Registered nurses and registered psychiatric nurses are members of multidisciplinary mental health teams that address the assessment and treatment of vulnerable youth. The phenomenon of interest for this study is nursing's distinct contribution to a multidisciplinary team in this clinical domain. An interpretive description drawing on the perspectives of seven nurses and seven clinicians from the professions of psychiatry, psychology, social work, child and youth care, and registered clinical counselling provides insight into understanding nursing's distinct contribution (NDC) to multidisciplinary mental health teams that serve vulnerable youth (MMHTSVY). Six major themes and multiple subthemes were inductively derived. The findings make explicit nursing’s contribution to MMHTSVY in ways that are meaningful to the clinical practice. / Graduate

Esta tese é composta por três estudos ecológicos que incluíram as 27 capitais brasileiras. Esses três estudos foram os seguintes: 1- A associação entre a disponibilidade de cirurgiões-dentistas e a quantidade de procedimentos odontológicos nos serviços públicos de odontologia; 2- A associação entre a disponibilidade de cirurgiões-dentistas e a proporção de dentes restaurados (em relação ao total de dentes atacados pela cárie) em indivíduos de 15 a 19 anos ; 3- A associação da disponibilidade de cirurgiões-dentistas com a prevalência e severidade da cárie em indivíduos de 15 a 19 anos. As três investigações são apresentadas sob forma de artigos. Foram utilizados diversos bancos de dados secundários, disponíveis gratuitamente na internet. No primeiro estudo foi identificada associação do número de Equipes de Saúde Bucal do programa Saúde da Família (ESB) e de cirurgiões-dentistas no SUS de uma forma geral com o número de procedimentos odontológicos no serviço público; quanto mais ESB e cirurgiões-dentistas mais procedimentos odontológicos, tanto preventivos quanto restauradores. Mais dentistas no serviço público de odontologia significaram mais procedimentos preventivos e coletivos, porém um número relativamente pequeno a mais de restaurações. É preocupante a quantidade relativamente pequena de restaurações realizadas pelos dentistas do serviço público no Brasil diante do grande número de dentes com cárie não tratada, identificado pela pesquisa nacional de saúde bucal. O segundo estudo revelou que a quantidade de dentistas nas capitais brasileiras é muito grande e que, portanto, há capacidade instalada para atender todas as necessidades de tratamentos restauradores. Entretanto, o índice de cuidado odontológico em jovens de 15 a 19 anos revelou que menos da metade dos dentes atacados pela cárie tinham recebido o cuidado adequado, i.e., estavam restaurados. Este estudo concluiu que, o grande investimento da sociedade brasileira em odontologia, seja no setor público ou privado, não está tendo o retorno esperado, pelo menos para jovens de 15 a 19 anos. O terceiro estudo concluiu que fatores socioeconômicos amplos e flúor na água foram os principais determinantes da variação na prevalência e severidade da cárie em jovens de 15 a 19 anos e que a contribuição do dentista foi relativamente pequena. Diante do papel relativamente pequeno do dentista na prevenção da cárie, o esforço clínico do mesmo deveria, portanto, enfatizar tratamentos de maior complexidade, visando a restauração e reabilitação de danos relevantes para a função e bem estar (Serviço Pessoal de Saúde). Esforços efetivos para evitar a cárie dentária ocorrem principalmente no âmbito de estratégias preventivas populacionais (Serviço não Pessoal de Saúde), com uma contribuição relativamente pequena do trabalho clínico. / This thesis comprises three ecological studies including the 27 state capitals. These three studies were as follows: 1- The association between the availability of dentists and the amount of dental procedures in public dental services; 2- The association between the availability of dentists and the proportion of filled teeth (in relation to total teeth attacked by caries) in subjects 15-19 years; 3- The combination of the availability of dentists with the prevalence and severity of dental caries in individuals 15-19 years. The three investigations are presented in the form of articles. Many banks side, available freely on the internet data were used. In the first study association was found in the number of oral health teams of the Family Health Program (ESB) and dentists in the NHS in general with the number of dental procedures in the public service; ESB as more and more dentists dental procedures, both preventive as restorers. "Most dentists" in public dental services meant more collective and preventive procedures, but a relatively small number of the most restorations. Worryingly the relatively small amount of restorations performed by dentists of the public service in Brazil on the number of teeth with untreated caries, identified by a national survey of oral health. The second study revealed that the number of dentists in the Brazilian capital is very large and, therefore, there is capacity to meet all the needs of restorative treatments. However, the rate of dental care for young people aged 15 to 19 years revealed that less than half of the teeth attacked by caries had received proper care, for example, were restored. This study concluded that the large investment in Brazilian society in dentistry, whether in the public or private sector, is not having the expected return, at least for young people 15-19 years. The third study found that larger socioeconomic factors and fluoride in the water was the major determinant of variation in the prevalence and severity of dental caries in young people 15-19 years and that the contribution of the dentist was relatively small. Given the relatively small role of dental caries prevention, clinical effort it should therefore emphasize more complex treatments, aimed at the restoration and rehabilitation of significant damage to the function and well-being ("Personal Health Service"). Effective efforts to prevent tooth decay occur primarily in population-based prevention strategies ("no Personal Health Service"), with a relatively small contribution of clinical work.

Esta tese é composta por três estudos ecológicos que incluíram as 27 capitais brasileiras. Esses três estudos foram os seguintes: 1- A associação entre a disponibilidade de cirurgiões-dentistas e a quantidade de procedimentos odontológicos nos serviços públicos de odontologia; 2- A associação entre a disponibilidade de cirurgiões-dentistas e a proporção de dentes restaurados (em relação ao total de dentes atacados pela cárie) em indivíduos de 15 a 19 anos ; 3- A associação da disponibilidade de cirurgiões-dentistas com a prevalência e severidade da cárie em indivíduos de 15 a 19 anos. As três investigações são apresentadas sob forma de artigos. Foram utilizados diversos bancos de dados secundários, disponíveis gratuitamente na internet. No primeiro estudo foi identificada associação do número de Equipes de Saúde Bucal do programa Saúde da Família (ESB) e de cirurgiões-dentistas no SUS de uma forma geral com o número de procedimentos odontológicos no serviço público; quanto mais ESB e cirurgiões-dentistas mais procedimentos odontológicos, tanto preventivos quanto restauradores. Mais dentistas no serviço público de odontologia significaram mais procedimentos preventivos e coletivos, porém um número relativamente pequeno a mais de restaurações. É preocupante a quantidade relativamente pequena de restaurações realizadas pelos dentistas do serviço público no Brasil diante do grande número de dentes com cárie não tratada, identificado pela pesquisa nacional de saúde bucal. O segundo estudo revelou que a quantidade de dentistas nas capitais brasileiras é muito grande e que, portanto, há capacidade instalada para atender todas as necessidades de tratamentos restauradores. Entretanto, o índice de cuidado odontológico em jovens de 15 a 19 anos revelou que menos da metade dos dentes atacados pela cárie tinham recebido o cuidado adequado, i.e., estavam restaurados. Este estudo concluiu que, o grande investimento da sociedade brasileira em odontologia, seja no setor público ou privado, não está tendo o retorno esperado, pelo menos para jovens de 15 a 19 anos. O terceiro estudo concluiu que fatores socioeconômicos amplos e flúor na água foram os principais determinantes da variação na prevalência e severidade da cárie em jovens de 15 a 19 anos e que a contribuição do dentista foi relativamente pequena. Diante do papel relativamente pequeno do dentista na prevenção da cárie, o esforço clínico do mesmo deveria, portanto, enfatizar tratamentos de maior complexidade, visando a restauração e reabilitação de danos relevantes para a função e bem estar (Serviço Pessoal de Saúde). Esforços efetivos para evitar a cárie dentária ocorrem principalmente no âmbito de estratégias preventivas populacionais (Serviço não Pessoal de Saúde), com uma contribuição relativamente pequena do trabalho clínico. / This thesis comprises three ecological studies including the 27 state capitals. These three studies were as follows: 1- The association between the availability of dentists and the amount of dental procedures in public dental services; 2- The association between the availability of dentists and the proportion of filled teeth (in relation to total teeth attacked by caries) in subjects 15-19 years; 3- The combination of the availability of dentists with the prevalence and severity of dental caries in individuals 15-19 years. The three investigations are presented in the form of articles. Many banks side, available freely on the internet data were used. In the first study association was found in the number of oral health teams of the Family Health Program (ESB) and dentists in the NHS in general with the number of dental procedures in the public service; ESB as more and more dentists dental procedures, both preventive as restorers. "Most dentists" in public dental services meant more collective and preventive procedures, but a relatively small number of the most restorations. Worryingly the relatively small amount of restorations performed by dentists of the public service in Brazil on the number of teeth with untreated caries, identified by a national survey of oral health. The second study revealed that the number of dentists in the Brazilian capital is very large and, therefore, there is capacity to meet all the needs of restorative treatments. However, the rate of dental care for young people aged 15 to 19 years revealed that less than half of the teeth attacked by caries had received proper care, for example, were restored. This study concluded that the large investment in Brazilian society in dentistry, whether in the public or private sector, is not having the expected return, at least for young people 15-19 years. The third study found that larger socioeconomic factors and fluoride in the water was the major determinant of variation in the prevalence and severity of dental caries in young people 15-19 years and that the contribution of the dentist was relatively small. Given the relatively small role of dental caries prevention, clinical effort it should therefore emphasize more complex treatments, aimed at the restoration and rehabilitation of significant damage to the function and well-being ("Personal Health Service"). Effective efforts to prevent tooth decay occur primarily in population-based prevention strategies ("no Personal Health Service"), with a relatively small contribution of clinical work.

Department of Advanced Nursing Science / MCur

Syftet med denna uppsats var att redogöra för det förebyggande arbetet kring hot och våld men också hantering av hot och våld i gymnasieskolan. Därmed användes en kvalitativ intervjustudie med rektorer, lärare samt en kurator som gav svar på följande frågeställningar; hur förebyggdes hot och våld i gymnasieskolan, hur identifierades hot och våld i gymnasieskolan samt hur bemöttes hot och våld i gymnasieskolan. Personalens svar på dessa frågeställningar analyserades utifrån Paulo Freires befrielseteori och därmed gavs en tydligare bild av skolans situation gällande hot och våld. Medvetandegöra-(conscientização) innebar att handlingsplanerna kritiskt reflekterades över som uppdaterades årsvis samt granskning av elevenkäter och medarbetarenkäter. I arbetslaget samtalades och delades erfarenheter som var en del i att hot och våld medvetandegjordes. Förutom i arbetslaget delades olika erfarenheter genom föreläsningar, litteratur och poddar, vilket ökade kunskapen om hot och våld. Eleverna diskuterade värdegrunden, normer och de förtryckta samt förtryckarnas världsbild. Därtill fick elever kännedom om den hjälp som fanns såsom kurator, socialtjänst och utväg om de hamnade i en våldsam eller hotfull situation. Det förebyggande arbetet kring hot och våld sammanfattades i följande strategier: skapandet av en trygg arbetsmiljö samt ökning av elevers och lärares kunskap. Dessutom behövdes både teoretiska och praktiska kunskaper om hur elever och lärare skulle agera vid hotfulla och våldsamma situationer. Olika handlingsplaner tillämpades vid olika hotfulla och våldsamma situationer. Vid övning av inrymning förbereddes lärare och elever hur de skulle agera vid våldsamma och hotfulla situationer. Dessutom behövdes kännedom om vilka aktörer som fanns inom skolan såsom elevhälsoteam, som oftast bestod av kurator, psykolog och skolläkare. Därutöver bestod en krisgrupp av andra professioner såsom pastor, diakon, mentor, präst eller imam. I samhället fanns det vid större katastrofer och olyckor stöd och råd från socialtjänsten och POSOM-gruppen att tillgå. Begrepp: Hot och våld medvetandegjordes, i skola, i nära relationer, i hemmet, barn for illa, elevhälsoteam, Krisgrupp, Socialtjänsten, Polisen, POSOM-gruppen / The purpose of this essay was to account for the preventive work on threats and violence but also the management of threats and violence in high school. Thus, a qualitative interview study was used with principals, teachers and a counselor´s who provided answers to the following questions; how threats and violence were prevented in high school, how threats and violence   were indentified in high school and how threats and violence in high school were adressed. The staff´s answers to these questions were analyzed on the basis of Paulo Freire´s liberation theory and thus gave a clearer picture of school´s sitaution regarding threats and violence. Awareness-raising (conscientização) meant that the action plans were critically reflected on, which were updated annually, as well as a review of student surveys and employee surveys. The work team discussed and shared experinces that were part of raising awareness of threats and violence. In addition to the work team, different experiences were shared through lectures, litterature and podcasts, which increased knowledge about threats and violence. The students discussed the values, norms and the world of oppressed and the opressors. In addition, students become aware of the help that was available, such as a counselor, social services and a resort if they ended up in a violent or threatening situation.  The preventive work on threats and violence was summarized in the following strategies: the creation of safe working environment and an increase students and teachers knowledge. In addition, both theoretical and practical knowledge was needed about how students and teachers should act in threatening and violent situations. Different action plans were applied in different threatning and violent situations. When practicing accomodation, teachers and students were prepared to act in violent and threatening situations. In addition, knowledge was needed about which actors were present within the school, such as student health teams, which usually consisted of a counselors, psychologists and school doctor. In addition, a crisis group consisted of other professions such as pastor, deacon, mentor, priest or imam. In the event of major disasters and accidents, support and advice from the social services and the POSOM group were availible. Concepts: Threats and violence were made aware, in school, close relationships, at home, children got hurt, student health team, Crisis-group, Social services, Police, POSOM group

La literatura científica sitúa la autonomía del paciente en la toma de decisiones en el ámbito clínico, en una encrucijada entre dos posiciones éticas; el paternalismo y la elección informada. Analizar los textos de los registros de las historias clínicas y los discursos de las enfermeras, mediante una metodología cualitativa y desde la perspectiva de la ética foucaultiana, permite conocer los factores que determinan el poder de decisión de los pacientes. Este estudio revela que el paciente no es autónomo en la toma de decisiones sobre sus cuidados debido; a una determinada institucionalización de la atención, que marca los ritmos de las decisiones, a las características de las relaciones interprofesionales y a las dinámicas relacionales que se establecen entre los profesionales, en particular, de la enfermera con el paciente y la familia. Se debe liberar al paciente de las reglas impuestas, promoviendo su propia conducta, su propio estilo de vida. / The scientific literature places the patient autonomy in decision-making in the clinical setting, at a crossroads between two ethical positions, paternalism and informed choice. Analyze records of clinical histories and nurses discourses, using a qualitative methodology and from the perspective of foucauldian ethics, allows knowing the factors that determine the power of patient decision. This study reveals that the patient is not autonomous in making decisions about your care because, to a certain institutionalization of care, which marks the rhythms of the decisions, the characteristics of the interprofessional-relationships and relational dynamics that exist between professionals, in particular, of the nurse with the patient and family. It should free the patient from the rules imposed by promoting their own behavior, their own lifestyle. / La literatura científica situa l'autonomia del pacient en la presa de decisions en l'àmbit clínic, en una cruïlla entre dues posicions ètiques, el paternalisme i l'elecció informada. Analitzar els textos dels registres de les històries clíniques i els discursos de les infermeres, mitjançant una metodologia qualitativa i des de la perspectiva de l'ètica foucaultiana, permet conèixer els factors que determinen el poder de decisió dels pacients. Aquest estudi revela que el pacient no és autònom en la presa de decisions sobre les seves cures a causa, a una determinada institucionalització de l'atenció, que marca els ritmes de les decisions, a les característiques de les relacions interprofessionals i les dinàmiques relacionals que s'estableixen entre els professionals, en particular, de la infermera amb el pacient i la família. Cal alliberar el pacient de les regles imposades, promovent la seva pròpia conducta, el seu propi estil de vida.

La prestation coordonnée de soins de santé primaires (SSP) a été éprouvée comme améliorant la qualité et l’accès des soins prodigués aux Canadiens. Plusieurs études ont notamment confirmé les avantages des infirmières praticiennes (IP) et des modèles interprofessionnels en SSP pour le système de santé. Les écrits suggèrent toutefois que l’intégration des IP en SSP est jalonnée de tensions et restructurations en raison d’une confusion supposée de leur rôle. À ce jour, les recherches ont principalement ciblé les barrières et facilitateurs de l’intégration du rôle des IP. Une analyse critique des dynamiques socioprofessionnelles et politiques de l’intégration des IP n’a toutefois pas encore été réalisée. Une ethnographie critique combinant la Théorie de l’acteur-réseau et les concepts foucaldiens de discours, savoir et pouvoir a permis l’examen des interactions sémiotiques caractérisant certains milieux de SSP. Différents modèles interprofessionnels de SSP (2 centres de santé communautaire, 2 équipes de santé familiale et 2 cliniques dirigées par les IP) ont été investis. Les données issues d’entrevues semi-dirigées avec des IP (n=23), d’observations directes de milieux et de rencontres interprofessionnelles, et d’analyse documentaire ont été soumises à une analyse thématique puis une analyse critique de discours. Les résultats montrent que la valeur morale des IP, les finalités organisationnelles des milieux de SSP, les normes de pratique, la collaboration interprofessionnelle et la prise en charge des patients disposent les IP à la négociation de leur rôle et à certains enjeux socioprofessionnels et politiques qui génèrent plusieurs contrecoups: pluralisme de leurs rôles professionnels, dissonance identitaire, sentiments d’incompétence et d’incertitude, glissements discursifs dans leurs propres discours, et divers états émotionnels et souffrances. Ces contrecoups commandent diverses stratégies d’adaptation et de résistance permettant aux IP de gérer ces tensions. Plusieurs entités non-humaines (inscription des clientèles, discours de soutien aux médecins et espaces physiques) émergent comme acteurs agissant sur l’intégration et la négociation du rôle des IP en SSP. Cette étude permet de décrire le processus de traduction du rôle de l’IP en SSP qui problématise certains discours tenus pour acquis en SSP. Elle permet également de proposer une nouvelle définition de l’intégration du rôle des IP en SSP.