Préoccupations éthiques des intervenants dans leur travail d'accompagnement auprès des aînés en fin de vie résidant en centre d'hébergement

Cette thèse en bioéthique a pour objectif d'identifier les préoccupations éthiques des intervenants dans leur tâche d'accompagnement des personnes âgées en fin de vie qui résident en centre d'hébergement. Dans le cadre d'une recherche exploratoire de type qualitatif, 12 entrevues semi dirigées sont réalisées avec des intervenants travaillant en contact direct auprès de la clientèle des centres d'hébergement. L'originalité de cette thèse est de donner la parole aux intervenants en contact direct avec les résidents et de recueillir les préoccupations qu'ils ont en tête lorsqu'ils exécutent leur gestes de soins. L'analyse qualitative des contenus d'entrevue permet de dégager de multiples préoccupations de ces intervenants face à différents éléments du milieu, tels l'établissement en tant qu'organisation, les résidents en fin de vie, les pairs de ces derniers, les collaborateurs des intervenants (familles et collègues de travail), de même qu'envers eux-mêmes au plan de leur savoir-faire et de leur savoir-être. Certains éléments en limitent toutefois la portée : le choix de volontaires comme participants, le nombre réduit de ces derniers particulièrement au niveau des personnes de sexe masculin, et l'effet de désidérabilité sociale qui a pu entraîner la présentation d'une vision améliorée de la réalité. Cette thèse contribue à l'avancement des connaissances en bioéthique en démontrant que le recours à la pensée éthique de Ricœur constitue une grille pertinente à utiliser pour la compréhension et l'analyse du fonctionnement institutionnel, du vécu des résidents en fin de vie de même que des interventions du personnel au plan de leur accompagnement envers les résidents et les familles. En s'appuyant sur les composantes de la peine éthique de Ricœur pour jeter les bases d'un programme de fin de vie en centre d'hébergement, cette thèse montre également que la référence à Ricœur peut constituer une ressource valable pour élaborer une réponse à la directive ministérielle en tenant compte des recommandations des intervenants.

Les interventions communautaires d’activation au Québec et leurs déterminants : orientations institutionnelles, appropriation et gouvernance.

Cette recherche exploratoire a pour objet d’étude la mise en œuvre des interventions d’activation pour l’emploi auprès des prestataires de l’assistance sociale en situation de grande vulnérabilité au Québec. Elle cherche à décrire les pratiques mises en œuvre par des intervenants de la première ligne (« street-level ») au sein des organismes communautaires œuvrant en employabilité, dans le cadre des mesures et programmes de l’agence Emploi- Québec, dans un contexte de contractualisation et partenariat entre le gouvernement et le secteur à but non lucratif. Le mémoire cherche à identifier les processus qui peuvent influencer les pratiques de la première ligne de services lors de l’interaction avec les destinataires du système intégré d’aide financière de dernier recours et d’aide à l’emploi, de même qu’à comprendre les rapports de force en présence lors de la mise en œuvre des interventions. L’on veut répondre aux deux questions suivantes : Quel est le poids relatif du cadre institutionnel du système d’activation et du pouvoir discrétionnaire des intervenants de la première ligne travaillant directement avec les prestataires les plus vulnérables, au sein des organismes communautaires en employabilité? Plus précisément, comment ces deux types de processus interagissent-ils entre eux, pour produire la politique telle que mise en œuvre? On se base sur des approches théoriques sur la mise en œuvre des politiques inspirées des perspectives de « street level bureaucracy » (Lipsky, 1971, 1980; Smith et Lipsky, 1993 ; Hupe & Hill, 2007 ; Brodkin, 2007, 2011, 2012, 2015; Rice, 2012), du néo-institutionnalisme discursif (Schmidt, 2008, 2010) et de l’Ethnographie institutionnelle (Smith, 1999, 2006; Campbell & Gregor, 2008). On considère que la mise en œuvre de la politique d’activation entraîne non seulement une « appropriation » du cadre institutionnel et systémique par les intervenants de première ligne, mais aussi une co-construction de la politique dans un contexte de gouvernance spécifique. La stratégie de recherche est qualitative et s’inspire de l’approche de l’ethnographie institutionnelle en sociologie, qui propose une méthodologie pour retracer les effets des institutions sur les travailleurs dans leur vie quotidienne (Smith, 2005, 1999, 1987; Campbell and Gregor, 2008). Elle comprend : i) des entretiens avec des intervenants communautaires qui fournissent des services d’aide et d’accompagnement pour l’intégration en emploi portant sur certains dossiers de prestataires du système; ii) des entretiens avec des coordinatrices d’organismes communautaires œuvrant en employabilité, et iii) une collecte et une analyse de la documentation institutionnelle et du cadre de réglementation pour la mise en œuvre du système d’activation. L'analyse aborde le discours institutionnel d'une part et, d'autre part, le discours des répondants du secteur communautaire en employabilité concernant leurs interventions auprès des prestataires dans le cadre des programmes et mesures d’E-Q, et leurs « explications » des pratiques quotidiennes.

A Literature Review on the Benefits of Ethnic and Minority Entrepreneurship

Ethnic/Minority entrepreneur is a business owner who does not represent the majority population of a country. Ethnic/Minority entrepreneurship can bring benefits to individual, society, region, economy, and globe too. So, understanding the importance of ethnic/minority entrepreneurship will really be useful to all the stakeholders. The unique culture and value system of ethnic minorities are the most wanted characteristics for any successful entrepreneur in general. Many industrial nations like U.S, U.K., Germany, etc. have utilised the ethnic minorities to build their economy. The future of the minority businesses looks bright as the world economy is booming, availability of experienced and already successful minority entrepreneurs as role models, and institutional support services. In this paper, literature relating to the benefits of ethnic and minority entrepreneurship is reviewed to understand its magnitude of benefits.

Management practices and challenges in smallholder indigenous chicken production in Western Kenya

The potential benefit of indigenous chicken (Gallus domesticus) production is still under-exploited in Kenya despite the efforts by different stakeholders to mainstream this production system as a pathway to rural development. The production system is often characterized by low input-low output productivity and low commercialization of the enterprise. This study which dwells on the current management practices and challenges faced by smallholder indigenous chicken farmers was conducted to gain insights into the underlying causes of production constraints. In Western Kenya women (76%) dominate the indigenous chicken production system. The flock composition consists mainly of chicks, hens and pullets (80%) which reflects their retention for production purposes. Less than half of the farmers access institutional support services such as extension, training, credit and veterinary services. In addition, indigenous chicken is largely reared in a low input-low output free-range system with only few farmers (24.2%) adopting management interventions as disseminated by extension service. To improve production and attain increased productivity, policy should focus on repackaging extension messages that considers farmers economic situations and strengthens collective action initiatives. Accessing joint input purchase and collective marketing of chicken products may further assist the farmers to increase profit margins.

ARTINTEC S.A.S.: propuestas interactivas con contenido educativo

ArtInTec es una organización creativa que ofrece servicios complementarios de apoyo pedagógico mediante instalaciones artísticas que integran arte y tecnología, unión que permite abarcar tres conceptos fundamentales: interactividad, lograda a través de herramientas tecnológicas convencionales y no convencionales; experiencias cognitivas significativas, mediante la generación de procesos de aprendizaje innovadores que permitan la construcción de saberes de trascendencia, y desarrollo de contenidos de diferentes temáticas que fortalezcan el aprendizaje. En su primera etapa, ArtInTec estará enfocada en el diseño, producción, comercialización, divulgación y venta de servicios transversales de apoyo pedagógico que impliquen la intermediación del arte y la tecnología, partiendo del concepto de instalación artística como género del arte contemporáneo que utiliza directamente el espacio de exposición como escenario para ser transitado por el espectador, logrando así una experiencia interactiva. Los tres servicios comparten características que se constituyen como columna vertebral de su naturaleza: tienen un objetivo altamente pedagógico, las temáticas son desarrolladas previo consenso entre la institución y ArtInTec, su componente artístico es el hilo conductor de la experiencia y se desarrollan en las instalaciones de la institución contratante. A continuación se enuncia cada uno de los servicios ofrecidos: a. Taller asistido por nuevas tecnologías. b. Instalación interactiva en gran formato. c. Instalación interactiva para dispositivos móviles.

Dimensões do êxito de egressos de escolas públicas no processo seletivo para o cursos de medicina da UFPE

Garantir a oferta de uma educação de qualidade nas escolas públicas de estados e municípios é um grande desafio a ser enfrentado pelo Brasil. Em se tratando da aprovação nos vestibulares para cursos superiores prestigiados socialmente, o êxito de egressos dessas instituições é difícil em qualquer universidade. Esta investigação, de natureza qualitativa articula dados quantitativos para fundamentar as discussões acerca dos fatores que explicam a aprovação desses estudantes no processo seletivo para o curso de medicina da Universidade Federal de Pernambuco [UFPE]. A fim de se realizar o estudo de caso em questão, utilizamos três instrumentos de recolha: o questionário, contendo informações pessoais e dados da formação educacional dos três egressos e de seus familiares; a entrevista semiestruturada, onde os três estudantes e seus pais tiveram a possibilidade de discorrer sobre os temas propostos; e a história de vida, através da qual um dos sujeitos retratou todo o conjunto da experiência vivida. Todo o material foi comparado e relacionado durante a análise por meio da triangulação de dados. Os nossos resultados confirmam os achados de outros trabalhos do gênero quando apontam que melhorar a qualidade da Educação Básica é essencial para que o Brasil avance na formação de mão de obra, mas, diferencia-se de alguns deles, quando sugere que, em relação aos candidatos que tentam ingressar no curso de medicina, tão importantes quanto o interesse e a mobilização do estudante e de seus pais em relação aos estudos são os investimentos em serviços de apoio pedagógico e psicológico, tanto aqueles prestados pelas escolas quanto os que são realizados em locais especializados [dependendo do caso].

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.

'Fair trade gold': Antecedents, prospects and challenges

This paper critically examines the challenges with, and impacts of, adopting the models in place for fair trade agriculture in the artisanal gold mining sector. Over the past two years, an NGO-led 'fair trade gold' movement has surfaced, its crystallization fuelled by a burgeoning body of evidence that points to impoverished artisanal miners in developing countries receiving low payments for their gold, as well as working in hazardous and unsanitary conditions. Proponents of fair trade gold contest that increased interaction between artisanal miners and Western jewellers could facilitate the former receiving fairer prices for gold, accessing support services, and ultimately, improving their quality of life. In the case of sub-Saharan Africa, however, the gold being mined on an artisanal scale does not supply Western retailers as perhaps believed; it is rather an important source of foreign exchange, which host governments employ buyers to collect for their coffers. It is maintained here that if the underlying purpose of fair trade is to improve the livelihoods and well-being of subsistence producers in developing countries, then the models that have proved so successful in alleviating the hardships of agro-producers of 'tropical' commodities such as coffee, tea, bananas and cocoa, should be adapted to artisanal gold mining in sub-Saharan Africa. Campaigns promoting 'fair trade gold' in the region should view host governments, and not Western retailers, as the 'end consumer', and focus on improving governance at the grassroots, organizing informal operators into working cooperatives, and addressing complications with purchasing arrangements - all of which would go a long way toward improving the livelihoods of subsistence artisanal miners. A case study of Noyem, Ghana, the location of a sprawling illegal gold mining community, is presented, which magnifies these challenges further and provides perspective on how they can be overcome. (c) 2007 Elsevier Ltd. All rights reserved.

Mercury: An agent of poverty in Ghana's small-scale gold-mining sector?

There is consensus worldwide that the artisanal and small-scale mining (ASM) sector is comprised of individuals who are trapped in a vicious cycle of poverty, lacking the necessary financial and technological means to improve their standards of living. Minimal work, however, has been undertaken to identify the very factors behind miners' plight, which inevitably vary from country to country. This paper uses a case study of Ghana to argue that an increased dependence upon mercury for amalgamation In artisanal gold-mining communities is one such-albeit overlooked-"agent of poverty". There is mounting empirical evidence which suggests that dealings with the monoponistic middlemen who supply mercury, purchases of costly medicines to remedy ailments caused by mercury poisoning, and a lack of appropriate safeguards and alternatives to amalgamation, are preventing gold miners from improving their practices and livelihoods. The solution to the problem lies in breaking this cycle of dependency, which can be achieved by providing miners with robust support services, mercury-free technologies and education. (c) 2006 Elsevier Ltd. All rights reserved.

Dual technological development in Botswana agriculture: A Stochastic input distance function approach

To improve the welfare of the rural poor and keep them in the countryside, the government of Botswana has been spending 40% of the value of agricultural GDP on agricultural support services. But can investment make smallholder agriculture prosperous in such adverse conditions? This paper derives an answer by applying a two-output six-input stochastic translog distance function, with inefficiency effects and biased technical change to panel data for the 18 districts and the commercial agricultural sector, from 1979 to 1996 This model demonstrates that herds are the most important input, followed by draft power. land and seeds. Multilateral indices for technical change, technical efficiency and total factor productivity (TFP) show that the technology level of the commercial agricultural sector is more than six times that of traditional agriculture and that the gap has been increasing, due to technological regression in traditional agriculture and modest progress in commercial agriculture. Since the levels of efficiency are similar, the same patient is repeated by the TFP indices. This result highlights the policy dilemma of the trade-off between efficiency and equity objectives.

Spatial patterns of office employment in the New York region

This study analyzes the regional spatial dynamics of the New York region for a period of roughly twenty years and places the effects of the 9/11 terrorist attacks in the context of longer-term regional dynamics. The analysis reveals that office-using industries are still heavily concentrated in Manhattan despite ongoing decentralization in many of these industries over the last twenty years. Financial services tend to be highly concentrated in Manhattan whereas administrative and support services are the least concentrated of the six major office-using industry groups. Although office employment has been by and large stagnant in Manhattan for at least two decades, growth of output per worker has outpaced the CMSA as well as the national average. This productivity differential is mainly attributable to competitive advantages of office-using industries in Manhattan and not to differences in industry composition. Finally, the zip-code level analysis of the Manhattan core area yielded further evidence of the existence of significant spillover effects at the small-scale level.

The cost of choice: how corporate real estate managers evaluate business space options

Firms are faced with a wider set of choices when they identify a need for new office space. They can build or purchase accommodation, lease space for long or short periods with or without the inclusion of services, or they can use “instant office” solutions provided by serviced office operators. But how do they evaluate these alternatives and are they able to make rational choices? The research found that the shortening of business horizons lead to the desire for more office space on short-term contracts often with the inclusion of at least some facilities management and business support services. The need for greater flexibility, particularly in financial terms, was highlighted as an important criteria when selecting new office accommodation. The current office portfolios held were perceived not to meet these requirements. However, there was often a lack of good quality data available within occupiers which could be used to help them analyse the range of choices in the market. Additionally, there were other organisational constraints to making decisions about inclusive real estate products. These included fragmentation of decisions-making, internal politics and the lack of assessment of business risk alongside real estate risk. Overall therefore, corporate occupiers themselves act as an interial force to the development of new and innovative real estate products.

The role of serviced offices in the corporate real estate supply chain

The paper analyses the evolving corporate real estate supply chain and the interaction of this evolution with emerging business models in the serviced office sector. An enhanced model of the corporate real estate portfolio is first presented incorporating vacant, alienated and transitory space. It is argued that the serviced office sector has evolved in response to an increasingly diverse corporate real estate portfolio. For the peripheral corporate real estate portfolio, the core serviced workspace product provides the ability to rapidly acquire high-quality workspace and associated support services on very flexible bases. Whilst it is arguably a beta product, the core workspace offer is now being augmented by managed office or back-to-back leases which enables clients to complement the advantages of serviced offices with a wider choice of premises. Joint venture business models are aligned with solutions to problems of vacant space.

Blended learning in distance education: Sri Lankan perspective

The purpose of this paper is to explore the implementation of online learning in distance educational delivery at Yellow Fields University (pseudonymous) in Sri Lanka. The implementation of online distance education at the University included the use of blended learning. The policy initiative to introduce online for distance education in Sri Lanka was guided by the expectation of cost reduction and the implementation was financed under the Distance Education Modernization Project. The paper presents one case study of a larger multiple case study research that employed an ethnographic research approach in investigating the impact of ICT on distance education in Sri Lanka. Documents, questionnaires and qualitative interviews were used for data collection. There was a significant positive relationship between ownership of computers and students’ ability to use computer for word processing, emailing and Web searching. The lack of access to computers and the Internet, the lack of infrastructure, low levels of computer literacy, the lack of local language content, and the lack of formal student support services at the University were found to be major barriers to implementing compulsory online activities at the University

‘Moving on’ : Violence, wellbeing and questions about violence in antenatal care encounters. A qualitative study with Somali-born refugees in Sweden

Background Somali-born women constitute one of the largest groups of childbearing refugee women in Sweden after more than two decades of political violence in Somalia. In Sweden, these women encounter antenatal care that includes routine questions about violence being asked. The aim of the study was to explore how Somali-born women understand and relate to violence and wellbeing during their migration transition and their views on being approached with questions about violence in Swedish antenatal care. Method Qualitative interviews (22) with Somali-born women (17) living in Sweden were conducted and analysed using thematic analysis. Findings A balancing actbetween keeping private life private and the new welfare system was identified, where the midwife's questions about violence were met with hesitance. The midwife was, however, considered a resource for access to support services in the new society. A focus on pragmatic strategies to move on in life, rather than dwelling on potential experiences of violence and related traumas, was prominent. Social networks, spiritual faith and motherhood were crucial for regaining coherence in the aftermath of war. Dialogue and mutual adjustments were identified as strategies used to overcome power tensions in intimate relationships undergoing transition. Conclusions If confidentiality and links between violence and health are explained and clarified during the care encounter, screening for violence can be more beneficial in relation to Somali-born women. The focus on “moving on” and rationality indicates strength and access to alternative resources, but needs to be balanced against risks for hidden needs in care encounters. A care environment with continuity of care and trustful relationships enhances possibilities for the midwife to balance these dual perspectives and identify potential needs. Collaborations between Somali communities, maternity care and social service providers can contribute with support to families in transition and bridge gaps to formal social and care services.