Problématique : Au Québec, le Processus de soins en nutrition (PSN) est peu utilisé, les organisations appréhendent que l’implantation sera ardue mais sont motivées à procéder. Objectif : Accompagner deux services de nutrition clinique d’établissements de santé de la grande région de Montréal dans le déploiement du PSN et documenter les barrières et facteurs facilitants. Méthodologie : L’Hôpital du Sacré-Cœur de Montréal et le CSSS Champlain–Charles-Le Moyne ont été recrutés. La collecte de données fut réalisée via des séances d’accompagnement tout au long du déploiement du PSN. Une rencontre de bilan fut effectuée dans chaque milieu, avec les nutritionnistes et les chefs de service. Les données colligées sont qualitatives. Les échanges furent enregistrés et un cahier de bord complété. La synthèse a été rédigée selon un modèle de gestion de changement. Résultats : Au total, 18 séances d’accompagnement eurent lieu et cinq rencontres de bilan. Les principaux obstacles à la mise en œuvre du PSN sont en grande partie liés à l'engagement des nutritionnistes, à la formation et aux contraintes de temps. Les principaux facteurs facilitants sont les présentations d’histoires de cas accompagnées de discussion et le manuel de la Terminologie internationale de diététique et de nutrition (TIDN). Discussion : Notre système de santé est de plus en plus sujet à des changements et les dirigeants devront optimiser les ressources. L’International Confederation of Dietetic Associations a suggéré d’adopter, à l’échelle internationale, le PSN en tant que cadre pour la profession. Les stratégies d’implantation portant sur des principes de gestion du changement organisationnel faciliteront l’intégration de ces changements importants. L’expérience des deux milieux documentés sera éclairante pour les autres organisations désirant implanter le PSN. / Problem: In Quebec, the use of the Nutrition Care Process (NCP) is limited, organizations apprehend its implantation will be arduous but are motivated to proceed. Objective: To accompany two clinical nutrition services of health facilities in the greater Montreal area in the deployment of the NCP and document the barriers and facilitating factors. Methodology: The Hôpital du Sacré-Cœur de Montréal and the CSSS Champlain–Charles-Le Moyne were recruited. Data collection was accomplished through accompanying sessions throughout the deployment of the NCP. An end of project meeting was held in each area, with nutritionists and heads of departments. The data collected is qualitative. The exchanges were recorded and a logbook was completed. The synthesis was written using a change management model. Results: A total of 18 accompanying sessions were held and five end of project meetings were held. The main obstacles to the implementation of the NCP are largely related to the commitment of nutritionists, training and time constraints. The main facilitating factors are the presentations of case studies with discussion and the manual of the International Dietetics and Nutrition Terminology (IDNT). Discussion: Our health system is increasingly subject to change and leaders will need to optimize resources. The International Confederation of Dietetic Associations suggested adopting the NCP as an international framework for the profession. Implementation strategies for organizational change management principles will facilitate the integration of these important changes. The experience of the two documented environments will be enlightening for other organizations wishing to implement the NCP.

[pt] O estudo tem como foco a negociação de identidades em situação de conflito em contexto de consulta médica pediátrica de crianças e adolescentes com diagnóstico de Transtorno de Déficit de Atenção e Hiperatividade (TDAH), em atendimento de rotina conduzido pela médica. O objetivo consiste em criar inteligibilidades sobre os conflitos familiares consequentes do transtorno e as identidades projetadas/negociadas por pais, crianças e adolescentes com TDAH, para si e para o outro. A pesquisa está ancorada em linhas teóricas da fala-em-interação em atendimento clínico. Situa-se na Linguística Aplicada das Profissões, em articulação com a Análise da Conversa Etnometodológica, em contexto institucional, com a Sociolinguística Interacional e com os estudos discursivos sobre identidades. A metodologia da pesquisa, de natureza qualitativa e interpretativista, com gravação em vídeo de quatro consultas pediátricas, tem caráter etnográfico, mediante observação participante na antessala de atendimento. Os dados foram transcritos de acordo com convenções da Análise da Conversa Etnometodológica. Os resultados das análises mostram a prática profissional da médica nos enquadres de consulta clínica e de orientação psicoeducativa. A médica realiza tanto atividades relacionadas a tarefas de avaliação física e comportamental das crianças e dos adolescentes, em ações que visam ao tratamento medicamentoso e psicológico do TDAH, quanto atos comunicativos como formuladora, mediadora e conselheira na intermediação de conflitos emergentes da inter-relação TDAH, família e escola, resultantes do comportamento dos filhos nas relações familiares e do baixo rendimento acadêmico destes no contexto escolar. Os pais se alinham junto à médica, no enquadre de transtornos escolares dos filhos, e estabelecem enquadres conflitantes junto aos filhos; projetam para si identidades cujos atributos oscilam entre participativos, compreensivos e responsáveis, e impacientes, frustrados e esgotados. As identidades que projetam para os filhos apresentam-se, por vezes, contraditórias, entre filhos amorosos, perspicazes e irritantes; e alunos inteligentes, ineptos e displicentes. As crianças e os adolescentes, embora se alinhem com a médica, nos enquadres de consulta e orientação, rejeitam o estigma de TDAH e projetam para si identidades de alunos e filhos respeitosos e intelectualmente capazes; e para seus pais, na maioria das vezes, de pais impacientes e exigentes em sua educação. O estudo proporciona maior entendimento da complexidade e das múltiplas atividades da atuação profissional da médica na consulta pediátrica, e contribui para uma melhor compreensão das experiências cotidianas de pais, crianças e adolescentes com TDAH, marcadas por conflitos desestruturantes da harmonia entre esses atores sociais nos contextos da escola e da família. / [en] The study focuses on the negotiation of identities during conflict situations in the context of pediatric appointments for children and teenagers diagnosed with Attention Deficit Hyperactivity Disorder (ADHD), in routine care conducted by the doctor. The main purpose consists on creating intelligibilities about the family conflicts resultant from the disorder and the identities projected/negotiated by the parents, children and teenagers with ADHA, for themselves and others. The research is based on theoretical lines of speech-in-interaction regarding clinical care. It is situated on Professions Applied Linguistics, in articulation with the Ethnomethodological Conversation Analysis, in an institutional context, in Interational Sociolinguistics and on discursive studies about identities. The research methodology, of a qualitative and interpretive nature, with video recording of four pediatric appointments, has an ethnographic character, by a participant observation in the Doctor’s office waiting room. Data were transcribed in accordance with conventions of the Ethnomethodological Conversation Analysis. The analyzes results indicate the professional practice of the Doctor concerning clinical care and the psycho-educative orientation. The Doctor carries out activities related to physical evaluation and behavior tasks of children and teenagers, in actions that aim at the ADHA medicated and psychological treatment, and also the communicative acts as a formulator, mediator and advisor when intermediating conflicts emerging from the ADHA, family and school inter-relation, resultant from the behavior of the children in family relation and the their low academic performance in the school context. The parents align with the Doctor, in the framings of their children school disorders, and stablish conflicting framings together with their children; they project to themselves the identities whose attributes oscillate between participative, comprehensive and responsible, and impatient, frustrated and exhausted. The identities that project toward children are occasionally presented as contradictory, among the children considered lovely, insightful and annoying; and intelligent, inept and ungracious students. Children and teenagers, although being aligned with the Doctor, in the framings of appointments and orientation reject the ADHA stigma and project to themselves the identities of students and children considered to be respectful and intellectually capable; and for their parents, most of the time, identities of impatient and demanding parents regarding education. The study provides a greater understanding of the complexity and the multiple activities of the professional performance of the Doctor during the pediatric care, and contributes for a better understanding of the daily experiences of parents, children and teenagers with ADHA, marked by destabilizing conflicts of harmony between these social authors in the school and family contexts.

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2017-10-18T12:04:18Z No. of bitstreams: 1 Fernanda Caldas de Azevedo.pdf: 2025107 bytes, checksum: dbf1f69bdaa4229e25c62adbf9f3ffa0 (MD5) / Made available in DSpace on 2017-10-18T12:04:18Z (GMT). No. of bitstreams: 1 Fernanda Caldas de Azevedo.pdf: 2025107 bytes, checksum: dbf1f69bdaa4229e25c62adbf9f3ffa0 (MD5) Previous issue date: 2017-09-22 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPES / This doctoral thesis analyses the job conditions of the social workers in the Special Children and Juvenile Courts of Law in the State of São Paulo. The goal of the present thesis is to prove that the workload intensification process has become one of the most decisive and crucial element to be tackled by the social workers class if they want to work fewer hours. Consequently, time and working activities are presented as vital aspects to be examined carefully when dealing with the inherent financial characteristics of the capital used in the productive and service sectors as well as in the restructuring of the public policies and working classes conditions. Within this context, the professional activity in the Court of Law was understood as the job performed itself and the social worker as the employee who performs a paid job and suffers the consequences of the economic conditions and working tendencies of all over the world. The relationship between the Law and the Legal System were objects of this study because they have a strong influence on the performance of the social workers’ daily activities due to the frequent law requisitions resulted from infringement acts which are treated at the Special Children and Juvenile Court of Law every single day. All the data collected for this paper were analysed in terms of their quality and quantity worth. Based on a semi-structured guide, ten social workers from the Court staff were interviewed face to face and asked to answer a written survey. Among the research findings, it was realised that the employees have been working under pressure due to the huge intensification of their workload and harmful working conditions, worsened by the organisational structure, rhythm and pace of the Court of Law, which reaffirm that the private sector entanglements are influencing the state public sector. Furthermore, it was also discovered that new social workers are not being hired because of the workload intensification of the current employees due to the reduction in the number of social workers who leave the job either from removal or retirement. Therefore resilience strategies are being held individually and collectively as well as internally and externally as an effective way to avoid the workload intensification of the social workers. However, it is still a challenge to be faced. In conclusion, this study shows that it is essential for the ones involved in this process to discover innovative legal means to prevent the social workers to be overloaded by work and give them useful tools to fight against capitalist exploitation / Essa tese analisa as condições de trabalho das Assistentes Sociais no Fórum das Varas Especiais da Infância e Juventude do Tribunal de Justiça do Estado de São Paulo, com o objetivo de apreender o seu processo de intensificação nesse espaço sócio-ocupacional, conferindo centralidade à categoria tempo de trabalho como um elemento determinante da luta histórica da classe trabalhadora pela redução da jornada de trabalho. Por isso, tempo e trabalho se apresentaram como dimensões relevantes a serem analisadas, notadamente na atual etapa de financeirização do capital que se refrata no setor produtivo, nos serviços, na reconfiguração das políticas públicas e nas condições de trabalho. Nesse âmbito, o exercício profissional no Tribunal de Justiça foi apreendido como trabalho e o/a assistente social como trabalhador/a assalariado/a, sofrendo as injunções das tendências gerais do mundo do trabalho. As relações entre Direito e Sistema de Justiça foram objeto de tematização por atravessarem e condicionarem o trabalho desenvolvido pelas assistentes sociais, por meio das interfaces com as requisições decorrentes do ato infracional a partir do fluxo de atendimento no Fórum das Varas Especiais da Infância e Juventude. A metodologia da pesquisa, de natureza qualitativa e quantitativa, envolveu a aplicação de questionários e entrevistas, com base em roteiro semiestruturado, com dez Assistentes Sociais que compõem a equipe técnica. Entre os achados da pesquisa constatou-se forte presença da intensificação do trabalho, percebida pela maioria das trabalhadoras por meio das precárias condições de trabalho e também pela própria estrutura do Judiciário em seus ritmos, velocidade e carga de trabalho, que reafirmam os ditames privados adentrando o espaço público-estatal. Identificou-se também a ampliação da jornada de trabalho, ainda mais estimulada pela redução do número de assistentes sociais na equipe técnica do Serviço Social em função do processo de remoção e de aposentadoria, que não têm levado a novas contratações. Estratégias de resistência - individuais e coletivas, internas e externas - são mobilizadas, mas resta o desafio de avançar com novas propostas contra a intensificação do trabalho, por meio de dispositivos no contrato de trabalho que possam vincular previamente o grau de intensidade do trabalho a ser realizado, a depender do fortalecimento das lutas coletivas do trabalho contra o capital

A Estratégia Saúde da Família (ESF), fundada nos referenciais da Atenção Primária à Saúde (APS) e sustentada pela Política Nacional de Atenção Básica orgânica e sistemicamente endossada pelos princípios do Sistema Único de Saúde (SUS) , se apresenta como modelo estruturante das Redes de Atenção à Saúde no Brasil. Qualificar a Atenção Básica em Saúde (ABS) e, por conseguinte, a ESF, neste contexto de grande complexidade, é propósito do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB), concebido pelo Ministério da Saúde, enquanto proposta de avaliação e indução de mudanças na gestão, gestão do cuidado e cuidado nos quais se encontram envolvidas Equipes de Saúde da Família (EQSFs) e gestão da ESF. Pouco estudos, focados em análises de experiências de implantação e/ou avaliação de resultados do PMAQ, retratando realidades municipais, têm sido relatados na literatura do campo; contudo, tendo em vista a inexistência de trabalhos publicados, esta pesquisa teve como objetivo analisar avaliações e percepções de trabalhadores de EQSFs e gestores da ESF em relação à concepção, implantação e operacionalização do PMAQ, com seus possíveis impactos, tomadas a partir do referencial de experiências dos sujeitos, no contexto de trabalho. Neste sentido, realizou-se pesquisa de abordagem mista, delineada por estudo de levantamento e grupo focal, com vistas a explorar, descrever e compreender o cenário experienciado por equipes e gestores, no contexto do PMAQ-AB, em municípios da região norte do Estado de São Paulo - Brasil. Referida pesquisa apontou para um perfil de profissionais atuantes em faixa etária significantemente jovem, com diminuto tempo de formado e de experiência na ESF, com baixa vinculação à equipe, num contexto de gestão ainda fragilizado pelas significativas instabilidades na composição das EQSFs, além da rotatividade de profissionais e precariedade de vínculos particularmente em relação aos médicos. Observou-se, em geral, elevado grau de aceitação dos sujeitos para com as propostas de avaliação do PMAQ-AB, embora tenha sido evidenciado significativo contingente de profissionais que desconheciam as diretrizes gerais e indicadores do programa, particularmente os médicos. Evidenciou-se significativo percentual de demandas relacionadas à qualificação sobretudo de enfermeiros , com razoável grau de discordância, por parte dos gestores da ESF, quanto à priorização de determinadas demandas, quando confrontadas com as indicadas pelos profissionais das EQSFs. Também, observaram-se inconsistências no processo de incorporação/implantação de ferramentas e programas estratégicos em diversas áreas de domínio da ESF e em relação ao PMAQ-AB , com variados e significativos graus de discordâncias, em relação aos mesmos, entre profissionais e estes e gestores. Neste contexto foram apontadas, em elevado grau, fragilidades relacionadas ao fazer cotidiano das EQSFs que, ordinariamente, comprometem o processo de trabalho. Em que pesem as observações empíricas reveladas, trabalhadores das EQSFs e das gerências da ESF, contraditoriamente, se autoavaliaram de forma razoavelmente satisfatória, em relação ao acesso e cuidado ofertados pelas equipes. A experiência com o PMAQ foi considerada satisfatória pelos trabalhadores das EQSFs, a despeito das críticas e restrições quanto a concepção, implantação, operacionalização e avaliações efetivadas pelo programa, em aspectos que se mostravam dependentes da instância federal e/ou da gestão municipal. Reiteram-se os desafios colocados para a gestão do trabalho e da educação na saúde, em relação aos trabalhadores atuantes na ESF, e reconhecem-se o momento oportuno, o potencial técnico e o caráter complexo e multidimensional que cercam o PMAQ, em sua necessária abrangência nacional; contudo, julga-se premente promover realinhamentos em sua concepção e operacionalização, de modo que seus componentes de indução e avaliação possam contemplar as demandas postas na cotidianidade da APS/ABS no Brasil, a fim de qualificar o acesso e o cuidado na ESF. / The Family Health Strategy (FHS), founded in the system of reference of the Primary Health Care (PHC) and supported by the Brazilian Primary Care Policy organic and systemically endorsed by the principles of the National Unified Health System (SUS) is presented as the model that structures the network of Brazilian Healthcare. Qualification of PHC, and as consequence, of FHS, in this context of great complexity, is the purpose of the National Program for Improving Access and Quality of Primary Care (PMAQ), ideated by the Ministry of Health as an evaluation proposal and induction of changes to improvement the administrative and care management, as well as of the quality of healthcare, provided by the Family Health Teams (FHT) and FHS managers. Few studies, focused on implementation experiences and/or evaluations of PMAQs initial results, have been reported in the literature, most portraying local realities. Given the scarcity of publications, this research aimed to analyse the evaluations and perceptions of FHTs workers and FHS managers about the design, implementation and execution of PMAQ, and its possible impact on the qualification of the local labor process, in the perspective of the subjects, on work environment. In this sense, it was proposed a mixed approach of research, outlined by survey studies and focus group to explore, describe and comprehend the scenario experienced by teams and managers, in the context of PMAQ, in municipalities in the north region of state of São Paulo - Brazil. The research pointed to a professional profile significantly young, with short time of graduation and work experience in the FHS. Many professionals have demonstrated low attachment to the FHT, in a context influenced by significant instability, high turnover among professionals and precariousness of the labor contract, mainly for the physicians. In general, there was high degree of acceptance to PMAQ\'s proposals, although a significant number of professionals did not know the general guidelines and the basic indicators of the program, particularly doctors. There was a high degree of demands related to professional qualification, particularly by the nurses, with a reasonable degree of disagreement of the managers in relation to such demands, when compared to the indicated by family health teams professionals. Also, observed it inconsistencies in the process of incorporation and deployment of tools and strategic programs, in various areas of the field of FHS and domains evaluation of the PMAQ, with variable degrees of significant discrepancies in assessments of this process by professionals and managers. In this context, weaknesses related to the real practices were identified in high degree by professionals, which may compromise the work process . Notwithstanding the empirical observations pointed out, FHTs workers and FHS\'s managers, contradictorily, considered, in a self-assessment, the access and care offered by the teams as reasonably satisfactory. The experience with PMAQ was considered satisfactory by FHT members, despite criticism and restrictions on the design, implementation, operation and evaluation models provided by the program. Emphasis is put on some challenges to be faced to the adequate management of labor force and of education of health profession in the FHS, although it is also recognized that PMAQ experience provide a unique opportunity to evaluate the complex and multidimensional nature of PHC in studied region and nationwide. However, it is deemed urgent promote realignments in the PMAQ\'s design and operation, so that their induction and assessment components can contemplate the daily life of PHC workers demands in Brazil, in order to qualify the access and care in the FHS.

Made available in DSpace on 2016-04-29T14:16:56Z (GMT). No. of bitstreams: 1 SSO - Vanessa Bega Menezes.pdf: 359507 bytes, checksum: f61ae628523d754890572c3ad0668c8e (MD5) Previous issue date: 2006-11-23 / Conselho Nacional de Desenvolvimento Científico e Tecnológico / The present thesis focuses on two basic dimensions of the profession of Social Work: educational formation and professional practice, from the perspective of the guidelines established by the ethical and political project developed by this professional category during the decades of 1980 and 1990. In terms of formation, it considers the need for continued education, while political, civic and professional participation is viewed in the context of professional practice. Both are regarded as potentially contributing to a professional practice embedded in that project. The discussion is guided by Critical Theory for the analysis of social reality and, therefore, its fundamental arguments deal with the challenges faced by the profession to articulate both dimensions in the present conjuncture. Thus, the thesis aims to contribute to the appropriation of such a professional, ethical and political project by reflecting on the need to materialize its principles / A presente dissertação trata da profissão de Serviço Social na articulação de duas dimensões fundamentais: atuação e formação profissional, tendo como referência a incorporação do projeto ético-político construído pela categoria profissional no decorrer das décadas de 80 e 90. Uma relação estabelecida é com a capacitação continuada; a outra é com a participação política, cívica e profissional, ambas potenciais catalisadoras de uma atuação profissional comprometida com esse projeto. Tal discussão está inserida no campo da teoria crítica de análise da realidade social e, assim, tem como reflexões fundamentais os desafios postos à profissão na atual conjuntura e os desafios para a categoria profissional na articulação dessas dimensões. Pretende-se contribuir com a discussão sobre a apropriação desse projeto profissional, ético-político, e refletir sobre as necessidades de dar materialidade a ele e aos seus princípios

This dissertation research study explored how registered nurses (RNs) use mobile devices as tools to support and enhance informal learning in their work settings. The mixed methods inquiry involved select Canadian practicing and regulated RNs who used mobile devices in their workplaces. A sequential explanatory research design collected quantitative and qualitative data using an online survey and semi-structured interviews. Quota sampling for the quantitative component yielded 170 usable online surveys. From the survey respondents, interview volunteers were purposively selected and ten (10) interviews were conducted. Descriptive, inferential, inductive, and integrated data analyses were conducted in order to explore strategies, processes, purposes, modes of use (individual [non-collaborative] or collaborative), and age-generational differences associated with RNs’ use of mobile devices for informal learning in the workplace. Findings indicated that the study participants primarily used their handheld devices for self-directed informal learning with non-collaborative strategies or processes in their work settings for accessing online resources for a range of reasons including: evidence-based support, new procedures/treatments, professional development, patient/client teaching, and maintaining competency. Age differences related to the use of mobile devices for informal learning were minimal. However, workplace-related influences including deficiencies in formal educational resources, Internet access, and/or employer support were relevant to the informal learning experiences. Positive perceptions of efficiencies, self-confidence, patient/client safety, patients/clients’ reactions, and the need for sanctioned resources for using mobile technologies in the healthcare workplace were articulated. The findings pointed to the significance of mobile devices as learning tools for RNs’ informal learning for construction of knowledge and meaning-making to inform professional development and continuing competence. / 2013-01

A Estratégia Saúde da Família (ESF), fundada nos referenciais da Atenção Primária à Saúde (APS) e sustentada pela Política Nacional de Atenção Básica orgânica e sistemicamente endossada pelos princípios do Sistema Único de Saúde (SUS) , se apresenta como modelo estruturante das Redes de Atenção à Saúde no Brasil. Qualificar a Atenção Básica em Saúde (ABS) e, por conseguinte, a ESF, neste contexto de grande complexidade, é propósito do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB), concebido pelo Ministério da Saúde, enquanto proposta de avaliação e indução de mudanças na gestão, gestão do cuidado e cuidado nos quais se encontram envolvidas Equipes de Saúde da Família (EQSFs) e gestão da ESF. Pouco estudos, focados em análises de experiências de implantação e/ou avaliação de resultados do PMAQ, retratando realidades municipais, têm sido relatados na literatura do campo; contudo, tendo em vista a inexistência de trabalhos publicados, esta pesquisa teve como objetivo analisar avaliações e percepções de trabalhadores de EQSFs e gestores da ESF em relação à concepção, implantação e operacionalização do PMAQ, com seus possíveis impactos, tomadas a partir do referencial de experiências dos sujeitos, no contexto de trabalho. Neste sentido, realizou-se pesquisa de abordagem mista, delineada por estudo de levantamento e grupo focal, com vistas a explorar, descrever e compreender o cenário experienciado por equipes e gestores, no contexto do PMAQ-AB, em municípios da região norte do Estado de São Paulo - Brasil. Referida pesquisa apontou para um perfil de profissionais atuantes em faixa etária significantemente jovem, com diminuto tempo de formado e de experiência na ESF, com baixa vinculação à equipe, num contexto de gestão ainda fragilizado pelas significativas instabilidades na composição das EQSFs, além da rotatividade de profissionais e precariedade de vínculos particularmente em relação aos médicos. Observou-se, em geral, elevado grau de aceitação dos sujeitos para com as propostas de avaliação do PMAQ-AB, embora tenha sido evidenciado significativo contingente de profissionais que desconheciam as diretrizes gerais e indicadores do programa, particularmente os médicos. Evidenciou-se significativo percentual de demandas relacionadas à qualificação sobretudo de enfermeiros , com razoável grau de discordância, por parte dos gestores da ESF, quanto à priorização de determinadas demandas, quando confrontadas com as indicadas pelos profissionais das EQSFs. Também, observaram-se inconsistências no processo de incorporação/implantação de ferramentas e programas estratégicos em diversas áreas de domínio da ESF e em relação ao PMAQ-AB , com variados e significativos graus de discordâncias, em relação aos mesmos, entre profissionais e estes e gestores. Neste contexto foram apontadas, em elevado grau, fragilidades relacionadas ao fazer cotidiano das EQSFs que, ordinariamente, comprometem o processo de trabalho. Em que pesem as observações empíricas reveladas, trabalhadores das EQSFs e das gerências da ESF, contraditoriamente, se autoavaliaram de forma razoavelmente satisfatória, em relação ao acesso e cuidado ofertados pelas equipes. A experiência com o PMAQ foi considerada satisfatória pelos trabalhadores das EQSFs, a despeito das críticas e restrições quanto a concepção, implantação, operacionalização e avaliações efetivadas pelo programa, em aspectos que se mostravam dependentes da instância federal e/ou da gestão municipal. Reiteram-se os desafios colocados para a gestão do trabalho e da educação na saúde, em relação aos trabalhadores atuantes na ESF, e reconhecem-se o momento oportuno, o potencial técnico e o caráter complexo e multidimensional que cercam o PMAQ, em sua necessária abrangência nacional; contudo, julga-se premente promover realinhamentos em sua concepção e operacionalização, de modo que seus componentes de indução e avaliação possam contemplar as demandas postas na cotidianidade da APS/ABS no Brasil, a fim de qualificar o acesso e o cuidado na ESF. / The Family Health Strategy (FHS), founded in the system of reference of the Primary Health Care (PHC) and supported by the Brazilian Primary Care Policy organic and systemically endorsed by the principles of the National Unified Health System (SUS) is presented as the model that structures the network of Brazilian Healthcare. Qualification of PHC, and as consequence, of FHS, in this context of great complexity, is the purpose of the National Program for Improving Access and Quality of Primary Care (PMAQ), ideated by the Ministry of Health as an evaluation proposal and induction of changes to improvement the administrative and care management, as well as of the quality of healthcare, provided by the Family Health Teams (FHT) and FHS managers. Few studies, focused on implementation experiences and/or evaluations of PMAQs initial results, have been reported in the literature, most portraying local realities. Given the scarcity of publications, this research aimed to analyse the evaluations and perceptions of FHTs workers and FHS managers about the design, implementation and execution of PMAQ, and its possible impact on the qualification of the local labor process, in the perspective of the subjects, on work environment. In this sense, it was proposed a mixed approach of research, outlined by survey studies and focus group to explore, describe and comprehend the scenario experienced by teams and managers, in the context of PMAQ, in municipalities in the north region of state of São Paulo - Brazil. The research pointed to a professional profile significantly young, with short time of graduation and work experience in the FHS. Many professionals have demonstrated low attachment to the FHT, in a context influenced by significant instability, high turnover among professionals and precariousness of the labor contract, mainly for the physicians. In general, there was high degree of acceptance to PMAQ\'s proposals, although a significant number of professionals did not know the general guidelines and the basic indicators of the program, particularly doctors. There was a high degree of demands related to professional qualification, particularly by the nurses, with a reasonable degree of disagreement of the managers in relation to such demands, when compared to the indicated by family health teams professionals. Also, observed it inconsistencies in the process of incorporation and deployment of tools and strategic programs, in various areas of the field of FHS and domains evaluation of the PMAQ, with variable degrees of significant discrepancies in assessments of this process by professionals and managers. In this context, weaknesses related to the real practices were identified in high degree by professionals, which may compromise the work process . Notwithstanding the empirical observations pointed out, FHTs workers and FHS\'s managers, contradictorily, considered, in a self-assessment, the access and care offered by the teams as reasonably satisfactory. The experience with PMAQ was considered satisfactory by FHT members, despite criticism and restrictions on the design, implementation, operation and evaluation models provided by the program. Emphasis is put on some challenges to be faced to the adequate management of labor force and of education of health profession in the FHS, although it is also recognized that PMAQ experience provide a unique opportunity to evaluate the complex and multidimensional nature of PHC in studied region and nationwide. However, it is deemed urgent promote realignments in the PMAQ\'s design and operation, so that their induction and assessment components can contemplate the daily life of PHC workers demands in Brazil, in order to qualify the access and care in the FHS.

<p>The construction industry contributes significantly to the GDP of the United States, attributing to its growth at an unprecedented rate. Efficient planning on all stages of construction is the only way to combat dynamic obstructions and deliver projects on time. The first element involved in the planning phase deals with the layout of the Construction Site. It significantly regulates the pace at which construction operations function and directly affects the time, cost, and safety linked to the successful delivery of the target project. Hence, it is paramount to ensure that every component of the construction site maneuvers with the utmost productivity. One such equipment that occupies significant attention while carrying out the CSLP process is Tower Crane. Tower crane optimization is pivotal to ensure proper lifting and handling of materials, and warrant conflict-free work zones. This research, therefore, aims to optimize its position by maximizing the lift ability. To achieve the goals, Generative Design- a paradigm that integrates the constructive features of mathematical and visual optimization techniques, is used to develop a relatively comprehensible prototype. The first part of the research, thus, utilized Generative Design on two construction sites- one from the United States and one from India. After implementing the visual programming algorithm, an improvement of 40% was warranted in the lift score. A pool of potential alternatives was explored and supplemented by the trade-off illustrations. The concept of trade-off was substantiated by allowing a framework for prioritization of lift cycles, and facilitating a holistic decision-making process. To evaluate the usability, 12 participants were chosen based on their previous experience with tower crane operations. The participants witnessed a live demonstration of the algorithm, answered a Likert scale questionnaire, and appeared for an open-ended interview to provide feedback about the proposed Generative Design technique. After carrying out narrative analysis for the usability aspect- it has been unanimously observed that the technique has extreme efficiency of usage and can evidently prevent the occurrence of errors. The study concludes by providing recommendations to augment the significance and usability of Generative Design for tower crane position optimization. </p><br>

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.

Abstracts in English, Afrikaans and Zulu / This integrated study examined the nexus between the theory and the practice of strategy. Given the nature of modern-day public and private business enterprises in South Africa and the rest of the world, management education should equip practitioners with knowledge and skills suitable for complex, dynamic, eclectic, and uncertain practice contexts. That is, management education should be playing a critical role in shaping and guiding the business community in the ‘management’ and ‘administration’ of business in the country. However, criticisms in management literature suggest that management education is not relevant to practice. Despite such criticisms, there is relatively little empirical evidence in the country on practitioners’ experiences with the relevance to practice of their management education in general and strategy education in particular. To this end, this study set out to develop a better understanding of the dynamic and nuanced interplay between strategy theory and strategy practice through a survey and interviews with selected business school alumni in professional practice. Statistical analyses were performed on quantitative data, while thematic analysis was performed on qualitative data. The survey findings of the study reveal a positive and significant relationship between academic rigour and practical relevance of strategy theory, while phenomenological findings reveal that practical relevance of strategy theory is largely constructed by practitioners according to their contextual demands. Strategic management appears to rest on the dynamic interplay between strategy theory and strategy practice within a complex and eclectic management environment. / In hierdie geïntegreerde studie is die verband tussen strategieteorie en -praktyk ondersoek. Bestuursopleiding moet praktisyns toerus met die kennis en vaardighede wat die komplekse, dinamiese, eklektiese en wisselvallige omgewing in openbare en private maatskappye in Suid-Afrika en elders in die wêreld vereis. Met ander woorde, bestuursopleiding moet leiding gee in die bestuur en administrasie van maatskappye in die land. In die literatuur word aangevoer dat bestuursopleiding irrelevant is. Daar is egter min empiriese bewys dat bestuursopleiding, en strategieopleiding in die besonder, ontoepaslik is. Om hierdie rede is ‘n studie van die dinamiese en genuanseerde wisselwerking tussen strategieteorie en -praktyk onderneem. Onderhoude is gevoer met en ‘n opname is gedoen onder sakeskoolalumni wat in die praktyk staan. ‘n Statistiese ontleding is van die kwantitatiewe data en ‘n tematiese ontleding is van die kwalitatiewe data gedoen. Volgens die opnamebevindings is daar ‘n positiewe en beduidende verband tussen akademiese stiptheid en die praktiese relevansie van strategieteorie. Uit die fenomenologiese bevindings blyk dat die praktiese relevansie van strategieteorie grotendeels deur praktisyns volgens die eise van hulle konteks bepaal word. Blykbaar berus strategiese bestuur op die dinamiese wisselwerking tussen strategieteorie en strategiepraktyk in ‘n komplekse en eklektiese bestuursomgewing. / Lolu cwaningo oludidiyelwe, lwacubungula futhi lwabukisisa ukuxhumana okukhona phakathi kwethiyori yeqhingasu kanye nenkambiso yokwenziwa nokufezekiswa kweqhingasu ngendlela ephathekayo nebonakalayo. Uma kubhekwa uhlobo nobunjalo bamabhizinisi, ezikhathi zanamuhla, angaphansi kwesandla sikahulumeni kanye nalawo asezandleni zabantu abazimele eNingizimu Afrika kanye nasemhlabeni wonke jikelele, imfundo yezokuphatha kumele ihlomise ongoti bomsebenzi ngolwazi namakhono adingekayo ezimweni zokusebenza ezinobunkimbinkimbi, ezinomdlandla, eziyingxubevange futhi ezinokungaqiniseki kanye nongabazane. Okusho ukuthi imfundo yezokuphatha kumele idlale indima esemqoka ekubumbeni nasekuholeni umphakathi wabamabhizinisi ekuphathweni nasekulawulweni kwamabhizinisi ezweni. Kodwa-ke, ukugxekwa okuvelayo emibhalweni yezokuphatha kubonisa ukuthi imfundo yezokuphatha, ikakhulukazi imfundo yamaqhingasu, ayinakho ukufanelana nokuhambelana nenqubo-nkambiso yokwenziwa komsebenzi ngendlela ebonakalayo nephathekayo. Lolu cwaningo luhlose ukuthuthukisa nokwakha ukuqonda okungcono maqondana nobuhlobo nokuxhumana okunomdlandla kepha okufihlakele okuphakathi kwethiyori yeqhingasu kanye nenkambiso yokwenziwa nokufezekiswa kweqhingasu ngendlela ephathekayo nebonakalayo, ngokusebenzisa inhlolovo kanye nama-inthaviyu (izingxoxo) nabantu abakhethiweyo abafunde bagogoda ezikoleni zebhizinisi abenza umsebenzi wobungoti. Kwenziwe uhlaziyo lwemininingo egxile ebuningini (quantitative data), kanti futhi kusenjalo kwenziwe nohlaziyo-ngqikithi lwemininingo egxile kukhwalithi (qualitative data). Imiphumela eyatholwa kwinhlolovo yocwaningo ibonisa ubukhona bobudlelwane obuhle futhi obuphawulekayo impela phakathi kwamazinga-bunyoninco ezemfundo kanye nokufaneleka okuphathekayo nokubonakalayo kwethiyori yeqhingasu, kanti futhi ngakolunye uhlangothi imiphumela yocwaningo ephathelene nezigameko nezimo abadlule kuzona ongoti bomsebenzi ibonisa ukuthi ukufaneleka okuphathekayo nokubonakalayo kwethiyori yeqhingasu kuyinto eyakhiwa ikakhulukazi ngongoti bomsebenzi ngokususela ezidingweni eziphathelene nesimo esithile. Ukuphatha ngokusebenzisa amaqhinga namasu athile kubonakala kuncike ekuxhumaneni okunomdlandla phakathi kwethiyori yeqhingasu kanye nenkambiso yokwenziwa nokufezekiswa kweqhingasu ngendlela ephathekayo nebonakalayo ngaphansi kwesimo sokuphatha esiyinkimbinkimbi futhi esiyingxubevange. / Business Management / M. Com. (Business Management)