Made available in DSpace on 2016-04-27T13:10:21Z (GMT). No. of bitstreams: 1 Marcelo Marques Ferreira.pdf: 1136535 bytes, checksum: 3c653d7eaddb2859712b6d72d5995c0d (MD5) Previous issue date: 2013-06-12 / The Community Health Workers (CHW) show themselves to be intriguing actors in what concerns the dialogue between the common knowledge and practice with the medical and scientifical knowledge. By the very nature of their work, they deal with an ethical and humane practice, which is connected to the very exercise of citizenship. However, neither do they possess a Code of Professional Ethics that endorses them, nor are they trained to solve ethical problems related to their daily life. Hence, the goal of this dissertation submitted as a requirement for the Master's degree was to show the perception of the inherently ethical aspects of the CHW who work in the Family Health Teams (FHT) in the city of Rolândia, state of Paraná, Brazil, by the means of a study that was both quantitative and qualitative and of descriptive ethics, hence non-normative. The subjects of said study were 52 (fifty two) female CHW out of the 72 (seventy two) CHW who work in the twelve FHT in that city. For the acquiring of systematic data, two steps were taken: 1) A sociologic and economic questionnaire was applied, followed by 2) a semi-structured interview, in which all CHW were exposed to three theoretical situations that are common in their daily practice, concerning: Systemic hypertension (SH), human immunodeficiency virus (HIV) and taking care of teenagers. All of their interviews were read and analyzed by the "content analysis" method. Eight thematic axes were identified, allowing their perceptions on daily ethical issues to be comprehended. Even though the participants don't have a code of deontology, they tend to guide their conduct by their own moral principles and did present answers that were considered, most of the times, to be correct. However, every single one of them stated that they believe the existence of such code to be necessary, in example of other professional categories. The interviews revealed the ethical dilemmas that spring from such a close relation to the community and also how these women perceived the complexity of these, otherwise, simple hypothetical situations. The proposed educational measure of intervention is the contextualized training of the CHW that work in Rolândia, which will certainly enhance their capability to take action / Os Agentes Comunitários de Saúde (ACS) revelam-se atores intrigantes no que se refere ao diálogo entre os saberes e práticas populares com o conhecimento médico-científico. Pela natureza do seu trabalho, lidam com uma prática ética, humana e vinculada ao exercício da cidadania. No entanto, não possuem um Código de Ética Profissional que os respaldem ou são capacitados para solucionar questões éticas relacionadas ao seu cotidiano. Nesse sentido, o objetivo dessa dissertação de mestrado foi revelar a percepção dos aspectos éticos inerentes ao processo de trabalho dos ACS que atuam na ESF do município de Rolândia, do estado do Paraná, por meio de estudo, quantitativo e qualitativo, de ética descritiva, portanto, de cunho não normativo. Os sujeitos do estudo foram 52 (cinquenta e dois) ACS do sexo feminino dos 72 (setenta e dois) que trabalham nas 12 (doze) equipes da Estratégia de Saúde da Família (ESF) de Rolândia, Paraná. Para coleta sistemática dos dados foi aplicado um questionário para obtenção dos dados sociodemográficos (primeira etapa) seguido de entrevista semi-estruturada (segunda etapa), onde as ACS foram expostas a três situações hipotéticas comuns em sua vivência profissional sobre: Hipertensão Arterial Sistêmica (HAS), Vírus da Imunodeficiência Humana (HIV) e atendimento com adolescentes. Os discursos foram lidos e analisados pelo método da análise de conteúdo . Oito eixos temáticos foram identificados permitindo a compreensão da percepção das ACS quanto a questões éticas cotidianas. Apesar das participantes desta pesquisa não terem o referencial de um código de deontologia, balizam sua conduta em preceitos morais e apresentaram respostas que foram consideradas em sua maioria corretas. No entanto, todas as ACS declararam que acham importante a existência de legislação específica, à semelhança de outras profissões. As entrevistas revelaram os dilemas éticos oriundos deste relacionamento próximo com a comunidade e como elas percebem os casos apresentados, que são triviais, mas complexos. A medida de intervenção educativa proposta é a capacitação contextualizada das ACS de Rolândia, o que certamente potencializará suas ações

There are different versions of the ethical approach known as “care ethics”, making care ethics more like a cluster of approaches rather than a singular one. Hence the question is not just whether care ethics is a suitable feminist ethic, but which version(s) of care ethics feminists should endorse. Considering which versions of care ethics are capable of recommending the sort of political activism that is required for progressive political change goes some distance in answering this question. The concern about whether care ethics can recommend the political activism needed for feminist aims arises because such activism exposes those the activist has intimate relationships with to various sorts of harm. I argue that when construed as an ethical theory that incorporates a decision procedure for generating correct conduct, care ethics recommends against the sorts of actions that are required of political activists and for the practical goals of feminists. Construed as an ethical framework that has the more modest concern of providing conceptual orientation and critical tools for interpreting and reflexively interrogating the ethical landscape, however, care ethics can overcome the challenge presented by political activism when including what Bernard Williams calls “ground projects” amongst its available tools. However, because feminist care theorists and others sympathetic with care ethics have criticized aspects of Williams’ account of ground projects, I first respond to these concerns in order to accommodate these criticisms and demonstrate that I am not importing something into care ethics as a framework that does not have a place there.

I denna vetenskapliga essä kommer jag att undersöka begreppet omsorg. Uppsatsen är skriven i essäform och har en hermeneutisk ansats. Min essä inleds med tre berättelser hämtade från mitt yrkesliv där jag varit delaktig som pedagog. I dessa situationer synliggörs dilemman kring hur omsorgsbegreppet kan tolkas och omsättas i förskolans praktik. Syftet med essän är att undersöka på vilka sätt omsorgsbegreppet kan förstås inom förskolan. Uppsatsens frågeställningar är: Hur kan begreppet omsorg förstås mot bakgrund av att relationen mellan barn och pedagog i förskolan är asymmetrisk Vilka faktorer kan påverka pedagogers meningsskapande av omsorgsbegreppet? samt Hur kan pedagogers meningsskapande av omsorgsbegreppet förstås i relation till rådande diskurser i förskola och samhälle? I min reflektion använder jag litteratur för att ställa frågeställningarna och berättelsen i relation till samtida diskurser gällande barnsyn, ålder, kön och genus. Jag undersöker begreppet omsorg utifrån Nel Noddings omsorgsetik. Min slutsats är att pedagogernas meningsskapande av omsorg har ett nära samband med diskurser i samtiden och förskolan. Utifrån ett omsorgsetiskt perspektiv anser jag att pedagogernas ansvar för relationen och omsorgen i omsorgssituationer är större än det talas om i förskolesammanhang idag. / This scientific thesis is written in the form of an essay in which I will inquire into the concept of care. The thesis is written in form of an essay and has a hermeneutic onset. My essay takes a starting point in three stories taken from my professional life where I had been involved as a pedagogue. In these situations the dilemma becomes visible about how the care concept can be interpreted and translated into pre-school practice. The essay’s questions are: How can the concept of care be understood in the light of the fact that the relationship between children and pedagogue is asymmetrical? What factors can affect the perception of the pedagogues of the concept of care? and How can educators' perception of the concept of care be understood in relation to current discourses in preschool and society?  In my reflection I use literature and my stories to set the questions in relation to contemporary discourses current to childcare, age, sex and gender. I will inquire into the concept of care from using Nel Noddings’ ethics of care. My conclusion is that pedagogue’s perceptions of care are closely linked to contemporary and pre-school discourses. From an ethics of care point of view, I consider that pedagogue’s responsibility for relationship and care in care situations is larger than it is spoken of in pre-school context today.

Nyckeln till en djupare förståelse av omsorgsbegreppet ligger i omsorgens verkliga synlighet i förskolan. Att synliggöra begreppet omsorg är dock inte lätt. Hur beskrivs omsorgsarbetet och hur förstår pedagogerna omsorg på ett djupare plan? Syftet med vår studie är att undersöka pedagogers förståelse av begreppet och emotionellt omsorgsarbete samt att ta reda på hur förskolor aktivt arbetar med omsorgsfrågor i sina arbetslag. Våra forskningsfrågor är följande; a) Hur beskriver pedagoger sin förståelse av begreppet omsorg? b) Hur förklarar pedagoger arbetet med barns rätt till omsorg? c) Hur tar pedagoger hand om och tillgodoser barns känslomässiga behov i förskoleundervisningen? Resultatet visar att omsorgen sker ömsesidigt i samspelet mellan pedagoger och barn men eftersom begreppet omsorg är mångsidigt och svårtolkat blir det sekundärt i förskoleundervisningen. Alla barn har rätt till lika mycket omsorg men det ser olika ut på grund av olika faktorer som barns ålder, personaltäthet, resurser, storleken på barngruppen et cetera. Respondenterna i vår studie framhåller att det inte samtalas tillräckligt mycket kring omsorg och hur man bedriver och aktivt arbetar med barns känslomässiga behov i förskoleutbildningen. / The key to a deeper understanding of the concept of care lies in the real visibility of care in preschool. However, making the concept of care visible is not easy. One must consider what care look like in its entirety between children and adults in today's preschool? How is care work described and how do the educators understand care on a deeper level? The purpose of our study is to examine educators' understanding of the concept of care and emotional care work and to find out how preschools actively work with care issues in their work teams. Our research questions are as follows; a) How do educators describe their understanding of the concept of care? b) How do educators explain the work with children's right to care? c) How do educators care for and provide for children's emotional needs in preschool education? The result is based on analyzes from a care ethics perspective by Nel Noddings. We have used Noddings concept to link educators' descriptions, which are from a care ethics perspective; role model, dialogue, practical actions and confirmation. The result shows that care takes place mutually in the interaction between educators and children but since the concept of care is versatile and difficult to interpret it becomes secondary in preschool education. All children have the right to the same amount of care, but it looks different due to different factors such as children's age, staff density, resources, size of the group of children etc. The respondents in our study say that there isn’t enough talk about care and how to conduct and actively work with children's emotional needs in preschool education.

Cette thèse est basée sur ma contribution à différents projets liés à la recherche clinique sur les anévrismes intracrâniens, le traitement endovasculaire, la compréhension des patients et la participation aux essais cliniques. Ce travail a donné lieu à quatre publications à ce jour. Pour cette thèse, je fournis d'abord quelques informations sur les anévrismes cérébraux et la façon dont ils sont gérés. Deuxièmement, je passerai brièvement en revue les principes de l'éthique médicale et de la recherche. J'aborde ensuite l'essai de soins ‘Comprehensive Aneurysm Management (CAM)’, car une partie du travail effectué pour ma thèse consistait à rendre compte des taux de recrutement dans CAM. J'ai également contribué à un article sur la démarcation recherche-soins, et pourquoi elle doit être révisée, ainsi qu'à un éditorial qui affirme que la recherche clinique doit être conçue dans le meilleur intérêt des patients. Enfin, j'ai apporté des contributions originales en concevant une enquête et en interrogeant des patients neurovasculaires avant qu'ils ne soient vus par un médecin dans le cadre d'un suivi. Les résultats de cette étude ont montré que les patients ont une meilleure compréhension de l'incertitude clinique et de l'existence d'options alternatives de prise en charge lorsqu'ils ont participé à des essais de soins. / This thesis is based on my contribution to different projects related to clinical research on intracranial aneurysms, endovascular treatment, patient understanding and participation in clinical trials. This work has led to four publications thus far. For this thesis, I first provide some background on cerebral aneurysms and how they are managed. Second, I briefly review medical and research ethics principles. I then discuss the Comprehensive Aneurysm Management (CAM) care trial because a portion of the work done for my thesis was to report on the recruitment rates in CAM. I also contributed to a paper on the research-care demarcation and why it must be revised, as well as to an editorial claiming that clinical research should be designed in patients' best interests. Finally, I made original contributions by designing a survey and interviewing neurovascular patients prior to being seen by a physician in follow-up. The results of that study showed that patients have a better understanding of clinical uncertainty and the existence of alternative management options when participating in care trials.

Infants with hypoxic-ischaemic encephalopathy (birth asphyxia) have a high risk of death or disability. Those with poor prognosis are sometimes allowed to die after withdrawal of intensive care. In recent years, doctors have used new types of brain scan, magnetic resonance imaging (MRI), to predict the type and severity of impairment if the infant survives and to help with such decisions. In this thesis, I analyse the issues arising from the use of MRI for prognostication and decision-making in newborn infants. I argue that previous prognostic research has been hampered by a failure to identify and focus on the most important practical question and that this contributes to uncertainty in practice. I outline recommendations for improving research. I then look at existing guidelines about withdrawal of life-sustaining treatment. I identify several problems with these guidelines; they are vague and fail to provide practical guidance, they provide little or no genuine scope for parental involvement in decisions, and they give no weight to the interests of others. I argue that parental interests should be given some weight in decisions for newborn infants. I develop a new model of decision-making that, using the concept of a Restricted Life, attempts to set out clearly the boundaries of parental discretion in decision-making. I argue that where infants are predicted to have severe cognitive or very severe physical impairment parents should be permitted to request either withdrawal or continuation of treatment. I justify this model on the basis of overlapping interests, (prognostic, experiential and moral) uncertainty, asymmetrical harms, and the burden of care. In the conclusion, I set out a guideline for the use of MRI in newborn infants with hypoxic-ischaemic encephalopathy. I suggest that this guideline would provide a more robust, coherent and practical basis for decision-making in newborn intensive care.

Il presente lavoro muove dall’idea che nell’autenticità sia possibile rintracciare una tematica importante per la teorizzazione pedagogica e un obiettivo rilevante per la formazione, soprattutto in questa epoca storica in cui l’uomo è sempre più spaesato, frammentato, in bilico nel rischio di perdersi e di non pervenire mai a sé stesso. La prospettiva dell’autenticità risulta aspetto rilevante della pienezza esistenziale della persona, ma è anche una dimensione valoriale e una “direzione intenzionale” capace di orientare e fornire direttrici di senso al percorso educativo, poiché non esiste intervento educativo che non sia sostenuto dalla ricerca di portare a compimento le possibilità più proprie dell’educando. È anche una indicazione epistemologica e metodologica attraverso la quale l’educatore rispetta la possibilità dell’educando di esistere secondo il più proprio poter-essere, il che si traduce nel riconoscere e sostenere il suo progetto di mondo, nell’alimentare il suo desiderio di divenire pienamente quello che può essere, nel far sì che si assuma la responsabilità di dare forma alla sua originale presenza nel mondo. Il riferimento teoretico è individuabile principalmente nell’ambito della pedagogia fenomenologico-esistenziale (ivi compresi i suoi sviluppi nell’ermeneutica e nelle filosofie della persona), con rimandi ai principali esponenti di tale orientamento in ambito filosofico e psicologico oltre che, principalmente, pedagogico. Nel percorso di ricerca sono stati individuati molteplici nuclei tematici di approfondimento, dovuti alla dimensione “di confine” dell’autenticità che tocca più campi educativi quali: relazione, comunicazione, cura, etica, identità, progetto, scelta, libertà, temporalità, morte, dolore, vita emotiva, tempo, corpo, spazio. La tesi si articola in due sezioni che procedono da considerazioni teoretico-pedagogiche verso indicazioni pratico-educative. / This works takes as a departing point the idea that authenticity is an important issue in pedagogical theorization as well as a relevant goal for education, and particularly so in the current historical era when the human being is increasingly bewildered, fragmented and subject to the risk of losing oneself and never attaining selfhood. Beside being an important aspect of existential wholeness, authenticity may act as a directional goal able to steer and provide meaning to an educational journey aiming to bring into actuality the person’s potentials. Authenticity also provides epistemological and methodological directions through which the educator respects the individuality of the person to be educated. The theoretical approach here adopted mostly refer to phenomenological-existential pedagogy (including developments in hermeneutics and philosophies of the person), with additional references to the main exponents of such perspective in philosophy, psychology and, mostly, theory of education. During the research process many themes have been thoroughly investigated, because of the boundary spanning nature of authenticity, which touches upon several educational fields, including: relationships, communication, care, ethics, identity, project, choice, freedom, temporality, death, sorrow, emotional life, time, body, space. The thesis consists of two sections that go from theoretical-pedagogical considerations to practical-educational directions.

This dissertation seeks to understand the conjunction of faculty roles as teachers and as researchers. This understanding is pursued through philosophical analysis. Discourse ethics, in particular, is used as a framework by which to best understand the roles played by faculty and if the roles of teacher and researcher are, in fact, commensurable. The purpose of the work is two-fold: 1) to develop a construct that may be used by future researchers to better understand the roles played by faculty, and 2) to suggest a best-construct that enables future researchers to propose how actual lived roles should be instantiated in the world. The dissertation reviews a series of university handbooks, professional association ethical guidelines, and philosophical arguments to establish how the roles of faculty are best understood. The investigation illuminates the tensions at the heart of faculty roles. This tension is not definitionally embedded in the roles of faculty as teacher and researcher. Rather, the tension emerges from the failure of institutions to fully actualize faculty roles as normatively grounded in human communicative interaction. As a result, the work suggests that in order to best resolve the cognitive dissonance that may be experienced as a result of role ambiguity, faculty should engage in a process of self-reflection and community dialectic in order to best determine how “faculty” can be actualized in a way that best benefits all stakeholders.