Contraintes vécues, idéal normatif et actions déployées en vue de transformer l’exercice de la profession infirmière en centre hospitalier : une étude exploratoire auprès d’infirmières québécoises politiquement engagées

Les changements socioéconomiques des dernières décennies ont profondément transformé le rapport qu’entretient le Québec avec ses professionnels de la santé. En ouvrant le champ à l’accumulation privée du capital dans les années 1990, se met en place au sein de la fonction publique une philosophie politique issue du monde des affaires. Dès lors, le paradigme de la gouvernance investit les hôpitaux, où exerce 65 % de l’effectif infirmier québécois. Des chercheurs ont investigué les contraintes et torts subis par les infirmières consécutivement à la restructuration du système de santé, cependant, peu d’entre eux ont tenu compte des rapports de force et des structures de pouvoir dans lesquels s’enracine le vécu des infirmières. La présente étude a pour but d’explorer les expériences vécues d’infirmières soignantes politiquement engagées qui exercent en centre hospitalier (CH), de rendre compte de l’ordre social existant au sein de cette institution, de décrire la façon dont elles aimeraient idéalement exercer et de répertorier les idées qu’elles ont et les actions qu’elles mettent en place individuellement ou collectivement de façon à favoriser la transformation de l’ordre social et de l’exercice infirmier en CH. Épistémologiquement, notre étude qualitative s’inscrit dans cette idée que la réalité est complexe, mouvante et dépendante de la perception des personnes, proposant une orientation compréhensive et contextualisée de l’action humaine et du politique; c’est ainsi que le point de vue politique des infirmières participantes est pris en compte. L’articulation des expériences vécues, de l’idéal normatif et de l’action politique des participantes est explorée suivant une perspective postmoderniste, praxéologique et dialectique issue de la théorie critique qui réfléchit non seulement sur ce qui est, mais également sur ce qui est souhaitable; une réflexion qui sous certaines conditions s’ouvre sur l’action transformatrice. Les notions de pouvoir, de rapport de force, de résistance et d’émancipation influencent notre analyse. Au terme de cette étude, les résultats indiquent la présence d’une déprofessionnalisation graduelle en faveur d’une technicisation du soin infirmier et d’une dérive autoritaire grandissante au sein des CH s’arrimant au registre sémantique de l’économie de marché à partir des notions d’efficacité, de performance et d’optimisation. Les infirmières soignantes perçues comme des « automates performants » se voient exclues des processus décisionnels, ce qui les prive de leurs libertés de s’exprimer et de se faire critiques devant ce qui a été convenu par ceux qui occupent les hautes hiérarchies du pouvoir hospitalier et qui déterminent à leur place la façon dont s’articule l’exercice infirmier. Le pouvoir disciplinaire hospitalier, par l’entremise de technologies politiques comme la surveillance continue, les représailles et la peur, la technicisation du soin et le temps supplémentaire obligatoire, concourt à la subjectivation des infirmières soignantes, en minimisant l’importance de leur jugement clinique, en affaiblissant la solidarité collective et en mettant au pas l’organisation syndicale, ce qui détournent ces infirmières de la revendication de leurs droits et idéaux d’émancipation les ramenant à une position subalterne. Nos résultats indiquent que les actions politiques que les participantes souhaitent déployer au sein des CH visent l’humanisation des soins et l’autodétermination professionnelle. Toutefois, nombre des actions répertoriées avaient pour finalité fonctionnelle la protection et la survie des infirmières au sein d’un dispositif hospitalier déshumanisant. Certaines infirmières soignantes s’objectent en conscience, déploient des actions de non-coopération individuelles et collectives, font preuve d’actes de désobéissance civile ou souhaitent agir en ce sens pour établir un rapport de force nécessaire à la prise en compte de leurs revendications par une gouvernance hospitalière qui autrement ferait la sourde oreille. Le pouvoir exercé de façon hostile par la gouvernance hospitalière doit à notre avis être contrecarré par une force infirmière collective égale ou supérieure, sans quoi les politiques qui lui sont associées continueront de leur être imposées. Le renouvellement radical de la démocratie hospitalière apparaît comme la finalité centrale vers laquelle doivent s’articuler les actions infirmières collectives qui permettront l’établissement d’un nouveau rapport de force puisque c’est à partir de celle-ci que les infirmières soignantes pourront débattre de l’orientation que doit prendre l’exercice infirmier.

Higher Education Governance in Vietnam: University Action, the State and Changing Relationships

Diese Dissertation stellt eine Studie da, welche sich mit den Änderungen in der Governance der Hochschulbildung in Vietnam beschäftigt. Das zentrale Ziel dieser Forschungsarbeit ist die Untersuchung der Herkunft und Änderung in der Beziehung der Mächte zwischen dem vietnamesischen Staat und den Hochschulbildungsinstituten (HI), welche hauptsächlich aus der Interaktion dieser beiden Akteure resultiert. Die Macht dieser beiden Akteure wurde im sozialen Bereich konstruiert und ist hauptsächlich durch ihre Nützlichkeit und Beiträge für die Hochschulbildung bestimmt. Diese Arbeit beschäftigt sich dabei besonders mit dem Aspekt der Lehrqualität. Diese Studie nimmt dabei die Perspektive einer allgemeinen Governance ein, um die Beziehung zwischen Staat und HI zu erforschen. Zudem verwendet sie die „Resource Dependence Theory“ (RDT), um das Verhalten der HI in Bezug auf die sich verändernde Umgebung zu untersuchen, welche durch die Politik und eine abnehmende Finanzierung charakterisiert ist. Durch eine empirische Untersuchung der Regierungspolitik sowie der internen Steuerung und den Praktiken der vier führenden Universitäten kommt die Studie zu dem Schluss, dass unter Berücksichtigung des Drucks der Schaffung von Einkommen die vietnamesischen Universitäten sowohl Strategien als auch Taktiken entwickelt haben, um Ressourcenflüsse und Legitimität zu kontrollieren. Die Entscheidungs- und Zielfindung der Komitees, die aus einer Mehrheit von Akademikern bestehen, sind dabei mächtiger als die der Manager. Daher werden bei initiativen Handlungen der Universitäten größtenteils Akademiker mit einbezogen. Gestützt auf die sich entwickelnden Muster der Ressourcenbeiträge von Akademikern und Studierenden für die Hochschulbildung prognostiziert die Studie eine aufstrebende Governance Konfiguration, bei der die Dimensionen der akademischen Selbstverwaltung und des Wettbewerbsmarktes stärker werden und die Regulation des Staates rational zunimmt. Das derzeitige institutionelle Design und administrative System des Landes, die spezifische Gewichtung und die Koordinationsmechanismen, auch als sogenanntes effektives Aufsichtssystem zwischen den drei Schlüsselakteuren - der Staat, die HI/Akademiker und die Studierenden – bezeichnet, brauchen eine lange Zeit zur Detektion und Etablierung. In der aktuellen Phase der Suche nach einem solchen System sollte die Regierung Management-Tools stärken, wie zum Beispiel die Akkreditierung, belohnende und marktbasierte Instrumente und das Treffen informations-basierter Entscheidungen. Darüber hinaus ist es notwendig die Transparenz der Politik zu erhöhen und mehr Informationen offenzulegen.

How was patient empowerment portrayed in information leaflets describing the community pharmacy Medicines Use Review service in the UK?

Objective The Medicines Use Review (MUR) community pharmacy service was introduced in 2005 to enhance patient empowerment but the service has not been taken up as widely as expected. We investigated the depiction of the patient–pharmacist power relationship within MUR patient information leaflets. Methods We identified 11 MUR leaflets including the official Department of Health MUR booklet and through discourse analysis examined the way language and imagery had been used to symbolise and give meaning to the MUR service, especially the portrayal of the patient–pharmacist interactions and the implied power relations. Results A variety of terminology was used to describe the MUR, a service that aimed ultimately to produce more informed patients through the information imparted by knowledgeable, skilled pharmacists. Conclusion The educational role of the MUR overshadowed the intended patient empowerment that would take place with a true concordance-centred approach. Although patient empowerment was implied, this was within the boundaries of the biomedical model with the pharmacist as the expert provider of medicines information. Practice implications If patient empowerment is to be conveyed this needs to be communicated to patients through consistent use of language and imagery that portrays the inclusivity intended.

Walled in: ordinary East Germans' responses to 13 August 1961

The building of the Berlin Wall on 13 August 1961 had repercussions not only on the international scene, but also for the power relationship between state and society in the German Democratic Republic. This article considers the short-, medium- and long-term reactions of the East German population to the border closure from a personal and political perspective, examining key groups such as educated elites, workers, and young people. The closed society elicited a new deference in the short term, but the author argues for considerable continuities of low-level disruptive behavior before and after 13 August. In the longer term, there was a generation born behind the Wall which by simple habituation rather than a conscious decision was forced to accept the new contours of the geopolitical landscape created by the Wall.

Reading the world through words: cultural themes in heritage Chinese language textbooks

This paper explores the social and cultural knowledge embedded in the textbooks for language and literacy education in a Chinese heritage language school, the Zhonguo School, in Montreal, Quebec, Canada. It examines how Chinese language arts textbooks introduce the child reader to cultural knowledge considered legitimate and valued in China as well as in Chinese diasporan communities. Furthermore, it looks at the construction of cultural knowledge in Chinese language textbooks in relation to the mainstream ideology to which immigrant children are exposed in and out of mainstream school classrooms. It looks at how the power relationship between legitimate cultural knowledge in majority and minority contexts is established and to what extent it affects language minority students' literacy practices in mainstream school and heritage language school contexts. Data sources are the Chinese textbooks used from kindergarten to Grade 5 in a Chinese heritage language school.

Shared decision-making in mental health care : a user perspective on decisional needs in community-based services

BACKGROUND: Shared decision-making (SDM) is an emergent research topic in the field of mental health care and is considered to be a central component of a recovery-oriented system. Despite the evidence suggesting the benefits of this change in the power relationship between users and practitioners, the method has not been widely implemented in clinical practice. OBJECTIVE: The objective of this study was to investigate decisional and information needs among users with mental illness as a prerequisite for the development of a decision support tool aimed at supporting SDM in community-based mental health services in Sweden. METHODS: Three semi-structured focus group interviews were conducted with 22 adult users with mental illness. The transcribed interviews were analyzed using a directed content analysis. This method was used to develop an in-depth understanding of the decisional process as well as to validate and conceptually extend Elwyn et al.'s model of SDM. RESULTS: The model Elwyn et al. have created for SDM in somatic care fits well for mental health services, both in terms of process and content. However, the results also suggest an extension of the model because decisions related to mental illness are often complex and involve a number of life domains. Issues related to social context and individual recovery point to the need for a preparation phase focused on establishing cooperation and mutual understanding as well as a clear follow-up phase that allows for feedback and adjustments to the decision-making process. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The current study contributes to a deeper understanding of decisional and information needs among users of community-based mental health services that may reduce barriers to participation in decision-making. The results also shed light on attitudinal, relationship-based, and cognitive factors that are important to consider in adapting SDM in the mental health system.

Poder compensatório e política de defesa da concorrência: referencial geral e aplicação ao mercado de saúde suplementar brasileiro

A criação de poder compensatório decorrente da ação concertada daqueles prejudicados em uma relação de poder assimétrica pode gerar aumento de bem-estar social. O desenvolvimento analítico a partir da estrutura proposta por Dobson et al. (1998) permite constatar que as condições para que sejam verificados os efeitos positivos são restritivas e estão diretamente relacionadas ao reconhecimento da interdependência e à cooperação entre os agentes envolvidos. Foi possível observar também que, diferentemente do que previu a análise de Dobson et al. (1998), a criação de poder compensatório pode ter efeitos positivos em termos de bem-estar, ainda que as partes não reconheçam sua interdependência e não cooperem entre si – o que depende da relação das elasticidades-preço da demanda e da oferta. A despeito da possibilidade de efeitos benéficos, as doutrinas de defesa da concorrência brasileira e nas demais jurisdições, como EUA e Comunidade Européia, aplicam de maneira equivocada o conceito de poder compensatório ou ignoram por completo sua existência. Há que se considerar, contudo, que o objetivo da política antitruste e o da criação de poder compensatório estão alinhados: equilíbrio de assimetrias de poder nas relações entre os agentes, coibindo o exercício abusivo do poder de uma das partes na transação. Verifica-se, portanto, uma incongruência entre a jurisprudência e a teoria econômica. O conflito na aplicação do conceito de poder compensatório pela doutrina antitruste pode ser nitidamente observado no mercado de saúde suplementar brasileiro. Um fenômeno verificado nesse setor é a coordenação de médicos em cooperativas para fazer frente ao exercício de poder de compra por parte das operadoras de planos de saúde. Essa ação concertada tem sido condenada pelas autoridades de defesa da concorrência com base na interpretação de que a coordenação entre médicos constitui formação de cartel, passível de condenação pelas autoridades antitruste. A análise empírica corrobora as proposições teóricas: no setor de saúde suplementar, pelo menos na dimensão preço, existe a possibilidade de efeitos positivos associados ao poder compensatório. Destaca-se, contudo, que esse resultado estaria associado às cooperativas condenadas pelo CADE, que devem representar o grupo de associações que efetivamente deteriam poder econômico para equilibrar a assimetria de poder na negociação com as operadoras de planos de saúde. Diante dessa constatação, é importante reavaliar as decisões do CADE acerca das cooperativas médicas enquanto política pública que visa aumentar o bem-estar social.

A relação entre confiança interpessoal e compartilhamento de conhecimento tácito

Empresas de negócios, que são constantemente pressionados por inovação, têm na criação de conhecimento organizacional a base para a estratégia de sobrevivência. Muito desse conhecimento acumulado é tácito, encarnado em indivíduos e incorporado pela organização, e que é de difícil articulação. A necessária justificativa de um novo conhecimento torna a sua criação um processo muito frágil. Indivíduos podem sentir-se ameaçados em compartilhar insights, intuição, novas ideias, know-how, habilidades específicas, diante de devastadores mecanismos de controle social como ridículo, difamação e opróbrio, ou pela possibilidade de mau uso de um conhecimento útil e valioso. Por outro lado, com a criança logo ao nascer, e derivado do narcisismo primário, emerge a confiança básica que acompanha o indivíduo ao longo de sua existência, e que, portanto, pode levá-lo a compartilhar seus achados. Esta pesquisa, um ensaio teórico, explorou a relação entre a confiança e compartilhamento de conhecimento tácito nas organizações. Com abordagem multidisciplinar, aderente ao pensamento complexo, incorporou referenciais teóricos advindos de trabalhos de neo-schumpeterianos (Teoria Evolucionária), da sociologia e da psicologia. O percurso metodológico contemplou a busca de artigos em base de dados, leitura de resumos de artigos, busca de autores consagrados na literatura, consulta de autores referenciados nos artigos, leitura e análise de trabalhos selecionados. Mediante análise de conteúdo, que busca identificar o que está sendo dito a respeito do tema, foram criadas as seguintes categorias de análise: inovação, poder, teoria de criação de conhecimento organizacional e confiança humana. Cada uma dessas categorias compôs um capítulo desta dissertação. Embora a escassez de pesquisas empíricas relacionadas ao tema, a análise de conteúdo dos artigos examinados permitiram concluir que a confiança interpessoal mantém relação de poder simétrico entre indivíduos e assim é capaz de acessar o conhecimento tácito enraizado na mente de indivíduos. Dessa forma, com a pesquisa aqui apresentada, espera-se ter contribuído para a literatura e práticas organizacionais relacionadas à gestão de conhecimento. Por fim, foram relatadas limitações no trabalho e sugestões para futuras pesquisas.

Valorização do magistério da educação básica no RN: participação do SINTE e do governo estadual na implementação do piso salarial profissional nacional na rede pública estadual no ano de 2009

This paper analyzes the policy of upgrading the teaching profession in relation to financing basic education, with a view to participation of the Union of Education Workers of Rio Grande do Norte - SINTE / RN and the state government in the implementation of Professional Base Salary the National Professional Teaching Public Basic Education - Law 11738/2008, the public state of Rio Grande do Norte. The participation of civil society, through the union movement presents itself as an important process of implementation of Professional Base Salary. The participation of SINTE / RN occurred since the fight to pass the plan, careers and Compensation (2006) until the implementation of the Base Salary (2009) highlighting the power relations established between the Union and State Government. To this end, there were actions such as public hearings and strikes by education professionals. In order to raise issues relevant to the issue of enhancement of teaching and participation of unions as a collective representation has been taken as a theoretical and methodological literature on the financing of basic education, enhancing teaching and participation as well as policy guidelines governing the career of teaching. Was used as a methodological procedure to document analysis and information gathering through semi-structured interviews. The results indicate the participation and the power relationship between the trade union movement and the state government in the implementation of the Base Salary. However, the current issues concerning the limitations of recovery of the teaching profession in order to implement the policy floor, not only merit of the state of Rio Grande do Norte, but the decisions that have been taken by the Supreme Court (STF) relating to the unconstitutionality of Action (ADI) filed by five governors. This fact greatly reduced the possibility of recovery of the teaching of the state, considering that the government was limited to decisions of the Supreme Court. Therefore, the enhancement of teaching remains a challenge for the union movement

Atividades profissionais da enfermagem no contexto hospitalar: influências nas relações de trabalho

The present study is based on an analysis of professional work relationships in the nursing team from the task/skills of its members as a contribution to understanding the work process in nursing. It is aimed to identify the skills of the nursing team members through the vision of nurses, technicians and nursing assistants, thus it attempts to find strategies to improve the health assistance to patients. It is a descriptive and analytical study with a qualitative approach grounded in theoretical and methodological framework of Symbolic Interactionism. The research was carried out in the participant work place, a Public Hospital of Reference for the SUS, located in the eastern health district of Natal/RN. Nineteen nursing professionals participated in the study, which seven was nurse and twelve nursing technician. As procedure to collect data we used an unstructured interview accompanied by a standard topic guide which was recorded and later transcribed. The content analysis was chosen as the main methodology to analyze the discussion, which gave rise to thematic categories that were considered relevant based on the theoretical framework of this study, and the interactionist theory. This study was in accordance with the ethical principles of the Resolution nº. 196/96, it has obtained an appropriate consent of the UFRN Research Ethics Committee. The results indicate that the professionals seen the nursing as a profession strongly attached to the health care process and as a profession that acquired a scientific status very recently. Regarding to the nursing functions in the work process in nursing, the professionals they identified the manage/administer category as the main activities developed by these professionals, thus the education and complex care in nursing categories. Concerning to the technicians and nursing assistants functions, it was figured out in the professional s opinion that there is not distinction among the attribution of these categories. The interviewed were unanimous in report that these professionals are more involved in direct patient health care through performance of basic duties in nursing care. Finally, with regard to the work relationship among nursing team members, the majority of those interviewed see this relationship as disharmony and quarrelsome and in general, there is not bond between categories that comprise the process of work in nursing. On the basis of our results we consider the importance of knowing the meaning of nursing given by these professionals; also their skills could be useful as basis to identify problems, which source could be detected in the power relationship, deviations of functions, gap between design (knowledge) and performance (doing) work, besides the loss of the global activities view in the process of nursing work

Transição política e cotidiano penitenciário

Este trabalho dedica-se ao estudo das décadas de 1980 e 1990 no Brasil, a partir da transição política, mas procurando abordar também seus desdobramentos que se materializaram, em grande parte, nos anos 1990. A abordagem baseia-se no estabelecimento de relações entre as mudanças políticas, em suas possibilidades e seus limites, e no cotidiano de instituições penitenciárias do Estado de São Paulo inicialmente, e posteriormente em uma região específica, o Oeste Paulista. Chegou-se assim à identificação das diferentes temporalidades próprias de cada uma delas, por vezes materializadas em fissuras no processo de democratização que envolvia o debate acerca dos direitos humanos, além da identificação das relações de poder comuns e específicas.

A disciplina de ginástica artística na formação do licenciado em educação física sob a perspectiva de docentes universitários

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Violência sexual infantil: compreensão de professoras sobre conceito e prevenção

Pós-graduação em Psicologia do Desenvolvimento e Aprendizagem - FC

Desvendando práticas familiares e escolares a partir das relações de gênero: uma reflexão sobre a educação de meninos e meninas

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

O que pode uma escola?: cartografias de uma escola do interior brasileiro

Pós-graduação em Educação Matemática - IGCE