Indicadores da individualização de cuidados para o curso de licenciatura em enfermagem

RESUMO: A individualização dos cuidados de enfermagem tem sido associada a uma evolução clínica mais favorável, representando um importante parâmetro de avaliação e de desenvolvimento dos serviços de saúde. A tónica atribuída a esta problemática não só é evidenciada por diversos autores, como se enquadra nas metas de modernização do Sistema Nacional de Saúde e é destaque em vários códigos normativos da profissão nacionais e internacionais, como uma obrigação moral e deontológica. Assim, pretende-se mediante os ganhos em saúde sensíveis às intervenções de enfermagem, identificar quais indicadores do cuidado individualizado, para se efectivar a sua incorporação na formação inicial em enfermagem. Para tal efeito, construiu-se uma bateria de indicadores mediante análise de duas revisões sistemáticas da literatura, que teve por base o Modelo da Eficácia do Papel de Enfermagem, desenvolvido por Irvine et al. (1998). Para à adaptação à realidade portuguesa recorreu-se à técnica de Delphi, com duas rondas, que incluiu respectivamente, 12 e 10 peritos de enfermagem. Na análise de dados utilizou-se o nível de concordância superior ou igual a 90%, na última ronda. Na segunda fase do estudo, aplicou-se um inquérito por questionário (α de Cronbach = 0,919) para testar a sua aplicabilidade dos indicadores, a 156 enfermeiros, do mesmo hospital da área da grande Lisboa, no Serviço de Medicina e Cirurgia. Recorreu-se ao SPSS, versão 19 e realizou-se análise univariada e estatística analítica. Na bateria final de indicadores foram incorporados aqueles com ponderação positiva (≥51%). Os dados qualitativos obtidos foram submetidos a análise de conteúdo. Dos 58 indicadores iniciais, consolidaram-se 8 categorias: cuidado à pessoa em fim de vida e família, toque terapêutico, educação para a auto-gestão da saúde, cuidados de proximidade, gestão de casos, empoderamento/ literacia para a saúde, linha telefónica de apoio permanente/ tele-assistência e apoio psico-emocional, com valorização de 28 indicadores. O tempo de experiência profissional, tipo de serviço e tempo de permanência no mesmo serviço influenciou a percepção dos enfermeiros, confirmando os pressupostos de Irvine et al. (1998) e Benner (2001). A correlação total dos indicadores, no questionário, variou entre 0,248 e 0,650, para p<0,01. O facto de todas as correlações serem positivas significa que provavelmente estão associados à problemática da individualização, pelo que se sugere a sua transposição para o ensino de enfermagem. ABSTRACT: The individualization of nursing care has been associated with a more favorable clinical evolution, an important parameter for the evaluation and development of health services. The emphasis given to this problem is not only evidenced by several authors, as fits the goals of modernizing the National Health System and is featured in several normative codes of the profession nationally and internationally, as a moral and ethical obligation. Thus, it is intended by the gains in health sensitive to nursing interventions, identify indicators of individualized care and give effect to its incorporation into the initial training in nursing. For this purpose, we constructed a series of indicators by analyzing two systematic reviews of literature, which was based on the The Nursing Role Effectiveness Model developed by Irvine et al. (1998). For the adaptation to the Portuguese appealed to the Delphi technique with two rounds, which included, respectively, 10 and 12 nursing experts. In data analysis we used the level of agreement greater than or equal to 90% in the last round. In the second phase of the study, we applied a questionnaire (Cronbach's α = 0.919) to test the applicability of the indicators, the 156 nurses in the same hospital in the Greater Lisbon area, the Department of Medicine and Surgery. Done using the SPSS, version 19 and conducted a univariate analysis and analytical statistics. In the final heat of indicators were incorporated into those with positive weight (≥ 51%). Qualitative data were subjected to content analysis. Of the initial 58 indicators, eight were consolidated categories: care to the person and family life, therapeutic touch education for self-management of health care outreach, case management, empowerment / literacy to health, a telephone line permanent support / tele-assistance and psycho-emotional, with an appreciation of 28 indicators. The length of professional experience, type of service and length of stay in the same service influenced the perception of nurses, confirming the assumptions of Irvine et al. (1998) and Benner (2001). The total correlation of the indicators in the questionnaire ranged between 0.248 and 0.650, p <0.01. The fact that all correlations are positive means that are probably associated with the problem of individuation, which is suggested by its implementation in nursing education.

Defining moments in men's lives : a study of personal narratives

This study explores the defining moments in six men’s lives. The empirical dimension of the research is built around the personal narratives these men tell of their lives across a series of four interviews. The central research theme is the notion of the defining moment as a key element in the processes of establishing how men understand and interpret the events and incidents that have shaped their lives. In the context of this study, the defining moment is seen as the moment or period in time when an individual gives definition to a specific event or experience, as a transition point with (potentially) life-altering consequences. Some of the thematic structures presented include relationships with significant adults (parents, teachers), masculinity, self-harm, schooling, mental illness, isolation, loneliness, stress and relationships with peers. In my pursuit of a methodology that could accommodate the aims of this study, I explored the process of meaning through the qualitative paradigm. Drawing on the principles of qualitative research, as applied through narrative inquiry, I deployed a semi-structured interview format to collect the lived experiences of participants. By privileging the stories that individuals tell of their experiences, the narrative method recognises that data are inexorably located in the contextual and contingent. The experiences and narratives that are presented in this thesis are built around the authentic voices of participants. The study presents a warrant for working with men’s defining moments to disrupt, alter and redefine their attitudes and behaviours in order to improve their lives. Based on the insights gleaned through this study, I argue that there are defining times/points in people’s lives where their experiences can be life altering. When these experiences involve uncertainty, anxiety, stress and other pernicious effects, their longer-term consequences can be devastating. The study confirms existing research, that men are reluctant to seek help or reveal their insecurities during such times, therefore making them particularly vulnerable to defining moments. The conclusion of this thesis establishes some broad recommendations pertaining to working effectively with men and their defining moments. I focus particular attention on the place of schooling and education in helping individuals recognise and respond to the early symptoms of what is potentially a life-altering experience. Schools and, by association, teachers need to be actively and strategically involved in this process. To this end, I argue the need for targeted interventions that are both sensitive and timely. In their engagements with young males, parents, teachers, coaches and mentors need to be particularly attuned to their silent screams for help.

Exploratory surgery of the female psyche

The thesis explores the visual narrative concerning a journey of empowerment for women. To enable the journey to advance the inquiry is directed into two areas. The first area is female gender, which is argued to be socially constructed and implicit in the marginalisation of women in western society. The second area is ‘feminine authority’, which is gained by developing an understanding and acceptance of the characteristics which have historically been considered as belonging to the feminine. Granting these characteristics agency would recognise their authority and assist in the elevation of the female to a position of equality in western society. Beginning from a feminist position, the research supported the belief that the female is marginalised in western society. It also confirmed the notion that empowerment and authority can be attained by women if they actively pursue the following; • Explore their own psychology beyond the existing socially constructed gender roles. • Develop an understanding of their feminine self by applying Jung's theories on individuation and archetypes. • Expose the underlying patriarchal influence in western epistemology and science by challenging existing deeply held cultural and scientific beliefs and by actively contributing as feminists to the areas of epistemology and science. Archetypal myths of the ‘feminine’ have developed from an androcentric position. They enforce and perpetuate gender imbalance which contributes to the disenfranchisement of women in western society, ‘Individuation’ is a process in which a person explores aspects of themselves to bring forth parts of their unconscious into their conscious mind in an attempt to gain a deeper understanding of themselves. As a consequence the consciousness develops closer links with archetypal memories which assists the exploration. The ‘true feminine’ is the feminine not restricted or defined by the dominant androcentric view. Knowledge of the feminine empowers women to address the marginalisation of the female in western society and assists in the process of gaining female authority. This enquiry also investigated the four stages of female psychological development with regard to patriarchal influences. Of particular importance is the second stage of psychological development where the female identifies with historically perceived inferior characteristics of the female. This is when she rejects her connections with the primacy of female power and her deep connections with nature which were inherited from archaic times. It is at this stage that she absorbs the myths associated with western patriarchal society which effectively disempower her. Western epistemology, with its emphasis on ‘objective’ investigation and empiricism contributes to the support for and promotion of ‘inferior’ female gender. This type of investigation is brought into question when areas of research into primates and human evolutionary theory is shown to develop from an androcentric view. Western knowledge has associations with power and justice and power is commonly associated with dominance. Regard for ‘truth’ and ‘absolute’ can be viewed as key elements in the support for knowledge and its associations with power. Knowledge has historically maintained suppression of individual experience which promotes a universalised account. This suppression of beliefs other than the dominant authority maintains the existing dominant social structure. Foucault's view of the genderised or inscribed body alerts us to areas where dominance, resistance and power play a part in maximising masculine power and control. Gender becomes an instrument of power within the existing patriarchal structure. Gender, knowledge and power are identified as areas obstructing female empowerment. Part 3 of this exegesis examines the imagery which embodies the visual narrative. Particularly, the harlequin image, its historical background and connections with ancient mythology including reference to Jungian psychology. The harlequin image is developed sequentially in the earlier black and white drawings on paper. These drawings contained a female figure which was often placed in juxtaposition with a Venus or goddess image, reference was also made to ‘eve’ and the ‘siren’. These elements provided the framework which enabled the harlequin image to emerge and evolve. The narrative developed with an understanding of the ‘feminine’ aspects of the psyche which resulted in the harlequin acquiring the elevated authority of a goddess. The Harlequin evolved from my need for symbolic representation of the female psyche. It represents contradiction and dualism. It is a composition of opposites, reflects masculine and feminine traits, the dark and light of the conscious and unconscious mind, it houses both comic and sinister elements, is a trickster and menace. The costume, colours and patterns are expressive elements conducive to fragmentation and layering within the composition of the paintings. Jung examined the harlequin in Picasso's paintings. He concluded that as Picasso drew on his inner experiences the harlequin became important as a symbol; it was a pictorial representation from the unconscious psyche. It travelled freely from the conscious to the unconscious and represented the masculine and feminine, chthonian and apollonian. The final painting in the series, a triptych, completes the narrative and stands alone as a salutatory work. It unites the series by combining existing compositional devices and technique while making reference to imagery from previous works, ‘The Three Graces Victorious’, expresses the authority of the feminine. It completes a victorious stage of a journey where the harlequin is empowered by archaic memories and knowledge of the psyche. The feminine is hailed, elevated and venerated. Other elements which assist in expressing the visual narrative are; colour, technique and influence. Colour is explored and its use as an emotive devise in expressionism. Paul Klee's writing on the use of colour and it's symbolic meaning and Julia Kristeva's investigation on colour from a psychoanalytic and semiotic view are also discussed. To indicate influences and connections within my oeuvre, reference is also made to the following: Jasper Johns' for his use of imagery in his ‘Four Seasons’ series with it's reference to a journey of maturation and Louise Bourgeois' work which deals with issues of gender, memories and past journeys. Although ‘The Three Graces Victorious’; the concluding painting for the investigation is celebratory and represents a finality to the thesis, it points to further areas that impede feminine development and need future examination. Reference is made to a continuation of the exploratory journey by plotting the Harlequin/Goddesses future directions. Although the Harlequin/Goddess is empowered with newly acquired authority, her future journey does not need to be bound by mathematics or limited by rationality. She does not require power to dominate or gender structures to subjugate, but requires limitless boundaries and contexts. The Harlequin/Goddess's future journey is not fixed.

Gender differences in the performance of individuating acts

Although several studies in social psychology suggest that male participants are more likely than female ones to engage in individuating behaviors, other studies have found no gender differences in willingness to perform individuating acts. This study posits that differences in findings across past investigations may be attributed to the chosen domain of individuating behavior. The content of the Individuation Scale (Maslach, Stapp, & Santee, 1985) is examined in terms of Bakan's (1966) agency‐communion theory to identify two types of individuating behaviors that are consistent with men's gender role orientations (i.e., eliciting conflict, leadership), one type of individuating behavior that is consistent with women's gender role orientations (i.e., personal disclosures), and a gender‐neutral type of individuation (i.e., performance). Responses to the scale are obtained from a sample of business school students (N = 273) and a more heterogeneous mail survey sample (N = 621). A sequence of measurement invariance tests of a 4‐factor correlated model of the individuation measure indicates a high degree of equivalence in the meaning of the measure across gender groups. Subsequent latent‐means structure analysis examines gender differences in willingness to perform the 4 types of individuation behaviors captured in the scale. In the student sample, there were no mean differences in willingness to perform any of the 4 types of individuating acts. However, in the mail survey sample, findings of mean differences supported hypotheses derived from agency‐communion theory: For men as compared with women, the latent means for leadership and eliciting conflict were higher and the latent mean for personal disclosure was lower.

Problematizing 'risk' and the principalship : the risky business of managing risk in schools

Over the past two decades, risk in education has stimulated increasing attention and prominence, with principals bearing responsibility and liability for ‘managing’ risk in schools. As a consequence, compulsory risk compliance régimes have become increasingly complex, technical and time-consuming. This article focuses on the responses of principals to issues surrounding ‘risk’ and suggests that some risk processes themselves may be inherently risky. Principals fear that risk management régimes can incur professional and personal danger while ignoring some commonly known, politically sensitive, ‘risky’ areas. The article considers the scope of risk in schools before turning to ‘undiscussables’: how risk management puts principals at risk, and issues surrounding leaders as risk. Principals’ concerns about marginalization from systemic risk decision-making, the individuation of risk management responsibility and suggestions for action are discussed, along with areas for future research.

Contributions of school design to adolescent identity formation : case studies of four Australian secondary schools

The paper presents a summary of the study that examined the relationship between school design and adolescent identity formation. Reviewing theories and empirical studies of identity development, three major processes involved in adolescent identity formation were identified: (1) separation or individuation process, (2) social integration or relational connectedness, and (3) developmental exploration. Two key characteristics of schools that support these identity formation processes were proposed: (1) having a supportive environment addressing needs for individuation and social integration, and (2) providing opportunities for developmental exploration. Implications of these characteristics for school design were studied through a review of research and practices of learning space design. Four secondary schools in Australia which represented an innovative approach to learning space design were then examined to provide insights into these design-related implications and better understand issues and challenges associated with them. The paper concludes with proposing five design principles which supports adolescent identity development through contributing to processes involved in identity formation.

Psychological Reflections on Post - Modernist Gothic Literature

The thesis consists of a creative component, two short stories, 'The Conservatory' and 'Psychosis', and a novella, 'The Lady of Tangiers', in the genre of Gothic fiction, and accompanying theoretical component with a psychological interpretation of literature, including theories of C.G.Jung, identifying psychological elements including symbolism of the unconscious, transformation and individuation in the short stories 'The Conservatory' and 'Psychosis', and an analysis of the novella 'The Lady of Tangiers', discussing the essay 'The Uncanny' by Sigmund Freud. The critical analysis and interpretation of the writing reflects the psychological development of the individual.

O Sublime Nanotecnológico

The nano convergence is a historic event, similar to the advent of cyberspace, which has equal potential disruption. As well as the aesthetics of communication Mario Costa has a technological sublime mediated through imaging techniques, we propose in this work the emergence of an aesthetic of nanocomunicasio, which, in turn, proposes a nanotechnological sublime mediated through technological individuation. While the technological sublime Mario Costa is entirely based on the Kantian sublime, the sublime nanotechnology is inspired by the sublime transimanente Schopenhauer. If the technological sublime Mario Costa is connected to virtuality and reproducibility of digital imaging techniques, we have the sublime nanotechnology refers instead to the materiality and autorreprodutibilidade the principle of individuation.

Reinventando a si mesmo no fio da carreira: uma reflexão sobre as metamorfoses nas segundas escolhas profissionais

O trabalho propõe uma reflexão sobre as trajetórias profissionais do ponto de vista subjetivo, abordando as "histórias de vida", os relatos daqueles que, por vontade própria, fizeram deslocamentos em suas carreiras ou se encontram em meio a tal processo. O universo pesquisado é constituído por pessoas das camadas médias urbanas, moradoras do município do Rio de Janeiro. A análise tomou como base vinte entrevistas pessoais gravadas, realizadas entre julho de 2004 e junho de 2005. As principais questões discutidas são a relativização da categoria "mudança" quando aplicada à carreira; os sentidos e os significados dos deslocamentos e o modo como a reinvenção profissional se integra a um projeto pessoal de autoconhecimento e autotransformação, nos quais as práticas psicológicas e alternativas contribuem para seu desenvolvimento e fortalecimento. A dimensão analisada é a do sujeito psicológico que possui um projeto individualizador e se reinventa a partir das condições que detém. Para contextualizar o significado que o indivíduo possui na cultura ocidental moderna, a discussão destes temas é precedida por um histórico sobre o indivíduo-valor e sobre o trabalho-valor.

Masculino e feminino nas organizações

A análise junguiana contribui de forma significativa para o estudo do gênero e da sexualidade nas organizações. O conceito de processo de individuação e a noção de arquétipos, especialmente de "SELBST", e Anima e Animus são de interesse particular para a pesquisa das masculinidades, feminilidades e sexualidade nas organizações. Esse é o caminho que procuramos trilhar neste texto. A idéia é demonstrar o relacionamento entre gênero e sexualidade com poder e cultura organizacional não como um segmento mas como alguma coisa, que está presente na maior parte do texto.

A importância do objeto transicional no desenvolvimento psíquico sadio

O objeto transicional é um mediador entre mãe e filho, eu e não-eu, mundo interno e mundo externo. A mãe suficientemente boa permitirá esse objeto e através dele a criança passará de um estado de ilusão para um estado de desilusão, do relacionar-se com o objeto para o uso do objeto. A passagem do princípio do prazer para o princípio da realidade permitida pela mãe boa, através de uma adaptação ativa com a criança facilitará uma capacidade do brincar criativo num espaço potencial. O jogo com as pessoas onde haverá amigos e inimigos somente se realizará através desse brincar criativo. Para que exista um desenvolvimento do processo de separação- individualização é necessário a existência de um objeto transicional em sua forma saudável como um acalmador da ansiedade. Daí a importância da disponibilidade da mãe e do objeto transicional para que todo o desenvolvimento psíquico saudável se realize; a importância de uma continuidade no cuidado e uma consequente confiança na mãe para que possa ser bem suportada a sua ausência; e para que no processo de dependência para o rumo à independência a criança possa seguir segura e feliz por essa separação ou independência da mãe e filho ao mesmo tempo. Caso isto não ocorra de uma forma saudável, isto e, se a mãe ou o ambiente não for suficientemente bom, pode haver o desenvolvimento, na criança e posteriormente no adulto, de um objeto transicional sendo o próprio corpo e mais tarde uma idéia fixa. O que é mais importante nisso tudo é que o objeto transicional exista e seja permitido em toda a sua plenitude sem interrupções. O processo deve realizar-se até o final, isto é, até que o objeto perca simplesmente o seu significado e não esquecido ou reprimido. Que fique reduzido somente ao nível de significante. O tempo que ele durará vai variar de criança para criança, de mãe para mãe, de meio para meio. E isto não terá muita importância. O que terá importância será somente que a ele seja permitido existir e se o processo for concluído a criança terá um desenvolvimento psíquico saudável e poderá, pela vida afora,confiar em si mesma e nas pessoas que a rodeiam. Poderá ser um "ser total" pronto para encarar e enfrentar o mundo externo.

Desenvolvimento emocional e as etapas da construção do objeto permanente

Este trabalho refere-se a um estudo longitudinal de um bebê, acompanhado em seu desenvolvimento cognitivo e emocional, a partir do oitavo ao décimo oitavo mês de vida. Baseando-se especificamente em observações sistemáticas realizadas no ambiente natural do bebê, este estudo tem por objetivo analisar o possível paralelo entre a construção da noção de objeto permanente em Piaget e as subfases do processo de separação-individuação. A visão integrada dos aspectos de desenvolvimento levam a resultados que evidenciam não a determinação de um aspecto sobre o outro, mas a conclusão de que ambos funcionam como estruturas que integram um mesmo sistema interdependente. Neste sentido, na relação mãe-bebê, não é a causa e o efeito que é necessário determinar, mas a compreensão da interação entre o sujeito e o objeto envolvidos neste processo. A constituição do objeto afetivo, está, portanto, estreitamente relacionado com a construção da noção de objeto permanente durante o período sensório-motor.

Dos tempos de escola aos dias atuais: reminiscências duradouras da experiência escolar

Este estudo trata sobre as marcas da experiência escolar no processo de individuação do sujeito e tem como objetivo geral conhecer de que forma essas experiências, a despeito das questões curriculares e pedagógicas, influenciam esse processo. Buscou-se interpretar as experiências reforçadas durante a escolarização e as trajetórias de enfrentamento das diversas situações vividas na escola. Tentou-se, também, compreender o sentido dos acontecimentos escolares críticos e igualmente como o meio familiar pode influenciar nas escolhas e formação dos sujeitos através do investimento pedagógico. Ademais, refletiu-se sobre os motivos que levaram alguns a permanecerem no ambiente escolar seja como estudante ou mais tarde, do lado de lá, como professor. Para tanto, foi realizada uma pesquisa qualitativa de inspiração fenomenológica utilizando-se de entrevistas narrativas com quatro sujeitos, a partir das quais se identificou as principais características, estrutura, condições de origem, o contexto social, as estratégias escolares, as formas como foram manejadas e suas conseqüências. A análise dos relatos deixou claro dois eixos fundamentais da experiência escolar que se destacam na constituição dos sujeitos: de um lado a dinâmica do ambiente escolar vivido deixou marcas indeléveis na memória que foram determinantes para as escolhas pessoais; por outro lado, a referência familiar, através das suas várias formas de investimento pedagógico, teve uma influência decisiva. As marcas combinadas da escola e da família deixaram um legado importante para formação dos sujeitos e para as escolhas que fizeram durante as suas vidas, especialmente no direcionamento da suas carreiras profissionais. Invariavelmente, percebeu-se na investigação, que muito do aluno que se foi persiste no adulto e profissional de hoje. Assim, o Eu escolar é parte do Eu profissional que existe em cada um. O cidadão, a pessoa e o profissional são derivados dos processos de socialização e individuação, os quais em grande parte se definem durante a vida escolar. E é com o uso desse "capital escolar" , adquirido nos tempos de escola, que temos condições de desenvolver os muitos papéis sociais nos dias atuais.

Dos tempos de escola aso dias atuais reminiscências duradousras da experiência escolar

This study it treats on the marks of the school experience in the individuation process of the subject and has as general aim to know of that it forms these experiences, the spite of the curricular and pedagogical questions, influences this process. It searched to interpret the experiences strengthened during the school education and the trajectories of confrontation of the diverse situations lived in the school. It was tried,also,to understand the direction of the critical school events and equally as the familiar way can influence in the choices and formation of the citizens through the pedagogical investment. Furthermore, it was reflected on the reasons that had taken some to remain in the school environment are as student or, later, of the side of there ,as teacher. For in such a way, it realized a qualitative research with a phenomenological inspiration using narratives interviews carried with four subjects, from which if it identified the main characteristics, structure, conditions of origin, the social context, the school strategies, the forms as they had been managed and its consequences. The analysis of the stories clearly left two basic axles about the school experience that if detach in the constitution of the subjects: in a hand, the dynamics of the lived school environment left undeleted marks in the memory that had been determinative for the personal choices; on the other hand,the familiar reference, through its different forms of pedagogical investment,had a decisive influence. The agreed marks of the school and the family had left an important legacy for formation of the subjects and the choices that had made during their lives, especially in the aiming of its professional careers. Invariably, it was perceived in the inquiry, that much of the pupil who if was persists in the adult and professional of today. Thus, the school I it s part of professional I that it exists in each one. The citizen, the person and the professional are derived from the processes of socialization and individuation, which to a large extent are defined during the school life. And it s with the use of this school capital , acquired in the school times, that we have conditions to develop the many social roles in the current days