin, le quatrième fait état d’un espace contradictoire à l’intérieur duquel se déroule la pratique d’interface, lequel comporte un processus de (re)configuration identitaire pour les infirmières. Une réflexion approfondie sur nos résultats, appuyée sur des savoirs disciplinaires en sciences infirmières et en sciences sociales, souligne des dimensions essentielles à considérer pour poursuivre le développement du concept de pratique en sciences infirmières. Spécifiquement, notre thèse permet de réfléchir les concepts centraux de soin et d’environnement en sciences infirmières, en plus d’expliciter le caractère fondamental de deux autres composantes à intégrer dans nos conceptions disciplinaires de la pratique, soit les savoirs et les projets. Cette thèse démontre la pertinence de contribuer à la création d’un « réseau de savoirs » avec d’autres disciplines pour soutenir notre capacité de théoriser la pratique et de renforcer l’intervention en contexte de vulnérabilité sociale. / Primary care nurses are key actors in programmes that are dedicated to vulnerable populations within Health and Social Service Centers (HSSC) in Québec. Such programmes provide opportunities to develop a nursing practice at the interface of an HSSC and community resources in order to reduce social vulnerability. Some nurses are now crossing their disciplinary, organisational and sectoral boundaries to engage in what we refer to here as interface nursing practice. Yet, to our knowledge, no study has documented this unfolding practice. Through a constructivist perspective, and building upon an analysis of nursing theorists’ conceptions of practice, the objective of this doctoral study was to produce a systemic model of interface nursing practice in the context of social vulnerability. This research also provides a case to reflect on the theory of practice in nursing science. A qualitative exploratory study was undertaken in three urban HSSCs. Fifteen primary care nurses participated in semi-structured interviews, followed by one year of direct and participant observation of the interface practice of two nurses. During this time, informal interviews with administrators, interprofessional teams and community actors, as well as an analysis of programme and governmental documents, were conducted to further our understanding of the context of interface nursing practice. Thematic analysis was initiated during data collection, whereas Le Moigne’s systemic modelling methodology was instrumental throughout the interpretive process of qualitative analysis and for the representation of our study results and further theoretical elaboration. Four inter-related themes qualify interface nursing practice. First, this practice is guided by a goal that is articulated as a social obligation for vulnerable populations, that of becoming autonomous. Second, relational processes are central as nurses interconnect vulnerable individuals with various actors and resources in the community. The third theme depicts interface nursing practice as strategic action. Finally, the fourth theme highlights opposing or contradictory processes that are experienced by nurses engaged in interface practice and that appear to change their sense of professional identity. Further examination of our results, at the intersection of nursing knowledge and social science theories, underscores fundamental dimensions of the concept of practice that are essential to consider in nursing theory development: the central concepts of care and environment, in addition to those of knowledge and projects. This thesis demonstrates the relevancy of creating coherent linkages with knowledge from various disciplines to strengthen our capacity to theorize nursing practice as well as intervention in the context of social vulnerability.

This report addresses the consequences of the Iraqi Public Distribution System (PDS), a food rationing system managed by the Iraqi Ministry of Trade (MoT), administered by the U.N. World Food Programme (WFP), and supported with U.S. food aid. The Saddam Hussein administration created the PDS as emergency food aid in 1991 when United Sanctions (UN) sanctions made food imports to Iraq difficult. After more than two decades in operation, the PDS has developed long-term negative effects on Iraq’s most vulnerable populations. Specific vulnerable populations include Iraqi War Widows, Iraqi farmers, and Internally Displaced Persons (IDP). This report introduces the current Public Distribution System following a thorough background on the development of government-citizen relations, Sunni-Shi’i dynamics, and urban-rural economies throughout the twentieth Century in Iraq. The PDS harms the most food vulnerable Iraqis more than it assists them in the long run because of the unreliable delivery times, poor quality of the PDS goods, and depreciation of the local food market; therefore, the WFP and Iraqi MoT should limit the PDS recipients, improve the efficiency and quality of fewer goods in the PDS basket, and strengthen Iraq’s agriculture sector to provide for the current market and wheat exports. Based on an analysis of the U.S. farm bill, this paper recommends a shift in U.S. food aid from distributing American surplus crops as food aid. The U.S. government should focus on building capacity in the Iraqi agriculture sector with a model similar to the Obama Administration’s Feed the Future (FTF) initiative. / text

Dans les services de première ligne des Centres de santé et de services sociaux (CSSS) au Québec, les infirmières sont des acteurs clés des programmes destinés à des populations vulnérables. Ces programmes créent des opportunités pour les infirmières de développer une pratique à l’interface du CSSS et des ressources de la communauté afin d’agir pour réduire la vulnérabilité sociale. Des infirmières commencent d’ailleurs à se mobiliser au-delà de leurs frontières disciplinaires, organisationnelles et sectorielles pour s’engager dans l’environnement de personnes vulnérables, ce que nous désignons ici comme pratique infirmière d’interface. Aucune étude n’a toutefois été repérée en regard de cette pratique infirmière en émergence. Fondée sur une perspective constructiviste et systémique, de même qu’une analyse des conceptions de théoriciennes infirmières sur la pratique, notre recherche doctorale avait pour but de modéliser la pratique infirmière d’interface en contexte de vulnérabilité sociale. Elle a également constitué un cas à partir duquel contribuer aux savoirs théoriques sur le concept de pratique en sciences infirmières. Une étude qualitative exploratoire a été entreprise dans trois CSSS d’une région urbaine. Des entretiens semi-dirigés ont été réalisés avec quinze infirmières. La pratique d’interface de deux infirmières a ensuite fait l’objet d’une année d’observation directe et participante, ce qui a permis de procéder à des entretiens informels avec des gestionnaires ainsi que des membres des équipes interprofessionnelles et communautaires. Une analyse de documents programmatiques et gouvernementaux a complété notre description du contexte de la pratique d’interface. Une analyse thématique amorcée en cours de collecte de données ainsi que la méthode de modélisation systémique de Le Moigne ont permis de soutenir la démarche interprétative et de rendre compte des résultats. Quatre thèmes inter-reliés qualifient la pratique infirmière d’interface. Le premier met en évidence une finalité d’autonomie qui se traduit comme exigence de conformité sociale à l’endroit des personnes vulnérables. Le second porte sur des processus d’engagement relationnels des infirmières pour créer des liens et mettre en relation la clientèle et les acteurs du milieu. Le troisième thème est celui de l’action stratégique de l’infirmière. Enfin, le quatrième fait état d’un espace contradictoire à l’intérieur duquel se déroule la pratique d’interface, lequel comporte un processus de (re)configuration identitaire pour les infirmières. Une réflexion approfondie sur nos résultats, appuyée sur des savoirs disciplinaires en sciences infirmières et en sciences sociales, souligne des dimensions essentielles à considérer pour poursuivre le développement du concept de pratique en sciences infirmières. Spécifiquement, notre thèse permet de réfléchir les concepts centraux de soin et d’environnement en sciences infirmières, en plus d’expliciter le caractère fondamental de deux autres composantes à intégrer dans nos conceptions disciplinaires de la pratique, soit les savoirs et les projets. Cette thèse démontre la pertinence de contribuer à la création d’un « réseau de savoirs » avec d’autres disciplines pour soutenir notre capacité de théoriser la pratique et de renforcer l’intervention en contexte de vulnérabilité sociale. / Primary care nurses are key actors in programmes that are dedicated to vulnerable populations within Health and Social Service Centers (HSSC) in Québec. Such programmes provide opportunities to develop a nursing practice at the interface of an HSSC and community resources in order to reduce social vulnerability. Some nurses are now crossing their disciplinary, organisational and sectoral boundaries to engage in what we refer to here as interface nursing practice. Yet, to our knowledge, no study has documented this unfolding practice. Through a constructivist perspective, and building upon an analysis of nursing theorists’ conceptions of practice, the objective of this doctoral study was to produce a systemic model of interface nursing practice in the context of social vulnerability. This research also provides a case to reflect on the theory of practice in nursing science. A qualitative exploratory study was undertaken in three urban HSSCs. Fifteen primary care nurses participated in semi-structured interviews, followed by one year of direct and participant observation of the interface practice of two nurses. During this time, informal interviews with administrators, interprofessional teams and community actors, as well as an analysis of programme and governmental documents, were conducted to further our understanding of the context of interface nursing practice. Thematic analysis was initiated during data collection, whereas Le Moigne’s systemic modelling methodology was instrumental throughout the interpretive process of qualitative analysis and for the representation of our study results and further theoretical elaboration. Four inter-related themes qualify interface nursing practice. First, this practice is guided by a goal that is articulated as a social obligation for vulnerable populations, that of becoming autonomous. Second, relational processes are central as nurses interconnect vulnerable individuals with various actors and resources in the community. The third theme depicts interface nursing practice as strategic action. Finally, the fourth theme highlights opposing or contradictory processes that are experienced by nurses engaged in interface practice and that appear to change their sense of professional identity. Further examination of our results, at the intersection of nursing knowledge and social science theories, underscores fundamental dimensions of the concept of practice that are essential to consider in nursing theory development: the central concepts of care and environment, in addition to those of knowledge and projects. This thesis demonstrates the relevancy of creating coherent linkages with knowledge from various disciplines to strengthen our capacity to theorize nursing practice as well as intervention in the context of social vulnerability.

L’évolution scientifique du VIH/sida ne peut se conter sans son aspect juridique ; en effet, la pandémie a soulevé de nombreuses interrogations sur le plan juridique, qui se sont traduites par l’adoption de multiples législations. De la sorte, la sérophobie, née de l’impuissance de la médecine et de la science face à cette maladie qui semblait inexorable et de la peur du fait de l’incertitude sur ses origines et sa prophylaxie, a eu pour corollaire des réactions liberticides accompagnée d’un anathème jeté sur certaines populations. Toutefois, ce fléau médical, devenu également social, a eu comme résultat de lutter contre diverses injustices. En effet, alors que depuis le XIXe siècle, la réponse apportée aux épidémies était très autoritaire, le VIH/sida a introduit une nouvelle conception du contrôle de ces dernières, éloignée de la conception classique. Une perspective inédite consistant en une réflexion plus globale s’est alors mise en place. À partir de cela, le respect des droits individuels ne fut plus considéré comme pouvant être contraire à l’intérêt général, mais comme étant un élément nécessaire au bien-être commun. Dès lors, après avoir constitué une boîte de pandore aux atteintes aux droits fondamentaux, la riposte au VIH/sida est devenue, de façon croissante, un moyen de lutter contre les obstacles juridiques, traditionnels ou religieux d’un État à la mise en place d’une protection juridique égale à tous. Mais nonobstant ces progrès, des pans de la population mondiale restent très vulnérables face à l’infection. L’histoire du VIH autant scientifique que juridique n’est donc pas terminée / The scientific development of HIV/AIDS cannot be told without its legal aspect. Indeed, the pandemic has raised many questions in terms of law, which led to the adoption of numerous legislations. Thus, the "serophobia", result of the powerlessness of medicine and science regarding this disease that seemed inexorable and of the fear due to the uncertainty about its origins and prophylaxis, has been followed by drastic reactions and an anathema thrown on certain populations. However, this medical scourge, that also became a social one, has permitted to fight against some injustices. Indeed, while since the nineteenth century, the response to an epidemic was very authoritarian, HIV/AIDS has changed the game and introduced a new concept of control of the latter, different from the classic design. A new perspective consisting of a more global thinking, was then introduced. From this, the respect for individual rights was no longer regarded as being contrary to public interest, but as a necessary element of public health. Therefore, after having been a Pandora's box for human rights violations, the response to HIV/AIDS has become, increasingly, a way to fight against the legal, traditional or religious national obstacles to the implementation of a legal protection equal to all. But despite this progress, some populations remain highly vulnerable to the infection. Thus, the scientific and legal story of HIV is far from over

Disasters are complex events characterized by damage to key infrastructure and population displacements into disaster shelters. Assessing the living environment in shelters during disasters is a crucial health security concern. Until now, jurisdictional knowledge and preparedness on those assessment methods, or deficiencies found in shelters is limited. A cross-sectional survey (STUSA survey) ascertained knowledge and preparedness for those assessments in all 50 states, DC, and 5 US territories. Descriptive analysis of overall knowledge and preparedness was performed. Fisher’s exact statistics analyzed differences between two groups: jurisdiction type and population size. Two logistic regression models analyzed earthquakes and hurricane risks as predictors of knowledge and preparedness. A convenience sample of state shelter assessments records (n=116) was analyzed to describe environmental health deficiencies found during selected events. Overall, 55 (98%) of jurisdictions responded (states and territories) and appeared to be knowledgeable of these assessments (states 92%, territories 100%, p = 1.000), and engaged in disaster planning with shelter partners (states 96%, territories 83%, p = 0.564). Few had shelter assessment procedures (states 53%, territories 50%, p = 1.000); or training in disaster shelter assessments (states 41%, 60% territories, p = 0.638). Knowledge or preparedness was not predicted by disaster risks, population size, and jurisdiction type in neither model. Knowledge: hurricane (Adjusted OR 0.69, 95% C.I. 0.06-7.88); earthquake (OR 0.82, 95% C.I. 0.17-4.06); and both risks (OR 1.44, 95% C.I. 0.24-8.63); preparedness model: hurricane (OR 1.91, 95% C.I. 0.06-20.69); earthquake (OR 0.47, 95% C.I. 0.7-3.17); and both risks (OR 0.50, 95% C.I. 0.06-3.94). Environmental health deficiencies documented in shelter assessments occurred mostly in: sanitation (30%); facility (17%); food (15%); and sleeping areas (12%); and during ice storms and tornadoes. More research is needed in the area of environmental health assessments of disaster shelters, particularly, in those areas that may provide better insight into the living environment of all shelter occupants and potential effects in disaster morbidity and mortality. Also, to evaluate the effectiveness and usefulness of these assessments methods and the data available on environmental health deficiencies in risk management to protect those at greater risk in shelter facilities during disasters.

The literature suggests that informed consent documents (ICDs) are not well understood by research participants. The patient decision aid model may suggest improvements for the informed consent process, particularly in the critical care setting (ICU) because of patient capacity issues. Our goal was to evaluate the extent to which existing ICDs used in ICU research adhere to standards and recommendations for high quality informed consent. Eighteen items from recommendations specific to ICU trials were added to a previously developed ICD evaluation tool. A sample of ICU trials was identified from clinicaltrials.gov database and the investigators contacted for their trial ICD. Conformity to the recommendations was variable. Some information are found routinely in consent documents for critical care research and some are not. Efforts should aim to establish tools for measuring decision quality in the ICU with the goal of facilitating and helping patients and surrogates work through trial participation decisions.

Made available in DSpace on 2009-11-18T18:56:20Z (GMT). No. of bitstreams: 1 juliane.M.pdf: 1712261 bytes, checksum: 0bde91f6f03b36bc385cc27b12746e54 (MD5) Previous issue date: 2009 / Bolsa Família is the major brazilian conditional cash transfer program. It provides money to poor families contingent on investments in human capital, such as sending children to school or bringing them to health centers. This work aims to investigate if this program, in its normative structure, can be considered an appropriate policy of income redistribution and if it is able, appliances of the Welfare State model in the brazilian society and to approach the program in two different ways: as an alternative to more traditional social assistance programs and as a demand-side complement to the supply of other social needs. We will work on the thesis that the program by itself can not provide vulnerable populations with enough means to overcome poverty and to participate effectively on the market. According to this assumption, this paper is going to consider the reasons why tackling income necessary, along with the program, that the Government - in both federal and local spheres shall place major investments in critical areas like education and health. / O trabalho procura avaliar se o Programa Bolsa Família, em sua estrutura normativa, representa uma forma justa de distribuição de recursos sociais às camadas menos favorecidas e se constitui uma possibilidade teórica de superação da pobreza através de mecanismos de capacitação profissional, entre outros. Em suma, trata-se aqui de averiguar a consistência teórica da intervenção do Estado na área social através desse programa público, tendo como preocupações iniciais a dependência gerada pelo programa na população, suas implicações na dinâmica do mercado e a superação das perspectivas assistencialistas. O presente estudo tem como hipótese substantiva a tese de que o Programa Bolsa Família não consegue sozinho proporcionar a seus beneficiários, a médio prazo, a aquisição de capacidade para superar a pobreza e participar de modo economicamente ativo na sociedade. Dessa forma, não consistiria o programa, por si só, em uma distribuição justa de riquezas sociais para as camadas mais desfavorecidas da sociedade, capaz de propiciar a inclusão destas na cidadania, fazendo-se necessário, ainda, articulá-lo com outros programas de promoção do desenvolvimento social. Neste sentido, dentre os instrumentos existentes, poder-se-ia mencionar programas de melhoria da qualidade de ensino, de acesso à saúde e à educação, de apoio às atividades produtivas, oficinas profissionalizantes, tudo isso em concomitância com programas de renda mínima também de Estados e Municípios, de modo a alcançar o objetivo da superação da pobreza e a saída autônoma do Programa.