CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior / O acompanhamento ao paciente submetido à cirurgia de revascularizaÃÃo do miocÃrdio (RM) deve ter uma abordagem holÃstica, realizado por uma equipe multiprofissional. Este estudo teve como objetivo geral avaliar um Protocolo de Consultas de Enfermagem (PCE) ao paciente apÃs RM, comparando com um grupo controle. E, como especÃficos: levantar caracterÃsticas dos pacientes em relaÃÃo a sexo, idade, escolaridade, renda familiar, estado civil, histÃria familiar de doenÃa arterial coronariana (DAC) e religiÃo; verificar prevalÃncia dos fatores de risco para DAC: hipertensÃo arterial, diabetes mellitus, dislipidemia, obesidade, sedentarismo e tabagismo; identificar mudanÃas comportamentais dos pacientes, enfatizando hÃbitos alimentares, exercÃcio fÃsico, abstinÃncia de tabagismo e etilismo, e uso contÃnuo de medicamentos; averiguar impacto do PCE na reduÃÃo dos fatores de risco para DAC, considerando o controle: pressÃo arterial, glicemia, colesterol, Ãndice de massa corporal, circunferÃncia da cintura e relaÃÃo cintura/quadril; e verificar aspectos relacionados à ansiedade e depressÃo. Ensaio clÃnico randomizado, desenvolvido no ambulatÃrio de um hospital pÃblico, Fortaleza-CE. Compuseram a populaÃÃo 146 pacientes revascularizados no perÃodo de coleta de dados, constituindo a amostra 78 pacientes, 39 do grupo controle (GC) e 39 do grupo de intervenÃÃo (GI). A participaÃÃo nos grupos foi definida pelo dia de cirurgia. Pacientes do GC fizeram o seguimento ambulatorial convencional, com avaliaÃÃo pela pesquisadora no momento da alta e seis meses apÃs a cirurgia; e pacientes do GI foram submetidos ao PCE com atendimentos na alta hospitalar e apÃs um, dois, quatro e seis meses. Estudo aprovado pelo Comità de Ãtica e Pesquisa. Encontrou-se similaridade nos grupos para os indicadores: sexo masculino (62,8%); idade (mÃdia: 65 anos); baixa escolaridade; renda familiar atà um salÃrio mÃnimo (55,1%); antecedentes familiares com DAC (65,4%); catÃlicos (82,1%). O estado civil apresentou diferenÃa significativa. Contudo, os fatores de risco para DAC nÃo apresentaram diferenÃas significativas (p>0,05): hipertensÃo arterial (83,3%), nÃo-diabÃticos (53,8%), sem dislipidemia (53,8%), obesidade (67,9%), sedentarismo (57,7%) e nÃo-tabagistas (65,4%). Na avaliaÃÃo da eficÃcia do PCE, os testes evidenciaram que 92,3%-GI e 76,9%-GC melhoraram a qualidade da alimentaÃÃo. O GI teve uma maior adesÃo à pratica de exercÃcio fÃsico do que o GC (p<0,10). Todos os pacientes do GI abstiveram-se do cigarro e do etilismo, e 33,3% dos fumantes e 50,0% dos usuÃrios de bebidas alcoÃlicas do GC mantiveram esses hÃbitos, constatando diferenÃa significativa (p<0,05). Um percentual maior (94,9%) do GI usava os medicamentos adequadamente (p>0,05). Houve um impacto na reduÃÃo dos fatores de risco para DAC, apÃs seis meses da cirurgia, quanto aos indicadores (p<0,05): pressÃo arterial, taxa de glicemia, Ãndice de massa corporal, circunferÃncia da cintura e relaÃÃo cintura/quadril. Conforme constatado, o GI teve um percentual menor de pessoas com ansiedade e/ou depressÃo em relaÃÃo ao GC. Conclui-se que o seguimento pelo PCE foi eficaz para as mudanÃas comportamentais no estilo de vida dos pacientes revascularizados. Como observado, um maior nÃmero de pessoas do GI melhorou a qualidade da dieta, aderiu à prÃtica de exercÃcio fÃsico e parou de fumar e de ingerir bebidas alcoÃlicas. Tais mudanÃas comportamentais foram positivas para reduzir fatores de risco e, conseqÃentemente, minimizar complicaÃÃes cardiovasculares.

Pesquisas demonstraram que a teleconsulta síncrona com vídeo interativo e compartilhamento remoto de aplicativos pode ser utilizada com sucesso na programação e verificação de aparelhos de amplificação sonora individuais (AASIs). Entretanto, esta consulta, mediada via tecnologia de informação e comunicação, pode dificultar a efetiva comunicação profissional/paciente, com consequente impacto negativo na compreensão e retenção da informação, adesão e bem-estar psicológico do paciente durante o tratamento. Este estudo comparou a comunicação nas consultas para adaptação do AASI realizadas face a face e a distância. Participaram do estudo 60 deficientes auditivos, com idades entre 50 e 89 anos (média=69), candidatos ao uso do AASI, divididos em dois grupos conforme a modalidade de atendimento: face a face (n=30) e teleconsulta (n=30). Estes participantes foram atendidos por cinco fonoaudiólogas com experiência na adaptação do AASI e, nas teleconsultas, por mais quatro facilitadores. O software TeamViewer 10© foi utilizado para a transmissão de áudio e vídeo e compartilhamento de dados (conexão via LAN USP, velocidade de 384 Kbps), entre o computador localizado no ambiente de teste, onde estavam o paciente e facilitador, e o ambiente remoto, onde estava a fonoaudióloga. Assim, a fonoaudióloga conduziu os procedimentos de programaçã e verificação do AASI à distância, com auxílio do facilitador. Todas as consultas foram gravadas em formato de vídeo. Dois avaliadores independentes analisaram os vídeos e atribuíram uma pontuação de 0 a 24 pontos para a comunicação ocorrida nas consultas, de acordo com a Escala Global de Pontuação de Consultas (Global Consultation Rating Scale GCRS). Pontuações maiores indicam resultados mais favoráveis. Em média, a duração das teleconsultas foi 10 minutos maior que a das consultas presenciais. Problemas técnicos ocorreram em 27% das teleconsultas, sendo necessário interrompê-las e reiniciá-las. A pontuação média da GCRS foi de 15,3 (presencial) e 12,6 (teleconsulta), sendo esta diferença significativa. Pontuações máximas ou próximas ao máximo não foram encontradas em nenhum dos casos. Para complementar os resultados, foi realizada análise qualitativa de 10 gravações das consultas, face a face (n=5) e a distância (n=5). A análise de conteúdo temático-categorial foi realizada utilizando o software NVivo 10. Nas duas modalidades de consulta, a análise da frequência de ocorrência das categorias indicou predominância da fala do profissional e, quando presente, do facilitador. O teor desta comunicação foi de caráter biomédico, sobressaindo o fornecimento de explicações sobre o uso e manuseio do AASI. A ocorrência de back channels, que podem indicar uma postura de escuta, foi mais frequente para os pacientes e acompanhantes. Concluiu-se que a comunicação nas consultas para adaptação do AASI não foi centrada no paciente, conforme atualmente preconizado. Além disto, esta comunicação sofreu a influência do uso das tecnologias de informação e comunicação. Sendo assim, é reforçada a recomendação da literatura quanto à necessidade de treinamento dos fonoaudiólogos para o uso de habilidades de comunicação efetivas, assim como de estratégias para contornar potenciais obstáculos advindos da interação via teleconsulta. / Researches have shown that the synchronous teleconsultation with interactive video and remote application sharing can be used successfully in programming and verification of hearing aids (HAs). However, this consultation, mediated via information and communication technology and communication, may difficult the effective communication professional/patient, with consequent negative impact on patients comprehension and retention of information, adherence and psychological welfare of the patient during the treatment. This study compared the communication in HA fitting consultations performed face-to-face and at distance. Participated in this study 60 hearing impaired, aged between 50 and 89 years (average=69), candidates to the HA use, divided into two groups according to the attendance modality: face to face (n=30) and teleconsultation (n=30). These participants were attended by five audiologists with expertise in hearing aid fitting and, in the teleconsultations, for another four facilitators. The TeamViewer software 10© was used to transmit audio and video and data sharing (connection via LAN USP, 384 Kbps speed), amongst the computer located in the test environment, where were the patient and the facilitator, and the remote environment, where was the audiologist. Thus, the audiologists conducted the programming procedures and examination of the hearing aid at the distance, with the facilitators assistance. All consultations were recorded in video format. Two independent examiners evaluated the videos and assigned a score of 0 to 24 points for communication occurred in the consultations, according to the Global Consultation Rating Scale GCRS. Higher scores indicate better results. On average, the duration of the teleconsultation was 10 minutes longer than the face to face consultations. Technical problems occurred in 27% of teleconsultation, being necessary to interrupt and restart them. The average score of the GCRS was 15.3 (in-person) and 12.6 (teleconsultation), and this is a significant difference. High scores or close to the maximum were not found in any of the cases. To complement the results, was performed qualitative analysis of 10 recordings of the consultations, face to face (n=5) and teleconsultation (n=5). The thematic categorical content analysis was performed using the NVivo software 10. In the two modalities of consultation, the categories\' occurrences frequency\'s analysis indicated a predominance of the professional speech and, when presence, of the facilitator. The contente of this communication was biomedical, protruding the providing explanations about the using and the HA handling. The occurrence of back channels, which can indicate a listening posture, was more common for patients and their companions. It was concluded that the communication in HA fitting consultations was not patient centered, as currently recommended. Furthermore, this communication has suffered the influence of the use of information and communication technologies. Thus, is strengthened the recommendation of literature regarding the need for training of audiologists to use effective communication abilities, as well as strategies to avoid potential obstacles arising from the interaction via teleconsultation.

A Unidade Básica de Saúde (UBS) é um equipamento do SUS no qual o psicólogo se insere prestando serviços relacionados à promoção, prevenção e tratamento de saúde. A UBS recebe pais que buscam ajuda do psicólogo para lidar com questões emocionais e comportamentais dos filhos, e este deve auxiliar na compreensão destas demandas e intervir em situações nas quais há necessidade de ajuda. D. W. Winnicott retrata a família (fundamentalmente a função materna e paterna) enquanto ambiente facilitador do processo de amadurecimento pessoal. Aponta também que intervenções psicoterápicas breves como consultas terapêuticas podem auxiliar a retomada do desenvolvimento emocional diante de dificuldades neste processo. Para tanto, se faz necessário que haja um entorno familiar fornecendo condições para que a criança usufrua do progresso atingido pelas consultas. O suporte e o cuidado aos pais, procurando dar condições para que a família facilite o desenvolvimento saudável da criança, pode ser, neste sentido, uma interessante estratégia de cuidado em saúde mental. Este estudo, desenvolvido numa UBS, visa analisar o alcance das primeiras intervenções psicoterápicas baseadas no modelo das consultas terapêuticas de Winnicott, realizadas com pais, crianças e adolescente. Foi feito o estudo qualitativo com mães que buscaram atendimento para seus filhos, visando proporcionar nas três primeiras entrevistas uma experiência de comunicação e integração. Intercaladas a estas entrevistas, realizaram-se duas consultas aos filhos, seguindo o mesmo modelo. Ao final dos atendimentos, foi feita uma entrevista semi-dirigida, através da qual analisamos o alcance das intervenções. O estudo mostrou que a experiência de escuta e intervenção proporcionada às mães tiveram diversos efeitos terapêuticos. Foi possível resgatar recursos quanto ao desempenho da função materna, que resultou na aproximação da relação mãe/filho. Houve também o fortalecimento das relações familiares em geral, bem como melhoria no uso dos recursos do entorno social. Este estudo permitiu mostrar como o psicólogo pode colaborar para que a UBS se torne um lugar que favorece a vivência de funções integradoras para os membros da família, proporcionando o holding, para o paciente, e para os familiares que buscam atendimento. Ao resgatar a possibilidade dos pais de conduzirem suas famílias a partir de um lugar mais amadurecido, podemos ajuda-los a formar sujeitos autônomos, contribuindo para uma sociedade mais saudável. Reitera-se, portanto, a importância de oferecer acesso a este tipo de ajuda sempre que preciso, justificando o investimento em políticas públicas que garantam o acesso ao serviço do psicólogo clínico / The Basic Health Unit (UBS) is an equipment of SUS in which the psychologist is inserted by providing services related to promotion, prevention and health care services. The UBS receives parents seeking help from a psychologist to deal with emotional and behavioral issues of children, and this should assist in understanding these demands and intervening in situations where there is need of help. Winnicott portrays the family (fundamentally maternal and paternal functions) as a facilitating environment of personal maturation process, throughout emotional development. He also points out that brief psychotherapeutic interventions such as therapeutic consultations can assist in the recovery of emotional development of difficulties in this process. For this purpose, it is necessary that there is a family environment acting as \"middle desirable environment\", giving conditions for the child to enjoy the progress achieved by the consultations. The support and care to parents looking to give conditions for the family to facilitate the healthy development of the child may be, in this sense, an interesting strategy for mental health care. This study, which was developed at an UBS, aims to analyze the scope of the first psychotherapeutic interventions based on the model of therapeutic consultations of D. W. Winnicott held with families and children. The qualitative study of mothers seeking care for their children, performing the first three interviews were done, according to the model of therapeutic consultations, aiming to provide an experience of communication and integration. Intertwined with these interviews, there were two visits to the children, following the same model. At the end of the consultations, there was a semi-directed interview, through which we analyze the scope of interventions. The study showed that the experience of listening and intervention provided to mothers had different therapeutic effects. It was possible to rescue resources concerning maternal function, which resulted in the approaching of the mother/child relationship. There was a strengthening of the family relationships in general, as well as of the use of resources from the social environment. This study allowed us to show how psychologists can contribute to the UBS so that it becomes a place that fosters the experience of integrative functions for family members, providing the holding for the patient and for the family members who seek care. By rescuing the ability of parents to lead their families from a more mature place, we favor that the family environment is conducive to the formation of responsible and autonomous subjects, which translates into a healthier society. It is reiterated, therefore, the importance of providing access to this type of help whenever needed, justifying the investment in public policies that guarantee access to the services of clinical psychologists

Este trabalho de Dissertação de Mestrado objetivou investigar as entrevistas iniciais realizadas com as famílias que buscavam atendimento para um dos filhos, no período de julho de 1997 a junho de 2001, na Clínica Psicológica Dr Durval Marcondes, do Departamento de Psicologia Clínica do IPUSP e em consultório particular. Fundamenta-se na leitura da obra de D. W. Winnicott, que traz importantes contribuições para a psicanálise contemporânea. Realiza uma crítica aos modelos de triagens existentes nas Clínicas-Escola e em outras instituições, destacando o caráter de exclusão dessa prática. Discute, também, aspectos da dinâmica e função da família do ponto de vista de D.W. Winnicott. A metodologia que embasou o trabalho utiliza-se do método psicanalítico para fundamentar a pesquisa de práticas clínicas diferenciadas e inovadoras. Recorre, ainda, às idéias de Walter Benjamim sobre o valor da narrativa como forma de partilhar experiências inter-humanas. Há o relato de cinco casos que ilustram a prática de consultas psicoterapêuticas com famílias. Na discussão dos casos não se pretende esgotar as compreensões destes, mas apontar possíveis sentidos. Discute-se, também, o modelo de intervenções usadas nesse trabalho, que se baseiam na idéia de o analista ser capaz de sustentar sua prática clínica (dar holding). Destaca-se, enfim, o valor deste trabalho para os pacientes e para as instituições públicas. / This master\'s dissertation aims at investigating the initial interviews carried out with the families that, between July, 1997, and June, 2001, sought help for one of their children at the Dr. Durval Marcondes Psychological Clinic, of the Department of Clinical Psychology at the University of São Paulo\'s Institute of Psychology, and at a private office. The dissertation is based on the writings of D. W. Winnicott, who has contributed much to contemporary psychoanalysis. A criticism is presented in regard to the screening models currently used in school-clinics and other institutions, especially the character of exclusion of this practice. Aspects of the dynamics and function of the family are also discussed from Winnicott\'s point of view, with the psychoanalytic method being used as the basis for studying innovative alternative clinical practices. Reference is also made to Walter Benjamin\'s ideas regarding the importance of narration as a way of sharing inter-human experiences. Five clinical cases are described to demonstrate the practice of therapeutic consultation work with families, although the discussion of these cases merely brings up possible meanings, and makes no pretense at providing any type of full understanding. Also discussed is the model of intervention used in this work, which is based on the idea of the analyst as someone able to give holding in his or her clinical practice. Finally, the value of this work for patients and for public institutions is also highlighted.

Ce travail est une contribution au renforcement des capacités de recherche et de l'identification des stratégies et des perspectives afin de promouvoir une meilleure recherche en santé bucco-dentaire en Afrique grâce à la production de l'avis d'un panel d'experts lors d'une consultation Delphi. Ceci d'autant plus que les systèmes de santé bucco-dentaire et les connaissances scientifiques évoluent rapidement. Le continent africain est confronté à de nombreux défis parmi lesquels figurent le fardeau des maladies bucco-dentaires et les besoins élevés en soins des populations. Afin de satisfaire la demande en soins et de poser des actions de santé publique efficaces, les décideurs ont besoin d'outils, de capacités et d'informations pour évaluer et suivre les besoins de santé, choisir des stratégies d'intervention, des options politiques appropriées pour la conception de leurs propres stratégies en vue améliorer la performance des systèmes de soins bucco-dentaires. Dans ce contexte, il est nécessaire de concevoir une approche cohérente de la politique de santé bucco-dentaire dans la Région africaine ce qui implique une meilleure connaissance de la situation. Car l'avancement de l'Afrique est tributaire de sa capacité à générer, à adapter et à utiliser des connaissances scientifiques pour satisfaire aux besoins locaux en matière de santé et de développement. C'est pourquoi il y a un besoin de former la prochaine génération de scientifiques africains. Les universités doivent promouvoir, soutenir la recherche ainsi que la formation de sorte que les étudiants puissent participer aux recherches et bénéficier de l'enseignement de chercheur tout au long de leurs formations. La collecte de données sur la santé bucco-dentaire est par conséquent essentielle pour obtenir une vision précise de la situation en Afrique et ainsi mesurer les progrès réalisés. L'objectif de ce travail de recherche est de produire l'avis d'un panel d'experts sur différents items lors d'une consultation Delphi à deux phases. Ceci dans l'optique d'évaluer l'état actuel de la recherche, d'identifier les stratégies afin de promouvoir une meilleure recherche en santé bucco-dentaire en Afrique et de dégager des perspectives pour son progrès. Les analyses soulignent les priorités aux actions à privilégier tout en impliquant un certain nombre de recommandations pour renforcer et promouvoir les capacités de la recherche en santé bucco-dentaire. En fin de compte la solution qui s'imposerait serait de favoriser et d'optimiser la culture de la recherche dans les programmes nationaux de santé bucco-dentaire et d'assurer une large diffusion des résultats de la recherche pour les utiliser à des fins de planification / This work is a contribution to the strengthening of research capacity and the identification of strategies and opportunities to promote better research in oral health in Africa through the filing of the notice of a panel of experts at a Delphi consultation. This especially as systems oral health and scientific knowledge evolves rapidly. However, the African continent is facing many challenges, including the burden of oral diseases and the needs of populations that are huge. To meet these challenges care and ask actions effective public health policy makers need tools, skills and information to assess and monitor health needs, choose intervention strategies, policy options appropriate for the design of their own circumstances and improve system performance oral care. In this context, it is necessary to develop a coherent policy approach to oral health in the African Region, but this implies a better knowledge of the situation. For the advancement of Africa depends on its ability to generate, adapt and use scientific knowledge to meet local needs in health and development. That is why there is an urgent need to build the next generation of African scientists. Universities should promote and support research and training so that students are exposed to research and be taught by researchers throughout their courses. The collection of data on oral health is essential to get an accurate picture of the situation in Africa and to measure progress. Thus the objective of this research is to produce the opinion of a panel of experts on various items at a Delphi consultation two phases. In order to assess the current state of research, identify strategies to promote better research in oral health in Africa and prospects for its development. Analyzes give priorities to focus on the actions and involve a number of recommendations to strengthen and promote the capacity of research in oral health. Ultimately, we must promote a culture of research in national programs of oral health, ensure wide dissemination of research results and use them for planning purposes

In a mineral development scenario, Aboriginal groups rely heavily on Environmental Assessment (EA) and Impact and Benefit Agreements (IBAs) to address their interests and concerns. While EA and IBAs are separate processes – EA is legislated and informed by the Crown, and IBAs operate in the realm of private contract law – together, the two are ostensibly part of a parallel process that connect the Aboriginal group(s), Government and the mining proponent. Indisputably, IBAs support a more inclusive development based on consultation, partnership and participation. IBAs and EA have the potential to enhance Aboriginal involvement in mineral development and positively influence the design and planning of the mine. This thesis examines the Tahltan Nation’s involvement and participation in the Galore Creek Project in British Columbia, and demonstrates the challenges and opportunities that arose during the EA and IBA process. It uses key informant interviews to gain multiple perspectives – from the proponent, Tahltan, and Government, to understand how the Tahltan utilized the EA and IBA to participate in the mineral development. / Applied Science, Faculty of / Mining Engineering, Keevil Institute of / Graduate

Development of windpower is a popular measure to meet the international and national goals to reduce the emissions of greenhouse gases. On the same time, there are goals to increase citizen participation in decision-making processes. In Sweden, citizens’ right to participate in the planning- and consultation process is regulated by the Planning and Building Act. The rapid increase of windpower turbines in Sweden has been followed by a growing number of conflicts. In this study, conflicts of interest appeared due to the establishment of windpower turbines at the popular city mountain Vårdkasen in Härnösand. By interpreting nine interviews carried out with some of the involved interests, deeper knowledge could be gained of how citizen participation and conflicts of interests are handled in windpower planning. It was the municipality owned company HEMAB who wanted to construct four windpower turbines, but the municipality was responsible for the formal planning and consultation process. A consultant working for HEMAB conducted an informal consultation process using walks, visits and meetings to interact with the interests. This interaction gave the consultant deeper insights on their concerns and that were the reason to why HEMAB strongly proposed a reduction of the planned turbines from four to two. That the consultation process started early made it possible for the different interests to influence the planning process. This long planning process made it possible for the planners to consider the different interests. Local interests could through participation influence the planning process, which prevented an escalating conflict and increased local democracy. This also created an acceptance of the establishment and therefore made the decision sustainable. In addition, the positive social memory of the process will be beneficial for similar projects in the future. These gained insights are useful if the different international and national goals to increase both windpower development and citizen participation shall be reached broadly.

Background. Telephone advice increases the accessibility to health care and the streamlined work at primary health care centres. The goal of telephone advice nursing is to give the caller a correct advice, adapted to the caller’s situation, in order to reach correct care level. However, registered nurse’s telephone advice includes risks for misjudgement. Aim. The aim was to describe the view of registered nurse’s telephone advice at primary health care centres and call canters. The issues were if registered nurse perceived difficulties in their telephone advice and in that case, which the difficulties are. Method. A literature study was used, with systematic search in Cinahl and Pubmed, and also a manual search. In total 13 articles were included in this study. Content analysis was used. Results. Registered nurse’s had difficulties in telephone advice in following areas: computerized decision aids, non-visual communication, third-part communication, limited resources, the registered nurse's vulnerability, genus and ethnicity, and also ethical questions. Conclusion. Registered nurses perceive difficulties in telephone advice. Registered nurses should take part in the development of computerized decision support and receive continuous training in communication skills. Registered nurse’s telephone advice should be facilitated by the existence of an open climate at the workplace, to discuss and to reflect on difficulties in telephone advice.  Keywords. Perception, telenursing, telephone consultation, literature review. / Bakgrund. Telefonrådgivning ökar tillgängligheten till sjukvården och effektiviserar vårdcentralernas arbete. Målet med telefonrådgivning är att ge rådsökande rätt råd, anpassade efter dennes unika situation för att rådsökande ska nå rätt vårdnivå. Men sjuksköterskans telefonrådgivning innefattar risker för felbedömningar. Syfte. Syftet var att beskriva sjuksköterskan syn på sin telefonrådgivning vid vårdcentraler och sjukvårdsrådgivningar. Frågeställningar var om sjuksköterskan uppfattar svårigheter i sin telefonrådgivning och i så fall vilka svårigheterna var. Metod. En litteraturstudie med systematisk sökning i Cinahl och Pubmed samt manuell sökning. Sökningen resulterade i totalt 13 vetenskapliga artiklar, vilka analyserade enligt innehållsanalys. Resultat. Sjuksköterskans hade svårigheter i telefonrådgivning inom följande områden: datoriserat beslutstöd, icke-visuell kommunikation, uppgifter i andrahand, begränsade resurser, sjuksköterskans utsatthet, genus och etnicitet samt etiska frågor. Slutsats: Sjuksköterskans uppfattar svårigheter i telefonrådgivning. Sjuksköterskorna bör vara med att utveckla det datoriserade beslutstödet och få fortlöpande utbildning i kommunikationsfärdigheter. Sjuksköterskans telefonrådgivning bör underlättas av att det råder ett öppet klimat på arbetsplatsen för att diskutera och reflektera de svårigheter som finns med telefonrådgivning. Nyckelord. Svårigheter, sjuksköterskor, telefonrådgivning, litteraturstudie.

Plusieurs études ont soulevé une fragilisation de la démocratie représentative, faisant état notamment d’un certain effritement de la légitimité de ses institutions et d’une volonté citoyenne plus grande de participer directement à la prise de décision publique. Ce constat sous-tend un rapport fragilisé entre les citoyens et la démocratie représentative qui traduit une inadéquation entre un idéal adulé et un réel désenchanté. Qui plus est, la polysémie inhérente au terme démocratie ajoute à la difficulté d’en cerner les contours (Dahl 2000). En effet, derrière cette notion se trouve une série d’approches et de modèles théoriques portant un regard à la fois descriptif et normatif sur ce concept. Au Québec, la préoccupation quant à la direction à donner à la démocratie est présente comme en témoignent les réformes et propositions périodiquement avancées — pensons aux États généraux sur la réforme des institutions démocratiques, aux pétitions en ligne à l’Assemblée nationale et aux débats sur les référendums d’initiative populaire et le mode de scrutin. Néanmoins, malgré les enquêtes continuant à souligner l’écart entre le citoyen et les institutions démocratiques, ces initiatives demeurent généralement à l’état d’esquisse ou encore limitées dans leur portée. De fait, ces débats sur la déclinaison de la démocratie sous-tendent un questionnement sur l’exercice démocratique en soi, et le rôle du citoyen en particulier. Ce mémoire s’y penche par la perspective d’anciens et d’actuels élus de l’Assemblée nationale du Québec. Pour ce faire, des premiers ministres, ministres, députés et présidents de l’Assemblée nationale ont été rencontrés et un sondage a été envoyé aux anciens et actuels élus. L’objectif de cette recherche est d’identifier les éléments constitutifs d’une compréhension institutionnelle du rôle du citoyen. Par son empirisme, son cadre spatial et la centralité des acteurs politiques, ce projet s’inscrit donc en complémentarité à la littérature existante sur la démocratie représentative.

Magister Philosophiae - MPhil / This study is aimed at empirically examining health seeking behaviours in terms of illness response on household level at South Africa using 2007 General Household Survey and other relevant secondary sources. It provides an assessment of health seeking behaviours at the household level using individuals as unit of analysis by exploring the type of health care provider sought, the reason for delay in health seeking and the cause for not consulting. This study also assesses the extent of dissatisfaction among households using medical centres and this factor in health care utilisation is considered as the main reason for not consulting health care services. All the demographic and health seeking variables utilised in this study are controlled for medical aid cover because it is a critical variable in health care seeking. Therefore this study makes distinction on illness reporting and they type of health care consulted by medical aid holders and non medical aid holders. Statistical analyses are conducted to explore and predict the way in which demographic variables and socio economic variables affect health care seeking behaviours. / South Africa