Bakgrund: Amning har många hälso-, ekonomiska och ekologiska fördelar för barn, föräldrar och samhället, men amningsstatistiken sjunker och beror ofta på otillräckligt amningsstöd. Syfte: att undersöka BVC-sjuksköterskors möjligheter och hinder för amningsrådgivning. Metod: Denna studie genomfördes med Critical Incident som metod. Sex bvc-sjuksköterskor i Sverige intervjuades om sina erfarenheter av att ge amningsrådgivning. Resultat: Resultatet delades in i två huvudincidenter utifrån syftet -Möjligheter och Hinder, med flera beteenden som kunde påverka incidenterna. Under Möjligheter kunde ses lyhördhet för kvinnans behov, att kunna ge enklare rådgivning och att ha tid för detta samt att kunna söka stöd hos andra. Beteenden som var hindrande för amningsrådgivning var bristande lyhördhet för kvinnans behov, att inte ha tillräckligt med djupare kunskaper eller tid, att inte samverka eller ha föräldraförberedande kurser. Konklusion: För att skapa möjligheter för individanpassad amningsrådgivning läggs stor vikt vid sjuksköterskans lyhördhet för kvinnan och barnets behov, förståelse för de förväntningar kvinnan har på amningen och att ha goda kunskaper samt tid. Hindrande för amningsrådgivningen är bristande lyhördhet för kvinnans behov, svårigheter att ge evidensbaserad information samt dåligt med tid. Samverkan mellan verksamheterna och att inte följa riktlinjer är en förbättringspotential för att stärka amningsrådgivningen. / Background: Breastfeeding has many health-, economical and ecological benefits for child, parents and society, but statistics of breastfeeding are declining and are often due to insufficient breastfeeding support. Aim of the study: to examine child health care nurses’ possibilities and hindrance for breastfeeding counselling. Method: This study was conducted using Critical Incident as a method. Six child healthcare nurses in Sweden were interviewed about their experiences of providing breastfeeding advice. Results: The result was divided into two main incidents based on the aim, - possibilities and hindrance, with several behaviours that could affect the incidents. Under Possiblities a sensitivity for the woman’s needs, to be able to give simple breastfeeding advice, having time to give it and look for support when needed was seen. Behaviours that was a hindrance for breastfeeding counselling was a lack of sensitivity for the woman’s and child’s needs, to not have deeper knowledge or time, to not cooperate with others or not provide preparatory courses for parents. Conclusion: To create possibilities for individual breastfeeding counselling a sensitivity for the woman’s and child’s needs is essential, to have an understanding of the expectations the woman has and to have enough knowledge and time. Hindrance for breastfeeding counselling is a lack of sensitivity for the woman’s needs, difficulties to give evidence based information and not enough time. Cooperation between the different facilities and to follow the recommendations are potentials for improvement to strengthen the breastfeeding counselling.

The aim of this diploma thesis is to design a health care center in Brno. The building is located in Ivanovice/Brno. The building is ambulatory health care center with two doctor's offices for adult patients, one doctor's office for child patients and one dentist's clinic. Also, there is a pharmacy in the building. Reinforced concrete strip foundation and reinforced concrete basement peripheral walls are designed for the building. For above ground floors, ceramic masonry blocks are designed for structural load bearing frame. Green roof solution is chosen for the roof of the building.

Depuis le début des années 90, le réseau de la santé au Québec est soumis à une vaste restructuration qui a eu des conséquences négatives sur la qualité de vie au travail (QVT) des infirmières et infirmiers. Les hommes se retrouvent en nombre croissant dans toutes les sphères de la pratique infirmière, mais les études existantes ne font malheureusement pas mention de la qualité de vie au travail de ceux-ci. Alors, il apparaît pertinent de s’attarder au phénomène de la qualité de vie au travail des hommes infirmiers dans la profession infirmière, et ce, plus précisément en CSSS mission CLSC. Le but de cette étude phénoménologique consiste à décrire et à comprendre la signification de la qualité de vie au travail pour des infirmiers œuvrant en CSSS mission CLSC. L’essence du phénomène, les huit thèmes et les 35 sous-thèmes qui se dégagent directement des entrevues énoncent que la signification de la qualité de vie au travail pour des infirmiers œuvrant en centre de santé et des services sociaux (CSSS), mission CLSC et déclarant avoir une qualité de vie positive au travail, signifie « un climat empreint de caring qui favorise l'épanouissement de l'infirmier en CLSC en œuvrant pour le maintien de l'harmonie entre les sphères professionnelle et familiale ». Si certains résultats corroborent ceux d’études antérieures, d’autres apportent des éléments nouveaux favorisant la santé des infirmiers par le biais de la qualité de vie au travail. Enfin, des avenues concrètes visant la mise en place de programmes d’optimisation de la qualité de vie au travail, sont proposées. / In the 1990s, health care organizations in Québec underwent sweeping reforms that disrupted the work climate and practices of nurses (Bourbonnais et al., 2000; Pérodeau et al., 2002). These reforms had a negative impact on nurses’ quality of working life (QWL), leading decision makers and researchers to investigate the QWL phenomenon from several perspectives (Delmas, 1999; 2001; Gascon, 2001; O’Brien-Pallas & Baumann, 1992). Most of the studies of this phenomenon were conducted in hospital settings and were based on paradigms of psychological distress (Bourbonnais et al., 1998, 2000) or burn-out (a pathogenic perspective) (Duquette et al., 1995) rather than a health paradigm (a salutogenic perspective) (Gascon, 2001). A salutogenic perspective represents a positive vision of an approach to health (Antonovsky, 1996; Delmas, 2001, Duquette & Delmas, 2002). The scientific literature (Brooks et al., 1996; Ekstrom, 1999; Evans, 2001) suggests that, in addition to living through the same upheavals as their female colleagues, some male nurses also have negative feelings related to sex discrimination, feelings of isolation, and the conflict between masculine values (strength, aggressiveness) and the feminine values (gentleness, flexibility) of the nursing profession. These feelings can only hamper nurses’ QWL, yet they are not mentioned in studies of male nurses (Boughn, 2001; Ekstrom, 1999; Evans, 1997, 2001). The aim of the study, using Giorgi’s (1985, 1997a) descriptive phenomenology as a method, is to describe and understand the significance of phenomena through people’s experiences. The findings were derived from semi-structured individual interviews of 60 to 90 minutes with five male nurses who reported a positive quality of life at work. Data analysis consisted of: collecting the data, reading and rereading the results, dividing the data into meaningful units, organizing and stating the raw data in the language of the discipline and, finally, synthesizing the findings and letting the essence of the phenomena emerge. Watson’s (1988, 2005) human caring philosophy served as a backdrop for the entire process. The analysis of verbatim transcripts revealed eight themes that defined the significance of the quality of working life for male nurses practising in community settings: 1) autonomy in their professional practice; 2) job satisfaction; 3) a healthy workplace setting; 4) relations with the administration characterized by support and respect; 5) caring relationships with other members of the interdisciplinary team; 6) working in partnership with female peers; 7) commitment to clients and their families; and 8) professional work-life balance. The essence of the phenomenon stems directly from the themes that emerged during the interviews; it states that for male nurses working in health and social service centres (CSSSs), as part of CLSCs, working life means “a caring climate that fosters the vitality of male CLSC nurses by trying to maintain a balance between their professional and family lives.” If some of the findings confirm what has been reported in other studies, others have added new information on how to promote the health of male nurses by targeting quality of working life. Concrete avenues are proposed for implementing quality of working life optimization programs.

No description available.

The purpose of this study was to compare receptive language, expressive language, and socialization skills of preschool children who have a history of expressive language delay (ELD) with age mates who have a history of normal language development.

The thesis deals with understanding of success and failure of work with clients from the educational care center staff's perspective and their sources of evaluation. This issue is part of the self-evaluation. Author uses a semi-empirical method. The theoretical part of the thesis presents activities, target groups and (teaching) staff's job specification in the educational care center. Then it defines self-evaluation, lists specific principles of professional work with clients and states the factors that are part of success or failure of staff's interventions. The conclusion of the thesis shows particular methods that can help to achieve self-evaluation and presents the self-efficacy studies. The goal of the survey research is to find out what the educational care center's staff considers as success and failure of their work and which indicators help them to evaluate their work. Author uses qualitative research design and semi-structured interview as a data collection method. The data are processed by the components of the grounded theory. The research shows that participants consider any small positive change in behavior or attitude of their clients as success. Especially non-cooperation is considered to be a failure. The sources for self-evaluation of their work are clients' feedback, different...

The aim of this study is to describe the day care center as an educational envirorunent, focusing the interaction between caregiver and child. The theoretical frame of reference is Bronfenbrenner's ecological mode! of human development. The day care center is considered as a "microsystem" where the children develop by interacting with the adults in terms of what the children and adults do together, how they do it and the role they take. It is a qualitative study. The author has spent two weeks in each of the four day care centers. The data have been collected by interviews, videorecordings and observations and are presented as "pictures". The thesis states that thi:? interaction between caregiver and child can be looked upon as "meetings". However, the adult and the child do not always meet. They may meet in a physical sense but that does not guarantee that they also meet in a psychological sense. Those caregivers who tend to "meet" the children are contingent, openminded and active. They respect the children, see them and confirm them with a permissible attitude. The possibilities to meet are finally regarded in relation to the physical setting, established norms, the personality of those who interact and the caregiver's "pedagogical attitude".

Bakgrund: Övervikt hos barn är ett växande folkhälsoproblem som hotar barns psykiska och fysiska hälsa. Distriktssköterskan har i uppdrag att främja barns hälsa i sitt arbete på barnavårdscentralen och kan med hjälp av familjefokuserad omvårdnad se till barnets helhet. Föräldrarna har ett stort inflytande över sina barns levnadsvanor och det är därmed av stor vikt att undersöka upplevelsen av det hälsofrämjande arbetet utifrån deras perspektiv. Syfte: Syftet med studien är att belysa hur föräldrar till barn med övervikt upplever distriktssköterskans hälsofrämjande arbete på barnavårdscentralen. Metod: Kvalitativ intervjustudie med induktiv ansats. Semistrukturerade intervjuer med 9 föräldrar som erhåller eller har erhållit stöd och behandling via barnavårdscentralen när barnet var i åldern 2 – 5 år. Data analyserades utifrån kvalitativ latent innehållsanalys. Resultat: Resultatet redovisas i 2 huvudkategorier: ”Baksidan av tillväxtkontroller” och ”Skiftande uppfattningar om det hälsofrämjande arbetet”. I “Baksidan av tillväxtkontroller” identifierades 2 underkategorier: “Olika syn på barnets övervikt” och “Känslan av att vara övervakad utan nytta”. I “Skiftande uppfattningar om det hälsofrämjande arbetet” identifierades fyra underkategorier: “Konkret rådgivning”,“Användbar rådgivning och positiva effekter”, “Brister i rådgivning och kompetens” och“Kampen mellan att följa råden och göra det bästa för sitt barn”. Slutsats: Behandlingen på barnavårdscentralen väckte mycket känslor hos föräldrarna och de hade sitt barns bästa i fokus huruvida de valde att följa behandlingen eller inte. Föräldrarna beskrev både positiva och negativa upplevelser av distriktssköterskans rådgivning och bemötande, vilket till stor del påverkade om familjen förändrade sina levnadsvanor. / Background: Obesity in children is a growing public health problem that threatens children's mental and physical health. The district nurse is tasked with promoting children's health through her work at the childcare centre and, with the help of family-centred care, can taken care of the child as a whole. Parents have a great influence over their children's lifestyle and it is therefore of great importance to examine the experience of the health promotion work from their perspective. Aim: The purpose of the study is to shed light on how parents to overweight children experience the district nurse's health promotion work at the childcare centre. Method: Qualitative interview study with an inductive approach. Semi-structured interviews with 9 parents who receive or have received support and treatment via the childcare centre when the child was aged 2 -5 years. The data was analysed based on qualitative latent content analysis. Results: The results are reported in 2 main categories: “The back side of growth controls” and “Changing perceptions of health promotion work". In "The back side of Growth controls" could 2 subcategories be identified: "Different views on the child's obesity" and "The feeling of being observes without benefit". In "Changing perceptions of health promotion work" 4 subcategories could be identified: "Concrete advice", "Useful advice and positive effects", "Deficits regarding advice and competence" and "The struggle between following the advice and doing the best for one's child". Conclusions: The treatment at the childcare centre aroused a lot of emotion in the parents and they had their child's best interests in focus regardless they chose to follow the treatment or not. The parents described both positive and negative experiences of the district nurse's advice and treatment, which largely influenced whether the family changed their lifestyle.

Introdução: A reforma psiquiátrica e a desinstitucionalização objetivam um tratamento em saúde mental de base territorial. Alinhados a uma proposta de saúde baseada na descentralização, temos no Brasil o Sistema Único de Sáude (SUS) e a Estratégia Saúde da Família (ESF), que tem no Agente Comunitário de Saúde (ACS), o profissional mais próximo do território, casa e rotina destes usuários. Objetivo: identificar aspectos que influenciam o atendimento de pessoas com transtornos mentais pelos Agentes Comunitários de Saúde, a partir de suas experiências. Métodos: Foram realizadas 4 sessões de grupos focais com o total de 27 ACS de 4 Unidade Saúde da Família (USF) diferentes. Um roteiro semi estruturado norteou as discussões que tiveram seus áudios gravados, transcritos, categorizados por temas e analisados através da metodologia de análise de conteúdo, proposta por Bardin. Resultados: Foram identificadas sete categorias temáticas: articulação e construção da rede; acolhimento, acompanhamento e orientação dos pacientes; educação permanente; respaldo, reconhecimento e estrutura; medo; visão antimedicamentosa; e responsabilidade das famílias. Como aspectos que dificultam o atendimento dos casos de transtorno mental, identificamos um processo falho de cadastramento dos casos, o que facilita a desestabilização do quadro; casos em crise que colocam o ACS em situação de risco; falta de apoio matricial e trabalho em rede. Como aspectos que facilitam o atendimento dos casos de transtorno mental, apareceram a visita compartilhada e educação permanente. Como propostas de enfrentamento, no ambiente da ESF foram propostas: reuniões semanais de equipe; vagas para casos de demanda espontânea; e prontuário da casa, mas com cadastro de cada indivíduo. Também enquadramos aspectos referentes à integração com outros equipamentos de saúde, como aumentar o número de visitas compartilhadas e implantar o apoio matricial. E por fim, as propostas relacionadas à reunião de rede intersetorial, que iria ao encontro da educação permanente. Conclusão: Olhar para o contexto das ações, pensar em inserção social através da reabilitação psicossocial e promover tratamento territorial em saúde mental, continua sendo um desafio. Apesar do distanciamento que ainda existe entre as políticas públicas e as práticas no SUS, as propostas de enfrentamento podem colaborar para a efetivação de um SUS com maior qualidade. / Introduction: Psychiatric reform and deinstitutionalization aim at a spatial-based mental health treatment. In line with a health proposal based on decentralization, we have in Brazil the Sistema Único de Saude (SUS) and the Family Health Strategy (ESF), which has in the Community Health Agent (ACS) and routine of these users. Objective: to identify aspects that influence the care of people with mental disorders by the Community Health Agents, based on their experiences. Methods: Four focal group sessions were conducted with a total of 27 ACS from 4 different Family Health Units (FHU). A semi structured script guided the discussions that had their audios recorded, transcribed, categorized by themes and analyzed through the methodology of content analysis, proposed by Bardin. Results: Seven thematic categories were identified: articulation and network construction; patient care, follow-up and orientation; permanent education; support, recognition and structure; fear; anti-drug vision; and family responsibility. As aspects that make difficult the attendance of the cases of mental disorder, we identified a failed process of registration of the cases, which facilitates the destabilization of the picture; cases in crisis that put the ACS at risk; lack of matrix support and networking. As aspects that facilitate the attendance of the cases of mental disorder, appeared the shared visit and permanent education. As proposals for confrontation, in the environment of the ESF were proposed: weekly team meetings; vacancies for cases of spontaneous demand; and records of the house, but with the registration of each individual. We also integrate aspects related to integration with other health equipment, such as increasing the number of shared visits and implementing matrix support. And finally, the proposals related to the intersectoral network meeting, which would meet the permanent education. Conclusion: Looking at the context of actions, thinking about social insertion through psychosocial rehabilitation and promoting territorial treatment in mental health, remains a challenge. Despite the distance that still exists between public policies and practices in SUS, the proposals for coping can contribute to the implementation of a higher quality SUS.

Introdução: O sofrimento psíquico infanto-juvenil foi historicamente atrelado às limitações cognitivas (idiotia infantil) e à necessidade de ação sobre o abandono e delinquência juvenil e traz em seu bojo práticas de cuidado historicamente segregadoras e médico-científicas moralizantes. A assunção do Estado às práticas de cuidado à infância e adolescência principalmente nos movimentos reformadores da década de 80 no Brasil construção do Sistema Único de Saúde e Reforma Psiquiátrica reivindicou um novo olhar em torno desse cuidado, o que foi concretizado na construção de uma política de cuidado infantojuvenil enredada estrategicamente nos CAPS infantojuvenis, bem como na necessidade dos processos de trabalho que apoiassem práticas interseçoras e relacionais produtoras de usuários sujeitos de direitos nesses estabelecimentos. Objetivo: Evidenciar a relação entre as modalidades de produção de cuidado em saúde mental e os processos de trabalho desenvolvidos em um CAPS ADi. Método: cartografia dos processos de trabalho com profissionais de um CAPS ADi de São Bernardo do Campo - São Paulo e dois usuários do estabelecimento. Utilizou-se a metodologia do caso-traçador na congregação de quatro focos de análise sobre dois casos emblemáticos atendidos no CAPS: observação do cotidiano de trabalho, caracterização, grupos focais com profissionais e entrevistas com dois usuários. Resultados: Os resultados apontaram para uma dinâmica de trabalho bastante complexa e atravessada por questões cotidianas do serviço, bem como por diferentes concepções acerca do cuidado, do que é projeto terapêutico e de como cuidar de adolescentes que trazem histórias sociais tão diversas quanto às suas famílias e situações de vulnerabilidade nas quais o uso abusivo de drogas se faz, por vezes, secundário em relação à demanda vivenciada dia-a-dia. Conclusão: É de suma importância construir espaços de reflexão e autoanálise para que os profissionais possam partilhar e rediscutir os processos de subjetivação gerados a partir de suas ações nos usuários e em si próprios, bem como, resignificar o sentido do cuidado e da existência de um Centro de Atenção Psicossocial voltado para crianças e adolescentes que fazem uso abusivo de álcool e drogas / Introduction: The child and youth psychological suffering was historically tied to cognitive deficits and the need for action on child abandonment and juvenile delinquency. They will be cared for the practices historically segregated and medical-scientific moralizing. Nevertheless, the State care practices for childhood and adolescence, the emergence of specific knowledge about child and youth development, and especially the reform movements of the 80s in Brazil the construction of integrated and universal health system, and psychiatric reform - demanded a new point of view around that care, what was achieved later in the construction of a policy of child and youth careful established in Child and Youth Psychosocial Care Centers CAPSi and in need of work processes that supported relational practices intercessors and producing users having rights in these establishments. Objective: It aims to show the relationship between modes of production of mental health care and work processes developed in Child and Youth Psychosocial Care Center to treat drug abuse CAPS ADi. Methods: The work process mapping with professionals and two users of Chlid and Youth CAPS to treat drug abuse at São Bernardo do Campo - São Paulo. We used the methodology of \"case-tracer\" in the congregation of four foci analysis on two emblematic cases seen at CAPS: observation of daily work, characterization and focus groups with professionals and interviews with two users. Results: The results showed a dynamic work quite complex crossed by the everyday issues of service, as well as different conceptions of care, which is the therapeutic project and how to care for adolescents who bring social stories as diverse as their families and vulnerability situations in which drug abuse is done sometimes secondary demand experienced dayto-day. Conclusion: It is extremely important to ensure spaces for reflection so that professionals can share and revisit the processes of subjectivity generated from their actions on users and themselves as well, reframe the meaning of care and the existence of a Psychosocial Center facing children and adolescents who abuse alcohol and drugs