Trata-se de um estudo quantitativo, com abordagem descritiva e comparativa, que objetivou verificar a influência da consulta de enfermagem gerontológica no nível de adesão terapêutica dos clientes com doenças crônicas não-transmissíveis, acompanhados num ambulatório especializado. Como objetivo específico, buscou-se comparar o nível de adesão terapêutica, perfil sociodemografico e clínico entre o grupo de clientes acompanhados na consulta de enfermagem e o grupo dos não acompanhados. Este foi motivado pela práxis da autora em consultas gerontológica, onde foram percebidos obstáculos enfrentados por muitos clientes com adesão inadequada ao tratamento, acarretando dificuldades no controle de suas doenças, fato este ratificado pela literatura. Os resultados evidenciaram similaridade entre os perfis sociodemográficos, com prevalência de sexo feminino, baixa escolaridade e renda. O perfil clínico revelou, em ambos os grupos, alto índice de hipertensão, diabetes e depressão, destacando-se esta última por ser desfavorável ao comprometimento com o autocuidado. Por fim, verificou-se que os níveis de adesão terapêutica ficaram majoritariamente dentro da faixa estabelecida como adesão ampla, sem diferença expressiva entre os grupos. É relevante citar que, entre os acompanhados pela consulta de enfermagem, observou-se, um maior conhecimento sobre a doença em tratamento e suas manifestações, maior acesso aos medicamentos e auto percepção de conhecimentos sobre efeitos colaterais. Constatando-se que, este último achado, exerce grande influência na adesão ao tratamento farmacológico. Este desfecho reflete a importância de uma assistência sistematizada, embasada em uma teoria de enfermagem, que neste contexto, foi a teoria do autocuidado de Orem, utilizada previamente nas consultas de enfermagem do ambulatório investigado. Os resultados corroboram o uso desta teoria, especialmente numa perspectiva educativa da assistência ambulatorial. Diante disso, é mister buscar novas abordagens de pesquisa, a fim continuar a investigação sobre as contribuições da enfermagem para uma melhor adesão terapêutica dos clientes idosos. Finalmente, a autora espera cooperar para o aprimoramento científico nesta matéria e para uma progressiva qualificação da assistência de enfermagem na prevenção e controle de agravos à saúde. / Using quantitative, descriptive and comparative approaches, this work aims at assessing the influence of the gerontological nursing consultation on treatment adherence of elderly clients with non-transmissible chronic illnesses in a specialized clinic. Urged by her experience, the author noticed difficulties faced by many elderly, leading to low levels of treatment adherence, and consequently to difficulty controlling their illnesses, a fact confirmed by the established literature. This study aims specifically, to compare both the level of adherence, of nursing consulted group with that of a non-consulted, and the sociodemographic and clinical profiles of the aforementioned groups. Results evidenced similarity between sociodemographic profiles, with the prevalence of female gender, low education and income. The clinical profiles showed a high degree of hipertension, diabetes and depression in both groups, the last one, with a considerable disadvantage to the commitment to self-care. The nursing consulted group client displayed a greater knowledge of the disease and its manifestations along the treatment, an increased access to medications, and knowledge about their side effects. Finally it was concluded that adherence levels it was good one, with no significant difference between groups. Such outcome reflects the importance of a systematized care, based on Orem's self-care theory, long deployed in gerontological nursing consultations in the aforementioned clinic. The results corroborate the use of Orem's theory, mostly in an educational perspective of the outpatient care. It is thus momentous to pursue new approaches in order to research nursing contributions to attain a higher degree of adherence of the elderly client. Lastly, the author hopes to contribute to the improvement of the knowledge in this field and to the onward qualification of nursing care in illness prevention and control.

OBJECTIVE: The vast majority of physicians frequently faces ethical dilemmas and feels overwhelmed as a result. Those at Boston Medical Center are no exception. Various studies show more adept handling of ethical issues can improve the quality of care and patient safety by reducing moral distress of physicians and fostering better patient-physician relationship. The method of Preventive Ethics, which actively identifies recurrent themes and underlying systematic issues among ethics consultations, is more effective than the traditional, case-by-case approach in reducing the number of ethical conflicts. The purpose of this study is to identify common themes prompting ethics consultations and any hotspots among recurrent ethical dilemmas at Boston Medical Center by using the Armstrong Clinical Ethics Coding System. METHODS: A total of 32 ethics consultations handled by the BMC Ethics Committee between October 2010 and April 2013 were reviewed. Each consultation was coded using the Armstrong Clinical Ethics Coding System. The data was analyzed to identify the types of ethical dilemma that are most prevalent at BMC. The consultations involving the most frequently occurring issues were evaluated further to expose common themes among these cases and potential underlying systematic failures. RESULT: "Clinical Candidacy or Risk / Benefit Analysis" (6.25%), "Concern About Decision Maker Choices" (14.6%) and "Futility / Inappropriate or Nonbeneficial Treatment" (13.5%) were the most prevalent types of ethical issues at BMC. Not only are these three frequently occurring, they also have a very high tendency to occur simultaneously. Further analysis of consultations involving these three issues revealed that at BMC, there are frequent instances of conflict, in which family members serving as healthcare proxies disagreed with physicians in deciding the best interest of patients with severe ailments, ultimately precipitating ethics consultations. DISCUSSION: Comparison with similar retrospective studies previously carried out at other institutions suggests that consultation involving the issue of futility may be more frequently occurring at BMC, which might be coming from unique systematic problems. Several interventions such as improved policies or educational training in physician-family communication should be considered. CONCLUSION: According to the principles of Preventive Ethics, the issue of physician-healthcare proxy conflict regarding patient futility should be issue to be addressed at BMC. The Armstrong Clinical Ethics Coding System can serve as a much needed standard documentation format for ethics consultations, which would open up the possibility of more detailed future studies

abstract: Within ethics, a number of scholars advocate an interdisciplinary approach of combining the two traditionally different professions of science and philosophy with the confidence that this collaboration will be a mutually beneficial experience. Current ethicist-scientist interactions include embedded-ethicists and research ethics consultation services. Both methods are employed with the hope that they will reduce social and ethical problems that could arise from scientific research, and enhance the reflective capacity of investigative teams. While much effort has been put forth in the endeavor of creating ethicist-scientist interactions, there remains opportunity to refine these new interaction models to make them more robust. There is need for ethicists to understand the context of ethical decision-making in the laboratory. By extension, before interacting with scientists in a research lab, research ethicists ought to have the ability to understand the science and also be familiar with the different factors that influence scientific research, such as funding, productivity requirements, time constraints, politics of laboratories and institutional reward structures. Through literature review and the analysis of qualitative data obtained from the ethnographic study in a neuroscience laboratory, this thesis explores the strengths and weaknesses of ethicist-scientist interactions and aims to understand the culture, traditions and values of this community and their perspectives on their role as scientists and their relationship to ethics. This study shows that the quantity and quality of ethics discussions in the lab are limited and dictated by time constraints and minimal incentives. Other influencing factors are the researchers' perspectives on ethics and how they view their role as a scientist in relation to the public. / Dissertation/Thesis / M.S. Applied Biological Sciences 2012

This research used interviews and Interpretative Phenomenological Analysis (IPA) methodology to explore the experiences of care staff who attended systemic consultations within an Intellectual Disability (ID) service. A systematic literature review revealed limited research in the area of systemic approaches used with people with IDs and their networks. Research questions encompassed 'How do care staff experience systemic consultations that they have attended in ID services'?, 'What do care staff find helpful in systemic consultations'?, and, 'What do care staff find unhelpful in systemic consultations'?. Seven participants were interviewed, and interview data was transcribed and analysed using IPA. Five superordinate themes emerged; 'Not knowing what to expect; it was something different', 'Our relationships improved', 'An outside person shone a new light enabling us to think and work differently', 'Making sense of what we have achieved', and 'They made us feel validated'. The research findings highlighted important clinical implications. These included a need for the context to be 'warmed' and relational reflexivity (Bunham, 2005) to be applied in order to help care staff prepare for systemic consultations and feel supported. Future research directions are also discussed in order to develop the evidence-base for systemic approaches within ID services.

xiv, 131 p. : ill. A print copy of this thesis is available through the UO Libraries. Search the library catalog for the location and call number. / This dissertation study investigated the impact of brief teacher consultation on teachers' implementation fidelity, quality of implementation, and student responsiveness during the Strong Kids social-emotional learning curriculum. Additional outcome measures included teachers' self-efficacy and teachers' perceptions of social validity of the Strong Kids program. Participants included six teachers, three of whom were randomly assigned to the treatment group and three of whom were randomly assigned to the control group. Teachers in the treatment group received brief performance feedback consultation for six out of the twelve Strong Kids lessons; whereas, teachers in the control group did not receive consultation, but instead were given a frequently asked questions sheet that provided them with general information about the curriculum. Results of the study indicated an increase in implementation fidelity for the teachers receiving performance feedback consultation and a decrease in implementation fidelity for the teachers who did not receive performance feedback. The data did not indicate any substantial effects for the consultation group teachers with respect to quality of implementation or student responsiveness. Overall, teachers in both the treatment and control groups had positive attitudes toward social-emotional learning and the curriculum. Both groups of teachers also reported similar negative attitudes regarding the curriculum. For example, both groups of teachers felt that the lessons took too long to implement within a given class period. Implications of this study for future research and practice are discussed. / Committee in charge: Kenneth Merrell, Chairperson, Special Education and Clinical Sciences; Jeffrey Sprague, Member, Special Education and Clinical Sciences; Terry Scott, Member, Special Education and Clinical Sciences; John Seeley, Member, Not from U of 0; Lynn Kahle, Outside Member, Marketing

This dissertation examines the shifting and multi-scalar governance of oil and gas projects in Peruvian Amazon. Using cases studies of oil extraction in blocks 1AB (192), 8 in Loreto (2006 to 2015), and the Environmental Impact Assessment (EIA) process for the expansion of the Camisea gas project in block 88 in Cusco, this dissertation explores how environmental decision-making processes of oil and gas projects are structured and enacted. In doing so, this study sheds light on the shifting interactions, negotiations, struggles and (at times) open conflicts between actors that define why, how and where hydrocarbon projects take place in the Amazon. Recognizing the variety of actors, I organize my analysis around government institutions, indigenous mobilizations, environmental assessments and the economic distribution of revenues from oil and gas projects. From my analysis I argue that resource extraction is changing substantially the relationship between the government and the indigenous peoples in the Peruvian Amazon. These changes involve profound changes in indigenous rights and the creation of new institutions and capacities in the state to address the social-environmental effects of extractive industries. The surge of social-environmental conflicts and the influence of international finance institutions have prompted the Peruvian government to reform the institutional framework regulating resource extraction. This reforms are taking place amid the globalization of indigenous rights, discourses, and laws (such as the Prior Consultation Law) granting special rights to indigenous peoples. However, power-knowledge asymmetries in the decision-making processes (such as the environmental assessments) tend to increase the sense of mistrust among the local populations, resulting in increasing social-environmental conflicts. In addition, the uneven distribution of benefits from resource extraction is creating regional disparities, increasing the dependency of some regions on resource extraction. An examination of the implementation of the Environmental Impact Assessment process for the expansion of the Camisea project in block 88 exposes unresolved practices of representation and citizenship of the indigenous peoples in voluntary isolation. However, overall, Amazonian indigenous people’s struggles are shifting the traditional national, social, and political life. They are ethnic minorities and citizens struggling for their rights to participate in decision-making processes and in the distribution of economic benefits from extraction, both particularity and equality.

Paraprofessionals spend the most time with the neediest students, but receive the least amount of training and support. All target students in the study had developmental disabilities, were between the ages of three and five, and had a history of challenging behavior. Paraprofessionals in the study were recruited because they had the least experience and training administering behavior support plans (BSPs) in their setting. A multi-level consultation model was used to train paraprofessionals (i.e., teaching assistants) to implement individualized BSPs. First, paraprofessionals were trained in a one-on-one setting how to implement the BSPs using behavioral skills training. Next, adherence to the BSP was monitored by independent observers and additional support was delivered contingent on meeting an adherence criterion. Through a cascading logic, data showed that paraprofessionals engaged in immediately and significantly higher levels of BSP adherence following application of the multilevel consultation model, and as a result, students engaged in immediately and significantly lower rates of challenging behavior (Tau-U = -.97 to -1), which maintained over time. Further, all adult participants rated the procedures as highly acceptable. Thus, with minimal training provided to each paraprofessional across the study (M = 151.2 minutes), and dramatic observed changes in challenging behavior, the multilevel consultation model proved highly efficient, effective, and acceptable.

Introdução: Quando os dilemas éticos surgem no âmbito de assistência à saúde, surge a necessidade de fazer uma reflexão no âmbito da Bioética Clínica, que pode ser entendida como sendo a identificação, análise e resolução de problemas ou dilemas morais que surgem no cuidado individual de pacientes. Embora as questões práticas sejam usualmente priorizadas na assistência ao paciente, é reconhecida a importância da teoria nos modelos de tomada de decisão. Quando a atenção se volta para a prática, descobrimos regras complexas de ação e percepção que raramente são discutidas. O Modelo da Bioética Complexa busca agregar estas visões, e sugere que a Bioética é uma reflexão complexa, compartilhada e interdisciplinar sobre a adequação das ações que envolvem a vida e o viver. Objetivos: O objetivo desta tese é analisar as consultorias de Bioética Clínica realizadas em um hospital geral universitário de grande porte, verificando os aspectos teóricos e práticos identificados e as suas interações. Métodos: Foi realizado um estudo transversal das 317 consultorias de Bioética Clínica realizadas no Hospital de Clinicas de Porto Alegre de fevereiro de 2009 até abril de 2013, que tiveram registros nos prontuários de 300 pacientes internados. O levantamento dos prontuários foi fornecido pelo Serviço de Arquivo Médico e Informações em Saúde, que é o responsável pela guarda e manutenção destes registros. Os referenciais teóricos utilizados foram analisados a partir da abordagem complexa da Bioética, utilizando quatro grandes referenciais: Virtudes, Princípios, Direitos Humanos e Alteridade. Os temas das consultorias foram analisados de acordo com a classificação proposta pela National Reference Center for Bioethics Literature, da Georgetown Law Library, adaptada nesta tese. Resultados: Foi possível identificar que 94,7% dos solicitantes eram médicos e 5,3% eram enfermeiros. Os Serviços que mais solicitaram consultorias foram o de Medicina Interna (22,3%), Pediatria (15,7%) e Psiquiatria (9,3%). O referencial das Virtudes estava presente em 99,3% dos casos, o dos Princípios em 99,0%; o dos Direitos Humanos em 97,3% e o da Alteridade em 94,4%. Dos pacientes, 50,0% eram do sexo feminino, com idade média de 37,42 + 25,61 anos, e tempo médio de internação de 52,1+120,82 dias. Destes, 63,0% tiveram alta para o domicílio e 33,3% foram a óbito. Os três temas mais frequentes nas consultorias foram: Morte e Morrer, (81,7%), Relacionamento Profissional (66,0%), e Consentimento Informado (64,7%). A média anual de consultorias foi de 78,0 e a mensal de 6,52, e o tempo para responder às consultorias foi, em média, de 40,0+102,1 horas. Avaliando os aspectos translacionais em prontuário, foi possível identificar que em 73,3% houve transposição evidente das condutas sugeridas para a prática assistencial. Conclusão: As características dos profissionais que solicitaram consultorias, para quais pacientes ocorreram estas solicitações, e os respectivos seviços médicos associados, possibilitaram identificar os temas mais relevantes nas consultorias de Bioética Clínica, e quais os referenciais teóricos que estão envolvidos nestes problemas éticos. Esta análise permitiu verificar a interação existente entre teoria e prática e a transposição das reflexões da Bioética à assistência aos pacientes. / Background: When ethical dilemmas arise in the context of health care, arises the need to think in the Clinical Ethics field, which can be understood as the identification, analysis and resolution of problems and moral dilemmas that arise in the individual patients care. Although practical issues are usually prioritized in patient care, the importance of theory in models of decision making process is recognized. When attention turns to practice, we find complex rules of action and perception that are rarely discussed. The Complex Bioethics Model intended to add these visions, and suggests that bioethics is a complex, interdisciplinary and shared reflection on the actions adequacy involving life and living. Objective: The aim of this thesis is analyze the Clinical Ethics consultations performed in a large general university hospital, verifying theoretical and practical aspects identified and their interactions. Methods: A cross-sectional study was conducted with 317 Clinical Bioethics consultations performed at Hospital de Clinicas de Porto Alegre in February 2009 until April 2013, registered in 300 inpatients medical records. The Medical Records and Health Information Service, responsible for the custody and maintenance of these records, provided medical records survey. The theoretical frameworks were analyzed using the bioethics complex approach to, using four major benchmarks: Virtues, Principles, Human Rights and Alterity. The consultations themes were analyzed according to the classification proposed by the National Reference Center for Bioethics Literature, the Georgetown Law Library, adapted for this purpose. Results: We found that 94.8 % of applicants were physicians and 5.3 % were nurses. Services that most requested consultations were Internal Medicine (22.3%), Pediatrics (15.7%) and Psychiatry (9.3%). The Virtues benchmark was present in 99.3% cases, Principles in 99.0%, Human Rights in 97.3 % and Alterity in 94.4 %. About patients, 50.0 % were female, mean age was 37.42 + 25.61 years, and mean hospital stay 52.1 days +120.82. Of these, 63.0 % were discharged home and 33.3 % died. The three most frequent themes in consultations were: Death and Dying, (81.7%), Professional Relationship (66.0%), and Informed Consent (64.7%). Annual consultations average was 78.0 and monthly average 6.52, time to respond to consultations was on average 40.0 +102.1 hours. Evaluating patient records translational aspects, we found that 73.3% had evident transposition of conduct suggested for clinical practice. Conclusion: Professionals characteristics of those who have requested consultations, which patients had these requests and their associated medical services, allowed to identify the most relevant Clinical Bioethics consultations topics, and which theoretical frameworks are involved in these ethical problems. This analysis enables to verify the theory and practice interaction and the transposition of the Bioethics reflections to patients’ assistance.

Trata-se de um estudo quantitativo, com abordagem descritiva e comparativa, que objetivou verificar a influência da consulta de enfermagem gerontológica no nível de adesão terapêutica dos clientes com doenças crônicas não-transmissíveis, acompanhados num ambulatório especializado. Como objetivo específico, buscou-se comparar o nível de adesão terapêutica, perfil sociodemografico e clínico entre o grupo de clientes acompanhados na consulta de enfermagem e o grupo dos não acompanhados. Este foi motivado pela práxis da autora em consultas gerontológica, onde foram percebidos obstáculos enfrentados por muitos clientes com adesão inadequada ao tratamento, acarretando dificuldades no controle de suas doenças, fato este ratificado pela literatura. Os resultados evidenciaram similaridade entre os perfis sociodemográficos, com prevalência de sexo feminino, baixa escolaridade e renda. O perfil clínico revelou, em ambos os grupos, alto índice de hipertensão, diabetes e depressão, destacando-se esta última por ser desfavorável ao comprometimento com o autocuidado. Por fim, verificou-se que os níveis de adesão terapêutica ficaram majoritariamente dentro da faixa estabelecida como adesão ampla, sem diferença expressiva entre os grupos. É relevante citar que, entre os acompanhados pela consulta de enfermagem, observou-se, um maior conhecimento sobre a doença em tratamento e suas manifestações, maior acesso aos medicamentos e auto percepção de conhecimentos sobre efeitos colaterais. Constatando-se que, este último achado, exerce grande influência na adesão ao tratamento farmacológico. Este desfecho reflete a importância de uma assistência sistematizada, embasada em uma teoria de enfermagem, que neste contexto, foi a teoria do autocuidado de Orem, utilizada previamente nas consultas de enfermagem do ambulatório investigado. Os resultados corroboram o uso desta teoria, especialmente numa perspectiva educativa da assistência ambulatorial. Diante disso, é mister buscar novas abordagens de pesquisa, a fim continuar a investigação sobre as contribuições da enfermagem para uma melhor adesão terapêutica dos clientes idosos. Finalmente, a autora espera cooperar para o aprimoramento científico nesta matéria e para uma progressiva qualificação da assistência de enfermagem na prevenção e controle de agravos à saúde. / Using quantitative, descriptive and comparative approaches, this work aims at assessing the influence of the gerontological nursing consultation on treatment adherence of elderly clients with non-transmissible chronic illnesses in a specialized clinic. Urged by her experience, the author noticed difficulties faced by many elderly, leading to low levels of treatment adherence, and consequently to difficulty controlling their illnesses, a fact confirmed by the established literature. This study aims specifically, to compare both the level of adherence, of nursing consulted group with that of a non-consulted, and the sociodemographic and clinical profiles of the aforementioned groups. Results evidenced similarity between sociodemographic profiles, with the prevalence of female gender, low education and income. The clinical profiles showed a high degree of hipertension, diabetes and depression in both groups, the last one, with a considerable disadvantage to the commitment to self-care. The nursing consulted group client displayed a greater knowledge of the disease and its manifestations along the treatment, an increased access to medications, and knowledge about their side effects. Finally it was concluded that adherence levels it was good one, with no significant difference between groups. Such outcome reflects the importance of a systematized care, based on Orem's self-care theory, long deployed in gerontological nursing consultations in the aforementioned clinic. The results corroborate the use of Orem's theory, mostly in an educational perspective of the outpatient care. It is thus momentous to pursue new approaches in order to research nursing contributions to attain a higher degree of adherence of the elderly client. Lastly, the author hopes to contribute to the improvement of the knowledge in this field and to the onward qualification of nursing care in illness prevention and control.

Made available in DSpace on 2016-06-02T20:00:25Z (GMT). No. of bitstreams: 1 2201.pdf: 2360516 bytes, checksum: b709ef2fb54a4e395089dc766afff836 (MD5) Previous issue date: 2008-10-13 / This paper presents a collection of consultation methods reported in the technical literature and its applicability. It seeks for identify the most appropriated way to involve the communities in drawing up directors plans and other actions related to the urban planning and management. This because, since the Federal Constitution, 1988, the legislation related to the public policies prescribe the need of popular participation in these programs. It chose to study case the elaboration process of the Participative Director Plan in Bauru - SP, which was evaluated by several segments involved in its process through the application of questionnaires that based on the Likert Scale and according to established principles by Carson and Gelber (2001), with the objective to verifying the reached level of participation in this. In the end, discussions are made about the role of professionals involved in urban planning ahead to the new situation of sharing decisions with the community. / Este trabalho apresenta uma seleção de métodos de consulta existentes na literatura técnica e sua aplicabilidade, buscando identificar, a partir de critérios objetivos, os mais adequados ao desenvolvimento de trabalhos com comunidades na elaboração de planos diretores e demais ações relativas ao planejamento e à gestão urbana, uma vez que, a partir da Constituição Federal de 1988, legislações referentes às políticas públicas prescrevem a necessidade de participação popular. Escolheu-se para estudo de caso o processo de elaboração do Plano Diretor Participativo do Município de Bauru SP, que foi avaliado pelos diversos segmentos envolvidos em seu processo de elaboração, por meio da aplicação de questionários na Escala Likert, e segundo os princípios estabelecidos por Carson e Gelber (2001), com o objetivo de verificar o grau de participação alcançado. Ao final, discute-se o papel dos profissionais envolvidos em planejamento urbano frente à nova situação de compartilhamento de decisões com a comunidade.