Introdução: A crescente prevalência das condições crônicas de saúde traz a demanda por Cuidados Paliativos (CP) para a agenda da Atenção Primária á Saúde (APS), gerando questionamentos acerca do impacto da incorporação dos CP sobre os problemas éticos da APS. A bioética não é só reativa, mas precisa reconhecer prospectivamente desafios éticos. Objetivos: Discutir desafios éticos (DE) para incorporação dos CP na APS, considerando o desempenho dos atributos deste âmbito do sistema de saúde na Região de Parelheiros, São Paulo; Cotejar os: problemas éticos dos cuidados paliativos na APS com o Instrumento PCATool-Brasil; problemas éticos dos CP na APS com a avaliação que os profissionais fazem do desempenho dos atributos deste nível do sistema de saúde na Região de Parelheiros, SP; o discurso dos gestores da saúde sobre a atenção às condições crônicas com os problemas éticos dos CP na APS. Método: Estudo de Caso, com múltiplas fontes de dados: entrevistas com profissionais da ESF para aplicação do PCATool-Brasil Versão Profissionais; discursos dos gestores locais sobre a rede de atenção às condições crônicas; resultados de uma scoping review sobre problemas éticos dos CP na APS. As perguntas e os resultados do PCATool foram correlacionadas com os desafios éticos sintetizados a partir dos problemas éticos da scoping review. O cenário de estudo fica na Região Sul da cidade de São Paulo, área com cobertura de ESF em quase 100%, com carência de serviços especializados e alta vulnerabilidade em saúde. Resultados: Os DE foram: o despreparo dos profissionais frente aos CP; a comunicação falha entre os profissionais na rede de atenção à saúde; infraestrutura inadequada para assegurar a continuidade da assistência paliativa por 24 horas; desgaste dos profissionais da APS devido á sobrecarga do trabalho; desconforto para falar sobre CP com o paciente; apoio familiar inapropriado; desconhecimento das Diretivas Antecipadas de Vontade. Considerando o desempenho dos atributos da APS como avaliado pelos profissionais da ESF na Região de Parelheiros, os três primeiros desafios éticos são as áreas de maior tensão ética para a incorporação dos CP na APS. Os discursos dos gestores reconhecem a demanda por CP existente no território, porém, mencionam que as demandas relativas às condições de violência e vulnerabilidades da Região acabam sendo prioritárias pelas urgências que representam. Todos os atributos do PCATool foram relacionados com os desafios éticos indicando que a avaliação do desempenho dos atributos permite reconhecer áreas de tensão ética na releitura feita do Instrumento. Conclusão: Identificando proativamente os DE dessa incorporação, com base na experiência de equipes que já ofertam este serviço e contextualizando-a à realidade local por meio do desempenho dos atributos da APS, torna-se possível confrontá-los com questões éticas correntes na APS, apontando caminhos para os profissionais e gestores com educação continuada, deixando-os mais preparados para o reconhecimento e manejo dos CP, com vistas a fomentar os valores necessários para o novo cenário dos serviços com a incorporação dessa atenção na APS. / Introduction: The increasing prevalence of chronic health conditions brings demand for Palliative Care (PC) to the agenda of Primary Health Care (PHC), raising questions about the impact of the merger of PC on the ethical problems of APS. The bioethics is not only reactive, but must prospectively recognize ethical challenges. Objectives: To discuss ethical challenges (EC) for incorporation of PC in the PHC, considering the performance of the attributes of this part of the health system in Parelheiros Region, São Paulo; Collating: ethical problems of palliative care in PHC with PCATool-Brazil Instrument; ethical problems of PC in the PHC with the assessment that the professionals do the performance attributes of this level of the health system in Parelheiros Region, SP; the discourse of health managers of care for chronic conditions with the ethical problems of PC in the PHC. Method: Case Study with multiple data sources: interviews with Family health strategy (FHS) professionals for the application of PCATool-Brazil Version professionals; speeches by local managers on the network of care for chronic conditions; results of a scopingreview on ethical problems of PC in the PHC. The questions and results of PCATool were correlated with the ethical challenges synthesized from the ethical problems of scopingreview. The study scenario is in the southern region of São Paulo, FHS coverage area with almost 100%, with lack of specialized services and high vulnerability to health. Results: the EC were: the unpreparedness of the professionals in the PC; communication failure among professionals in the health care network; inadequate infrastructure to ensure the continuity of palliative care for 24 hours; wear PHC practitioners due to work overload; discomfort to talk about PC with the patient, familiar support inappropriate; ignorance of the Advance Directives Will. Considering the performance of PHC attributes as evaluated by FHS professionals in Parelheiros Region, the first three ethical challenges are the areas of highest ethical tension to the incorporation of PC in the PHC. The speeches of the managers recognize the demand for PC existing on the territory, however, mention that the demands on the conditions of violence and Region vulnerabilities end up being priority by the urgencies they represent. All PCATool attributes were related to the ethical challenges indicating that the attributes of performance assessment allows us to recognize areas of ethical tension in rereading made the instrument. Conclusion: Identifying proactively the EC this merger, based on the experience of teams that have proffer this service and contextualizing it to local conditions through the performance attributes of the PHC, it is possible to compare them with current ethical issues in PHC, pointing paths for professionals and managers with continuing education, making them more prepared for the recognition and management of PC, designed to promote the values needed for the new scenario for services with the incorporation of this attention in the PHC.

Introdução: A crescente prevalência das condições crônicas de saúde traz a demanda por Cuidados Paliativos (CP) para a agenda da Atenção Primária á Saúde (APS), gerando questionamentos acerca do impacto da incorporação dos CP sobre os problemas éticos da APS. A bioética não é só reativa, mas precisa reconhecer prospectivamente desafios éticos. Objetivos: Discutir desafios éticos (DE) para incorporação dos CP na APS, considerando o desempenho dos atributos deste âmbito do sistema de saúde na Região de Parelheiros, São Paulo; Cotejar os: problemas éticos dos cuidados paliativos na APS com o Instrumento PCATool-Brasil; problemas éticos dos CP na APS com a avaliação que os profissionais fazem do desempenho dos atributos deste nível do sistema de saúde na Região de Parelheiros, SP; o discurso dos gestores da saúde sobre a atenção às condições crônicas com os problemas éticos dos CP na APS. Método: Estudo de Caso, com múltiplas fontes de dados: entrevistas com profissionais da ESF para aplicação do PCATool-Brasil Versão Profissionais; discursos dos gestores locais sobre a rede de atenção às condições crônicas; resultados de uma scoping review sobre problemas éticos dos CP na APS. As perguntas e os resultados do PCATool foram correlacionadas com os desafios éticos sintetizados a partir dos problemas éticos da scoping review. O cenário de estudo fica na Região Sul da cidade de São Paulo, área com cobertura de ESF em quase 100%, com carência de serviços especializados e alta vulnerabilidade em saúde. Resultados: Os DE foram: o despreparo dos profissionais frente aos CP; a comunicação falha entre os profissionais na rede de atenção à saúde; infraestrutura inadequada para assegurar a continuidade da assistência paliativa por 24 horas; desgaste dos profissionais da APS devido á sobrecarga do trabalho; desconforto para falar sobre CP com o paciente; apoio familiar inapropriado; desconhecimento das Diretivas Antecipadas de Vontade. Considerando o desempenho dos atributos da APS como avaliado pelos profissionais da ESF na Região de Parelheiros, os três primeiros desafios éticos são as áreas de maior tensão ética para a incorporação dos CP na APS. Os discursos dos gestores reconhecem a demanda por CP existente no território, porém, mencionam que as demandas relativas às condições de violência e vulnerabilidades da Região acabam sendo prioritárias pelas urgências que representam. Todos os atributos do PCATool foram relacionados com os desafios éticos indicando que a avaliação do desempenho dos atributos permite reconhecer áreas de tensão ética na releitura feita do Instrumento. Conclusão: Identificando proativamente os DE dessa incorporação, com base na experiência de equipes que já ofertam este serviço e contextualizando-a à realidade local por meio do desempenho dos atributos da APS, torna-se possível confrontá-los com questões éticas correntes na APS, apontando caminhos para os profissionais e gestores com educação continuada, deixando-os mais preparados para o reconhecimento e manejo dos CP, com vistas a fomentar os valores necessários para o novo cenário dos serviços com a incorporação dessa atenção na APS. / Introduction: The increasing prevalence of chronic health conditions brings demand for Palliative Care (PC) to the agenda of Primary Health Care (PHC), raising questions about the impact of the merger of PC on the ethical problems of APS. The bioethics is not only reactive, but must prospectively recognize ethical challenges. Objectives: To discuss ethical challenges (EC) for incorporation of PC in the PHC, considering the performance of the attributes of this part of the health system in Parelheiros Region, São Paulo; Collating: ethical problems of palliative care in PHC with PCATool-Brazil Instrument; ethical problems of PC in the PHC with the assessment that the professionals do the performance attributes of this level of the health system in Parelheiros Region, SP; the discourse of health managers of care for chronic conditions with the ethical problems of PC in the PHC. Method: Case Study with multiple data sources: interviews with Family health strategy (FHS) professionals for the application of PCATool-Brazil Version professionals; speeches by local managers on the network of care for chronic conditions; results of a scopingreview on ethical problems of PC in the PHC. The questions and results of PCATool were correlated with the ethical challenges synthesized from the ethical problems of scopingreview. The study scenario is in the southern region of São Paulo, FHS coverage area with almost 100%, with lack of specialized services and high vulnerability to health. Results: the EC were: the unpreparedness of the professionals in the PC; communication failure among professionals in the health care network; inadequate infrastructure to ensure the continuity of palliative care for 24 hours; wear PHC practitioners due to work overload; discomfort to talk about PC with the patient, familiar support inappropriate; ignorance of the Advance Directives Will. Considering the performance of PHC attributes as evaluated by FHS professionals in Parelheiros Region, the first three ethical challenges are the areas of highest ethical tension to the incorporation of PC in the PHC. The speeches of the managers recognize the demand for PC existing on the territory, however, mention that the demands on the conditions of violence and Region vulnerabilities end up being priority by the urgencies they represent. All PCATool attributes were related to the ethical challenges indicating that the attributes of performance assessment allows us to recognize areas of ethical tension in rereading made the instrument. Conclusion: Identifying proactively the EC this merger, based on the experience of teams that have proffer this service and contextualizing it to local conditions through the performance attributes of the PHC, it is possible to compare them with current ethical issues in PHC, pointing paths for professionals and managers with continuing education, making them more prepared for the recognition and management of PC, designed to promote the values needed for the new scenario for services with the incorporation of this attention in the PHC.

This thesis examines the role of management with regard to reducing and preventing workplace incivility through a care-focused and conflict transformation theory lens. The discussion on workplace incivility is expanded through an exploration of two theories: care-focused theory and conflict transformation theory. These theories are integrated into one theoretical framework, The Care-Centered Moral Imagination Framework (CMIF), which is applied to current literature recommendations on reduction and prevention of workplace incivility. The current literature recommendations were summarized through an ethnographic content analysis on existing academic studies conducted on workplace incivility. The result is a précis of current themes in the literature with regard to managing workplace incivility followed by a discussion of missing elements of management as determined through the application of the CMIF. These elements were rolled into ten valuable actions: care ethic, humility, pragmatism, treasure relations, embracing change and diversity, relationship building, dialogue, engagement, understanding and reflect and critique, that were recommended for managers to adopt and model in the workplace. The actions are suggested strategies for managers to use in the workplace when engaging with workplace incivility. I discuss suggestions and implications of the research in the concluding remarks. / Graduate / 0617 / 0344 / 0534 / lynn_86@msn.com

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Sogar eine vegetarische Ernährung führt durch den Konsum von Milchprodukten zum Schlachten der nicht mehr produktiven oder ausselektierten Milchkühe sowie der männlichen Nachkommen. Eine Rinderhaltung ohne Schlachtung (ROS) wäre (für Lakto-Vegetarier) hier ein Ausweg. Es wurden narrative und semi-strukturierte Interviews mit Tierhaltern der 5 hier dargestellten Fallbeispiele mit qualitativen Methoden der interpretativen Sozialforschung (Grounded Theory, Biographieforschung und sequentielle Feinanalyse) erhoben und untersucht. Die 5 Fallbeispiele wurden anhand biographischer Entwicklungen, ihrer Ethik und ihrem Tierhaltungssystem sowie anhand ihrer Konventionen verglichen. Der Fallvergleich ergab 5 Grundsätze des Care-Systems einer ROS: 1. Universal, 2. Bedingungslos, 3. Das ganze Leben betreffend - „a lifetime of Care“, 4. Familisierend, 5. Präventiv. Das Agrar-System der Fallbeispiele wurde in drei Betriebsstile differenziert: Reine Sanctuaries (Lebens-/Gnadenhof), Landwirtschaftliche Sanctuaries und Vegetarische Rinderhaltung/Milcherzeugung. Das Care- und das Agrar-System ergeben zusammen ein Agrar-Care-System. Kernelemente des Agrar-Systems der 4 hier untersuchten europäischen Betriebe sind u.a. ein hohes durchschnittliches Abgangsalter der Kühe von 12,5 Jahren und der Ochsen von 10 Jahren, stabile Herden, insg. vielfältige Dungnutzung, eine weitgehend muttergebundene Kälberaufzucht und partielle Ochsenanspannung. Bei dem dritten Fallbeispiel beträgt die Dauer der Laktationen durchschnittlich 2,8 Jahre und es werden dabei 9.055 kg pro Laktation ermolken. Bei Kühen mit sehr langen Laktationen sinken vom ca. 4.-6. Jahr die Leistungen nicht mehr und sind persistent. Die Milchkühe sind für 3,4 Jahre (als Mittel der beiden melkenden Betriebe) „in Rente". Der kostendeckende Milcherlös liegt bei ca. 2,95 bis 3,05 EUR pro kg Milch. Eine gemolkene Kuh trägt dabei die Kosten von 0,63 Kühen „in Rente" sowie von 1,48 Ochsen. Milch und Dung wären hier Beiprodukte des Tierlebens. / Even a vegetarian nutrition, through consumption of milk products, leads to the slaughtering of dairy cows that are no longer productive or have been sorted out, and of their male offspring. A cattle husbandry without slaughtering (here ‘CWS’) could be a solution (for lacto-vegetarians). Narrative and semi-structured interviews with the heads of animal husbandry in a total of five cases have been carried out and reviewed using qualitative methods of interpretive social research (Grounded Theory, biography research and detailed sequential analysis). In a case comparison, the five cases have been compared to each other in terms of their biographical developments, their ethics and their animal husbandry systems and also in terms of their conventions. The following five principles for a care system in CWS were derived: Universality, Unconditionality, A lifetime of care, Familialisation and Prevention. The agri-system of the case studies has been differentiated into three styles of farming: Pure sanctuary, agricultural sanctuary and vegetarian cattle husbandry. The combination of the agri- and care-system becomes the agri-care-system. Core elements of the agricultural system of CWS and of the 4 European farms are: a high average dying age which is 12.5 years for cows and 10 years for oxen, novel dung products, mostly rearing calves with the dam and on some farms the use of oxen for traction. In regard to the third case study, the average duration of lactation is 2.8 years, generating about 9,055 kg milk per lactation cycle. The dairy cows "retire" for a period of 3.4 years as a mean of the two milking case studies. In cows with very long lactation cycles, the milk yield, instead of decreasing from the 4th to the 6th year, rather seems to be constant during this period. The cost-covering milk revenue would be about 2,95 up to 3,05 EUR per kg. Each milked cow carries the cost of ca. 0,63 "retired" cows and 1,48 oxen. Milk and dung are the by-product of the animal life.