The development of the Quality Indicator for Rehabilitative Care (QuIRC): a measure of best practice for facilities for people with longer term mental health problems

BACKGROUND: Despite the progress over recent decades in developing community mental health services internationally, many people still receive treatment and care in institutional settings. Those most likely to reside longest in these facilities have the most complex mental health problems and are at most risk of potential abuses of care and exploitation. This study aimed to develop an international, standardised toolkit to assess the quality of care in longer term hospital and community based mental health units, including the degree to which human rights, social inclusion and autonomy are promoted. METHOD: The domains of care included in the toolkit were identified from a systematic literature review, international expert Delphi exercise, and review of care standards in ten European countries. The draft toolkit comprised 154 questions for unit managers. Inter-rater reliability was tested in 202 units across ten countries at different stages of deinstitutionalisation and development of community mental health services. Exploratory factor analysis was used to corroborate the allocation of items to domains. Feedback from those using the toolkit was collected about its usefulness and ease of completion. RESULTS: The toolkit had excellent inter-rater reliability and few items with narrow spread of response. Unit managers found the content highly relevant and were able to complete it in around 90 minutes. Minimal refinement was required and the final version comprised 145 questions assessing seven domains of care. CONCLUSIONS: Triangulation of qualitative and quantitative evidence directed the development of a robust and comprehensive international quality assessment toolkit for units in highly variable socioeconomic and political contexts

La construcció del coneixement pràctic. Una anàlisi integrada des dels plans social i individual

La tesi doctoral aborda la relació entre coneixement i pràctica en l’àmbit de la pràctica professional dels mestres. Aquest problema s’aborda des de la psicologia històrico-cultural, la qual implica un trencament amb la “racionalitat tècnica” des de la que s’ha abordat el problema tradicionalment. Aquest nou abordatge de la problemàtica implica una considerable elaboració teòrica, que en la tesi es vehicula mitjançant dos constructes fonamentals: la situació i els conceptes pràctics. Les dades de la tesi consisteixen en les converses face-to-face i on-line entre un estudiant de Mestre en pràcticum i el seu tutor en el centre de pràctiques. L’estudi analitza dos casos d’uns quatre mesos de duració cadascun. L’anàlisi es porta a terme mitjançant anàlisi de discurs, utilitzant diverses unitats d’anàlisi i diverses dimensions, les quals fan possible una anàlisi integrada que permeti considerar de manera relacionada l’activitat conjunta (pla social) i l’ús individual de conceptes (pla individual). Els resultats preliminars suggereixen una especificitat estructural i genètica dels conceptes pràctics (en contrast amb els espontanis i científics), i l’existència de mecanismes d’activitat conjunta que potencien especialment el desenvolupament d’aquests conceptes.

Study protocol for a pragmatic randomised controlled trial in general practice investigating the effectiveness of acupuncture against migraine.

BACKGROUND Migraine is a chronic neurologic disease that can severely affect the patient's quality of life. Although in recent years many randomised studies have been carried out to investigate the effectiveness of acupuncture as a treatment for migraine, it remains a controversial issue. Our aim is to determine whether acupuncture, applied under real conditions of clinical practice in the area of primary healthcare, is more effective than conventional treatment. METHODS/DESIGN The design consists of a pragmatic multi-centre, three-armed randomised controlled trial, complemented with an economic evaluation of the results achieved, comparing the effectiveness of verum acupuncture with sham acupuncture, and with a control group receiving normal care only. Patients eligible for inclusion will be those presenting in general practice with migraine and for whom their General Practitioner (GP) is considering referral for acupuncture. Sampling will be by consecutive selection, and by randomised allocation to the three branches of the study, in a centralised way following a 1:1:1 distribution (verum acupuncture; sham acupuncture; conventional treatment). Secondly, one patient in three will be randomly selected from each of the acupuncture (verum or sham) groups for a brain perfusion study (by single photon emission tomography). The treatment with verum acupuncture will consist of 8 treatment sessions, once a week, at points selected individually by the acupuncturist. The sham acupuncture group will receive 8 sessions, one per week, with treatment being applied at non-acupuncture points in the dorsal and lumbar regions, using the minimal puncture technique. The control group will be given conventional treatment, as will the other two groups. DISCUSSION This trial will contribute to available evidence on acupuncture for the treatment of migraine. The primary endpoint is the difference in the number of days with migraine among the three groups, between the baseline period (the 4 weeks prior to the start of treatment) and the period from weeks 9 to 12. As a secondary aspect, we shall record the index of laterality and the percentage of change in the mean count per pixel in each region of interest measured by the brain perfusion tomography, performed on a subsample of the patients within the real and sham acupuncture groups. TRIAL REGISTRATION Current Controlled Trials ISRCTN98703707.

La evaluación entre iguales en el grado de educación social. Aproximación a la vida profesional

La relación educativa entraña, inevitablemente, el debate entorno de la verticalidad y del ejercicio del poder. De qué modo nos relacionamos y cómo gestionamos la comunicación entre educadores y educandos, así como entre iguales. Esa tensión se ve amplificada en la medida que incorporamos lógicas evaluativas en nuestro quehacer profesional. La siguiente comunicación describe la experiencia de la metodología de aprendizaje basada en la evaluación entre iguales aplicada a la profesionalización de los y las educadores/as sociales. Tanto a nivel escolar como en el universitario hay numerosas experiencias publicadas en relación a la metodología de evaluación entre iguales. Además, existen numerosos apartados de los “Documentos profesionalizadores” donde se justifica el hecho de que se entrenen algunas habilidades que deberían darse en la práctica profesional (como por ejemplo en la definición, en el código ético, y en el catálogo de funciones y competencias del/la educador/a social). En esta comunicación pretendemos dar a conocer la experiencia de entrenamiento de futuros educadores en aspectos que tienen una relación directa con la evaluación entre educadores/as sociales. Así pues, utilizaremos una justificación académica y metodológica de la actividad, enlazándola con los documentos profesionalizadores con un fin relacionado directamente con el ejercicio de la profesión.

Las habilidades sociales en la intervención social y educativa: de la creatividad a la adquisición de competencias

Presentamos una comunicación sobre la experiencia llevada a cabo en la asignatura de Habilidades Sociales, en la Facultad de Educación Social y Trabajo Social Pere Tarrés. Se trata de una metodología innovadora centrada en el alumno que, desde la creatividad y el sentido del humor, utiliza la metáfora de la fiesta de cumpleaños como elemento simbólico favorecedor del proceso de aprendizaje y de crecimiento personal y profesional. La vinculación de esta metáfora con las competencias trabajadas se hace a través de diversos elementos que representan el contenido específico de la asignatura. Es así como se ofrecen herramientas y estrategias para transferir lo experimentado en el aula al futuro entorno profesional. La valoración del profesorado y de los estudiantes nos confirma que es una práctica educativa de éxito.

Entrevista y urgencia social: un reto para las competencias profesionales del educador social

Si decimos que los seres humanos sólo son capaces de vivir como tales mediante la reconstrucción narrativa de sus experiencias, estamos teniendo en cuenta conceptos e ideas que recuerdan a algunos autores contemporáneos (Ricoeur, Gadamer) que defienden la importancia de ser reconocido como una creatura hecha de palabras. En la medida en que son interpretadas, traducidas, contextualizadas y ordenadas por los profesionales, la situación dialogal significativa cobra importancia. Desde esta perspectiva hemos planteado las asignaturas: Habilidades Sociales, Técnicas de Entrevista y Gestión de Situación de Crisis diseñadas para integrar los diferentes modelos teóricos y las variables que se presentan en la relación comunicativa con el usuario y en particular en la situación de entrevista. Se mostrará también el modo cómo en nuestro proceso formativo, basado en la simulación de situaciones, se fomenta el compromiso con el trabajo en equipo, la autocomprensión y enseña a crear un clima de trabajo cooperativo en el que se hace más eficaz la relación de ayuda. A través de la presentación en clase de un caso práctico en el cual se describen todos los procedimientos y las fases del que se compone el ejercicio de la práctica profesional –paso a paso-, se busca poner de manifiesto las competencias adquiridas, los modelos empleados y las habilidades sociales que han sido necesarias para afrontar con éxito la situación de urgencia social. Finalmente se deja abierta la cuestión sobre la manera en que incide y beneficia este aprendizaje en las futuras situaciones de manejo del estrés profesional (burn out).

La evaluación entre iguales en la educación social: entre lo profesional y lo académico

El siguiente artículo describe la experiencia de la metodología de aprendizaje basada en la evaluación entre iguales aplicada a la profesionalización de los educadores/as sociales.Tanto a nivel escolar como universitario, hay numerosas experiencias publicadas en relación con la metodología de evaluación entre iguales. Además, existen numerosos apartados de los “Documentos profesionalizadores” donde se justifica el hecho de que se entrenen algunas habilidades que deberían darse en la práctica profesional (como porejemplo en la definición, en el código ético y en el catálogo de funciones y competencias del educador/a social). En estas páginas pretendemos dar a conocer la experiencia de entrenamiento de futuros educadores/as en aspectos que tienen una relación directa con la evaluación entre educadores/as sociales.

Estrategias analógicas y sentido del humor en el aprendizaje de la competencia social de los profesionales de la educación social

Exploramos, en este artículo, el desarrollo y los resultados iniciales de una metodología innovadora que, usando la metáfora y el sentido del humor, crea un espacio narrativo en un contexto de formación universitaria en competencia social que favorece el proceso de aprendizaje. La experiencia consiste en vincular un escenario metafórico al escenario académico y al futuro escenario profesional. En el artículo se describen los ingredientes de la metáfora utilizada (la fiesta de cumpleaños) y sus vínculos con las competencias trabajadas en la asignatura de Habilidades sociales en la Facultad de Educación Social y Trabajo Social Pere Tarrés (URL). La valoración del profesorado y de los estudiantes la avala como una práctica educativa de éxito cuyos ingredientes pueden ser generalizados a otros contextos formativos.

Supporting the reuse of effective CSCL learning designs through social structure representations

Distance and blended collaborative learning settings are usually characterized by different social structures defined in terms of groups' number, dimension, and composition; these structures are variable and can change within the same activity. This variability poses additional complexity to instructional designers, when they are trying to develop successful experiences from existing designs. This complexity is greatly associated with the fact that learning designs do not render explicit how social structures influenced the decisions of the original designer, and thus whether the social structures of the new setting could preclude the effectiveness of the reused design. This article proposes the usage of new representations (social structure representations, SSRs) able to support unskilled designers in reusing existing learning designs, through the explicit characterization of the social structures and constraints embedded either by the original designers or the reusing teachers, according to well-known principles of good collaborative learning practice. The article also describes an evaluation process that involved university professors, as well as the main findings derived from it. This process supported the initial assumptions about the effectiveness of SSRs, with significant evidence from both qualitative and qualitative data.

Prescription des psychotropes au cabinet médical [Psychotropic drug prescription in general practice].

General practitioners treat patients with psychiatric disorders, for whom they have to evaluate the indication of a psychotropic medication. In addition to the patient's symptoms, the clinician has to take into account transferential and countertransferential elements linked to the prescription. Sociological factors also influence both the patient and the clinician, partly due to the western society's value of performance. Consistent with the bio-psycho-social model of disease, we recommend that the evaluation of the indication of a psychotropic medication includes the patient's symptoms, but also the psychological and sociological factors.

Monitoring the effects of adult psychotherapy in routine practice in Switzerland: A feasibility trial

Background: Several studies have been published on the effects of psychotherapy in routine practice. Complementing traditional views summarised as 'dose-effect models', Stiles et al. put forward data consistent with the responsive regulation model underlining the importance of the client's active participant role in defining length of treatment. One may ask what level of change reached by a patient is considered to be the 'good enough level' (GEL) and if it is related to the duration of psychotherapy. Aims: The main objective of the present feasibility trial was to monitor the patient's session-by-session evolution using a self-report questionnaire in order to define the GEL, i.e. the number of sessions necessary for the patient to reach significant change. Method: A total of N=13 patients undergoing psychotherapy in routine practice participated in the study, completing the Outcome Questionnaire - 45.2 (OQ-45), which assesses the symptom level, interpersonal relationships and social role after every psychotherapy session. The data was analysed using multi-level analyses (HLMs). Results: High feasibility of fine-grained assessment of effects of psychotherapy in routine practice in Switzerland was shown; response rates being acceptable; however, detailed analysis of the GEL was not feasible within the short study time-frame. Conclusions: Reflections on the political context of monitoring in the specific case of routine psychiatric practice in Switzerland are discussed.

Moral distress: challenges for an autonomous nursing professional practice

Constantly experiencing limiting situations that hinder a professional practice coherent with its principles - of autonomy and advocacy of users' interests -, and often conditioned to experience moral distress, the nursing profession plays a prominent role in the current health model because it has the characteristic of managing the care rendered to users in a perspective of social inclusion, both in the basic health network and in hospitals. Aiming at carrying out a reflection on the nursing practice and the difficulties present in its work routine, and considering its characteristics as a profession, this article sought to make a reflection between the practice of nursing and the numerous moral challenges imposed by the routine, resulting, in many cases, in a value crisis that can reverberate directly on the quality of the service rendered, and in abandonment of the ideals of advocacy for users.

New evidence for the social embeddedness of infants' early triangular capacities.

Infants appear to be active participants in complex interactional sequences with their parents far earlier than previously theorized. In this report, we document the capacity of 3-month-old infants to share attention with two partners (mothers and fathers) simultaneously, and trace links between this capacity and early family group-level dynamics. During comprehensive evaluations of the family's emergent coparenting alliance completed in 113 homes, we charted infants' eye gaze patterns during two different mother-father-infant assessment paradigms. Triangular capacities (operationalized as the frequency of rapid multishift gaze transitions between parents during interactions) were stable across interaction context. Infants exhibiting more advanced triangular capacities belonged to families showing evidence of better coparental adjustment. Theoretical and practice implications of these findings are discussed.

As práticas de responsabilidade social organizacional: uma análise nas empresas cabo-verdianas

A responsabilidade social organizacional (RSO) constitui um assunto cada vez mais discutido no seio dos diversos sectores e é considerado importante na gestão das organizações. As acções de responsabilidade social, gradualmente, têm vindo a tornar-se um diferencial em termos de estratégia e competitividade, contribuindo, no seu todo, para a sustentabilidade da sociedade e das pessoas que nela vivem. Assim, torna-se importante compreender a forma como as organizações e seus gestores entendem e assumem o seu compromisso para com todos os stakeholders, bem como despertar-lhes o interesse para os benefícios e vantagens que poderão obter com a prática e implementação de uma gestão da responsabilidade social nas organizações. Apesar de as práticas de RSO constituírem ainda um assunto muito recente em Cabo Verde, já é notável o crescimento das acções desencadeadas pelas organizações em prol de uma sociedade mais justa, responsável e transparente. Com o objectivo de identificar as práticas de responsabilidade social das organizações cabo-verdianas na sua vertente económica, social e ambiental, o presente trabalho inclui uma análise quantitativa e qualitativa, feita a partir da aplicação de um inquérito por questionário, com questões fechadas, complementado por questões abertas. Assim foi realizada uma pesquisa exploratória-descritiva nas organizações, escolhidas em função da sua notoriedade e da sua posição estratégica para o desenvolvimento do país. Entre os principais resultados obtidos pode-se destacar a preocupação com questões ambientais, o respeito pela Lei laboral e apoio regular às comunidades. Dos resultados obtidos e da análise efectuada, pode-se concluir que a cultura da RSO nas organizações cabo-verdianas, ainda se apresenta de forma incipiente. Espera-se, com este trabalho, explicitar o carácter estratégico da responsabilidade social organizacional, bem como fomentar reflexões posteriores de forma a efectivar uma mudança de cultura, levando gestores, colaboradores, e demais stakeholders a desenvolverem o interesse sobre esta matéria, uma vez que a RSO não é apenas um assunto das grandes empresas, mas sim, de todos nós. Social organizational responsibility (SOR) is an increasingly discussed subject amongst several sectors and it’s considered as extremely important on organization management. The social responsibility actions have gradually becoming a disparity regarding strategy and competitivety, contribution in its whole for the society’s and its inhabitant’s sustainability. Thus, it’s important to identify the way the organizations and its managers understand and assume their commitment with the stakeholders, as well as to bring up their interest for the benefits and advantages that they may obtain with the social responsibility management practice on the organizations. Although the SOR practices are still considered as a recent subject in Cape Verde, it’s already noticeable the organizations actions growth towards a fairer, responsible and transparent society. Aiming to identify the capeverdian social organizational responsibility practices on its economical, social and environmental string, this written presentation includes a quantitative and qualitative analysis, with closed questions, completed by open ones. It was therefore performed an explanatory-descriptive research for the organizations, each chosen regarding their notoriety and strategic position for the country’s development. Amongst the main results we may enhance the concern on environmental issues, the respect for the Labour law and the regular support for the communities. From the obtained results and the analysis done, we may conclude that the SOR culture on the Capeverdian organizations is still considered as quite insipient. With this written presentation, it’s expected to explain the social organizational responsibility strategic character, as well as to enhance the posterior reflections in order to implement a cultural change, influencing the managers, co-workers and remaining stakeholders to develop their interest on the subject, once the SOR should not only be some big companies issue, but instead, one regarding all of us.

Identidade e Pertença: para além das Dimensões Materiais do Sofrimento Social

Um olhar antropológico sobre as relações sociais em dois microcosmos etnográficos – um bairro e um centro de saúde – revela as limitações de encarar a pobreza material como o único critério para compreender os processos de sofrimento social. De forma a explorar como o sofrimento social pode ser vivenciado através das identificações e das pertenças, a identidade étnica e a identidade profissional são examinadas como exemplos da identidade social em geral. A relação dialética entre a identidade social e a identidade pessoal demonstra como o poder não está depositado nas pessoas, mas depende das suas relações sociais. Dado que o exercício de poder não pode ser garantido pelo simples estatuto de uma determinada categoria social, urge procurar vivências e subjetividades nas fissuras das categorias, distinguindo entre uma categoria de prática e uma categoria de análise, de forma a alargar o horizonte sobre a natureza dos processos de sofrimento social.