Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Submitted by SBI Biblioteca Digital (sbi.bibliotecadigital@puc-campinas.edu.br) on 2017-04-07T17:59:10Z No. of bitstreams: 1 CLEBER JOS? AL? DE MORAES.pdf: 1935163 bytes, checksum: b0b051a2693d436c37e59d827fac106b (MD5) / Made available in DSpace on 2017-04-07T17:59:10Z (GMT). No. of bitstreams: 1 CLEBER JOS? AL? DE MORAES.pdf: 1935163 bytes, checksum: b0b051a2693d436c37e59d827fac106b (MD5) Previous issue date: 2017-02-21 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior - CAPES / The notions of paternity and maternity undergo sharp transformations in contemporary society. The transition to fatherhood reveals itself as a period of significant changes in man, which alter his perception of himself and the world in a profound way. This paper investigates the experience of transition to fatherhood in first time fathers. Semi-structured interviews were carried out with each of the six couples participating in this study, in three different moments: at the end of pregnancy, in the first month after childbirth and at six months of the baby's life. In the first interview, the Interactive Narrative was used as a dialogical resource, which consists of a fictitious story, previously developed by the researcher, which presents the subject to be investigated, but which is interrupted at some point in the plot, allowing participants to finalize the story as they wish. The interview records were made by the researcher after the end of each one, and later transformed into transferential narratives. The material produced on the transition to fatherhood was discussed in the light of psychoanalytic thinking and contemporary authors with scientific production on this subject, and the argument arises that parental care can be exercised by both men and women, who are available in a healthy way to an active adaptation to the baby's needs. As the final product of the reflexive process, it presents the proposal to extend the Winnicottian concept of primary maternal concern to primary parental concern. / As no??es de paternidade e maternidade passam por transforma??es acentuadas na sociedade contempor?nea. A transi??o para a paternidade se revela como um per?odo de expressivas mudan?as no homem, que alteram sua percep??o de si mesmo e do mundo de maneira profunda. Este trabalho investiga a experi?ncia de transi??o para a paternidade em homens que se tornam pais pela primeira vez. Foram realizadas entrevistas semiestruturadas junto a cada um dos seis casais participantes desta pesquisa, em tr?s momentos distintos: ao final da gravidez, no primeiro m?s ap?s o parto e aos seis meses de vida do beb?. Na primeira entrevista, utilizou-se como recurso dial?gico a Narrativa Interativa, que consiste em uma hist?ria fict?cia, desenvolvida previamente pelo pesquisador, que apresenta o tema a ser investigado, mas que se interrompe em algum momento da trama, permitindo que os participantes finalizem a hist?ria como desejarem. Os registros das entrevistas foram realizados pelo pesquisador ap?s o t?rmino de cada uma delas, e posteriormente transformados em narrativas transferenciais. O material produzido sobre a transi??o para a paternidade foi discutido ? luz do pensamento psicanal?tico e de autores contempor?neos com produ??o cient?fica nesta tem?tica, emergindo o argumento de que o cuidado parental pode ser exercido tanto por homens quanto por mulheres, que se disponham de maneira saud?vel a uma adapta??o ativa ?s necessidades do beb?. Como produto final do processo reflexivo, apresenta a proposta da amplia??o do conceito winnicottiano de preocupa??o materna prim?ria para preocupa??o parental prim?ria.

過去有關創造力的研究主要是依據 Guilford (1956) 與 Torrance (1966) 的理論，從心理測量的觀點來界定創造力的歷程。80 年代以後，在研究方法與研究領域方面產生了一些變化：第一個變化是 Amabile (1983) 等人開始以評量創意的方式進行實驗研究；另一個變化則是研究者開始對日常生活的創造經驗產生興趣，並進行相關的研究 (Richards, 1988)。本研究中所探討的「創造力」，除了包含 Guilford、Torrance 等人所界定的「創造思考能力」以外，也包括以 Maslow (1958) 為主的學者所提出的「自我實現的創造力」，也就是「創意生活經驗」。 本研究的第一個目的是探討從小學六年級到大學階段的學生，在創造力方面的發展與性別差異。研究假設為：無論是創造思考能力或是創意生活經驗，都會隨年齡的增長而改變或增加，但在不同性別之間可能沒有差異。本研究的第二個目的是探討動機取向與創造力之間的關係，研究中所討論的動機變項有「成就目標」與「目標導向」二類。研究假設為：(1)「學習精熟」、「趨向表現」的成就目標，與創造行為之間會有正相關，「迴避表現」的成就目標則與創造行為有負相關。(2)「尋求成長」與「尋求證明」二種目標導向與創造行為之間皆有正相關。 本研究的樣本包括：小學六年級、國中一年級、國中二年級、高中一年級、高中二年級學生以及大學生，共 672 人（男女各佔一半）。研究中所使用的測量工具包括：「創意生活經驗驗量表」、「新編創造思考測驗」、「成就目標量表」、「目標導向量表」四種。研究的結果如下： 一、創意生活經驗方面 (1)各年齡層學生的創意生活經驗大致上有隨年齡成長而增加的趨勢，尤其是在「運用新知精益求精」、「視覺生活的設計」、「開放心胸」、「製造驚喜意外」「舊瓶新裝」等經驗上特別明顯。 (2)女生在「表演藝術創新」、「視覺生活的設計」、「開放心胸」等方面的經驗較多，而男生「科學的創新的問題解決」經驗較多。 (3)兩種目標導向（尋求成長、尋求證明）與九種創意生活經驗之間分別都達到顯著的正相關，其中相關較低的是「電腦程式設計」。「尋求成長取向」與創意生活經驗之間的相關大致上高於「尋求證明取向」與創意生活經驗之間的相關。 (4)學生的「學習精熟」、「趨向表現」兩種成就目標取向與創意生活經驗之間亦分別達到顯著的正相關，「學習精熟取向」與創意生活經驗之間的相關大致上高於「趨向表現取向」與創意生活經驗之間的相關。「迴避表現取向」與創意生活經驗之間沒有顯著的相關。 (5)典型相關的結果顯示：「尋求成長取向」、「尋求證明取向」、「學習精熟取向」與「趨向表現取向」分數愈高的學生，具有較多的「科學的創新的問題解決」、「運用新知精益求精」、「表演藝術創新」、「視覺生活的設計」、「生活風格的變化」、「開放心胸」、「製造驚喜意外」、「舊瓶新裝」等創意生活經驗。 二、創造思考能力方面 (1)各年齡層學生的創造思考能力大致上也有隨年齡成長而增加的趨勢。 (2)女生在「語文創造思考變通力」、「圖形創造思考變通力」、「圖形創造思考的流暢力」等方面顯著高於男生。男女生在圖形創造思考的流暢力方面則沒有顯著的差異。 (3)兩種目標導量（尋求成長、尋求證明）與語文創造思考變通力、語文創造思考流暢力、圖形創造思考變通力、圖形創造思考流暢力等四種創造思考能力之間皆達到顯著的正相關，而與圖形創造思考精進力之間則沒有顯著的相關。「尋求成長取向」與創造思考能力之間的相關大致上高於「尋求證明取向」與創造思考能力之間的相關。 (4)學生的「學習精熟」、「趨向表現」兩種成就目標與創造思考能力之間亦分別達到顯著的正相關，「學習精熟取向」與創造思考能力之間的相關大致上高於「趨向表現取向」與創造思考能力之間的相關。「迴避表現取向」與創造思考能力之間沒有顯著的相關。 (5)典型相關的結果顯示：「尋求成長取向」、「尋求證明取向」與「學習精熟取向」分數愈高的學生，具有較高的語文創造思考變通力、語文創造思考流暢力、圖形創造思考變通力與圖形創造思考流暢力。 本研究對於六個年齡層學生所收集的創造思考能力與創意生活經驗之資料與研究結果，可供往後研究者在教學與研究方面的參考。 / This research explore the relationships among creative life experiences, creativity, age, gender, achievement goals and goal orientation.

Despite an increased interest in autism over the last decades, little research exists about life outcomes of autistic adults. The earliest follow-up studies of autistic individuals suggested that self- understanding and conscious efforts to change could be crucial factors in successfully reaching good life outcomes. However, these initial suggestions have not been further investigated. Therefore, this exploratory qualitative study examined the lives of eight highfunctioning autistic adults aged 25 to 63, from their own perspectives, through in-depth, semistructured interviews, to consider the relation of self-understanding and conscious efforts to change—in this study referred to as intentional personal development—to their life outcomes. All participants demonstrated a level of self-understanding beyond what would be predicted by current theoretical models of autism. Their self-understanding was assessed through participants’ self-definitions, meaning-making of life experiences, and understanding of emotions. In their self-definitions, the participants emphasized their abilities and personality characteristics, rather than their disabilities. For their self-defining memories, as indicators of their meaning making of life experiences, most participants chose positive experiences related to their personal development. Their autobiographical accounts revealed that most participants possess a large iii repertoire of emotion words, supporting an understanding of emotions. When a good life outcome is defined traditionally—as being employed, living independently, and having social relationships—this study, contrary to expectations, did not provide overwhelming evidence for the significant role of intentional personal development in achieving this. However, when a good life outcome is defined in terms of achieving personal excellence, then the study did provide confirmation of intentionality as important to attaining good life outcomes. This study therefore suggests that traditional life outcome measures are inadequate for assessing the life outcomes of autistic individuals because such measures do not take into account the individuals’ own sense of satisfaction with themselves and with their lives.

Despite an increased interest in autism over the last decades, little research exists about life outcomes of autistic adults. The earliest follow-up studies of autistic individuals suggested that self- understanding and conscious efforts to change could be crucial factors in successfully reaching good life outcomes. However, these initial suggestions have not been further investigated. Therefore, this exploratory qualitative study examined the lives of eight highfunctioning autistic adults aged 25 to 63, from their own perspectives, through in-depth, semistructured interviews, to consider the relation of self-understanding and conscious efforts to change—in this study referred to as intentional personal development—to their life outcomes. All participants demonstrated a level of self-understanding beyond what would be predicted by current theoretical models of autism. Their self-understanding was assessed through participants’ self-definitions, meaning-making of life experiences, and understanding of emotions. In their self-definitions, the participants emphasized their abilities and personality characteristics, rather than their disabilities. For their self-defining memories, as indicators of their meaning making of life experiences, most participants chose positive experiences related to their personal development. Their autobiographical accounts revealed that most participants possess a large iii repertoire of emotion words, supporting an understanding of emotions. When a good life outcome is defined traditionally—as being employed, living independently, and having social relationships—this study, contrary to expectations, did not provide overwhelming evidence for the significant role of intentional personal development in achieving this. However, when a good life outcome is defined in terms of achieving personal excellence, then the study did provide confirmation of intentionality as important to attaining good life outcomes. This study therefore suggests that traditional life outcome measures are inadequate for assessing the life outcomes of autistic individuals because such measures do not take into account the individuals’ own sense of satisfaction with themselves and with their lives.

Diss. (sammanfattning)--Umeå : Umeå universitet, 2009. / Härtill 4 uppsatser. Även tryckt utgåva.

This thesis evaluates experiences, effects, and costs of abdominal massage for people with constipation. The thesis comprises four papers: Paper I is a literature review of health economic analysis of nursing practice. Paper II and III is a prospective randomized controlled trial that evaluates abdominal massage in terms of effects and costs. Paper IV uses a qualitative approach to illuminate the experiences of receiving abdominal massage. Paper II and III included 60 participants who were constipated in accordance with Rome II criteria. Paper IV included nine participants. Paper I investigated the application of economic evaluation in studies of nursing practice. Systematic database searches were performed and gave nearly 600 papers that were screened and 115 studies were relevant according to stipulated inclusion criteria. The result showed that there was a trend of increased publications from the year 2000. Few studies reported the health economic methods used and the perspective of the economic analysis. There was a large variability in number of included cost items. Because the methodological weaknesses in many studies, it was difficult to use some studies as ground for discussion of resource distribution. Paper II investigates the effects of abdominal massage on gastrointestinal function and laxative intake on persons with constipation. The questionnaire Gastrointestinal Symptom Rating Scale (GSRS) was used and data were analyzed using multiple linear regression. The results showed that after eight weeks of abdominal massage the intervention group experienced significantly fewer gastrointestinal symptoms and had significantly more bowel evacuation compared with the control group. There were no differences in laxative intake. Paper III evaluated the change in health-related quality of life (HRQoL) for people with constipation when receiving abdominal massage and estimates the cost-effectiveness of two alternative implementation scenarios: 1) abdominal massage given by enrolled nurses in a department; and 2) participants giving themselves abdominal massage after receiving training in self-massage. Both scenarios imply that all participants received abdominal massage for eight weeks and those who found the treatment effective continued to receive treatment for eight more weeks. EQ-5D was used to assess HRQoL and for calculating QALY. The intervention group had after eight weeks of abdominal massage significantly higher HRQoL assessed with EQ-5D VAS compared with the control group. No significant differences were assessed with the EQ-5D index. Abdominal massage is initially expensive, but for those who respond favourably abdominal massage can be a cost-effective long-term treatment. Paper IV examines the experiences of receiving abdominal massage when having constipation. Four themes were formulated: being on one’s guard, becoming embraced by safe hands, feeling touch to body and mind, and being in a fragile state. Receiving abdominal massage was described as comfortable and lead to decreased problems with constipation. The improvement was described as easily disturbed and it was associated with demands to continue massage to maintain the new state. Conclusion: Abdominal massage is a pleasant treatment that provides significantly fewer gastrointestinal symptoms and increased health-related quality of life. As a long- term treatment, abdominal massage can be a cost-effective treatment.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal

Using a critical feminist approach, and with attention to participants’ broad life experiences, this qualitative study explores seven women’s challenging, transformative decisions to give birth at home with midwives in Ontario, Canada. To make this choice, the women had to draw on their own strength, take responsibility for their decisions, and resist the dominant view of birth as inherently risky, and of women’s birth experiences as unimportant and incompatible with more narrowly defined good outcomes. As participants became informed decision-makers, resisted medicalized birth, and envisioned more woman-centred possibilities, they were empowered as active agents in their births. They were able to trust that with the care of their midwives, and the support of their partners or close family, they could have satisfying and safe births at home.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2017-01-05T14:39:20Z No. of bitstreams: 1 claudiasoaresdossantos.pdf: 1927808 bytes, checksum: 5902218e3907d5fa92e9cbc9f18b713d (MD5) / Approved for entry into archive by Diamantino Mayra (mayra.diamantino@ufjf.edu.br) on 2017-01-31T11:29:36Z (GMT) No. of bitstreams: 1 claudiasoaresdossantos.pdf: 1927808 bytes, checksum: 5902218e3907d5fa92e9cbc9f18b713d (MD5) / Made available in DSpace on 2017-01-31T11:29:36Z (GMT). No. of bitstreams: 1 claudiasoaresdossantos.pdf: 1927808 bytes, checksum: 5902218e3907d5fa92e9cbc9f18b713d (MD5) Previous issue date: 2016-07-27 / INTRODUÇÃO: Experiências espirituais no final da vida (ELEs) e fenômenos à beira do leito são comumente relatados de forma anedótica. Porém, ainda existem poucos estudos que tenham avaliado sistematicamente essas experiências. OBJETIVOS: Objetiva-se descrever e comparar as características e a prevalência das ELEs de acordo com relatos de profissionais de saúde em diferentes instituições (Unidade de cuidados paliativos, Instituições de Longa Permanência e Hospital oncológico) e avaliar a influência das crenças religiosas nesses relatos. MÉTODOS: Estudo multicêntrico, conduzido em Instituições de Longa Permanência (ILPI) em Juiz de Fora e no Hospital de Câncer de Barretos (Unidade oncológica-ONC e Cuidados Paliativos-PC), no Brasil. Foram avaliados dados sócio-demográficos, relatos de ELEs (pelo questionário de Fenwick), religiosidade (DUREL), espiritualidade (SRSS) e saúde mental (DASS 21). A análise foi feita através de ANOVA e qui-quadrado. RESULTADOS: 133 profissionais (46 ONC; 36 PC e 51 ILPI‟s) foram entrevistados, sendo que 70% tiveram relatos de ELEs nos últimos 5 anos. As principais ELEs relatadas foram “visões de parentes falecidos buscando o falecido” (n=82, 88,2%), “desejo súbito de reconciliamento” (n=79, 84,9%) e “parentes falecidos próximos ao leito proporcionando conforto” (n=75, 80,6%). A maioria dos profissionais (70-80%) acreditava que tais experiências tinham um cunho espiritual e não ocorriam por condições biológicas. Na comparação entre os grupos, PC tiveram mais relatos que os demais grupos e relataram maior abertura frente ao tema e maior interesse em um treinamento. As crenças individuais não interferiram de forma importante na percepção das ELEs. CONCLUSÃO: O estudo mostrou uma grande prevalência de ELEs relatadas por profissionais de saúde, associadas a opinião de que essas experiências seriam espirituais. Apesar de comum em todas as instituições, profissionais que atuam com cuidados paliativos referiram mais ELEs, maior abertura em sua instituição e maior desejo de treinamento. As crenças religiosas e espirituais tiveram pouca influência nos relatos de ELEs pelos profissionais, mostrando que não esse não foi um aspecto determinante para sua percepção. / INTRODUCTION: Spiritual end-of-life experiences (ELEs) and deathbed phenomena are often reported in an anecdotal fashion. Few studies however, have systematically assessed these experiences. OBJECTIVES: The objective of this study was to compare the characteristics and prevalence of ELEs as reported by health professionals at different institutions (palliative care, nursing homes and oncology hospital) and to assess the influence of religious beliefs on these reports. METHODS: A multi-center study was conducted at Nursing Homes (NH) in Juiz de Fora and at the Hospital de Câncer de Barretos (Oncology-ONC and Palliative Care-PC Unit) in Brazil. Sociodemographic data, ELE reports (Fenwick´s questionnaire), religiosity (DUREL), spirituality (SRSS) and mental health (DASS 21) were assessed. The analysis was performed using the ANOVA and Chi-square tests. RESULTS: A total of 133 health professionals (46 ONC, 36 PC and 51 NH) were interviewed, 70% of whom had ELEs reported to them in the past 5 years. The main ELEs reported were “visions of dead relatives collecting the dying person“ (n=82, 88.2%), “a desire to mend family rifts” (n=79, 84.9%) and “dead relatives near the bed who provide emotional comfort” (n=75, 80.6%). The majority of the health professionals (70-80%) believed these experiences had spiritual significance and were not due to biological conditions. Comparison among the groups revealed that the PC had more reports than the other groups and also greater openness on the issue and more interest in training. Individual religious beliefs had no relevant influence on the perception of ELEs. CONCLUSION: The study revealed a high prevalence of ELEs reported by health professionals, who believed these experiences were spiritual. Although prevalent in all of the institutions, greater ELEs, openness at their institution and desire for training were reported by palliative care professionals. Religious and spiritual beliefs had little influence on ELEs reported by the health professionals, indicating this was not a factor determining the perception of ELEs.