Toma como objeto os processos de trabalho dos fonoaudiólogos inseridos nos Núcleos de Apoio à Saúde da Família - NASF, recortado diante do quadro teórico do Trabalho em Saúde. Considerando as questões históricas da profissão, a formação insuficiente e a limitada produção de conhecimento acerca dos processos de trabalho, o objetivo foi compreender as características do trabalho do Fonoaudiólogo no NASF e os determinantes que orientam as práticas deste profissional. Trata-se de um estudo descritivo e exploratório, cujo caminho metodológico se delineou por meio da identificação do perfil de formação destes profissionais, da caracterização do trabalho no NASF a partir dos elementos que o compõem: objeto/finalidade, meios e instrumentos, organização e divisão do trabalho, e identificação dos determinantes operacionais que orientam suas práticas. A coleta dos dados se deu por meio de um questionário on-line, do tipo auto-aplicado. Os resultados apontam para uma formação insuficiente em nível de graduação para a maioria dos respondentes, e que apenas os fonoaudiólogos que cursaram Residência Multiprofissional em Saúde da Família (21%) chegaram para atuação no NASF com experiência prévia em Atenção Primária a Saúde. A principal motivação se refere às inclinações pela proposta NASF, pelo campo da Saúde Coletiva e pela forma de organização do trabalho. O objeto do trabalho consiste nas equipes de Saúde da Família e na população adscrita, o meio é o Apoio e os instrumentos consistem nas ferramentas tecnológicas preconizadas nos documentos do Ministério da Saúde. Observa-se variação na conformação das equipes, e a organização do trabalho parte de reuniões onde são compartilhadas as demandas e definidas as ações possíveis. Os determinantes envolvem a demanda e o trabalho em equipe, atravessados muitas vezes por questões como as metas de produção e as cobranças institucionais. Foram identificadas potencialidades que envolvem principalmente questões práticas como a evolução dos processos de trabalho entre as equipes, maior resolubilidade na demanda fonoaudiológica e o matriciamento efetivo em Fonoaudiologia. As dificuldades envolveram principalmente problemas no entendimento da proposta NASF, consequente falta de co-responsabilização pelos processos, falta de estrutura e espaço físico, metas de produção incompatíveis com a realidade e falta de suporte da Rede, principalmente no nível secundário de atenção / The aim of this study was to describe the work processes of speech therapists engaged in the Núcleos de Apoio à Saúde da Família (Family Health Support Centers) - NASF, according to the theoretical chart of duties defined for Healthcare Assistance. Past issues of the profession, lack of training and scant knowledge on work processes prompted this study describing the characteristics of the work of Speech Therapists under the NASF and the factors determining practices of this group of health professionals. A descriptive, exploratory study was conducted whose approach involved identifying the qualification/training profile of this group of professionals and characterizing their work at the NASF under the following topics: objective/purpose, means and instruments, organization and division of work, and identification of the operational factors determining work practices. Data collection was performed by application of a self-reporting on-line questionnaire. Results revealed a lack of graduate-level training among majority of respondents, and that only those speech therapists who had completed a Multiprofessional Residency in Family Health (21%) joined NASF with previous experience in Primary Health Care. Main motivators included affinity for NASF goals, the field of Public Health and the organization of the work. The work objective was the Family Health teams and population of service users, the means was the Support provided while the instruments consisted of the technological tools recommended by the Ministry of Health. Differences were observed in the structuring of teams and the organization of work through meetings where workloads are assigned and courses of action decided. Determining factors included the service demand and team work, often influenced by issues such as productivity targets and institutional demands. Potential areas for improvement were identified, predominantly involving practical issues such as refinement of work processes among teams, catering of speech therapy demands and effective matrix-based health strategies in Speech Therapy. Main difficulties involved problems understanding the NASF goals, a resultant lack of coresponsibility for processes, lack of infrastructure and physical space, productivity targets incongruent with reality, and lack of support from the health system network, particularly at the secondary level of health care

Made available in DSpace on 2016-03-15T19:43:19Z (GMT). No. of bitstreams: 1 Sylvana dos Santos Rocha.pdf: 1685586 bytes, checksum: 604658c8e1f2ec67ad19607b17a30a7d (MD5) Previous issue date: 2008-02-22 / Fundo Mackenzie de Pesquisa / This work is an exploratory study on the perceptions of corporations and educational administrators, concerning their acceptance of students coming from long distance graduation courses. The methodology used was qualitative, exploratory and the data has been collected from Centro de Integração Empresa-Escola (CIEE), using semi-structured interviews with corporative and educational administrators. It has been concluded that although Long Distance education in Brazil is still in full growth and presents a new paradigm for Brazilian University Education, we are faced with a scenery in which there is discredit, prejudice and lack of knowledge about the corporative environment investigated. Our research emphasizes the dichotomy formed by education and work, with an urgent need for overcoming, in order to meet the demand of knowledge society. / O presente trabalho trata de um estudo exploratório sobre as percepções dos gestores educacionais e de empresas a respeito do ingresso de estudantes egressos cursos de Graduação a Distância. A metodologia utilizada foi a qualitativa de cunho exploratório e os dados foram coletados do banco do Centro de Integração Empresa Escola-CIEE, entrevistas semi- estruturadas com gestores educacionais e de empresas. Constatou-se que, apesar da Educação a Distância EAD, no Brasil, estar em ampla expansão, e apresentar um novo paradigma na educação superior brasileira , depara-se com um cenário de descrédito, preconceito e falta de conhecimento do meio empresarial investigado. A pesquisa ressalta a dicotomia entre o mundo da educação e do trabalho, com necessidade urgente de superação, para atender às demandas da sociedade do conhecimento.

Esta dissertação pretende investigar a atuação profissional da arquiteta Lina Bo Bardi, mais particularmente analisando e discutindo o modo como a arquiteta procura solucionar a relação entre o antigo e o novo nas intervenções em espaços públicos considerados representativos da memória coletiva. Primeiramente, investiga-se sua formação e trajetória a fim de apontar alguns momentos paradigmáticos da discussão sobre a possibilidade do convívio entre permanência e inovação, o que, de certa forma, condiz com uma postura crítica frente à idéia de ruptura com o passado promovida pelo movimento moderno de vanguarda. Desta forma, são estudadas as nuances históricas da convivência entre o antigo e o novo, principalmente a partir das reflexões inseridas no contexto do pós-guerra europeu, onde a destruição de inúmeras cidades projeta grandes expectativas com relação à reconstrução, e conseqüentemente, suscita, nos domínios das disciplinas da arquitetura, do urbanismo e do restauro, importantes discussões sobre o modo de se fazer tais intervenções. Num segundo momento, são analisados dois projetos de Lina - a proposta para o Concurso: Vale do Anhangabaú em São Paulo e o Projeto para o Centro Histórico de Salvador, ambos da década de 1980, entendidos aqui como exemplos significativos de intervenções urbanas na trajetória profissional da arquiteta e também reveladores de sua formação, ao mesmo tempo afinada com o debate do pós-guerra e em sintonia com a situação brasileira através de um olhar específico e crítico. Cabe dizer que estes projetos analisados são concebidos num momento em que as nossas categorias culturais estão sendo questionadas e modificadas num propósito de democratização e ampliação do acesso à cidade e, portanto, dos espaços públicos e da memória. Isto é verificado na tentativa de modernização do Sphan, órgão ligado à preservação dos bens patrimoniais, assim como na proliferação de concursos públicos. Esta abordagem reconstitui uma postura profissional baseada em práticas e fundamentos que podem contribuir para as atuações profissionais contemporâneas a fim de se colocar como contraponto dos discursos que participam de uma noção meramente especulativa das intervenções nas cidades. / This is a research involving the architect Lina Bo Bardi\'s professional works, discussing and analyzing how she solves the relationship between old and new in the urban\' interventions at public spaces of putative collective memory. Firstly It carry out a research about the origins and evolution of some paradigmatic moments in discussion about the possibilities of meeting between the establishment and innovation. Furthermore, It correlates to the critical\' views of the idea of rupture with the past promoted by vanguard modern movement. It studies the pondering between old and new that have came out after second war period in the Europe, where the vast destruction of the cities gave the background for their reconstruction and It started important discussions about how to evolve these interventions in the context of architecture, urbanism, and restore projects issues. In the second moment, It analyzes two urban interventions projects of Lina: The propose for Vale do Anhangabau\'s Contest at São Paulo city and the other one for the Salvador\'s History Center, that have been done in the 1980. This period is featured by the political open in Brazil that able the discussion about the public space and the collective memory.

Esta pesquisa buscou compreender as práticas e o trabalho multiprofissional, além de analisar o impacto da formação profissional, na atuação de profissionais da Psicologia em Núcleos de Apoio à Saúde da Família (NASF) de um município do interior do nordeste do Brasil. Situando-me no campo das pesquisas qualitativas, utilizei duas estratégias de coleta de dados: a entrevista e a etnografia. A hermenêutica foi utilizada como método na interação com os sujeitos pesquisados e na análise dos dados colhidos em campo. Foram realizadas entrevistas com 6 psicólogas e 1 enfermeira atuante como referência do NASF. A etnografia foi realizada com 2 das psicólogas entrevistadas, acompanhando durante alguns meses suas atividades em campo. Todas as psicólogas entrevistadas se inseriram no NASF por indicação política e estavam vinculadas a uma cooperativa de serviços de saúde. Os maiores subsídios para suas atuações no NASF foram obtidos após a realização de suas graduações, através de cursos de pós-graduação e capacitações, além da experiência adquirida pela inserção em outras políticas públicas. Como estas profissionais lidavam semanalmente com 5 unidades de Saúde da Família com perfis diferentes, o processo de adaptação de suas ações era contínuo e desafiador. Elas enfrentavam no seu cotidiano várias formas de precarização do trabalho: vínculo informal e sem garantia de direitos trabalhistas, uma diversidade de dificuldades estruturais e de condições de trabalho. De forma geral, as profissionais desconheciam o significado do conceito de apoio matricial e sua relação com as ações desenvolvidas nos NASF. A maior parte das ações desenvolvidas se concentrava na realização de atendimentos individuais, atividades em grupo, salas de espera e visitas domiciliares. Outras ações eram desenvolvidas (tais como interconsulta e projeto terapêutico singular), mas de maneira pontual. A ênfase de suas ações se dava na dimensão clínico-assistencial do referencial teórico-metodológico do apoio matricial, com poucas ações técnico-pedagógicas sendo desenvolvidas com as equipes de Saúde da Família. Apesar da liberdade de ação e das inúmeras possibilidades de desenvolvimento de um cuidado ampliado e integral, essas profissionais tendiam a reproduzir uma ação próxima de uma lógica ambulatorial clínica tradicional, com poucas inovações em suas práticas e com reduzidas reflexões sobre o impacto de suas ações no âmbito do SUS / This research intended to comprehend multi-professional work and practices, as well as analyze the impact of professional formation in the performance of Psychology professionals in Family Health Support Centers (NASF) of a town in the interior of the northeast region of Brazil. Choosing the field of qualitative research, two strategies for data collection were used: interviews and ethnography. Hermeneutics was used as a method in the interaction with the research subjects and in the analysis of the collected data in the field. Interviews were conducted with six Psychologists and one nurse that was a NASF reference. The ethnography was undertaken with two of the interviewed Psychologists, following their field activities during some months. All the interviewed Psychologists were inserted in NASF through political connections and participated in a Health Services Cooperative. The basis for their performance at NASF was obtained after University graduation, in Post-Graduation courses and training courses, besides the experience acquired by the insertion in other public policies. As these professionals dealt weekly with five Family Health Support Centers with different profiles, the adapting process of their actions was continual and challenging. They faced in their daily routine several forms of precariousness of their labor, such as informal job linkage with no guarantee of working rights and a diversity of structural and working conditions difficulties. In general, the professionals did not know the meaning of the concept of matrix support and its relation to the actions performed in NASF. The majority of the developed actions focused on individual care, group activities, waiting rooms and house visits. Other actions were developed (as interconsultation and single therapeutical project), but only on occasion. The emphasis of the actions was in the assistential-clinical dimension of the theoretical and methodological reference of the matrix support, with few technical-pedagogical actions performed by the Family Health teams. In spite of the freedom of action and the numberless possibilities of developing an amplified and comprehensive care, these professionals tended to reproduce an action close to a traditional ambulatory and clinic logic, with few innovations in their practices and reduced reflections on the impact of their actions in the SUS environment

Made available in DSpace on 2016-04-29T14:17:51Z (GMT). No. of bitstreams: 1 Milka Sayuri Nakayama Ohya.pdf: 625819 bytes, checksum: 755f49dd4238c88d99ac25114c221128 (MD5) Previous issue date: 2009-06-24 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / This paper took as an object the study of the professional practice in an Assistance Institution for adolescents who carry out social-educative procedures of freedom deprivation, the CASA Foundation / São Paulo. It was proposed to discuss the Professional Practice, once it is deeply related to the achieved results together with the adolescents, for their lives orientation, even as institutionally or personally. It was identified that there is no way of thinking on the adolescent without thinking on the professional who acts straight with him and faces several situations in the institution, that in some ways could qualify (or not) his everyday s actions. For a better understanding of the institutional dynamic and the professional action, at a first moment, it was contextualized the appearance of the assistance institutions for children and adolescents who, by some means were in situation of high vulnerability, with the focus privileged in the São Paulo s context. Subsequently, the subject of professional practice was worked out, followed by the perspectives of resistance and overcoming. These approaches are due to the fact that the Foundation is considered a historical-social institution which, facing the past political movements, was highlighted for moments of violence and negligence to the rights of the adolescents, but it is found today in a process of change, with the perspective of rights guarantee. In this way, to achieve the understanding of how it is placed the professional practice ruled in the movements of resistance and overcoming, interviews were performed with a social worker (who no longer works for the Foundation) and a psychologist (who still remains in the Foundation) who, from their academic background and knowledge accumulated by their activities in the Foundation contributed/contribute for the institutional dynamic and had/have a significant role in the adolescents life whom they worked / work / Esta dissertação teve como objeto o estudo da prática profissional em uma Instituição de atendimento a adolescentes que cumprem medida socioeducativa de privação de liberdade, a Fundação CASA/São Paulo. Nos propusemos a discutir a Prática Profissional, uma vez que esta está intimamente relacionada aos resultados obtidos junto aos adolescentes, ao direcionamento de suas vidas, tanto institucionalmente quanto pessoalmente. Compreendemos que não há como pensar no adolescente, sem pensar no profissional que atua com ele diretamente e que enfrenta diversas situações na instituição que de algum modo podem qualificar (ou não) suas ações cotidianas. Para melhor entendimento da dinâmica institucional e da ação profissional, em um primeiro momento contextualizamos o surgimento das instituições de atendimento às crianças e aos adolescentes que, de algum modo encontravam-se em situação de alta vulnerabilidade, com o foco privilegiado no contexto paulistano. Posteriormente, trabalhamos a questão da prática profissional e, em seguida, as perspectivas de resistência e de superação. Esses enfoques se devem ao fato de considerarmos a Fundação uma instituição sócio-histórica que, diante dos movimentos políticos vivenciados, foi marcada por momentos seja de violência, seja de negligência aos direitos dos adolescentes, mas que encontra-se hoje em um processo de mudança, com a perspectiva de garantia de direitos. Desta forma, para que pudéssemos ter o entendimento de como se coloca a prática profissional pautada nos movimentos de resistência e de superação, realizamos entrevistas com uma assistente social (que não mais atua na Fundação) e uma psicóloga (que ainda permanece) as quais, a partir de suas formações acadêmicas e dos conhecimentos acumulados por suas atividades na Fundação, contribuíram/contribuem na dinâmica institucional e tiveram/tem papel significativo na vida dos adolescentes com os quais trabalharam/trabalham

Made available in DSpace on 2016-04-29T14:18:01Z (GMT). No. of bitstreams: 1 Maria Ines Fontana.pdf: 1698500 bytes, checksum: a1851411e8290aa81c668aa1fd22cfa5 (MD5) Previous issue date: 2010-04-16 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / The general objective of this thesis is to comprehend the liaison between academic research and professional practice of the Social Assistant during its daily work in the various actuation areas. This research subjects were professionals who work on public and private institutions and, concomitantly, were trainee supervisors of students from University of Social Services of Bauru, in 17 cities inside the 7th Administrative region of São Paulo state. The research took quantitative and qualitative data from the answers of 63 people, who answered a list of specific questions. Between these subjects were selected eight professionals who participated of a focal group. The collected data showed that the Social Assistants recognize the relevance of the research on their daily work, point it as a need for a better qualification of the professional work and describe it as a fundamental instrument of reality knowledge as well as the professional demand, attributing it relevance on the directionally professional intervention. Also the research was qualified by the subjects as one way to maintain the professional competence and job on daily work; responsible to forward the professional projects on the direction of the ethic-politic accomplishment inside the profession. The subjects also detached that having a distinguished perspective, this research can be used as a strength way of population struggle, as a possibility of social practices transposition and, per its democratic sign, to mark the subjects take part. They still related that the category uses the research only as an insipient way, attributing its non usage on the professional practice to the leak of habit and research method knowledge, behind the difficulty of a systemization and to the poor tradition of research on the Social Service. They explained that the alteration of this scenario will be possible per a collective construction which must be stimulated and effectuated by the representative agencies (CRESS, CFESS e ABPESS) which should happen during the studies and be present on the agenda and roll of continuous capacitating of theses professionals. Finally it was evident the humility feeling by the subjects and the conception that the current scenario must be improved / Esta tese tem como objetivo geral compreender a vinculação da pesquisa com a prática profissional do assistente social no seu cotidiano institucional, nas diferentes áreas de atuação. Os sujeitos da pesquisa foram profissionais que trabalhavam em instituições públicas ou privadas e que, concomitantemente, eram supervisores de campo de estágio de alunos da Faculdade de Serviço Social de Bauru, em 17 municípios da 7ª Região Administrativa do Estado de São Paulo. A pesquisa levantou dados quantitativos e qualitativos, com a participação de 63 sujeitos, que responderam a um questionário. Dentre estes sujeitos foram selecionados oito profissionais para participar do grupo focal. Os dados obtidos evidenciaram que os assistentes sociais reconhecem a relevância da pesquisa no exercício profissional, apontam a sua necessidade para uma maior qualificação do trabalho profissional, e descrevem-na como instrumento fundamental de conhecimento da realidade, bem como das demandas profissionais, atribuindo-lhe relevância no direcionamento à intervenção profissional. Também foi considerada pelos sujeitos como uma das formas de sustentação da competência e da manutenção da profissão no mundo do trabalho; responsável por encaminhar os projetos profissionais na direção da efetivação do projeto ético-político da profissão. Os sujeitos também destacaram que, por ter perspectiva superadora, a pesquisa pode ser trabalhada como uma forma de fortalecimento de luta da população, como possibilidade de transposição das práticas sociais e, pelo seu alcance democrático, marcar a participação dos sujeitos. Os sujeitos afirmaram ainda, que a categoria utiliza a pesquisa de forma incipiente e atribuíram a sua não utilização na prática profissional à falta de hábito e domínio metodológico em pesquisa, à dificuldade de sistematização e à pouca tradição de pesquisa no Serviço Social. Evidenciaram que a alteração deste quadro será possível por uma construção coletiva, que deve ser estimulada e efetivada pelos órgãos representativos (CRESS, CFESS e ABPESS) e que deve acontecer na formação, bem como fazer-se presente na agenda e nas pautas da capacitação continuada dos profissionais. Ficou evidenciado o sentimento de humildade e de consciência por parte dos sujeitos quanto à necessidade de superação do quadro atual

Made available in DSpace on 2016-07-27T13:54:22Z (GMT). No. of bitstreams: 1 Maria de Fatima Bastos.pdf: 597390 bytes, checksum: 39b10d5a3a6e8f563489f2b0aa222c43 (MD5) Previous issue date: 2009-09-15 / This dissertation sets out to study teacher formation for the early years of Primary School in the Pedagogy Course. Its general aim is to analyze the professional action of two teachers who concluded a course called a Full Modular Licentiate (LPP) in the Laranjeiras/Goiânia Campus of the Goiás State University (UEG) in 2005, and are teaching second and third grades at primary level in a municipality school, to which they were attached before starting their Third Level Education. The method of investigation is dialectic and the research is qualitative in the form of a case study, using direct observation in two classrooms and an analysis of interviews with the Principal, pedagogical coordination and teachers. The theoretical referential deals with teacher formation; professionalizing teachers; the Curricular Guidelines for the Pedagogy Course; the LPP/UEG of the Pedagogy Course in the Laranjeiras Campus. It is based on the ideas of Mizukami (1986); Nóvoa (1991); Garcia (1996); Freire (1996); Silva (1999); Cunha (1999); Alarcão (1998, 2001); Brzezinski (1996, 2001, 2005, 2007); Freitas (2001, 2007); Saviani (1987, 2007); and others. The historical review of the evolution of the Pedagogy Course in Brazil was supported and referenced by research in documentary sources: laws, decrees, resolutions, reports, guidelines, with a view to situating the paradigms for the formation of a pedagogue. The choice of the intentional sample responded to the following criteria: a) being a regular teacher in the school; b) having formation in Pedagogy in the University Program for Workers in Education at UEG (Full Modular Licentiate) in the Larangeiras Campus; c) being a graduate from the course in 2005; d) being a teacher working with students from 1st to 5th grade of Primary School; e) remaining on in the same school, from before entering the LPP/UEC Program to the time of observation of teaching practice. A documental analysis of the LPP/UEC Program, the Pedagogical Policy Project of the Pedagogy Course (contract V) and of the National Curricular Guidelines for the formation of primary education teachers was carried out. The research allows us to affirm that the course offered by LPP/UEG seems to have changed the pedagogical actions of the teachers very little, given that the knowledge, conceptions and theories which underlie the project for the course were not identified in the praxis of these teachers. / O objeto de estudo desta dissertação é a formação do professor para os anos iniciais do Ensino Fundamental no Curso de Pedagogia. O objetivo geral é analisar a atuação profissional de duas pedagogas que concluíram o curso, na Licenciatura Plena Parcelada (LPP) do Pólo Laranjeiras/Goiânia da Universidade Estadual de Goiás (UEG) em 2005, e estão em exercício no segundo e quarto anos do Ensino Fundamental em uma escola Municipal, à qual eram vinculadas antes de ingressarem no Ensino Superior. O método da investigação é dialético e a pesquisa é qualitativa na modalidade estudo de caso, com uso da observação direta em duas salas de aula e análise de entrevistas com a direção, coordenação pedagógica, e professores. O referencial teórico aborda a formação de professores; a profissionalização docente; as Diretrizes Curriculares do Curso de Pedagogia; o Programa de LPP/UEG do curso de Pedagogia do Pólo Laranjeiras. A fundamentação se organiza com base nas idéias de Mizukami (1986); Nóvoa (1991); Garcia (1996); Freire (1996); Silva (1999); Cunha (1999); Alarcão (1998, 2001); Brzezinski (1996, 2001, 2005, 2007); Freitas (2001, 2007); Saviani (1987, 2007); entre outros. A revisão histórica acerca da evolução do curso de Pedagogia no Brasil foi subsidiada e referendada por pesquisas em fontes documentais: leis, decretos, resoluções, pareceres e indicações, objetivando situar os modelos da formação do pedagogo. A escolha da amostra intencional atendeu aos seguintes critérios: a) ser professor efetivo da escola; b) ter formação em Pedagogia no Programa Universidade para os Trabalhadores da Educação da UEG (Licenciatura Plena Parcelada/LPP) no Pólo Laranjeiras; c) ser egresso do curso em 2005; d) ser professor atuante do 1º ao 5º ano do Ensino Fundamental; e) manter-se na mesma escola, desde o período anterior ao ingresso na LPP/UEG até o momento da realização da observação da prática pedagógica. Foi realizada análise documental do Programa de LPP/UEG, do Projeto Político Pedagógico do Curso de Pedagogia (convênio V) e das Diretrizes Curriculares Nacionais de formação de professores para a Educação Básica. A pesquisa permitiu constatar que o curso oferecido pela LPP/UEG, não alterou as ações pedagógicas das professoras observadas, uma vez que os saberes, concepções, e teorias que sustentam o projeto do curso não foram identificados na prática destas professoras.

Målet med denna avhandling var att undersöka partnerrelaterat våld mot kvinnor i Sverige från olika perspektiv och med ett särskilt fokus på graviditetsperioden. Syftet var: 1) att ta reda på barnmorskors erfarenheter, attityder och rutiner angående partnerrelaterat våld mot gravida kvinnor inom mödravården; 2) att utforska hur personer som arbetar inom olika program för våldsbenägna män (inom och utom kriminalvården) talar om manligt och kvinnligt och om partnerrelaterat våld, speciellt i förhållande till graviditet; och 3) att belysa kvinnors erfarenheter av att bli och vara gravid samtidigt som de var utsatta för våld i relationen, samt deras möten med barnmorskorna på mödravårdscentralen. Data för tre studier samlades in under åren 1998-2003 med kvantitativa och kvalitativa metoder. En enkät skickades till alla yrkesverksamma mödravårdsbarnmorskor i Västerbotten och analyserades statistiskt och med innehållsanalys. Forskningsintervjuerna utfördes och analyserades enligt ’grundad teori’ (för att skapa teoretiska förklaringsmodeller), ’diskursanalys’ (för att visa hur ett gemensamt språkbruk konstruerar ’sanning’) och ’narrativ metod’ (för att tolka och återberätta innebörden i personliga berättelser). Resultaten från de studier som lade grunden till denna avhandling visar på problemets komplexitet, både från de professionellas och från kvinnornas perspektiv. Barnmorskorna (artikel I) var yrkeskunniga men också kunniga om partnerrelaterat våld mot kvinnor, men utan PM eller andra riktlinjer, så blev de osäkra och ställde sällan direkta frågor eftersom ämnet ansågs vara känsligt och tabubelagt. De professionella (artikel II-III) som arbetade med våldsbenägna män i olika program (inom eller utanför kriminalvården) krävde att män skulle ta ansvar för sitt våld. De ansåg att våldsamma män var tämligen vanliga män men avvikande i särskilda avseenden såsom i samspel, kommunikation, nära relationer och i deras kvinnosyn. De professionella beskrev stereotyper om könsskillnader och hur aggressivitet kan starta på olika sätt hos olika typer av män och ansåg också att graviditet kan utlösa konflikter och våld. Likväl så ingick i programmen vanligtvis inte känsliga frågor, om t.ex. graviditet och samlevnad, och trots en god vilja och avsikt att skapa en ’ny maskulinitet’, så tycktes deras strategier och tankegångar rent av kunna motverka deras egna goda syften. De nio intervjuade kvinnorna (artikel IV) som hade varit utsatta för våld beskrev hur deras liv hade varit komplicerade och blivit till en mardröm då deras hjärtevän hade förvandlats till en förövare. Två kvinnor bröt upp från sina relationer under graviditeten på grund av livshotande våld medan de andra för det mesta höll uppe en fasad och dolde det pågående våldet inför barnmorskan och andra alltmedan de gick balansgång mellan hopp och förtvivlan eller väntade på rätt tidpunkt att ge sig av. Förutom kvinnornas berättelser om partnerrelaterat våld under graviditet (artikel IV) så presenterades två professionella grupper och deras gemensamma svårigheter gällande tabun och känsliga frågor utanför det man vanligtvis sysslade med i sin profession (artikel I-III). Barnmorskorna var yrkeskunniga men hade ingen handlingsplan för att kunna bemöta och identifiera komplexiteten i våldsutsatta gravida kvinnors situation som ofta består i att dölja och balansera. De professionella i program för män konfronterade tydligt mäns våld och hade ambitionen att utmana deras maskulinitet, men då de i samtalen exempelvis förbisåg att ta upp vissa känsliga frågor kan utfallet ifrågasättas. / The aim of this thesis was to examine - from different perspectives - intimate partner violence (IPV) against women, focusing on the period of pregnancy, with the object of increasing the available knowledge about this complex subject area, in a Swedish context. The specific aims were: i) to assess the experience, knowledge, attitudes and routines of midwives working in antenatal care regarding IPV against pregnant women; ii) to explore discourses with special reference to IPV, gender and the period of pregnancy of professionals running various intervention programs for men inclined to violence (outside or within the treatment of offenders); and iii) to illuminate experiences in women subjected to IPV by analyzing their stories about becoming and being pregnant as well as meeting antenatal care providers. Three studies were carried out using a combination of quantitative and qualitative methods. Questionnaires sent to all midwives working at antenatal care clinics in the county of Västerbotten were processed by statistical methods and content analysis. The qualitative research interviews followed the ‘grounded theory’, ‘discourse analysis’ or ‘narrative analysis’ approach. The results indicate the complexity of the problem of IPV from the viewpoints of both professional actors and the women. The midwives, although knowledgeable about IPV and certainly experts on pregnancy, felt uncertain regarding IPV and rarely asked direct questions of pregnant women, because the midwives perceived the subject to be difficult and taboo and they lacked guidelines to help them tackle the issue. The professionals in men’s programs intended men to take full responsibility for their own violent behavior. They viewed violent men as rather ordinary but yet deviant in certain respects such as in interplay, communication, relationships and in their views of women. The professionals described gender stereotypes and attributed and generalized certain masculine characteristics to aggressiveness. They also believed that pregnancy could be a potential trigger for conflicts and violence. Nevertheless, pregnancy and sensitive relational topics did not constitute significant parts of the intervention programs. Despite good intentions to change concepts of masculinity, the professionals’ discourses appeared to be rather lacking in reflection and even counter-productive. The women who had been subjected to violence described their complex lives as being terrible nightmares where their lovers turned into perpetrators. Two of the nine interviewed women left their relationships during pregnancy because of life-threatening violence whereas the others mostly kept up a front, hiding the IPV from the antenatal care staff and others while they trod a fine line between hope and despair or waited for the right moment to leave. In addition to women’s stories about IPV during pregnancy, two professional groups presented shared dilemmas regarding taboos and sensitive matters outside ordinary practice. Midwives were proficient but had no action plan to recognize and meet the complexity of the abused pregnant women’s situation involving concealment, balancing and decision-making. Professionals in programs for men were explicitly confronting men’s violence and wanted also to challenge masculinity in their clients. However, their discourse lacked depth by, for instance, their overlooking of sensitive relational topics in dialogues with men.

Bien qu’il soit largement reconnu dans différents milieux d’intervention au Québec que l’intervenant est un des agents actifs les plus importants de l’efficacité d’une intervention – et c’est un des postulats centraux de l’intervention psychoéducative –, il existe encore très peu d’instruments de mesure validés empiriquement permettant l’évaluation du fonctionnement d’un groupe d’intervenants. Néanmoins, il existe un instrument pouvant mesurer le climat social d’une équipe, soit le Questionnaire du climat social d’une équipe d’intervenants (QCSÉI; Le Blanc, Trudeau-Le Blanc, & Lanctôt, 1999; Moos 1987). Le QCSÉI compte 10 échelles de premier niveau. Dans ses écrits théoriques, Moos (2003) a suggéré que le climat social est un construit hiérarchique et que l’ensemble des instruments mesurant différentes dimensions du climat social d’un groupe ou d’une équipe devrait se regrouper en trois facteurs d’ordre supérieur, soit les relations interpersonnelles, la découverte de soi et le maintien de l’ordre et du changement. Un examen conceptuel des échelles du QCSÉI suggère que ce modèle théorique est problématique. Cette étude visait à déterminer si la structure hiérarchique proposée par Moos était adéquate pour le QCSÉI dans un échantillon d’intervenants québécois. L’échantillon utilisé était composé d’intervenants faisant partie de Boscoville2000, un projet d’intervention cognitivecomportementale en milieu résidentiel pour les adolescents en difficulté. Des analyses factorielles exploratoires ont d’abord démontré que la structure de premier niveau est bien reproduite. Deux échelles jugées importantes pour mesurer le climat social ont ensuite été ajoutées. Par la suite, des analyses factorielles exploratoires et confirmatoires ont démontré que la structure théorique hiérarchique en trois dimensions d’ordre supérieur de Moos ne représente pas bien les données. Les analyses ont révélé une structure alternative plus intéressante sur le plan conceptuel et qui représentait mieux les données. Des corrélations entre les échelles de climat social de l’équipe et les traits de personnalité des intervenants ainsi que différentes variables sociodémographiques et liées à la pratique professionnelle ont procuré un appui qui suggère que le QCSÉI possède une validité de critère acceptable. / Even though it is largely recognized in various psychosocial intervention settings that the counselor is one of the main active component of an intervention efficacy – and it is one of the central postulate of psychoeducation –, there are still very few empirically-validated instruments for the assessment of a youth counselors’ team functioning. Still, there is one interesting instrument for assessing the social climate of a team, the Counselors’ Team Social Climate Questionnaire (“Questionnaire du climat social de l’équipe d’intervenants”, QCSÉI; Le Blanc, Trudeau-Le Blanc, & Lanctôt, 1999; Moos 1987). The QCSÉI is composed of 10 first order scales. In his theoretical writings, Moos (2003) suggested that the social climate is a hierarchical construct and that all instruments measuring different foci of the social climate should group into three higher-order dimensions, namely Relationships, Personal Growth, and System Maintenance and Change. A conceptual examination of the QCSÉI scales suggested that this theoretical model is problematic. This study aimed at evaluating if the hierarchical structure postulated by Moos was adequate in a sample of youth counselors from Quebec. The sample that was used was composed of youth counselors from Boscoville2000, a residential cognitive-behavioral intervention program for adolescents with serious adjustment problems. Exploratory factor analyses first demonstrated that the first order structure was well reproduced. Two additional scales judged as important aspects of the social climate were then added. Next, exploratory and confirmatory factor analyses confirmed that the theoretical hierarchical structure with three higher-order dimensions was not well reproduced in the data. The analyses rather revealed an alternative structure that was conceptually more interesting and provided a better fit to the data. Correlations between the teams’ social climate and youth counselors’ personality traits, as well as socio-demographic and professional practice variables provided evidence suggesting that the instrument have acceptable criterion-related validity.

Le rôle que jouent les services orthophoniques dans l’ajustement des proches de personnes aphasiques ainsi que le contexte dans lequel les orthophonistes mettent en place des interventions auprès de ces proches ne sont actuellement pas connus. La présente thèse a donc pour but de comprendre de quelle manière les relations entre les orthophonistes et les proches de personnes aphasiques, développées en contexte de réadaptation, s’inscrivent dans la trajectoire dynamique des proches et dans la pratique des orthophonistes. Une approche qualitative par théorisation ancrée a été utilisée dans quatre études pour analyser les entrevues effectuées auprès de proches de personnes aphasiques et d’orthophonistes. Dans l’étude 1, les entrevues menées à trois reprises dans la première année suivant l’accident vasculaire-cérébral (AVC), et ce, auprès de quatre filles dont la mère est aphasique, ont été analysées. Un modèle théorique représentant la relation mère-fille a été développé. Ce modèle illustre que les perceptions de fragilité, de difficultés et de compétence, qu’ont les filles à l’égard de leur mère, les amènent à adopter des comportements de protection ou de confiance, ce qui génère des réactions de satisfaction ou d’insatisfaction chez la mère, renforçant alors les perceptions initiales des filles. Quatre patterns relationnels peuvent donc coexister au sein d’une même dyade. L’aphasie complexifierait cet ajustement relationnel. Dans l’étude 2, les entrevues effectuées à trois reprises durant la première année suivant l’AVC, auprès d’une fille dont la mère est sévèrement aphasique, ont été analysées. Un modèle théorique représentant l’expérience d’aider a été élaboré. Selon ce modèle, percevoir des difficultés chez sa mère et ressentir que leur relation antérieure est menacée a déclenché le processus d’aide chez la fille. Parallèlement, la reconnaissance de la compétence de sa mère a motivé la fille à offrir de l’aide visant à rendre sa mère heureuse et à favoriser son indépendance. Ce type d’aide a contribué à augmenter l’indépendance de sa mère, à retrouver une relation satisfaisante avec celle-ci et à s’adapter à l’aphasie. Dans l’étude 3, les entrevues de 12 proches de personnes aphasiques ont été analysées. Un modèle théorique représentant l’expérience de l’aphasie et de la réadaptation post-AVC a été développé et illustre que les proches sont centrés sur la personne aphasique et participent à la réadaptation dans le rôle d’aidant. Cette disposition influence alors leurs attentes envers la réadaptation, leurs interactions avec les professionnels, dont les orthophonistes, et leur appréciation de la réadaptation. Dans l’étude 4, les entrevues effectuées auprès de huit orthophonistes travaillant en réadaptation ont été analysées. Un modèle théorique illustrant le processus d’intervention des orthophonistes auprès des proches de personnes aphasiques a été construit. Pour les orthophonistes, le travail avec les proches est majoritairement perçu comme un ajout positif, mais exigeant, à leur pratique de base centrée sur la personne aphasique. Une satisfaction professionnelle peut en découler, mais des idéaux non-atteints peuvent persister. La relation proche-orthophoniste serait donc principalement axée sur le rôle d’aidant que joue le proche, et ce, en raison de leur expérience respective. Un agrandissement du territoire de rencontre entre les orthophonistes et les proches pourrait soutenir les proches dans les ajustements relationnels induits par l’AVC avec aphasie ainsi que permettre aux orthophonistes d’atteindre leurs idéaux. / The role speech-language therapy (SLT) services play in significant others’ adjustment to stroke and aphasia as well as the context in which SLTs offer interventions to significant others are currently unknown. The present dissertation aims to understand how in rehabilitation settings, relationships between SLTs and significant others of persons with aphasia develop, and fit within significant others’ process of change, on one hand, and into SLTs’ practice, on the other hand. A grounded theory approach was used in four studies to analyze interviews conducted with significant others of persons with aphasia and with SLTs. In study 1, four daughters of aphasic women were each interviewed three times over the first year post-stroke and their discourse was analyzed. A theoretical model of the daughter-mother relationship was constructed. This model shows how the daughters’ perception of maternal fragility, problems, and abilities motivated daughters to take on protective and trusting behaviors that resulted in maternal reactions of satisfaction and dissatisfaction that, in turn, reinforced the daughters’ initial perceptions. Four relational patterns may therefore coexist in a given dyad. Aphasia could make relational adjustments more complex. In study 2, three interviews conducted over the period of one year with the daughter of a woman with severe aphasia were analyzed. A theoretical model representing the experience of caregiving was elaborated. This model illustrates that for the daughter, perceiving her mother’s problems and feeling their previous relationship was threatened triggered the caregiving process. In parallel, the daughter’s recognition of her mother’s competence encouraged her to offer care aiming to make her mother happy and to foster her mother’s independence. Increases in her mother’s independence, a renewal of their relationship and adaptation to aphasia were consequences of this type of caregiving. In study 3, the interviews conducted with 12 significant others of aphasic persons were analyzed. A theoretical model representing significant others’ experience of aphasia and rehabilitation following stroke was developed and showed that significant others participated in rehabilitation as caregivers centered on the person who had aphasia. This disposition influenced their expectations of rehabilitation, their interactions with professionals, such as SLTs, and how they appraised rehabilitation. In study 4, the interviews conducted with eight SLTs working in rehabilitation settings were analyzed. A theoretical model representing SLTs’ process of working with significant others of persons with aphasia was elaborated. SLTs mostly perceived work with significant others as a challenging bonus to their fundamental approach centered on the person with aphasia. As a consequence, SLTs felt professional satisfaction while dreaming for something more to offer significant others. The relationship between significant others and SLTs thus mainly seem to focus on the caregiver role endorsed by significant others as a result of the experience of each of them. Expanding the shared territory of SLTs and significant others could support significant others’ adjustment to the relational changes induced by stroke and aphasia and could help SLTs attain their professional dreams.