Gestão da Mudança na Implementação de Sistemas de Informação em Organizações de Saúde

O sector da saúde a nível nacional e internacional atravessa uma fase de digitalização de processos. As organizações de saúde têm por isso sido confrontadas com a realização de projectos de sistemas de informação. Sendo a sua área de actuação sensível, é essencial diminuir o impacto da mudança provocada pela implementação de sistemas de informação para a saúde, maximizando a eficiência dos sistemas de informação e minimizando o impacto negativo na prestação de cuidados de saúde. Um dos principais problemas de um processo de mudança é o impacto nos profissionais, que exercem resistência, podendo inviabilizar o projecto de sistemas de informação. Neste âmbito, surge a gestão da mudança, que pretende suportar a mudança organizacional. Tendo em conta a importância dos sistemas de informação para a actividade das organizações de saúde, pretende-se estudar o comportamento dos profissionais e da organização durante o processo, ou seja, as características dos processos da gestão de mudança em projectos de sistemas de informação de saúde. A metodologia de investigação utilizada seguiu um método qualitativo interpretativo com base num estudo de caso. A instituição escolhida foi o Centro Hospitalar de S. Francisco, Leiria. Procurou-se ainda uma confrontação dos principais resultados obtidos através da realização de um inquérito alargado a profissionais de outras organizações de saúde. Com os resultados obtidos espera-se poder auxiliar as organizações na definição de estratégias para maximizar a aceitação dos sistemas de informação e minimizar a resistência dos profissionais. Os resultados do estudo indiciam já uma tendência das organizações de saúde na aplicação de estratégias para minimizar o impacto dos processos de mudança nos projectos de sistemas de informação.

Utmaningen från andra berättelser : En studie om moraliskt omdöme, utvidgat tänkande och kritiskt reflekterande berättelser i dialogbaserad feministisk etik

The present study has a threefold aim: First, the theoretical aim is to give a contribution to refinement of the theory of dialogue based feminist ethics, concerning the understanding of judgment and narration within such an ethics.  The study also has an empirical aim, defined as to clarify what kind of knowledge, relevant to the moral judgment of an engaged outsider actor, can be received from dialogical interpretation and analysis of a limited selection of critically reflecting life stories. Third, a methodological aim is defined as to develop an approach to interpretation and analysis of reflecting life stories, which renders the storyteller visible as a reflecting moral subject, and makes the story accessible as a source of knowledge for the moral judgment of an engaged outsider actor. The thesis combines philosophical reflection and argumentation, with a narrative-hermeneutic method for interpretation of life stories, relating the two to each other in a hermeneutic process.  The theoretical reflection draws on Seyla Benhabibs theory of communicative ethics. A dialogue based model for moral justification and a likewise dialogue based model for political legitimacy are at the heart of this universalistic theory, although in combination with a conception of a narratively and hermeneutically constituted context sensitive moral judgment, based on Hannah Arendt’s concept “enlarged thought”. In the reflection, this model is related to other feminist theorizing within the tradition of dialogue based feminist ethics, as found in the works of Iris M. Young, Georgia Warnke and Shari Stone-Mediatore. The empirical study draws on three critically reflecting life stories from Israeli-Palestinian women activists for a just peace. The methodology for interpretation and analysis that is worked out combines dialogical interpretation as presented in Arthur W. Frank’s socio-narratology with a method for structural analysis derived from Shari Stone-Mediatores theory of storytelling as an expression of political resistance struggle. The results show that some stories drawing on marginalized experiences have a potential­ to stimulate further public debate through their capacity to enable a stereoscopic seeing, elucidating a tension between ideologically structured discourse and non-linguistic experience; implying that narrative-hermeneutic competence should be considered crucial for public debate.  

Working an identity, buying a life: the remains of Disney way of life among ICP alumni

O Disney International College Program (ICP) é um programa de estágio patrocinado pela Walt Disney Company, destinado a estudantes universitários estrangeiros. Uma vez aceitos no programa, estes jovens viajam para os Estados Unidos durante as férias de verão para trabalhar por três meses no Walt Disney World Resort na Flórida. O ICP tornou-se um programa popular dentre os estudantes universitários brasileiros. Todos os anos, aproximadamente trinta mil jovens candidatam-se para o programa. Contudo, apenas cerca de oitocentos conseguem ser aprovados. Durante o programa esses jovens desenvolvem uma “identidade Disney” que passará a fazer parte do self deles. O objetivo deste trabalho é explorar o papel ICP na vida dos seus participantes, assim como desvendar seus efeitos na construção do self destes jovens. O presente estudo também procurou avaliar como os participantes conseguem sustentar sua “identidade Disney”, mesmo após deixarem o programa. Para tanto, foi desenvolvido um estudo de caso qualitativo, no qual o caso analisado foi a identidade de participantes do ICP. Após uma breve análise da literatura sobre identidade, consideramos o self como a capacidade do individuo em manter viva uma narrativa particular. Assim, nossos dados foram coletados e analisados por meio do método de análise narrativo. Através deste estudo, descobrimos que a Walt Disney Company realiza um trabalho eficiente em convencer os participantes do ICP que a sua missão e seus valores são muito importantes. Com isso, estes jovens passam a louvar a marca Disney. Também foi observada a existência de uma comunidade de Disney Alumni (pessoas que participaram do ICP) unida por princípios, ideias e consumo.

A brincadeira e as atividades fomais de ensino no primeiro ano do ensino fundamental: uma análise das manifestações das crianças de seis anos

Pós-graduação em Educação - FCT

A formação do professor de espanhol no Centro de Línguas da FCL UNESP/Assis: histórias compartilhadas

This paper presents some reflections regarding Spanish/FL teachers professional development process, considering their experiences in the context of the project “Center for Languages and Teachers Development”, UNESP – Assis. The study aimed to develop a space for reflection and to identify the main concerns that the teachers-students have in their initial education trajectory. To do so, we use the qualitative approach principles and the narrative research method.

Psychosexual Perspectives of the Husbands of Women Treated With an Elective Hysterectomy

The purpose of this study was to explore the psychosexual perspectives of a group of Brazilian men whose wives underwent an elective hysterectomy. A qualitative design based on the narrative analysis method was used to interview 22 husbands. Results showed similarities and differences among husbands regarding the support provided to their wives, the notion of sexual absence in the postsurgical period, the notion of sexual pleasure after the hysterectomy, and feelings regarding the impossibility of having children. The authors conclude that personal care requirements should be identified and satisfied to provide comprehensive and meaningful care.

Mariátegui, Vallejo y la literatura peruana

Para enriquecer y superar la comprensión eurocéntrica histórica del fenómeno americano es preciso indagar en la reflexión que sobre éste realizan los propios pensadores de América. En este ocasión, nuestra particular elección ha recaído en José Carlos Mariátegui (1895-1930) y su obra Siete ensayos de interpretación de la realidad peruana (1928). Si bien su pensamiento fue poco formal, estuvo enriquecido por intuiciones y observaciones que aún esperan su oportunidad de tener un papel activo en la interpretación de nuestra cultura. Este trabajo se centra en la visión de la literatura peruana a partir de los aportes desde variadas perspectivas que realiza Mariátegui. Si bien parte de un método interpretativo relativamente rígido -materialista, economicista, historicista, lógico-dialéctico-, su obra tiene toda la amplitud crítica y la profundidad existencial que le da su posición privilegiada de observador y partícipe de los procesos políticos y sociales de la vida peruana. En sus comentarios sobre la literatura peruana, Mariátegui destaca el papel de Cesar Vallejo quien, nacido y criado en la sierra peruana, es el primer poeta capaz de representar a la nación con sus dos mundos: el mundo indio y el mundo mestizo. De esta manera, el pensamiento de Mariátegui nos ayuda a entender el carácter de la literatura peruana desde una novedosa y diferente perspectiva.

On being thrown into phenomenological research: a book review of J.A. Smith, P. Flowers & M. Larkin (2009) Interpretative Phenomenological Analysis: Theory, method and research. London: Sage.

Book review

A Hermeneutic Case Reconstruction of a published first-person narrative

Hermeneutic Case Reconstruction (Rosenthal, 1993) is a systematic method of analysing biographical self-presentations from an interpretivist perspective. The method consists of five major analytic steps. The first is an analysis of the biographical data that can stand independently of the narrator’s perspective. ‘Objective’ data is extracted from the text or interview transcript and ordered chronologically. Secondly, a thematic field analysis is undertaken in which the data is divided into separate units according to the type of text used, whilst keeping the sequence of these texts units intact. In this step, hypotheses are developed regarding the potential significance of the style and sequence of the events presented. The product of this second step is a reconstruction of the life story. A reconstruction of the life history then follows as the third step. The purpose of this step is to generate hypotheses about the meanings that biographical experiences might have had for the narrator at the time they occurred, given the sociocultural context in which they occurred. In the fourth step, microanalysis of individual text segments is undertaken, in which all hypotheses generated in the earlier steps are tested against the text for support or refutation. The final step consists of a contrastive comparison of the life history and life story. The life story and life history are compared to determine, for example, which aspects of the narrator’s experience have been emphasised or minimised. Through this comparison, the selective process is highlighted. This is referred to as the case structure. This paper describes an application of this method to a published first-person narrative of a woman’s experiences of sustaining a brain injury in a motor vehicle accident.

The development of the N1 and N2 components in auditory oddball paradigms: a systematic review with narrative analysis and suggested normative values

Auditory event-related potentials (AERPs) are widely used in diverse fields of today’s neuroscience, concerning auditory processing, speech perception, language acquisition, neurodevelopment, attention and cognition in normal aging, gender, developmental, neurologic and psychiatric disorders. However, its transposition to clinical practice has remained minimal. Mainly due to scarce literature on normative data across age, wide spectrumof results, variety of auditory stimuli used and to different neuropsychological meanings of AERPs components between authors. One of the most prominent AERP components studied in last decades was N1, which reflects auditory detection and discrimination. Subsequently, N2 indicates attention allocation and phonological analysis. The simultaneous analysis of N1 and N2 elicited by feasible novelty experimental paradigms, such as auditory oddball, seems an objective method to assess central auditory processing. The aim of this systematic review was to bring forward normative values for auditory oddball N1 and N2 components across age. EBSCO, PubMed, Web of Knowledge and Google Scholarwere systematically searched for studies that elicited N1 and/or N2 by auditory oddball paradigm. A total of 2,764 papers were initially identified in the database, of which 19 resulted from hand search and additional references, between 1988 and 2013, last 25 years. A final total of 68 studiesmet the eligibility criteria with a total of 2,406 participants from control groups for N1 (age range 6.6–85 years; mean 34.42) and 1,507 for N2 (age range 9–85 years; mean 36.13). Polynomial regression analysis revealed thatN1latency decreases with aging at Fz and Cz,N1 amplitude at Cz decreases from childhood to adolescence and stabilizes after 30–40 years and at Fz the decrement finishes by 60 years and highly increases after this age. Regarding N2, latency did not covary with age but amplitude showed a significant decrement for both Cz and Fz. Results suggested reliable normative values for Cz and Fz electrode locations; however, changes in brain development and components topography over age should be considered in clinical practice.

Interpretative research in information systems: two qualitative research design projects

In a scientific research project is important to define the underlying philosophical orientation of the project, because this will influence the choices made in respect of scientific methods used, as well as the way they will be applied. It is crucial, therefore, that the philosophy and research design strategy are consistent with each other. These questions become even more relevant in qualitative research. Historically, the interpretive research philosophy is more associated to the scientific areas of social sciences and humanities where the subjectivity inherent to human intervention is more explicitly defined. Information systems field are, primarily, trapped in computer science field, though it also integrates issues related with management and organizations field. This shift from a purely technological guidance for the consideration of the problems of management and organizations has fostered the rise of research projects according to the interpretive philosophy and using qualitative methods. This paper explores the importance of alignment between the epistemological orientation and research design strategy, in qualitative research projects. As a result, it is presented two PhD projects, with different research design strategies, that are being developed in the technology and information systems field, in the light of the interpretive paradigm.

Self-narrative reconstruction after dilemma-focused therapy for depression: a comparison of good and poor outcome cases

Objective: The aim of this study is to improve the understanding of self-changes after an intervention for depression focused on implicative dilemmas, a type of cognitive conflict related to identity. As recent research has highlighted the relevance of identity-related dilemmas in clients with depression, we sought to assess the way in which clients resolve such inner conflicts after a tailored dilemma-focused intervention and how this is reflected in the clients’ self-narratives. Method: We used three instruments to observe differences between good (n = 5) and poor (n = 5) outcome cases: (i) the Repertory Grid Technique to track the resolution of dilemmas, (ii) the Change Interview to compile clients’ accounts of changes at posttreatment, and (iii) the Innovative Moments Coding System to examine the emergence of clients’ novelties at the Change Interview. Results: Groups did not differ in terms of the number and relevance of client-identified significantly helpful events. However, between-group differences were found for the resolution of dilemmas and for the proportion of high-level innovative moment (IM) types. Furthermore, a greater self-narrative reconstruction was associated with higher levels of symptom improvement. Conclusions: Good outcome cases seem to be associated with the resolution of conflicts and high-level IMs.

Narrative innovations predict symptom improvement: Studying innovative moments in narrative therapy of depression

Objective:Innovative moments (IMs) are moments in the therapeutic dialog that constitute exceptions toward the client's problems. These narrative markers of meaning transformation are associated with change in different models of therapy and diverse diagnoses. Our goal is to test if IMs precede symptoms change, or, on the contrary, are a mere consequence of symptomatic 15 change. Method: For this purpose, IMs and symptomatology (Outcome Questionnaire-10.2) were assessed at every session in a sample of 10 cases of narrative therapy for depression. Hierarchical linear modeling was conducted to explore whether (i) IMs in a given session predict patients' symptoms in the following session and/or (ii) symptoms in a given session predict IMs in the next session. Results: Results suggested that IMs are better predictors of symptoms than the reverse. Conclusions: These results are discussed considering the contribution of meanings and narrative processes' changes to symptomatic improvement.

Narrative change in Gloria Films: Comparing various processes of therapeutic innovation

Aims: The present study focuses on the analysis of novelty emergence in classic Gloria Films with Rogers, Perls, and Ellis to understand how the same client formulated her own problem and if and how change occurred in those three sessions. Method: The Innovative Moments Coding System was applied to track innovative moments (IMs) and their themes. Results: The session with Rogers showed more diversity in disclosed problems and themes of IMs, as well as a higher proportion of reflection IMs. The session with Perls demonstrated a high proportion of protest IMs. The session with Ellis showed less innovation than other sessions. The changes found were based mostly on reflection and protest IMs in three sessions. Conclusion: Narrative innovations occurred in the three single sessions. The type of dominant innovation is consistent with the therapeutic model and the IMs model. The exploration of the IMs’ themes allowed a more precise identification of Gloria's new narrative positions and their development throughout those sessions.

Influència de la música sobre l'atenció humana: especial a la metodologia d'anàlisi, tot combinant metodologia quantitavia amb qualitativa (mix method)

Projecte de recerca elaborat a partir d’una estada a la University of Calgary, Canadà, entre desembre del 2007 i febrer del 2008. El projecte ha consistit en l'anàlisi de les dades d'una recerca en el camp de la psicologia de la música, concretament en com influeix la música en l'atenció a través de les vies dels estats emocionals i enèrgics de la persona. Per a la recerca es feu ús de videu en les sessions, obtenint dades visuals i auditives per a complementar les dades de tipus quantitatiu provinents dels resultats d'uns tests d'atenció subministrats. L'anàlisi es realitzà segons mètodes i tècniques de caràcter qualitatiu, apresos durant l'estada. Així mateix també s'ha aprofundit en la comprensió del paradigma qualitatiu com a paradigma vàlid i realment complementari del paradigma qualitatiu. S'ha focalitzat especialment en l'anàlisi de la conversa des d'un punt de vista interpretatiu així com l'anàlisi de llenguatge corporal i facial a partir de l'observació de videu, tot formulant descriptors i subdescriptors de la conducta que està relacionada amb la hipòtesis. Alguns descriptors havien estat formulats prèviament a l’anàlisi, en base a altres investigacions i al background de la investigadora; altres s’han anat descobrint durant l’anàlisi. Els descriptors i subdescriptors de la conducta estan relacionats amb l'intent dels estats anímics i enèrgics dels diferents participants. L'anàlisi s'ha realitzat com un estudi de casos, fent un anàlisi exhaustiu persona per persona amb l'objectiu de trobar patrons de reacció intrapersonals i intrapersonals. Els patrons observats s'utilitzaran com a contrast amb la informació quantitativa, tot realitzant triangulació amb les dades per trobar-ne possibles recolzaments o contradiccions entre sí. Els resultats preliminars indiquen relació entre el tipus de música i el comportament, sent que la música d'emotivitat negativa està associada a un tancament de la persona, però quan la música és enèrgica els participants s'activen (conductualment observat) i somriuen si aquesta és positiva.