Este trabalho tomou como objeto de estudo as transformações ocorridas no trabalho, vida e, especialmente, maneira de pensar e agir das atendentes de enfermagem a partir de sua qualificação como auxiliares pelo Projeto Larga Escala (PLE). Utilizou o trabalho e a qualificação como categorias de análise e teve como objetivo dimensionar as mudanças ocorridas com as atendentes a partir de sua qualificação. Constituíram os sujeitos deste estudo as atendentes que se qualificaram como auxiliares de enfermagem pelo PLE na Administração Regional de Saúde - 5 (da cidade de São Paulo) no período de 1990 a 1992, utilizando histórias de vida como estratégia de captação da realidade. A análise das histórias permitiu reconhecer as possibilidades e limites dos processos de qualificação. Observou-se que a qualificação garantiu às antigas atendentes: a) o acesso a uma posição de melhor remuneração, de promoção a uma categoria profissional e alguns direitos trabalhistas; b) a conquista de alguns direitos como cidadãs, que não se relacionam com a possibilidade de ascensão social; c) mudança no padrão de conhecimento; d) autonomia relativa aos aspectos técnicos da atenção à saúde; e) ganhos na humanização do cuidado. A qualificação parece ter uma força relativa na modificação da qualidade da atenção à saúde, permitindo uma certa compreensão do objeto de trabalho e no domínio das tecnologias utilizadas no processo de trabalho. Não parece constituir-se, no entanto, em força capaz de suscitar transformações no modelo constituído de assistência clínica individual, desvelando assim uma certa fragilidade da apreensão da dimensão política proposta pelo PLE para a qualificação dos profissionais da saúde / This study took as object the transformations occurred in working, living and specially in the thinking and acting way of nursing attendants after their qualification as nursing auxiliaries through the LSP (Large Scale Project). It utilized work and qualification as analytical categories. The aim was to evaluate the dimension of the changes occurred with attendants after de qualification process. Study subjects were attendants who have qualified as auxiliaries through LSP, conducted by the Regional Health Administration – 5 (São Paulo city), during 1990 a 1992. Life histories were used as a methodological tool to apprehend these transformations. The analyses allowed the recognition of both potentialities and limitations of the qualification process. Qualification have guarantied to the attendants: a) access to improved remuneration, promotion to a professional status e some working rights; b) conquer of some citizen rights not directly related with social rising; c) change in knowledge patterns; d) a certain autonomy related to technical aspects of health attention; d) gains in the humanization of care. The qualification process seems to have a relative power to modify the quality of health attention, allowing a certain understanding of the object of the health work and dominating technologies used in the working process. Nevertheless, it does not seems to constitute changes in the individual and clinical model of health assistance, showing a certain fragility to apprehend the political dimension proposed by the LSP to qualify health workers

Several factors may affect the choice of place of delivery among expectant mothers in Ghana and few studies have examined the choice of place of delivery with a focus on differences between rural and urban areas. In this study, the factors that influence the choice of place of delivery among expectant mothers in both rural (Tolon District) and urban (Tamale) settings in the northern part of Ghana were identified and compared using the conceptual framework provided by Thaddeus and Maine. A mixed-method study was used to examine expectant mothers and their responses related to factors that affect their choice of place of delivery through a concurrent triangulation using health professional interviews and a detailed participant survey.. The sample consisted of 552 expectant mothers between the ages of 15 and 49 years. Individual interviews were held with 8 health professionals (4 each from rural and urban areas) with a minimum of 5 years of work experience and a focus group discussion with randomly selected pregnant women and lactating mothers. Themes were generated through open coding of the interview data, while multiple regression was performed to identify the factors associated with choice of place of delivery, rural area, preference (60.1%) was for home delivery compared to 20.7% for urban participants. Statistically significant variables affecting the choice of place of delivery among study participants were found to be educational background, the experience of previous deliveries, the attitude of hospital staff toward pregnant women during labor, and frequency of accessing antenatal care. The study's implications may lead to positive change where stakeholders develop and implement policies to promote health facility delivery for expectant mothers in both rural and urban areas of Ghana.

The central concern of this study is the social, cultural and political position of traditional birth attendants (TBA), known as yiey maap (grandmother midwives) in Chup Commune (pseudonym). In particular, this study explores strategies yiey maap use to negotiate or bypass Western model health services in an attempt to maintain their personal integrity and cultural capital as birth attendants, and to ensure the physical, emotional, economic and cultural safety of the woman they care for. / This thesis explores traditional maternity knowledges and practices using ethnographic methods to investigate the central issues, concerns and barriers confronting rural woman as they make choices to adapt, resist or negotiate Western maternity care. It is vital to consider historical, political, cultural and economic factors that influence women's decisions in order to understand how and why women hold onto or surrender their traditional childbirth knowledges and practices, including the preservation of yiey maap, their favoured birth attendant. / Safe Motherhood initiatives were introduced into resource-poor countries by the World Health Organization in 1987 with the goal of reducing maternal mortality rates. They were based on the premise that pregnancy, childbirth and postpartum care were safer when provided by skilled birth attendants in a modern health facility. TBAs were not considered skilled birth attendants by Safe Motherhood partner agencies, as training and utilizing TBAs in Safe Motherhood initiatives did not have a measurable impact on maternal mortality rates. Instead, TBAs' roles have been recast, and TBAs are expected to be health promoters and educators, referral agents and information gatherers. / I argue that Khmer women do not engage with the modern health system because it is unfamiliar and expensive, and health personnel provide poor quality care. Instead, in times of obstetric emergencies, women attempt to negotiate their own and their family's safety through personal autonomy and agency. / I conclude by proposing alternative approaches and strategies, including the increased utilisation of yiey maap in Cambodian Safe Motherhood programs. A central question is whether the Ministry of Health, supported by bilateral and multilateral agencies, should train and utilize yiey maap or midwives in maternity care. I argue that both are of equal importance. Until yiey maap are valued for their contribution to, and enjoy equitable inclusion in midwifery care, initiatives that involve yiey maap as program "extras", who undertake peripheral tasks, will not reduce maternal mortality rates.

Este trabalho tomou como objeto de estudo as transformações ocorridas no trabalho, vida e, especialmente, maneira de pensar e agir das atendentes de enfermagem a partir de sua qualificação como auxiliares pelo Projeto Larga Escala (PLE). Utilizou o trabalho e a qualificação como categorias de análise e teve como objetivo dimensionar as mudanças ocorridas com as atendentes a partir de sua qualificação. Constituíram os sujeitos deste estudo as atendentes que se qualificaram como auxiliares de enfermagem pelo PLE na Administração Regional de Saúde - 5 (da cidade de São Paulo) no período de 1990 a 1992, utilizando histórias de vida como estratégia de captação da realidade. A análise das histórias permitiu reconhecer as possibilidades e limites dos processos de qualificação. Observou-se que a qualificação garantiu às antigas atendentes: a) o acesso a uma posição de melhor remuneração, de promoção a uma categoria profissional e alguns direitos trabalhistas; b) a conquista de alguns direitos como cidadãs, que não se relacionam com a possibilidade de ascensão social; c) mudança no padrão de conhecimento; d) autonomia relativa aos aspectos técnicos da atenção à saúde; e) ganhos na humanização do cuidado. A qualificação parece ter uma força relativa na modificação da qualidade da atenção à saúde, permitindo uma certa compreensão do objeto de trabalho e no domínio das tecnologias utilizadas no processo de trabalho. Não parece constituir-se, no entanto, em força capaz de suscitar transformações no modelo constituído de assistência clínica individual, desvelando assim uma certa fragilidade da apreensão da dimensão política proposta pelo PLE para a qualificação dos profissionais da saúde / This study took as object the transformations occurred in working, living and specially in the thinking and acting way of nursing attendants after their qualification as nursing auxiliaries through the LSP (Large Scale Project). It utilized work and qualification as analytical categories. The aim was to evaluate the dimension of the changes occurred with attendants after de qualification process. Study subjects were attendants who have qualified as auxiliaries through LSP, conducted by the Regional Health Administration – 5 (São Paulo city), during 1990 a 1992. Life histories were used as a methodological tool to apprehend these transformations. The analyses allowed the recognition of both potentialities and limitations of the qualification process. Qualification have guarantied to the attendants: a) access to improved remuneration, promotion to a professional status e some working rights; b) conquer of some citizen rights not directly related with social rising; c) change in knowledge patterns; d) a certain autonomy related to technical aspects of health attention; d) gains in the humanization of care. The qualification process seems to have a relative power to modify the quality of health attention, allowing a certain understanding of the object of the health work and dominating technologies used in the working process. Nevertheless, it does not seems to constitute changes in the individual and clinical model of health assistance, showing a certain fragility to apprehend the political dimension proposed by the LSP to qualify health workers

Traditional Birth Attendants (TBAs) are the primary health care providers for women at the time of childbirth in many parts of the world. In India, particularly in remote areas such as Garhwal, these women play a key role in maternal health. Training programmes for TBAs can lead to dramatic reductions in neonatal mortality as well as in maternal morbidity and mortality, due to improved hygienic practices at the time of delivery. Yet training programmes for TBAs often lack sociocultural relevance, and fail to incorporate an understanding of the TBAs' perceptions of the process of pregnancy and delivery. Understanding more about the role of the TBA as a diagnostician and a decision-maker within a given sociocultural context can make such training programmes more culturally congruent. This research report describes the way in which TBAs (dais) in Garhwal interpret obstetrical complications, and how they make decisions regarding the need for cosmopolitan medical care. TBAs in Garhwal interpret obstetrical complications using a variety of explanatory models, arising from an understanding of health and illness which shows influences of Vedic, Ayurvedic, folk and cosmopolitan medical models. These explanatory models often led to a perception of "danger” and the "dangerous case" which is widely divergent from the cosmopolitan medical model. Specific areas are identified where the dais' interpretation of "danger" was particularly divergent from the cosmopolitan medical model. These areas of conceptual conflict result in diagnoses and treatment procedures which can lead to significant delays in the woman receiving needed cosmopolitan medical care. The third stage of action-research process is the development of a participatory training programme, in which the TBA is an active participant. The aim of the training programme is to move towards a shared perception of risk regarding major obstetrical complications. / Thesis / Master of Arts (MA)

Thesis (M.S.)--Oregon State University, 2009. / Printout. Includes bibliographical references (leaves 114-119). Also available on the World Wide Web.

This research implemented a multiple case study design to investigate the effects of aesthetic and emotional labor in the premium airline context of Emirates, in comparison to the low-cost airline context of easyJet. This was achieved through the conduct of interviews with flight attendants from each airline as they are the frontline employees who are mostly concerned with the implementation of these standards. Even before the recruitment process employees are introduced to the requirements of aesthetic and emotional labor as airlines aim to find those who will best ‘fit’ their organizational culture, and that through training they will be even more equipped to represent the company during their interactions with customers. Thus, flight attendants are regarded as a strategic resource that contributes to the competitive advantage and organizational performance of airlines. Taking into consideration that aesthetic and emotional labor standards define the very nature of flight attendants’ job and that their performance determines the organization’s performance, the potential effects on their performance cannot be disregarded. The main themes that were yielded through the thematic analysis of the empirical findings were found to be parallel to some of the performance factors in Herzberg’s two-factor theory of motivation, while aesthetic and emotional labor were located as components within identified themes. Thus, this provided us with a general theoretical framework that allowed us to further discuss our findings in connection to relevant theory. Results showed that the different operational business models as well as the different cultures of each airline mostly contributed to the differences that were found in regard to the implementation of standards between the two contexts. Aesthetic labor standards were found to have a stronger effect on employees’ performance in the case of Emirates due to the fact their supervision was stricter. In both cases, aesthetic labor standards were not found to have an effect on employees' performance when it comes to their interaction with customers. While easyJet was found to receive a more diverse training when it comes to interaction with customers, in both cases emotional labor standards were found to have an overall positive link to employees’ performance not only when it comes to interaction with customers but also when it comes to dealing with co-workers, managers and the demands of the job in general. However, the aspect of personality was found to be a moderating factor influencing employees’ understanding and following of standards. It should be noted that the results of this research cannot be generalized. Further investigation across different contexts and airlines is suggested so as to conclude whether the results are representative of a specific context.

<p>This thesis presents perspectives and experiences of different stakeholders and their ways of reasoning around pregnancy and pregnancy care. Data were generated from individual interviews with 25 health care providers, 18 women and 6 traditional birth attendants (TBAs) as well as 11 focus groups discussions with women, men and TBAs. </p><p>The challenges experienced by health care providers in their provision of antenatal care, while attempting to change antenatal care through routines proven to have medical value, are highlighted. Changing some long established routines, such as weighing and timing of visits, proved difficult mostly because of resistance from the users of care, whose reasoning and rationale for using care did not correspond with the professional perspectives of care. </p><p>Women also combined biomedical and traditional care. The women used the clinic to receive professional care and assurance that the pregnancy was progressing well and used TBAs, who are believed to have supernatural powers, for cultural forms of assurance and protection. The health care staff did not appreciate these aspects and discouraged women using TBAs. Midwives had problems to change routines of care because of their stressful working situations and the expectations of the women.</p><p>In addition, they described the paradoxes in providing antenatal care in the context of HIV and AIDS. The caregivers were aware of the magnitude of HIV and AIDS and yet did not have any information on the HIV status of the women they cared for. This also caused fear for occupational transmission. HIV/AIDS is highly stigmatised in this area and women used various strategies to avoid testing.</p><p>The study emphasised the need to broaden the conceptualisation and practice of evidence-based care to incorporate different types of evidence and include realities, knowledge and perspectives of not only the beneficiaries but also those implementing change as well as local knowledge. The necessity of reorganising the health care systems to accommodate the new challenges of the HIV/AIDS epidemic is also emphasised.</p>

This thesis presents perspectives and experiences of different stakeholders and their ways of reasoning around pregnancy and pregnancy care. Data were generated from individual interviews with 25 health care providers, 18 women and 6 traditional birth attendants (TBAs) as well as 11 focus groups discussions with women, men and TBAs. The challenges experienced by health care providers in their provision of antenatal care, while attempting to change antenatal care through routines proven to have medical value, are highlighted. Changing some long established routines, such as weighing and timing of visits, proved difficult mostly because of resistance from the users of care, whose reasoning and rationale for using care did not correspond with the professional perspectives of care. Women also combined biomedical and traditional care. The women used the clinic to receive professional care and assurance that the pregnancy was progressing well and used TBAs, who are believed to have supernatural powers, for cultural forms of assurance and protection. The health care staff did not appreciate these aspects and discouraged women using TBAs. Midwives had problems to change routines of care because of their stressful working situations and the expectations of the women. In addition, they described the paradoxes in providing antenatal care in the context of HIV and AIDS. The caregivers were aware of the magnitude of HIV and AIDS and yet did not have any information on the HIV status of the women they cared for. This also caused fear for occupational transmission. HIV/AIDS is highly stigmatised in this area and women used various strategies to avoid testing. The study emphasised the need to broaden the conceptualisation and practice of evidence-based care to incorporate different types of evidence and include realities, knowledge and perspectives of not only the beneficiaries but also those implementing change as well as local knowledge. The necessity of reorganising the health care systems to accommodate the new challenges of the HIV/AIDS epidemic is also emphasised.

<p><font size="3"> <p>Namibia has recorded an ascending trend of maternal and neonatal mortality rate from 225 &ndash / 449 per 100 000 women from 1992 to 2006, and 38 &ndash / 46 per 1000 live births from 2000 to 2006 respectively. Kavango Region in Namibia is one among the top seven regions with high maternal and infant mortality rate. Most pregnant women in peri-urban areas of Rundu District in the Kavango region, where this study was conducted, attend ante-natal care services but do not use public health facilities for delivery. The health records from the public health facilities in Rundu, especially from Nkarapamwe clinic and Rundu Hospital maternity section, reveal that although the pregnant women comply with the required standard policy of a minimum of three visits per pregnancy or more, over 40% of women who attend public ante-natal care clinics do not deliver in the public health facility. The aim of this study was to explore the perceptions of women regarding obstetric care in public health facilities in Kehemu settlement, a peri-urban area of Rundu town. The objectives of the study were to explore the perceptions of women on accessibility and acceptability of maternity services in public health facilities. An explorative qualitative study design using focus group discussion as a data collection method was conducted with three groups of women. A purposeful sampling procedure was used to select participants. Ethical approval was obtained from the High Degree Committee of University of the Western Cape and permission to use data from local facilities was obtained from the Ministry of Health and Social Services. Participants were recruited on their own free will and they signed an agreement on confidentiality. A data reduction process was used for analysis. The study findings indicate that women wish to use public health facilities for deliveries due to perceived benefits, in particular, safety for the mother and the baby and that those services are<font size="3"> affordable. However a number of reasons hinder women to access services including the attitudes of health care providers, inability to afford transport at night and cultural influences. The study recommends that delivery services at the local clinic be expanded from eight to twenty-four hours / an information campaign on pregnancy and birth complications as well as the benefits of delivering in a public facility be implemented / refresher training for nurses to improve their caring practices during delivery should be considered and that a similar research be conducted with care providers to ascertain ways to improve maternity services in the public health facility in the area. </font></p> </font></p>