Cuidar dos cuidadores : o (des)envolvimento da espiritualidade na prevenção de quadros de stress e burnout

A Humanidade anda cansada, esgotado. Um cansaço que é a soma do fardo de cada um e também parte do fardo de outros. E a Humanidade busca explicações para este cansaço. E quer aliviá-lo. E quer minimizá-lo. Mas busca muito mais que isso. Trata-se, enfim, de buscar não o remédio mas o sentido da própria existência, as respostas adedentro, ou seja, bem no interior do ser humano. O presente trabalho pretende ser uma reflexão – compreender para agir - sobre a busca da dimensão da espiritualidade como possível resposta na prevenção de quadros de stress e burnout. Quem trabalho na área da assistência e na relação de ajuda contínua com pessoas em situação de extrema fragilidade sabe que se não houver um cuidado na reposição de energias, com muita facilidade a pessoa chega a um estado de cansaço e a qualquer momento o turboadrenalina pode queimar. No âmbito da gestão de unidades sociais e bem-estar, cuidar dos cuidadores é a maior e mais nobre missão de qualquer Instituição. Pois, que serviços seriam vivenciados sem as pessoas que formam o corpo e, por isso, a vida de uma Instituição? O caminho da nossa reflexão é orientado para a Comunidade Vida e Paz, como espaço relacional que quer e procura ser um espaço de renovação de vidas – das pessoas sem abrigo – onde, amparadas por um conjunto de Cuidadores, cujo olhar se orienta num trabalho de unificação da pessoa, são imbuídos por uma espiritualidade que se quer colaborante na missão de dignificar cada pessoa e devolvê-la à sua condição original. A pessoa, cada pessoa, é a soma de si, da relação com outros e da relação com o transcendente. Na missão de cuidar, pode a espiritualidade ser ausente? Desta, retiramos um sentido coerente da existência, a verdade do dom e da dádiva e, por isso, uma vida feliz.

Determinantes sociais condicionantes das altas clínicas dos utentes da rede nas UCCI: um estudo de caso

Introdução: O adiamento das altas clínicas nas Unidades de Cuidados Continuados Integrados (UCCI) por motivos sociais é actualmente considerado um dos principais motivos que impedem a integração atempada de novos clientes na Rede Nacional de Cuidados Continuados, RNCC, daqui em diante designada como a REDE. Este atraso tem impacto ao nível da recuperação e estabilização dos utentes, bem como ao nível de eficiência e eficácia da UCCI, não podendo deixar de se considerarem os aspectos sociais e económicos. Objectivo Geral: Identificar os determinantes que influenciam as altas clínicas em UCCI. Métodos e População do Estudo: Este é um estudo de caso colectivo, em que os dados observacionais, transversais, são recolhidos por meio de questionário de auto-relato (por cada área de intervenção directa) e por análise dos processos de consulta de pacientes. O objecto desta pesquisa abrange dois grupos: o grupo de amostra composto por 70 profissionais de saúde que lidam directamente com os utentes e o grupo amostra composto de utentes internados na UCCI L Nostrum, com alta clínica entre 1/1/2011 e 31/12/2012, e que foram integrados através da REDE. Foram recolhidos os dados de 293 utentes sendo objecto de estudo os casos de 83 utentes integrados através da REDE e com prolongamento de internamento por motivos sociais. Resultados: Na percepção dos profissionais de saúde, as respostas institucionais apresentam-se como a condicionante mais indicada, tanto para os utentes em geral, com 22 indicações (88%) como para os utentes da REDE, com 10 indicações (40%). Relativamente aos motivos familiares há referência de 76% para os utentes em geral e de 36% para os utentes da REDE. Os motivos económicos também apresentam, para os profissionais inquiridos, um valor expressivo (68%) nos utentes em geral, estando nos da REDE este factor condicionante a par com os motivos familiares (36%). Os motivos estruturais têm menor expressão tanto nos utentes em geral (32%) como nos utentes da REDE (16%). “Outros” para os utentes em geral, refere-se a dependência funcional (4%). Nos motivos familiares, para os utentes em geral, 23 (92%) foi mais vezes indicada a insuficiência de suporte familiar, para os utentes da REDE, 13 (52%). A ausência de suporte familiar, para os utentes em geral, representa 48% das respostas, seguindo-se o suporte inadequado (28%) e a ausência de cuidadores (24%). Para os utentes da REDE, o suporte inadequado apresenta-se como segundo motivo (7%), seguindo-se a ausência de suporte familiar (16%). Na percepção dos profissionais, os utentes da REDE estão também condicionados pela distância geográfica (8%) da sua área residencial. Em termos estruturais, os motivos mais assinalados pelos profissionais para a generalidade dos utentes foram as barreiras físicas à mobilidade (80%) e a habitação sem condições básicas de habitabilidade (78%). Os mesmos motivos foram assinalados para os utentes da REDE, barreiras físicas à mobilidade (40%) e habitação sem condições de habitabilidade (28%). No entanto, relativamente aos utentes em geral, a ausência de habitação (29%) e a distância geográfica (4%) também foram motivos assinalados. Dos motivos económicos percebidos pelos profissionais, a insuficiência de rendimentos é o factor mais assinalado pela generalidade dos utentes (84%) e pelos da REDE (68%), seguida da percepção da capacidade de reposta limitada das instituições, 64% para a generalidade dos utentes e 28% para os da REDE e por fim os tipos de respostas insuficientes para as necessidades individuais dos utentes (20% dos utentes em geral e 12% da REDE). No total dos dois anos, 2011 e 2012, verificaram-se na UCCI L Nostrum 293 prorrogações (100%) das quais 210 (71,6%) foram consideradas dentro do prazo e justificadas com motivos clínicos, enquanto 83 (28,3%) foram efectivamente protelamentos por motivos sociais, tendo em conta que nestes casos os utentes já não tinham critérios clínicos que justificassem a sua permanência na UCCI. Das 210 prorrogações consideradas dentro do prazo e justificadas com motivos clínicos, 93 (44,3%) foram-no por tempo de espera para transferência de UCCI. Em 2011, dos 146 utentes com alta protelada (100%), 50 utentes (34,2%) permaneceram na UCCI por motivos sociais, enquanto em 2012 houve registo de 33 casos de protelamento (22,4%) em 147 (100%) altas prorrogadas. Conclusões: Dos factores identificados como motivo de protelamento nos 83 utentes, estritamente por motivos sociais, destaca-se o protelamento de alta por espera de integração em equipamento/resposta adequada, nomeadamente lar ou serviços de apoio domiciliário (79,5%), seguindo-se a insuficiência de rendimentos do utente/familiares para contratação de serviços ou resposta institucional (74,7%), a inexistência de condições habitacionais para regresso ao domicílio (63,9%) e a insuficiência de suporte familiar (54,2%). Regista-se também a inadequação do suporte familiar (31,3%), a inexistência de suporte familiar (28,9%) e, em menor percentagem, a ausência de condições estruturais (13,3%). A ausência de domicílio (sem abrigo) (8,4%) e a ausência de rendimentos (4,8%) também foram factores inibidores da alta clínica. Dos 293 utentes identificados que tiveram protelamento da alta por motivos sociais verificou-se que 144 (49,1%) dos utentes permaneceram unicamente pela existência de condicionantes institucionais e familiares/estruturais. Aspectos éticos: ao longo deste estudo, foram assegurados e respeitados, todos os procedimentos de garantia da confidencialidade e rigor na recolha dos dados, e a não interferência nas dinâmicas da instituição, dos utentes e dos profissionais.

Estimators in capture–recapture studies with two sources

This paper investigates the applications of capture–recapture methods to human populations. Capture–recapture methods are commonly used in estimating the size of wildlife populations but can also be used in epidemiology and social sciences, for estimating prevalence of a particular disease or the size of the homeless population in a certain area. Here we focus on estimating the prevalence of infectious diseases. Several estimators of population size are considered: the Lincoln–Petersen estimator and its modified version, the Chapman estimator, Chao’s lower bound estimator, the Zelterman’s estimator, McKendrick’s moment estimator and the maximum likelihood estimator. In order to evaluate these estimators, they are applied to real, three-source, capture-recapture data. By conditioning on each of the sources of three source data, we have been able to compare the estimators with the true value that they are estimating. The Chapman and Chao estimators were compared in terms of their relative bias. A variance formula derived through conditioning is suggested for Chao’s estimator, and normal 95% confidence intervals are calculated for this and the Chapman estimator. We then compare the coverage of the respective confidence intervals. Furthermore, a simulation study is included to compare Chao’s and Chapman’s estimator. Results indicate that Chao’s estimator is less biased than Chapman’s estimator unless both sources are independent. Chao’s estimator has also the smaller mean squared error. Finally, the implications and limitations of the above methods are discussed, with suggestions for further development.

Estimators in capture-recapture studies with two sources

This paper investigates the applications of capture-recapture methods to human populations. Capture-recapture methods are commonly used in estimating the size of wildlife populations but can also be used in epidemiology and social sciences, for estimating prevalence of a particular disease or the size of the homeless population in a certain area. Here we focus on estimating the prevalence of infectious diseases. Several estimators of population size are considered: the Lincoln-Petersen estimator and its modified version, the Chapman estimator, Chao's lower bound estimator, the Zelterman's estimator, McKendrick's moment estimator and the maximum likelihood estimator. In order to evaluate these estimators, they are applied to real, three-source, capture-recapture data. By conditioning on each of the sources of three source data, we have been able to compare the estimators with the true value that they are estimating. The Chapman and Chao estimators were compared in terms of their relative bias. A variance formula derived through conditioning is suggested for Chao's estimator, and normal 95% confidence intervals are calculated for this and the Chapman estimator. We then compare the coverage of the respective confidence intervals. Furthermore, a simulation study is included to compare Chao's and Chapman's estimator. Results indicate that Chao's estimator is less biased than Chapman's estimator unless both sources are independent. Chao's estimator has also the smaller mean squared error. Finally, the implications and limitations of the above methods are discussed, with suggestions for further development.

A follow-up study of characteristics of young people that dropout and continue psychotherapy: service implications for a clinic in the community

Background: The paper reports the findings from a follow-up study of the factors that contribute to whether young people dropout or continue once-weekly psychotherapy at a voluntary sector psychotherapy service for young people aged 12 to 21 years. Method: The study uses data from an ongoing audit of the psychotherapy service that started in 1993; 882 young people were included in the study. Premature termination of treatment was defined as dropping out before the 21st session. Continuation in treatment was defined as remaining in therapy after 20 sessions. Measures and areas of interest used in the study include diagnostic measures, the Youth Self Report Form and Young Adult Self Report Form, demographic characteristics and treatment related information. Results: Young people who continued in treatment were more likely to be older, have anxieties about sexual and relationship issues and have higher scores on self-reported anxiety-depression. Young people who dropped out of treatment were more likely to be younger, have higher self-reported delinquency scores, have a diagnosis of hyperactivity-conduct disorder and be homeless. Conclusions: The study of treatment termination has demonstrated the value of service audit and has led to a significant change in clinical practice.

Natthärbärget som vandrande lösning

The shelter as a recurrent solution to homelessness During most of the 20th century shelters for the homeless has been criticized as being of too low standard and an unworthy way of living in a welfare society. During the 1960s and 1970s most shelters in Sweden were shut down and replaced with other forms of housing for the homeless. Since the late 1980s and early 1990s the issue of homelessness has returned to the political agenda as an existing social problem in Sweden. In this period we have also experienced a return of the shelters. These newly opened shelters are in many ways based on the same ideas like the old shelters described in stories of poverty and deprivation from the 19th century. In our article we raise the question how a system that has been rejected and condemned from both ethical and ideological standpoints as an unworthy way of living can be “remodernized” and considered again as a (temporary) solution to homelessness. We examine how shelters are justified in the 21st century and what functions they fill. We also discuss the fact that the shelters are almost exclusively run by (religious) voluntary organizations.

Elevers läsvanor : En kvalitativ studie av fyra fordonselevers läsvanor

The following study was conducted at an upper secondary school in Sweden and attempts to explore the question of what influences male pupils’ reading habits. Many quantitative international studies, including PISA, PIRLS and IEA Reading Literacy, have sought to answer this question, but only partially succeeded due to the limitations of their methods. Therefore, this study seeks to explore this question in more depth using qualitative methods, including interviews and classroom observations, but also minor tests. Two facts which the previously mentioned international studies have found is that boys and particularly immigrant boys tend to have worse reading results than their counterparts. It is therefore the aim of this study to study four male students in upper secondary school; of which two are native Swedes and the other two are unaccompanied refugee children; one from Afghanistan and the other from Morocco. The findings of this study are as follows. Firstly, necessity was found to be the single most important factor for the reading habits of these four pupils; especially the two refugees. Both refugees learnt to read under harsh circumstances in madrassas in their respective home countries. Moreover, the Moroccan pupil learnt to speak and read Spanish fluently during his seven years as a homeless child. Furthermore, in the absence of necessity, interest was found to be decisive in determining the pupils’ reading habits. In addition to this, the study theorizes that an interest in reading generally arises before the ability to read and not vice versa. However, teachers can in fact affect their pupils’ reading habits even in upper secondary school.

Negotiating motherhood: the struggles of teenage mothers

Aims. This article presents the results of an ethnographic study exploring how teenagers negotiated motherhood. The main aims of the study were to explore how the young women negotiated motherhood and how they constructed their own identities and relationships through teenage parenting.

Background. Approximately 10% of all births occur to teenage mothers worldwide. This phenomenon is of concern because teenage mothers are reported to be disadvantaged financially, educationally, and cognitively in both the short and long term. Many teenage mothers find strength and fulfillment in their motherhood role but this does not come without cost to themselves or their children, as many teenagers are considered unsuitable to be parents and do not have adequate support.

Design. This interpretive study incorporated ethnographic practices and was guided by feminist principles. After ethical approval from the university, data was collected over a 12-month period from five homeless Australian sole-supporting teenage mothers. Methods used included observation, interviews, field notes, journalling, and discussions with key informants.

Findings. The five participants described stories of disrupted lives, unhappiness in childhood, turmoil during adolescence and a need to find love and connection in their lives. Analysis of the data revealed four major themes; transforming lives and opportunities for change, accommodating the challenges, tolerating the abandonment of supports and living publicly examined lives.

Conclusions. It was concluded that becoming a sole-supporting mother during the teenage years was a difficult struggle for the young women, because of their youth, their lack of preparation for motherhood and their reliance on welfare supports. In addition, they experienced negative public attitudes directed towards them wherever they went, and this included their visits to community child health centres. Recommendations are made for nurses to take a different approach when working with teenage mothers to help ameliorate the negative impact of poor parenting.

Practice into theory : working collaboratively with clinicians to articulate mental health triage practice

Learning objectives: To contribute to mental health nurses understanding and knowledge of mental health triage practice through the presentation of current research findings on the topic. A specific focus of the paper will be an overview of how mental health triage practice differs across the lifespan.

Mental health triage is a highly specialised area of clinical practice for mental health nursing that is in its infancy in terms of articulating practice and theory. This paper addresses the conference theme of mental health nursing practice: new roles, new challenges by presenting the findings of a qualitative research project that investigated mental health triage/duty/intake practices across the five community mental health agencies of The Alfred Hospital, Melbourne. The overall aim of the project was to work collaboratively with clinicians to further develop the quality and consistency of mental health triage, duty, and intake clinical practice across all arms of Alfred Psychiatry. The project was designed to facilitate the expansion of the mental health triage knowledge base, and thus contribute to the further development of triage clinical practice. One of the unique aspects of the project was its triangulation across the adult triage service (acute), the two Continuing Care Teams, and the specialist psychiatric services such as the Child and Adolescent Mental Health Service, the Homeless and Outreach Psychiatric Service, and the Mobile Aged Psychiatric Service. The project employed focus group method to collect in-depth, qualitative data. A series of nine focus groups were conducted at each site, which concentrated on eliciting data on the core areas of mental health triage practice such as telephone consultation skills, mental status examination, risk assessment, decision-making, negotiation, crisis assessment, secondary consultation, and documentation. The investigation produced a considerable amount of high quality, in-depth data that was analysed using content analysis methods. The project produced data that will make a significant contribution to the expanding body of knowledge on mental health triage practice.

Decisions, decisions, decisions : an exploration of clinical decision-making in mental health triage

This paper presents the findings of a project that investigated mental health triage/duty/intake practices across the five community mental health agencies of The Alfred Hospital, Melbourne. The overall aim of the project was to work collaboratively with clinicians to further develop the quality and consistency of mental health triage, duty, and intake clinical practice. The project was designed to facilitate the expansion of the mental health triage knowledge base, and thus contribute to the further development of triage clinical practice. One of the unique aspects of the project was its triangulation across the adult triage service (acute), the two Continuing Care Teams, and the specialist psychiatric services such as the Child and Adolescent Mental Health Service, the Homeless and Outreach Psychiatric Service, and the Mobile Aged Psychiatric Service. The project employed focus group method to collect in-depth, qualitative data. A series of nine focus groups were conducted at each site, which concentrated on eliciting data on the core areas of mental health triage practice such as telephone consultation skills, mental status examination, risk assessment, decision-making, negotiation, crisis assessment, secondary consultation, and documentation. The investigation produced a considerable amount of high quality, in-depth data that was analysed using content analysis methods. The focus of this paper is on presenting the data on clinical decision-making that was raised through the project.

‘My history is a tile in a mosaic’ : an interview with Jim Cullen

JIM CULLEN was born in Queens, New York, and attended public schools on Long Island. He received his B.A. in English from Tufts University, and his A.M. and Ph.D. degrees in American Civilization from Brown University. He has taught at a number of colleges and universities, including Harvard and Brown. He is currently a teacher, and serves on the Board of the Trustees, at the Ethical Culture Fieldston School in New York City. Jim is married to historian Lyde Cullen Sizer and has four children.
CONTEXT: Dr Glenn Moore co-ordinates the subject 'Searching for the American Dream’ at The University of Melbourne. For the last nine years he has taken second and third year history students to Boston, New York and Washington, D.C to explore the philosophy of genius loci. Dr Moore gets students to work in food banks, visit homeless shelters, museums and organizes an array of guest speakers with experts such as Boston public defender, Denise Regan, Neera Tanden, Hillary Clinton’s campaign manager and Alec Ross, vice president of One Economy. As the leading expert on the American Dream, with the publication of so many books in American history such as: The American Dream: A Short History of an Idea that Shaped a Nation, Born in the U.S.A.: Bruce Springsteen and the American Tradition and Restless in the Promised Land: Catholics and the American Dream, Jim Cullen has spoken to the students for the last five years. I interviewed him prior to his recent discussion with the students in New York on 5 July 2006 at the Fashion Institute of Technology.

The lived experience of place for marginalised young people

This study explored the relationship between place and health for homeless, rural young people. Places that supported young people's health had the following attributes: feelings of physical safety and security, psychological fulfilment, sense of control, and identity. Places that appeared harmful to their health were described as alienating and threatening.