This dissertation focuses on shared care of elderly in their homes in the municipal district of Prague 7. The goal was an understanding of the context and organization of the care, as well as how the informal care providers perceive their current situation and what is their idea of the optimal form of the care. Data for the analysis were gathered through means of semi-structured surveys with answers from twenty respondents who are informal care providers. Results are indicating that at the moment, the state of home shared care for the elderly is not fully satisfactory. Therefore, the conclusion includes recommendations which could contribute to the improvement of the current situation.

<p>This research examined the barriers and facilitators involved in the development and sustainability of palliative care teams using a shared care model. Shared care is established when interdisciplinary specialist palliative care teams (usually comprised of a palliative care physician, an advanced practice nurse, a psychosocial spiritual advisor, a bereavement counselor, a case manager and an administrator) form partnerships with primary care providers (usually frontline family physicians and home care nurses) to support the complex needs of terminally-ill patients and their family members in the home setting. Palliative care teams overcome gaps in the current health care system, such as: lack of palliative care specialists; poor coordination and integration of care, and; a health care workforce with insufficient training in palliative care. This type of service delivery model is common in medical specialties such as mental health and obstetrics, and various forms of palliative shared care have been implemented in other countries such as the US, Australia, UK, Italy and Spain, where it has been shown to be cost-effective. There are few palliative care teams working in a shared care model in Canada; this provided the impetus to investigate the process of how this integrated approach is developed and sustained within the context of specific populations and geographies. A longitudinal case study in a Local Health Integration Network (LHIN) area in Southern Ontario, comprised of urban and rural communities, was conducted in order to evaluate barriers and facilitators in using a shared care model from the perspective of team members, key-informants and stakeholders. The evaluation of barriers and facilitators informed recommendations to guide the sustainability of palliative care teams working in a shared care model.</p> / Doctor of Philosophy (PhD)

Au Québec, face à la prévalence élevée des problèmes de santé mentale et à la pénurie de médecins psychiatres, le médecin omnipraticien (MO) occupe une place primordiale dans la prise en charge et le suivi des soins de santé mentale. Dans le contexte de réforme du système de santé mentale axée sur un renforcement de la collaboration entre les MO, les psychiatres et les équipes de santé mentale, notre étude vise à mieux comprendre la pratique clinique et la pratique collaborative développée par les MO, leur appréciation des outils de travail et de la qualité des services de santé mentale, dans le but d’améliorer la complémentarité des soins au niveau primaire. Cette étude transversale impliquait 1415 MO de neuf territoires de centre de santé et de services sociaux (CSSS) du Québec. L’échantillon final était constitué de 398 MO représentatifs de lieux de pratique diversifiés et le taux de réponse était de 41%. Nos résultats mettent en évidence que la pratique clinique et la pratique collaborative des MO diffère selon le degré de gravité des problèmes de santé mentale des patients rencontrés, c’est à dire, trouble transitoire/modéré de santé mentale (TTM.SM) ou trouble grave de santé mentale (TG.SM), et que les MO sont favorables au fait de travailler en collaboration avec les autres professionnels de la santé mentale. Ainsi, il apparaît important de renforcer l’accessibilité des MO aux professionnels de la santé mentale, particulièrement les psychiatres, et de les informer de l’existence des autres acteurs en santé mentale sur leur territoire, pour renforcer la collaboration et la qualité des soins primaires de santé mentale. / In Quebec, considering the high prevalence rate of mental health disorder and the scarcity of psychiatrists, general practitioners (GPs) hold an importante role in the management and the follow-up of mental health care. In the context of the ongoing mental health system reform aimed at reinforcing collaboration between GPs, psychiatrists and mental health teams, our objectives are to have a better understanding of clinical practice and collaborative practice, developed by GP and their assessment of working tools and quality of mental health services, in order to improve the complementary of primary mental health care. The study was carried out using a cross-sectional design, involving 1415 GPs from nine Quebec territories. The final sample included 398 GPs, representing diverse practice places, and the response rate was 41%. The study highlighted that GPs have different clinical and collaboration practices according to the seriousness of mental disorder patients seen, i.e. transient and moderate mental disorder (TMMD) or serious and permanent mental disorder (SPMD); and GPs strongly support care coordination efforts with all mental health professionals. Therefore, it appears important to reinforce GP accessibility to other mental health professionals, particularly psychiatrists, and to inform them on the presence of all actors in mental health in their territory, in order to develop collaboration and quality of primary mental healthcare.

This thesis deals with the security system care services and other related services, including informal care for seniors in the Czech Republic. The aim of the work is to evaluate, describe and offer a closer understanding of nursing as a basic social care service in connection with the principle of shared care in a natural home environment for seniors as the ideal form of care for the elderly at present and due to the demographic development in the future. The thesis is divided into a theoretical and a practical part. The theoretical part covers three main topics: day care service system in the Czech Republic, seniors as a target group of caring and sharing and municipalities and their role in caring for the elderly. The practical part is devoted to the research, which focuses on the relationship of care services and communities from the perspective of potential service users, ie. the elderly. A combination of qualitative and quantitative research methods is used in the research and interprets the results of the survey conducted among the elderly in three senior clubs in Prague 17. The research complements the findings mentioned in the theoretical part.

Made available in DSpace on 2016-04-26T20:23:35Z (GMT). No. of bitstreams: 1 Anna de Moraes Salles Beraldo.pdf: 2039912 bytes, checksum: 20f021550d206330cb65a5b6167f0961 (MD5) Previous issue date: 2015-03-12 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / In the context of recent decades, it was observed that the residence order was commonly given to the mother, and to the father only in exceptional cases. To the male parent it usually remained the right to biweekly "visits" and the child s financial support. This resulted in disencouraging the strengthening of the paternal-filial relationship. Thus, the aim of the thesis was to question whether the judicial decisions concerning the child arrangements order would effectively meet the child's best interest. Moreover, it questioned if these decisions are able to break the conflictual dynamics. The hypothesis is that in matters relating to family law and, more precisely, in the conflicts involving children and teenagers, the court decision is not the most appropriate way. The choice of the subject is justified given that currently the parental roles are no longer so strictly defined, with the women entering the labour market and, in parallel, the father's search for a more active role in their children's lives. Therefore, given the breakdown of the relationship of the parents, it must be chosen a family arrangement, covering the constitutional principles of the best interests of the child and responsible parenthood. This thesis was based in legislative, doctrinal and jurisprudential analysis, as well as a substantial part of its research conducted in England, where significant changes relating to parental responsibility have occured in recent years, which may be relevant to Brazil. The results of this study demonstrate the importance of using other means, not only the court for the maintenance and strengthening of emotional bonds due to the transformation of that nuclear family. In this sense, conflict mediation and collaborative practice can greatly assist parents in such troubled times that is the disruption of the relationship. This is another approach that seeks to focus on the responsibility of parents and common interests, rather than on the logic of seeking to blame the responsible for the relationship breakdown. Moreover, the mere enactment of laws on child arrangements order without a systemic change that involves society and the State will not provide representative advances / Na conjuntura das últimas décadas, observava-se que a guarda dos filhos era comumente determinada à mãe e ao pai somente em casos excepcionais. Ao genitor masculino cabia o direito quinzenal de visitas e o pagamento da pensão alimentícia. Isso acabava desestimulando o fortalecimento da relação paterno-filial. Diante disso, o objetivo da tese foi questionar se as decisões judiciais relativas à guarda dos filhos vão, efetivamente, ao encontro do melhor interesse da criança. E mais, se essas decisões são capazes de romper a dinâmica de conflito. A hipótese é que nas questões relativas ao Direito de Família e, mais precisamente, nos conflitos envolvendo crianças e adolescentes, a sentença judicial não é o caminho mais adequado. Justifica-se a escolha do tema, tendo em vista que atualmente os papéis parentais já não estão mais tão definidos, havendo a inserção da mulher no mercado de trabalho e, paralelamente, a busca do pai por uma participação mais ativa na vida de seus filhos. Por isso, diante da ruptura do relacionamento dos genitores, é preciso escolher um arranjo familiar que contemple os princípios constitucionais do melhor interesse da criança e da paternidade responsável. Essa tese contou com a apreciação normativa, doutrinária e jurisprudencial, além de pesquisas realizadas na Inglaterra, onde mudanças expressivas relativas à autoridade parental ocorreram nos últimos anos, as quais, este trabalho argumenta, podem ser relevantes para o Brasil. Os resultados desse estudo demonstram a importância da utilização de outros meios, que não somente o judicial, para a manutenção e fortalecimento dos laços afetivos diante da transformação do núcleo familiar. Nesse sentido, a mediação de conflitos e as práticas colaborativas podem auxiliar sobremaneira os genitores no período tão conturbado que é o rompimento do relacionamento. Trata-se de uma outra abordagem que procura focar na responsabilização dos pais e nos interesses comuns, ao invés da lógica de procurar culpados pelo término do relacionamento. Ademais, a simples promulgação de leis sobre a guarda dos filhos, sem uma mudança sistêmica que passe pela sociedade e pelo Estado, não proporcionará avanços representativos

Au Québec, face à la prévalence élevée des problèmes de santé mentale et à la pénurie de médecins psychiatres, le médecin omnipraticien (MO) occupe une place primordiale dans la prise en charge et le suivi des soins de santé mentale. Dans le contexte de réforme du système de santé mentale axée sur un renforcement de la collaboration entre les MO, les psychiatres et les équipes de santé mentale, notre étude vise à mieux comprendre la pratique clinique et la pratique collaborative développée par les MO, leur appréciation des outils de travail et de la qualité des services de santé mentale, dans le but d’améliorer la complémentarité des soins au niveau primaire. Cette étude transversale impliquait 1415 MO de neuf territoires de centre de santé et de services sociaux (CSSS) du Québec. L’échantillon final était constitué de 398 MO représentatifs de lieux de pratique diversifiés et le taux de réponse était de 41%. Nos résultats mettent en évidence que la pratique clinique et la pratique collaborative des MO diffère selon le degré de gravité des problèmes de santé mentale des patients rencontrés, c’est à dire, trouble transitoire/modéré de santé mentale (TTM.SM) ou trouble grave de santé mentale (TG.SM), et que les MO sont favorables au fait de travailler en collaboration avec les autres professionnels de la santé mentale. Ainsi, il apparaît important de renforcer l’accessibilité des MO aux professionnels de la santé mentale, particulièrement les psychiatres, et de les informer de l’existence des autres acteurs en santé mentale sur leur territoire, pour renforcer la collaboration et la qualité des soins primaires de santé mentale. / In Quebec, considering the high prevalence rate of mental health disorder and the scarcity of psychiatrists, general practitioners (GPs) hold an importante role in the management and the follow-up of mental health care. In the context of the ongoing mental health system reform aimed at reinforcing collaboration between GPs, psychiatrists and mental health teams, our objectives are to have a better understanding of clinical practice and collaborative practice, developed by GP and their assessment of working tools and quality of mental health services, in order to improve the complementary of primary mental health care. The study was carried out using a cross-sectional design, involving 1415 GPs from nine Quebec territories. The final sample included 398 GPs, representing diverse practice places, and the response rate was 41%. The study highlighted that GPs have different clinical and collaboration practices according to the seriousness of mental disorder patients seen, i.e. transient and moderate mental disorder (TMMD) or serious and permanent mental disorder (SPMD); and GPs strongly support care coordination efforts with all mental health professionals. Therefore, it appears important to reinforce GP accessibility to other mental health professionals, particularly psychiatrists, and to inform them on the presence of all actors in mental health in their territory, in order to develop collaboration and quality of primary mental healthcare.

Modernisierungstheoretischen Annahmen zufolge sind soziale Beziehungen in Gesellschaften der zweiten Moderne keine gegebenen Größen mehr, sondern Gegenstand von Aushandlungsprozessen, handlungsleitende gesellschaftliche Wissensvorräte erodieren und das bürgerliche Kernfamilienmodell sieht sich zunehmend soziokulturell legitimierten Alternativen gegenüber. Zahlreiche Wandlungstendenzen von Familie lassen sich ablesen, unter diesen die Zunahme von Fortsetzungsfamilien nach Trennung und Scheidung und im Zuge dessen die Aufweichung der monolokalen Haushaltsbindung von Familie. Diese Dynamiken werfen die Frage nach der Ausgestaltung der Herstellungsleistungen von Familie auf, die mit Doing und Displaying Family im Rahmen einer praxistheoretischen Wende innerhalb der Familiensoziologie bereits angeschnitten sind. Hier setzt das Forschungsinteresse der vorliegenden Arbeit an: (1) Bereits vorliegende empirische Erkenntnisse und theoretisch-konzeptuelle Überlegungen maßgeblicher Forschungsfelder werden zusammengeführt und diskutiert. (2) Aus praxeologisch-wissenssoziologischer Perspektive richtet die Empirie der vorliegenden Studie ihre Aufmerksamkeit auf die Rekonstruktion familialer Identitätspolitiken und der Herstellung von Gemeinschaft im sogenannten paritätischen Wechselmodell, in dem Kinder regelmäßig und zu gleichen Teilen an den Orten der getrenntlebenden Eltern wohnen. Mit den Befunden kann gezeigt werden, dass eine von Eltern und Kindern geteilte Differenzthese zentraler Ankerpunkt für die Identitätskonstruktionen der untersuchten Familien bildet. Zwei Familienkerne stehen sich nach der Relokalisierung eines Elternpaares im Zuge der Auflösung ihrer Zweierbeziehung als zwei Familienwirklichkeiten mit je unterschiedlichen Behauptungen sozialer Ordnung gegenüber. In diese müssen sich die Kinder aktiv einpassen bzw. regelmäßig durch die monolokalen Familienmitglieder re-integriert werden. Die Behauptung und Stabilisierung der lokalen Ordnungen wird über fünf Formen physischer und symbolischer Schließung als Teil familialer Identitätspolitiken abgesichert: (1) kommunikativ, (2) räumlich, (3) personell, (4) materiell und (5) habituell. Zwischen materieller und habitueller Schließung zu verorten, wurde das Olfaktorische als Medium der Vergemeinschaftung identifiziert. Das empirische Material eröffnet zudem einen Blick auf die Normalisierungsstrategien der untersuchten Eltern und Kinder im Umgang mit extern herangetragenen Markierungen von Andersartigkeit, Abweichungsvermutungen und der Normalisierungsmacht des bürgerlichen Kernfamilienmodells. Der Studie liegt ein qualitatives multi-method Design zugrunde. Der Materialkorpus speist sich aus problemzentriert-narrativen Interviews, Gruppendiskussionen, ego-zentrierten Netzwerkkarten sowie fotografischen Alltagsdokumentationen der aktiv multilokal lebenden Kinder aus insgesamt fünf Familienensembles. Die Materialien wurden auf Grundlage der dokumentarischen Methode der Text- und Bildinterpretation analysiert. / According to modernization theory social relationships in second modernity are no longer a given quantity but are subject to negotiation processes. Guiding social knowledge is eroding and the nuclear family model is increasingly confronted with sociocultural legitimate alternatives. There are numerous transformations of the family observable – among these increasing numbers of families after separation and divorce, and in consequence the dissolution of the monolocal household family in favour of multi-local family arrangements. These dynamics raise the question of Doing and Displaying Family practices, addressed within the framework of a practice turn within family sociology. Main aim of this paper is (1) to discuss existing empirical findings and theoretical/conceptual considerations of relevant research fields, and (2) by employing a praxeological approach, to focus on identity politics as a means to establish and stabilize family identity and belonging within shared residence arrangements where children regularly shuttle between their separated parent’s households. Data suggest that passive multi-locally living parents and their partners oscillate between referring to the other household on behalf of the active multi-locally living children to create a cross-spatial sense of commonness and belonging and at the same time applying territorialisation practices to promote a place-bound social order and family identity. This includes processes of communicative, spatial, personal, material, and habitual closure. Moreover, in a way between material and habitual closure, the olfactory was identified as a medium of identification and distinction. However, children face the challenge to merge both residential places and family nuclei into a coherent whole and simultaneously need to distinguish between different family sociotopes. Moreover, the empirical material provides insights into the normalization strategies of parents and children in dealing with externally applied difference markers, deviance attributions and the normalization power of the nuclear family model. The basis of the empirical research is a multiple methods comprising qualitative research design. Narrative interviews, group discussions and visual methods were employed. Data are analysed by means of the documentary method for text and picture interpretation within a qualitative reconstructive approach.

Modernisierungstheoretischen Annahmen zufolge sind soziale Beziehungen in Gesellschaften der zweiten Moderne keine gegebenen Größen mehr, sondern Gegenstand von Aushandlungsprozessen, handlungsleitende gesellschaftliche Wissensvorräte erodieren und das bürgerliche Kernfamilienmodell sieht sich zunehmend soziokulturell legitimierten Alternativen gegenüber. Zahlreiche Wandlungstendenzen von Familie lassen sich ablesen, unter diesen die Zunahme von Fortsetzungsfamilien nach Trennung und Scheidung und im Zuge dessen die Aufweichung der monolokalen Haushaltsbindung von Familie. Diese Dynamiken werfen die Frage nach der Ausgestaltung der Herstellungsleistungen von Familie auf, die mit Doing und Displaying Family im Rahmen einer praxistheoretischen Wende innerhalb der Familiensoziologie bereits angeschnitten sind. Hier setzt das Forschungsinteresse der vorliegenden Arbeit an: (1) Bereits vorliegende empirische Erkenntnisse und theoretisch-konzeptuelle Überlegungen maßgeblicher Forschungsfelder werden zusammengeführt und diskutiert. (2) Aus praxeologisch-wissenssoziologischer Perspektive richtet die Empirie der vorliegenden Studie ihre Aufmerksamkeit auf die Rekonstruktion familialer Identitätspolitiken und der Herstellung von Gemeinschaft im sogenannten paritätischen Wechselmodell, in dem Kinder regelmäßig und zu gleichen Teilen an den Orten der getrenntlebenden Eltern wohnen. Mit den Befunden kann gezeigt werden, dass eine von Eltern und Kindern geteilte Differenzthese zentraler Ankerpunkt für die Identitätskonstruktionen der untersuchten Familien bildet. Zwei Familienkerne stehen sich nach der Relokalisierung eines Elternpaares im Zuge der Auflösung ihrer Zweierbeziehung als zwei Familienwirklichkeiten mit je unterschiedlichen Behauptungen sozialer Ordnung gegenüber. In diese müssen sich die Kinder aktiv einpassen bzw. regelmäßig durch die monolokalen Familienmitglieder re-integriert werden. Die Behauptung und Stabilisierung der lokalen Ordnungen wird über fünf Formen physischer und symbolischer Schließung als Teil familialer Identitätspolitiken abgesichert: (1) kommunikativ, (2) räumlich, (3) personell, (4) materiell und (5) habituell. Zwischen materieller und habitueller Schließung zu verorten, wurde das Olfaktorische als Medium der Vergemeinschaftung identifiziert. Das empirische Material eröffnet zudem einen Blick auf die Normalisierungsstrategien der untersuchten Eltern und Kinder im Umgang mit extern herangetragenen Markierungen von Andersartigkeit, Abweichungsvermutungen und der Normalisierungsmacht des bürgerlichen Kernfamilienmodells. Der Studie liegt ein qualitatives multi-method Design zugrunde. Der Materialkorpus speist sich aus problemzentriert-narrativen Interviews, Gruppendiskussionen, ego-zentrierten Netzwerkkarten sowie fotografischen Alltagsdokumentationen der aktiv multilokal lebenden Kinder aus insgesamt fünf Familienensembles. Die Materialien wurden auf Grundlage der dokumentarischen Methode der Text- und Bildinterpretation analysiert. / According to modernization theory social relationships in second modernity are no longer a given quantity but are subject to negotiation processes. Guiding social knowledge is eroding and the nuclear family model is increasingly confronted with sociocultural legitimate alternatives. There are numerous transformations of the family observable – among these increasing numbers of families after separation and divorce, and in consequence the dissolution of the monolocal household family in favour of multi-local family arrangements. These dynamics raise the question of Doing and Displaying Family practices, addressed within the framework of a practice turn within family sociology. Main aim of this paper is (1) to discuss existing empirical findings and theoretical/conceptual considerations of relevant research fields, and (2) by employing a praxeological approach, to focus on identity politics as a means to establish and stabilize family identity and belonging within shared residence arrangements where children regularly shuttle between their separated parent’s households. Data suggest that passive multi-locally living parents and their partners oscillate between referring to the other household on behalf of the active multi-locally living children to create a cross-spatial sense of commonness and belonging and at the same time applying territorialisation practices to promote a place-bound social order and family identity. This includes processes of communicative, spatial, personal, material, and habitual closure. Moreover, in a way between material and habitual closure, the olfactory was identified as a medium of identification and distinction. However, children face the challenge to merge both residential places and family nuclei into a coherent whole and simultaneously need to distinguish between different family sociotopes. Moreover, the empirical material provides insights into the normalization strategies of parents and children in dealing with externally applied difference markers, deviance attributions and the normalization power of the nuclear family model. The basis of the empirical research is a multiple methods comprising qualitative research design. Narrative interviews, group discussions and visual methods were employed. Data are analysed by means of the documentary method for text and picture interpretation within a qualitative reconstructive approach.