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This thesis is a study of the role of the domiciliary home help and community auxiliary nursing services in England and Wales. The origins of the two services, interwoven as they are with political, social and demographic changes, are traced. Factors in the development of the services such as the effects of war, infant mortality, the professionalisation of nursing and medicine, the low status of domestic service, the role of voluntary organisations and the policies of successive governments in particular since 1948, are discussed. The parallel development of both services since 1948 is analysed. The increase in the numbers employed in the auxiliary nursing field, since the separation of nursing and the home help service in 1972, and its effect upon the role of the home help is examined. The concern at the possible duplication and overlapping of a role, because of the independent development of the two services since 1972, is also discussed. In an attempt to identify the actual tasks carried out by both groups of workers, I carried out a large study of the role of each group. A postal questionnaire, listing 110 tasks was completed by 1037 home helps in 20 Local Authorities and 1368 nursing auxiliaries in 81 District Health Authorities. The completed questionnaires were analysed under the headings of: Professional Nursing; Basic Nursing; Administrative; Domestic; Personal; Advisory; Escorting and Miscellaneous Tasks. The data collected on the role of the home help and auxiliary nurse is examined and areas of potential overlap discussed, along with an analysis of the perception that each group has of their role. The variation in practice in differing authorities is also discussed. The thesis is concluded by a summary and conclusions. In the appendices each group of tasks is analysed, in tables, by frequency, perception of role, age, sex, time in post, marital status, qualifications, political affiliation of each authority and type cf authority. A comparison of the number of tasks and the percentage of staff carrying them out in each authority is also included.

No / The community care reforms enabled some older people with severe disabilities to remain at home with domiciliary care services, as an alternative to institutional admission. This paper explores the extent to which the reforms actually enabled older people receiving domiciliary care to have greater choice and control in their daily lives than older people living in institutions. Findings are reported from a comparative study carried out in Greater Belfast, Northern Ireland, that determined the extent to which the subjective quality of life of older people--particularly autonomy--varied according to the type of setting. The older people were interviewed using a structured interview schedule and subjective autonomy was assessed using a measure of perceived choice. The measure consisted of 33 activities relating to aspects of everyday life such as what time to get up, when to see visitors or friends, and how much privacy was available. Qualitative data were also recorded which informed on the older people's perspectives on their own lives, particularly the extent to which they exercised choice on a daily basis. Two-hundred and fourteen residents in 45 residential and nursing homes were interviewed, as were 44 older people receiving domiciliary care in private households. The study found that older people living in institutions perceived themselves to have greater decisional autonomy in their everyday lives than did older people receiving domiciliary care. Indeed, it was clear that living at home did not ensure that one's decisional autonomy would be supported. However, living alone may facilitate exercising a relatively higher degree of autonomy when living at home. Whilst the community care reforms have provided some older people who have severe disabilities with the option of receiving care at home, this has not necessarily enabled them to have greater choice and control in their everyday lives than older people admitted to institutions.

A família representa a unidade de equilíbrio de cada indivíduo, podendo ser comparada ao seu eixo central. No entanto, ao perceber a doença, há uma desestruturação e desequilíbrio no contexto familiar, costuma-se dizer que ao adoecer uma pessoa da família, esta também adoece. Acompanhando os preceitos da Reforma Psiquiátrica, observamos um aumento de alternativas de atendimento a pessoas com transtornos mentais: Centros de Atenção Psicossocial, Residências Terapêuticas e mais recentemente, propostas de atendimento de pacientes com transtornos mentais pelo Programa de Saúde da Família. Com o objetivo de reintegração ao meio sociofamiliar; a abordagem da reabilitação psicossocial favorece inovações relacionadas ao conhecimento teórico e a aproximação com o território vivencial de cada usuário, ampliando as oportunidades de inserção social dos mesmos, e recuperando-os enquanto cidadãos. Este trabalho teve como objetivo conhecer o significado da convivência entre pacientes e familiares no contexto do domicílio, utilizando como sujeitos os usuários do Centro de Reabilitação e Hospital-Dia do Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Trata-se de uma pesquisa qualitativa, em que foram realizadas entrevistas semi-estruturadas, acompanhadas da caracterização do domicílio de cada indivíduo. A técnica utilizada para organização dos discursos foi baseada na análise de conteúdo temática de Bardin (1977). Nos discursos dos sujeitos, podemos perceber, ao mesmo tempo em que observamos, que o domicílio é um local de trocas afetivas, contendo particularidades que identificam cada indivíduo com a sua história e sua subjetividade. Percebemos que nele podem acontecer relações estereotipadas, favorecendo a cronificação da doença por meio de atitudes perpetuadas pelos próprios familiares. É a cristalização da loucura, do pensamento manicomial que acompanha cada cena familiar. O presente estudo sugere que a assistência domiciliária em saúde mental representa um importante instrumento na abordagem do indivíduo com transtorno mental e sua família. Esta permite aos profissionais entender a dinâmica familiar no seu próprio meio, verificando possibilidades e/ou dificuldades de envolvimento dos familiares no tratamento e acompanhamento do usuário, visando à sua reintegração na família e na sociedade. / The family represents the equilibrium of each individual and might be compared to their central axle. However, the family represents the unit of balance of each individual, being able to be compared to their central axle. However, when noticing the illness there is a lack of structure and disequilibrium in the familiar context, it’s common to say that when someone gets sick in the family, the family also becomes ill. Following the rules of the Psychiatric Reformation we observe an increase of attendance alternatives to the people with mental disturbance: Centers of Psychosocial Attention, Therapeutical Residences and more recently, proposals of attendance of patients with mental disturbance by the Program of Health of the Family. With the objective of reintegration to the social family environment; the approach of the psychosocial rehabilitation favors innovations related to the theoretical knowledge and the approach with the existential territory of each user, extending their chances of social insertion recovering them while citizens. This research had as objective to know the meaning of the living between patients and their families in the context of the domicile, using as individuals, users of the Center of Rehabilitation and Hospital-Dia of the Institute of Psychiatry of the Hospital of the Clinics of the College of Medicine of the University of São Paulo. This is a qualitative research, where they had been carried out semi-structured interviews, followed by the characterization of the domicile of each individual. The technique used for organization of the speeches was based on the thematic analysis of the content of Bardin (1977). In the speeches of the individuals, we can perceive that at the same time that we observe the domicile is a place of affective exchanges, contending particularitities that identify each individual with its background, and its subjectivity. In it can happen stereotyped relations, favoring an increase of the illness by means of proper attitudes perpetuated by the family. It is the crystallization of madness, of the manicomial thought that followed each familiar scene. The present study suggests that the domiciliary assistance in mental health represents an important instrument in approaching the individual with mental disturbance and his/her family. This allows the professionals to understand the familiar dynamics in its proper environment, verifying possibilities and/or difficulties of involvement of the family in the treatment and the accompaniment of the user, aiming at his/her reintegration in the family and in the society.

This dissertation explores the British colonial government’s attempt to reconstruct women’s reproductive behaviors in colonial Ghana through the sites of maternal and infant welfare services and western midwifery education. In the early 1920s, the fear that the high maternal and infant mortality rates in the Gold Coast would have repercussive effects on economic productivity caused the colonial government to increasingly subject women’s reproduction to medical scrutiny and institutional care. I argue that female reproduction was selected as a site of intervention because the British colonial government conceived of it as a path of least resistance to social reconstruction, economic security, and political dominance. The five chapters have been designed to analyze colonial reproductive intervention as a socio-economic and political exigency of colonial rule. This dissertation speaks to the fact that cross-culturally, the female body has been politicized through narratives of power, culture, tradition, modernity, race, disempowerment, and empowerment. / text

A família representa a unidade de equilíbrio de cada indivíduo, podendo ser comparada ao seu eixo central. No entanto, ao perceber a doença, há uma desestruturação e desequilíbrio no contexto familiar, costuma-se dizer que ao adoecer uma pessoa da família, esta também adoece. Acompanhando os preceitos da Reforma Psiquiátrica, observamos um aumento de alternativas de atendimento a pessoas com transtornos mentais: Centros de Atenção Psicossocial, Residências Terapêuticas e mais recentemente, propostas de atendimento de pacientes com transtornos mentais pelo Programa de Saúde da Família. Com o objetivo de reintegração ao meio sociofamiliar; a abordagem da reabilitação psicossocial favorece inovações relacionadas ao conhecimento teórico e a aproximação com o território vivencial de cada usuário, ampliando as oportunidades de inserção social dos mesmos, e recuperando-os enquanto cidadãos. Este trabalho teve como objetivo conhecer o significado da convivência entre pacientes e familiares no contexto do domicílio, utilizando como sujeitos os usuários do Centro de Reabilitação e Hospital-Dia do Instituto de Psiquiatria do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. Trata-se de uma pesquisa qualitativa, em que foram realizadas entrevistas semi-estruturadas, acompanhadas da caracterização do domicílio de cada indivíduo. A técnica utilizada para organização dos discursos foi baseada na análise de conteúdo temática de Bardin (1977). Nos discursos dos sujeitos, podemos perceber, ao mesmo tempo em que observamos, que o domicílio é um local de trocas afetivas, contendo particularidades que identificam cada indivíduo com a sua história e sua subjetividade. Percebemos que nele podem acontecer relações estereotipadas, favorecendo a cronificação da doença por meio de atitudes perpetuadas pelos próprios familiares. É a cristalização da loucura, do pensamento manicomial que acompanha cada cena familiar. O presente estudo sugere que a assistência domiciliária em saúde mental representa um importante instrumento na abordagem do indivíduo com transtorno mental e sua família. Esta permite aos profissionais entender a dinâmica familiar no seu próprio meio, verificando possibilidades e/ou dificuldades de envolvimento dos familiares no tratamento e acompanhamento do usuário, visando à sua reintegração na família e na sociedade. / The family represents the equilibrium of each individual and might be compared to their central axle. However, the family represents the unit of balance of each individual, being able to be compared to their central axle. However, when noticing the illness there is a lack of structure and disequilibrium in the familiar context, it’s common to say that when someone gets sick in the family, the family also becomes ill. Following the rules of the Psychiatric Reformation we observe an increase of attendance alternatives to the people with mental disturbance: Centers of Psychosocial Attention, Therapeutical Residences and more recently, proposals of attendance of patients with mental disturbance by the Program of Health of the Family. With the objective of reintegration to the social family environment; the approach of the psychosocial rehabilitation favors innovations related to the theoretical knowledge and the approach with the existential territory of each user, extending their chances of social insertion recovering them while citizens. This research had as objective to know the meaning of the living between patients and their families in the context of the domicile, using as individuals, users of the Center of Rehabilitation and Hospital-Dia of the Institute of Psychiatry of the Hospital of the Clinics of the College of Medicine of the University of São Paulo. This is a qualitative research, where they had been carried out semi-structured interviews, followed by the characterization of the domicile of each individual. The technique used for organization of the speeches was based on the thematic analysis of the content of Bardin (1977). In the speeches of the individuals, we can perceive that at the same time that we observe the domicile is a place of affective exchanges, contending particularitities that identify each individual with its background, and its subjectivity. In it can happen stereotyped relations, favoring an increase of the illness by means of proper attitudes perpetuated by the family. It is the crystallization of madness, of the manicomial thought that followed each familiar scene. The present study suggests that the domiciliary assistance in mental health represents an important instrument in approaching the individual with mental disturbance and his/her family. This allows the professionals to understand the familiar dynamics in its proper environment, verifying possibilities and/or difficulties of involvement of the family in the treatment and the accompaniment of the user, aiming at his/her reintegration in the family and in the society.

FundaÃÃo de Amparo à Pesquisa do Estado do Cearà / O cuidador familiar do idoso dependente passa a ser foco da atenÃÃo em saÃde recentemente. Objetivou-se, neste estudo, conhecer as competÃncias e habilidades desenvolvidas pelo enfermeiro no atendimento ao cuidador familiar do idoso dependente no domicÃlio. Cuidar adequadamente destes pacientes exige tambÃm profundo preparo tÃcnico cientÃfico dos profissionais que realizam visitas domiciliares a idosos dependentes, assim como planejamento de intervenÃÃes educativas, realizaÃÃo de procedimentos e tratamentos medicamentosos. Essa diversificaÃÃo vem gerando reflexÃes e questionamentos entre os profissionais que visitam e cuidam desses idosos. O que se busca neste estudo Ã, a partir da realidade social dos enfermeiros que trabalham com assistÃncia, internaÃÃo e visita domiciliar, conhecer a construÃÃo do cuidado dispensado ao idoso e a seu cuidador. O trabalho, em funÃÃo de seu objetivo e propÃsito implica a utilizaÃÃo de metodologia de corte qualitativo. A populaÃÃo do estudo constituiu-se de enfermeiros integrantes da EstratÃgia SaÃde da FamÃlia (ESF), do Programa de Atendimento DomiciliÃrio (PAD) e Home Care. Para tanto foram escolhidos 8 (oito) enfermeiros da ESF e 8 (oito) das demais instituiÃÃes pÃblicas e privadas, totalizando 16 enfermeiros. Para coleta de dados, optou-se pela tÃcnica de Grupo Focal (GF) associado a uma entrevista individual como instrumento complementar. Dentre as tÃcnicas qualitativas, optamos pelo Discurso do Sujeito Coletivo (DSC) obtido atravÃs da anÃlise das entrevistas realizadas com enfermeiros sujeitos da pesquisa. Segundo LEFÃVRE e LEFÃVRE, que acreditam ser esta a melhor opÃÃo para o estudo proposto. As idÃias centrais foram: orientar e treinar o cuidador sobre o cuidado com o idoso, com tecnologia de enfermagem. O cuidador nÃo à importante, ele nÃo à foco da atenÃÃo, a famÃlia orientada no cuidado ao idoso, o cuidador necessita mais de cuidados que o prÃprio doente, pois na maioria dos casos o cuidador à tambÃm idoso, nÃo existindo disponibilidade de tempo para assistÃncia ao este. A assistÃncia à dada de acordo com as queixas e as necessidades de capacitaÃÃo para uma assistÃncia de qualidade. O conteÃdo dos discursos nÃo deixa dÃvidas de que hà necessidade de potencializar as aÃÃes de enfermagem embasada em conhecimentos cientÃficos, normatizaÃÃoes e criaÃÃo de instrumentos para assistÃncia domiciliar nas instituiÃÃes pÃblicas. Iniciando pela ESF, que trabalharà em concomitÃncia com o Programa de InternaÃÃo Domiciliar (PID), implantado nas instituiÃÃes hospitalares das redes pÃblicas municipais e estaduais. / The familiar cuidador of the aged dependent very starts to be focus of the attention in health recently. It was objectified, in this study to know the abilities and abilities developed for the nurse in the attendance to the familiar cuidador of the aged dependent in the domicile. To take care of adequately of these patients also demands deep preparation scientific technician of the professionals who carry through visits domiciliary the aged dependents, as well as planning of educative interventions, medicaments accomplishment of procedures and treatments. This diversification comes generating reflections and questionings between the professionals whom they visit and they take care of aged in domiciles. What one searchs in this study is, from the social reality of the nurses who work with assistance, internment and domiciliary visit. To know the construction of the care excused to aged and its cuidador. The work, in function of its objective and intention implies the use of methodology of qualitative cut. The population of the study consisted of integrant nurses of the Strategy Health of Family (ESF), of the Program of Domiciliary Attendance (PAD) and Home Care. For 8 (eight) nurses of ESF and 8 (eight) of the too much public and private institutions had been in such a way chosen totalizing 16 nurses. For collection of data associate to an individual interview opted itself to the technique of Focal Groupe (GF) as complementary instrument. Amongst the qualitative techniques, we opt to the Speech of Collective Citizen (DSC) gotten through the analysis of the interviews carried through with nurses citizens of the research according to LEFÃVRE and LEFÃVRE, to believing to be this the best option for the considered study. The ideas central offices had been: it guides and it trains on the care with the aged one, the cuidador as nursing technology, the cuidador is not important, the cuidador is not focus of the attention, the family guided in the care to the aged one, the cuidador needs more than well-taken care of that the proper sick person, the cuidador is also aged, does not exist availability of time for assistance to the cuidador, the assistance is given in accordance with to the complaints and necessity of qualification for a quality assistance. The content of the speeches does not leave doubts of that it has necessity of get up the actions of nursing based in scientific knowledge, rules and creation of instruments domiciliary assistance in the public institutions. Initiating for the ESF, that will work in concurrence with the Program of Domiciliary Internment (PID) implanted in the hospital institutions of the municipal and state public nets.

Submitted by Fabiana Gonçalves Pinto (benf@ndc.uff.br) on 2015-12-15T15:36:11Z No. of bitstreams: 1 Neusa Maria de Azevedo.pdf: 2018532 bytes, checksum: b1b626705b2415506a8b02b394ad1328 (MD5) / Made available in DSpace on 2015-12-15T15:36:11Z (GMT). No. of bitstreams: 1 Neusa Maria de Azevedo.pdf: 2018532 bytes, checksum: b1b626705b2415506a8b02b394ad1328 (MD5) Previous issue date: 2010 / Empreendimento Esportivo e Lazer Vale dos Ipês Ltda / Mestrado Profissional em Enfermagem Assistencial / Trata-se de uma pesquisa desenvolvida no Programa de Mestrado Profissional de Enfermagem Assistencial da Escola de Enfermagem Aurora de Afonso Costa - EEAAC, da Universidade Federal Fluminense – UFF, cujos objetivos foram: 1- discutir as possibilidades de orientação e suporte ao familiar cuidador do idoso pelo enfermeiro; 2- descrever o ambiente domiciliar do idoso; 3- caracterizar o familiar cuidador do idoso; 4- conhecer o perfil do idoso em situação de internação domiciliar; 5- identificar as necessidades do familiar cuidador do idoso em internação domiciliar. Estudo de natureza qualitativa do tipo estudo de caso, desenvolvido com 20 familiares cuidadores de idosos em situação de internação domiciliar, captados no Programa de Internação Domiciliar do Hospital Geral de Nova Iguaçu (PID-HGNI). A coleta de informações envolveu observação participante no domicílio dos sujeitos e entrevistas com o familiar cuidador desses idosos, bem como a aplicação de um roteiro para sua caracterização. Após analise temática dos dados, emergiram três categorias: “Percebendo o Cuidando do idoso”, “Percebendo os Sentimentos de quem cuida” e “As orientações da enfermeira ao familiar cuidador do idoso”. A primeira possibilitou visualizar que todos os idosos do estudo apresentavam limitações em realizar tanto as atividades de vida diária (AVDs) como também as atividades instrumentais de vida diária (AIVDs), o que os tornavam extremamente dependentes do familiar cuidador. Esta dependência ocasionou mudanças no cotidiano deste familiar, levando a alterações em sua vida, manifestadas a partir da sobrecarga de cuidados, afastamento do trabalho, cansaço físico e déficit de auto-cuidado (principalmente quando este cuidado ocorre de maneira solitária sem a colaboração de outros familiares). A seguir, na segunda categoria, demonstra-se no dia-a-dia deste cuidar os sentimentos aflorados pela vivência/convivência do familiar cuidador com o idoso. Suas falas revelam sentimentos de dever e obrigação pelo matrimônio ou pela vida em comum; retribuição dos cuidados recebidos no passado; sentimentos ambíguos na conciliação do cuidado com outras atividades; incertezas frente ao amanhã; apoio religioso. Todos estes sentimentos mobilizam o familiar cuidador a desempenhar a atividade de cuidar do seu familiar idoso, independente dos possíveis danos que possam sofrer; apesar de existirem relatos de melhora da própria saúde e planos pessoais para futuro em decorrência da atividade realizada. Finalmente, na categoria “As orientações da enfermeira ao familiar cuidador do idoso”, revela-se o cotidiano do familiar cuidador, na situação da doença, o desconhecimento e a falta de habilidades para cuidar desses idosos. Neste contexto, a enfermeira passa a ter o foco neste familiar, através da observação de como ele enfrenta a situação do cuidado ao idoso, que ocorre de maneira cotidiana e progressiva, associando e visualizando os recursos disponíveis. A implementação de ações educativas possibilitam ao familiar cuidador alcançar independência para realizar os cuidados necessários, diminuindo o estresse deste cotidiano e abrindo ainda possibilidades de resgate do autocuidado. Concluímos que cabe à enfermeira conhecer o ambiente domiciliar, sua dinâmica, identificar o perfil do idoso e de seu familiar cuidador antes de estabelecer um programa de orientações porque é no cotidiano do cuidado ao idoso em internação domiciliar que emergem situações que demandam orientações, escuta e olhar atentos às necessidades tanto do idoso quanto do familiar cuidador, que necessita de suporte e ajuda para saber cuidar do idoso e de si mesmo no inquietante contexto que os envolve durante o processo de internação domiciliar / It is about a research developed at Escola de Enfermagem Aurora Afonso Costa – EEAAC – at Universidade Federal Fluminense's Programa de Mestrado Profissional de Enfermagem Assistencial, whose goals were 1- discuss the possibilities of guiding and support to the family caregiver of elderly people; 2- describe the domiciliary environment of the elderly; 3- characterize the family caregiver; 4- identify the elderly people in situation of home care; 5- identify family caregivers' needs. Study case by qualitative aproach developed with 20 elderly in situation of domiciliary. The caregivers familiar are recruited at Programa de Internação Domiciliar of Hospital Geral de Nova Iguaçu (PIDHGNI). In data collection used participant observation, and interviews with caregiver familiar of elderly with support one instrument to data collection to characterization the research participants. The information analyzing unveiled three thematic categories: "Realizing the care of to elderly", "Realizing the feelings of the familiar caregiver" and "The nurses’ guidelines to family caregivers of the elderly". The first one enables the view that all subjects had limitations in performing both survival and instrumental activities of daily living, that making them highly dependent on the family caregiver. This dependence causes changes in family daily living, leading the changes in their lives, expressed as follows: care burden, absence from work, physical exhaustion, self-care deficit (especially when this care is lonely with no cooperation from other family members). Next, the second category demonstrates that feelings of everyday care are evidenced by family caregivers and the elderly’s experience/coexistence. The results manifest feelings of duty and obligation by marriage or others commitments; reciprocation of the care received in the past; mixed feelings up in the coordinating care and other activities, uncertainties related to the future; and religious support. All these feelings mobilize the family caregivers to perform the activity of caring of their elderly relatives, regardless of the possible damage they may suffer. However, there are reports of improvements in their own health and personal plans for the future as a result of the activity done. At last, in the third category the family caregiver’s everyday life in disease situation and lack of knowledge and skills to take care of the elderly is revealed. In this context, the nurse focuses on observation of how the family caregiver faces the care to the elderly, which occurs in a daily and progressive way, associating and identifying the available resources. The implementation of educational interventions enables the caregiver to achieve independence to carry out the necessary care, reducing stress on everyday life, opening up further possibilities for redemption of self-care. We conclude that it is up to the nurse getting to know the home environment, its dynamics, to identify the elderly and their family caregivers’ profiles before establishing one orientation program due to be in the daily care of elderly at homecare situations that arise up required orientation, attentive listen and look to the needs of the elderly as well as the caregiver familiar, who needs support and help to learn how to take care of the elderly and of himself within the disturbing context that surrounds them during the process of homecare

Evaluates the noise generated in the urban environment through the collecting of recyclable solid residues, done by compacting trucks. It is related the levels of noises to the concept of acoustic comfort. It demonstrates how is realized the recyclable solid residues in the residential zone, with predominantly familiar occupation. The levels of noise made in the collecting activity, in its totality, show superior values to what is allowed by NBR 10151/2000 in external diurnal residential areas. / Avalia-se o ruído gerado no meio urbano, pela coleta dos resíduos sólidos recicláveis, efetuada por caminhões compactadores. Relaciona os níveis de ruído aos conceitos para o conforto acústico. Demonstra como é realizada a coleta dos resíduos sólidos recicláveis em zona residencial, com ocupação predominantemente residencial unifamiliar. Os níveis de ruído produzidos nas atividades de coleta, em sua totalidade, indicaram valores superiores aos permissíveis pela NBR 10151/2000 para áreas residenciais externa e diurna.