A auto-estima da criança que sofre violência física pela família

This research investigates the self-esteem of children who suffered physical violence by family members. Seven children took part in the research: three boys and four girls, aged between six and twelve years old. The analysis were done from the constructed data obtained from: semi-structured interview, activities about human feelings, activities that included facial expressions, unfinished phrases, Pinocchio s story, a drawing of a family and a drawing of their own family. Data were analyzed from the Content Analysis. The Thematic Units were: violence, intrafamily violence, and self-esteem. The synthesis of the categories studied evidenced that the physical violence and the psychological violence present in the lives of children affect the positive development of their self-concept and, consequently, of their self-esteem. Among the results, we emphasize some negative feelings that are present in children s lives such as fear, a sense of guilt, and sadness, arising out of the situations of violence they have experienced

Os significados de ludoterapia para as protagonistas do processo: crianças em atendimento

The ludic therapy in a Phenomenological-Existential perspective is conceived as a psychotherapeutic process in which, the listening and talking, mediated by playing activities, allow the child to deal with their grief/suffering. This study is based on the need to broaden the understanding of this modality of clinical intervention by emphasizing the speech of the protagonists in the process: children in therapy. The objective was to understand the ludic therapy from the children s perspective, knowing the meanings assigned to the therapeutic process, to the psychologist and to the involvement of the children in clinical consultations. The main ideas that underlie this research are presented in three theoretical chapters covering, respectively, the suffering of children and the demand for psychotherapy, the Phenomenological-Existential clinical psychology, and the psychotherapy for children, in Brazil, under this theoretical-methodological approach. The study was qualitative, on a phenomenological basis, and included six children as participants, aged between six and ten years, undergoing ludic therapy for at least six months, and referred by their own therapists. In the research s corpus construction, individual meetings were held and mediated by tools to support expressiveness (ludic and pictures/figures boxes), added by the storytelling of an incomplete story about a child s visit to the therapy session, and the request for the elaboration of a message to be passed to a child who will go to see a psychologist. The analysis of the data was based on a variant of the phenomenological method proposed by Amedeo Giorgi. The results reveal a lack of knowledge by the children about the psychologist s activities. Thus, the children develop fantasies about this intervention modality because of lack of information. These observations are consistent with the historical meanings assigned to clinical psychology, involving ideas of normality and guilt. The meanings associated with the motives for a referral to a psychologist highlight the conflict "be a problem versus having a problem" and an elitist conception of clinical psychology. Children understand the characteristics of the therapeutic process, such as the specifics of the therapist-client relationship and the notion of freedom. They also demonstrate remarkable pleasure in the therapeutic process. Finally, it was concluded that the meanings attributed to the ludic therapy by the children are consistent with that proposed in the literature about the children s psychotherapy process in the Phenomenological-Existential perspective. Moreover, the relevance of both the children s experience in the therapeutic setting and the meanings of these proceedings understood by the children are highlighted by the listening to the protagonists in the ludic therapeutic process. The comprehension of these aspects and their transference from the clients experience to the reflective field, promote advances in the understanding of child psychotherapy and indicate the need for further studies with children using this approach.

A experiência de depressão na contemporaneidade: uma compreensão fenomenológico-existencial

The depression is one of the most common forms of getting ill nowaday. Due to the increase in incidence of depression cases registered worldwide, this theme has been the subject of important studies, especially regarding the symptomatological description and biological etiology of the disease. This research had the objective to understand the unique experience of depression experienced by people who recognize themselves in depression, under the focus of existential phenomenology of Martin Heidegger. To reach the proposed objective, individuals narratives interviews were conducted with four participants, starting from the triggering question, "from your experience, how is for you to being depressed?". The survey revealed that depression affects the whole person and is related to stressful life contexts. Depression was narrated as an experience of disempowerment and lack of self esteem and personal worth. The collaborators of the research referred to the depression from sad, angry, bored and pessimistic mood. The time is experienced as a restriction to the projective opening towards the possibilities of being in which the future is seen as catastrophic and the past lived as debt and guilt. The corporeality, in depression is experienced through the weight, fatigue and pains for no reason. The space is lived from the notion of fall and collapse. We also realized the desire for isolation and avoidance of social contact. Suicide is desired and represents the end of the suffering in life. The depression has proved, still, very stigmatized, because it is discredited and misunderstood. The stigma also addressed to the experience of hospitalization and the unsuitability to the socially imposed standards of beauty, which generates enough suffering to the depressed person. The medication was described based on its positive effects, as a balance and suffering reducer, but also as a producer of dependence. Were also identified according to the collaborators, traces of selfdemand, ordenality and being-for-others, characteristic of typus melancholicus. This study contributes to an understanding of the depression that goes beyond the merely biological perspective and symptomatology of the pathology. The investigation of the depressive experience, through the lens of Heidegger's phenomenology, showed us the phenomenon of the depression in their singularity, complexity and multiple meanings, showing the close relationship between the formation of the depression and the context of personal and social life of the participants

O processo de readaptação funcional e suas implicações no gerenciamento em enfermagem

Hoje há maior interesse pelo trabalhador da saúde. A preocupação com o processo de readaptação funcional foi a proposta desta investigação. O objetivo foi compreender a vivência dos sujeitos nos processos de readaptação funcional, em uma instituição hospitalar pública. No estudo, qualitativo, foram realizadas entrevistas para apreensão da vivência do profissional de enfermagem quanto ao processo de readaptação funcional, analisadas utilizando a Análise de Conteúdo, proposta por Bardin. Os resultados evidenciam a problemática do processo de trabalho em enfermagem nas categorias organização do trabalho , trabalho em equipe , afastamento e readaptação funcional e gerenciamento da equipe , gerando sugestões para a melhoria dos processos de trabalho. O processo de readaptação funcional gera individual, profissional e socialmente sentimento de incompetência e culpa no trabalhador. Importantes reflexões e mudanças de atitude são urgentes e necessárias, subsidiando o gerenciamento da equipe que implicará em melhoria na assistência prestada à população.

Representação de gestantes tabagistas sobre o uso do cigarro: estudo realizado em hospital do interior paulista

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Dimensional analysis of burden in family caregivers of patients with obsessive-compulsive disorder

Aims: Obsessivecompulsive disorder (OCD) also generates emotional burden in the patient's family members, but no study has evaluated the specific dimensions of burden. The objectives were to evaluate the dimensions of the Zarit Burden Interview (ZBI) and possible correlates. Methods: This was a cross-sectional study involving 47 patients and 47 caregivers, using a sociodemographic questionnaire; the ZBI; the Self Reporting Questionnaire; the Family Accommodation Scale; and the YaleBrown ObsessiveCompulsive Scale. The ZBI factor analysis was conducted using Varimax Rotation. Results: Six factors were identified, explaining 74.2% of the total variance: factor 1, interference in the caregiver's personal life (36.6% of the variance); factor 2, perception of patient's dependence (10.8%); factor 3, feelings of irritation or intolerance (9.2%); factor 4, guilt (7.2%); factor 5, insecurity (5.6%); and factor 6, embarrassment (4.8%). The six ZBI factors were associated with greater OCD severity and with greater accommodation to the patient's symptoms, and factors 1, 2, 5 and 6 with caregiver's psychological morbidity. Caregiver's sex (female) was associated with factors 5 and 6, relationship with the patient (being a parent or son/daughter) with factor 5, higher educational level with factor 6, living with the patient with factor 3, worse self-evaluation of health with factors 1, 5 and 6, and occupational status (not working) with factors 1, 2, 5 and 6. Conclusion: The dimensions of burden identified indicate the most affected aspects of a caregiver's life and could guide the planning of more specific interventions. Thus, the caregiver could participate more effectively in the OCD patient's treatment, with a lower impact on his/her life.

Sentimentos e percepções de puérperas com relação à assistência prestada pelo serviço materno-infantil de um hospital universitário

OBJETIVOS: avaliar percepções e sentimentos de puérperas adultas e adolescentes, relacionados ao filho e a assistência materno-infantil, em hospital universitário de nível terciário. MÉTODOS: estudo transversal, envolvendo 180 puérperas, no Alojamento Conjunto (AC) e no Berçário Interno (BI) do Hospital das Clínicas da Faculdade de Medicina de Botucatu , entrevistadas no segundo e terceiro dia pós-parto e distribuídas em três grupos: adultas primíparas, adultas multíparas e adolescentes. Para comparação entre grupos e locais de internação utilizou-se o chi2 ou teste de Fisher. RESULTADOS: ultrasom obstétrico e cardiotocografia tiveram impacto positivo na emoção materna. Houve pouca diferença entre os grupos quanto aos sentimentos antes e após o parto, sendo felicidade, amor, responsabilidade, ansiedade e medo os mais freqüentes. A culpa predominou nas adolescentes do BI. As percepções relacionadas ao filho, a avaliação da assistência e equipe, não diferiram entre adultas e adolescentes. Nas duas enfermarias o relacionamento entre mães e cuidadores foi bom, as mães mostraram-se satisfeitas com a equipe e a assistência, mas o aleitamento materno foi pouco valorizado e poucas mães conheciam o médico. CONCLUSÕES: está ocorrendo um processo de humanização na assistência materno-infantil deste hospital universitário, mas alguns aspectos precisam ser melhorados, especialmente a valorização do aleitamento materno e a individualização no contato médico-paciente.

Tratamento do transtorno de pânico com terapia psicodramática de grupo

INTRODUÇÃO/OBJETIVOS: Há poucos trabalhos publicados sobre psicoterapia grupal para pacientes com transtorno de pânico (TP); além disso, esses estudos geralmente são restritos a abordagens cognitivo-comportamentais. O objetivo deste trabalho é relatar uma experiência de atendimento psicoterápico psicodramático grupal para portadores de TP, iniciada em 1996 na Faculdade de Medicina de Botucatu/Unesp, e discutir aspectos psicodinâmicos desse transtorno. MÉTODOS: Atende-se uma média de oito a dez pacientes em sessões mensais de duas horas de duração, nas quais se utilizam técnicas psicodramáticas. O uso associado de psicofármacos é a regra. A temática é aberta, centrando-se tanto em aspectos próprios do TP (sintomas mais comuns; peregrinação em serviços médicos até o diagnóstico; preocupações hipocondríacas; limitações e dependência; reações dos familiares; estratégias de exposição e enfrentamento; efeitos e reações dos medicamentos) quanto em problemas individuais específicos. RESULTADOS: A abordagem psicodramática favorece a identificação e a elaboração de aspectos psicodinâmicos. Entre estes, destacaram-se os sentimentos de desamparo e seus desdobramentos: insegurança; fragilidade e medo; raiva e culpa; sentimentos de desamor e rejeição; vergonha e inferioridade; isolamento e dificuldade de pedir ajuda; dificuldade de identificar e de expressar sentimentos - manifestados somaticamente -; e dificuldade de assumir o papel de cuidador e outras responsabilidades. CONCLUSÕES: Aspectos valiosos para o tratamento do TP, como apoio mútuo, companheirismo, confiança, modelo e estímulo, são favorecidos pelo contexto grupal homogêneo. O compartilhar de experiências e sofrimentos comuns propiciou rápida coesão e suporte grupal, melhora da capacidade de expressar sentimentos e da auto-estima e o aprimoramento de papéis sociais. Além da melhora dos sintomas, possibilitou-se a melhor compreensão e elaboração destes, que passam a ser integrados significativamente no contexto existencial.

Quadro clínico do transtorno obsessivo-compulsivo

Obsessive-compulsive disorder is a very heterogeneous condition, not always easy to be identified. Obsessions are intrusive thoughts, impulses or images that cause anxiety or other emotional discomfort, whereas compulsions are repetitive behaviors or mental acts voluntarily performed to counterbalance or minimize the discomfort, or magically prevent any feared events. The most common symptoms are contamination, aggressive, somatic and sexual obsessions and washing, checking, repeating, counting and ordering compulsions. Patients usually have multiple symptoms simultaneously, which often change over time. Although the insight is typically preserved, it varies among patients and also fluctuates in the same patient in different ocasions. The main features are: exacerbated appraisal of risks, pathological doubts and incompleteness, as well as excessive sense of responsibility and guilt and thought/action fusion. As patients frequently feel ashamed of their symptoms, they can be reticent about them. Consequently, it usually takes time till they get adequate treatment.

Tragedy on grade crossing: driver failure or systemic fragility?

In 2010, an accident occurred in Americana-SP, Brazil, involving two trains and one bus on a Grade Crossing, when 10 people died and 17 were injured including workers. This paper aims to analyze the accident using the Model of Analysis and Prevention of Work Accidents (MAPA). The method provides observation of work, interviews and analysis of documents to understand precedents of the event in the following stages: to understand the usual work from the involved people, the changes occurred in the system, the operation of barriers, managerial and organizational aspects. By the end, measures are suggested to avoid new occurrences. The accident took place at night in a site with insufficient lighting. The working conditions of bus drivers, train operators and watchmen are inadequate. There were only symbolic barriers (visual and acoustic signals) triggered manually by watchman upon train operator radio communication. The fragility of the barrier system associated to poor lighting and short time to trigger the signaling seem to play a critical role in the event. Contrary to the official report which resulted in guilt of the bus driver, the conclusion of the paper emphasizes the fragility of the safety system and the need of level crossing reproject.

Armadilhas cognitivas: o caso das omissões na gênese dos acidentes de trabalho

Neste artigo discute-se o tema das omissões na gênese de acidentes do trabalho, tendo como referência contribuições de James Reason. Os autores descrevem três acidentes de trabalho ocorridos em atividades de manutenção, e nos quais a omissão de passos na execução da atividade foi apontada como causa nas análises efetuadas pelas empresas, acarretando atribuição de culpa aos acidentados. Nos três casos, a análise efetuada pelos autores revelou que, na seqüência de passos da atividade havia presença simultânea de pelo menos quatro das características apontadas por Reason como geradoras de omissões, caracterizando as denominadas armadilhas cognitivas.

Transtorno mental: dificuldades enfrentadas pela família

Utilizando uma metodologia qualitativa (entrevistas abertas, desenho-estória e análise temática) identificamos e analisamos 4 categorias (descompasso temporal, culpa, conflitos e perdas) presentes no discurso de mães (e uma irmã) de pacientes psiquiátricos do Núcleo de Atenção Psicossocial (NAPS) de Ribeirão Preto/SP, e avaliamos sua importância conforme o objetivo de se entender a dinâmica da relação entre serviço de saúde mental, paciente psiquiátrico e sua família.

Aircraft accident in Brazil: Boeing vs. Legacy?

Air accidents represent a small proportion of the flights registered worldwide. Airplane collisions in the air are rare. In September of 2006, a Boeing 737-800 collided in midair with a Legacy Jet. It was the largest accident registered in the history of Brazilian aviation until that time. The present study explores aspects of press coverage of the accident. Data and information reported in the media about the accident from September 2006 to August 2007 were collected and discussed. Media coverage called attention to two unusual aspects: politicisation of the discussion, culminating in the opening of congressional inquiries, and equally the concomitance of police investigations interfering in the work of agencies responsible for the official accident investigation. Emphasis on assigning guilt and establishing penalties may close the windows of opportunity an accident had opened for discussions on the improvement of air safety. In Brazil, political imperatives and organizational pressures have interfered and the possibilities of organizational learning from the accident have been drastically curtailed.

Gli infortuni sul lavoro in Brasile. Studio nello Stato di San Paolo del Brasile, regione di Botucatu, utilizzando il metodo dell'albero delle cause

This paper discusses, within the prevaling Brazilian situation, the possibility of applying 'Causal Tree' (CT) method in investigating occupational accidents by safety personnel in the public health services and workers' unions. The method was developed during the seventies in France, for use by plant safety personnel. The authors used this method in Botucatu, State of Sao Paulo, Brazil, in order to investigate 40 serious occupational accidents that occurred in industrial plants during the second half of 1993, that had been registered by Social Security. In these cases, the predominance of situations in which the lack of safety measures were identified by inspection indicates that in most instances, the use of CT is unnecessary. However, the authors discuss its use by safety personnel from the public health services and workers' unions to investigate certain accidents to contribute to the knowledge base and help overcome the cultural based guilt which, in Brazil, has turned the victim into the person responsible for the accident.

Psicoterapia grupal no transtorno obsessivo-compulsivo

There are few published papers about group psychotherapy for patients with obsessive-compulsive disorder (OCD), and usually restricted psychoeducational, support or cognitive-behavioral approaches. This article describes the experience of group psychotherapy for OCD patients started in 1996 in Botucatu Medical School - Unesp, São Paulo, Brazil. The two-hour sessions occur once a month, with 6 to 10 female patients, and are based on psychodramatic techniques. Psychotropic prescriptions are given after the sessions. In the beginning, aggressive obsessions were more prominent and were reported with much anguish and shame. Gradually, the themes changed from OCD specific issues (symptoms, pharmacological treatment, outcome, need of exposure and response prevention) to deeper and more personal psychodynamic aspects. The psychodramatic approach (techniques of double, mirror, role inversion, search for prymary scenes) has mostly shown: difficulty in accepting their own human mistakes or negative emotions due to excessive personal demands. This seems to generate guilt, low self-esteem, idealization of others, difficulty in enjoying pleasant situations, fear of taking responsibilities and of losing control (madness/aggressiveness). The group has been considered very important by the patients, since sharing experiences helps to diminish feelings of isolation, shame and guilt, stimulates the exposure to feared situations and enhances self-esteem. The fact that all participants have the same disorder favors group cohesion and provides relief, as they see in the others some of their afflictions and are able to share similar feelings and experiences. Many times the burden of the symptoms are dealt with humor. The confidence in such therapeutic setting is helping the identification and resolution of personal conflicts and contributing to the adherence to pharmacological treatment. The group also provides valuable training experiences for resident physicians in psychiatry.