Patient participation : what it is and what it is not

In general, patient participation is regarded as being informed and partaking in decision making regarding one’s care and treatment. This interpretation is common in legislation throughout the Western world and corresponding documents guiding health care professionals, as well as in scientific studies. Even though this understanding of the word participation can be traced to a growing emphasis on individuals’ autonomy in society and to certain dictionary defi nitions, there are other ways of understanding participation from a semantic point of view, and no trace of patients’ descriptions of what it is to participate can be found in these definitions. Hence, the aim of this dissertation was to understand patients’ experience of the phenomenon of patient participation. An additional aim was to understand patients’ experience of non-participation and to describe the conditions for patient participation and non-participation, in order to understand the prerequisites for patient participation. The dissertation comprises four papers. The philosophical ideas of Ricoeur provided a basis for the studies: how communication can present ways to understand and explain experiences of phenomena through phenomenological hermeneutics. The first and second studies involved a group of patients living with chronic heart failure. For the fi rst study, 10 patients were interviewed, with a narrative approach, about their experience of participation and non-participation, as defi ned by the participants. For the second study, 11 visits by three patients at a nurse-led outpatient clinic were observed, and consecutive interviews were performed with the patients and the nurses, investigating what they experience as patient participation and non-participation. A triangulation of data was performed to analyse the occurrence of the phenomena in the observed visits. For paper 3 and 4, a questionnaire was developed and distributed among a diverse group of people who had recent experience of being patients. The questionnaire comprised respondent’s description of what patient participation is, using items based on findings in Study 1, along with open-ended questions for additional aspects and general issues regarding situations in which the respondent had experienced patient participation and/or non-participation. The findings show additional aspects to patient participation: patient participation is being provided with information and knowledge in order for one to comprehend one’s body, disease, and treatment and to be able to take self-care actions based on the context and one’s values. Participation was also found to include providing the information and knowledge one has about the experience of illness and symptoms and of one’s situation. Participation occurs when being listened to and being recognised as an individual and a partner in the health care team. Non-participation, on the other hand, occurs when one is regarded as a symptom, a problem to be solved. To avoid non-participation, the information provided needs to be based on the individual’s need and with recognition of the patient’s knowledge and context. In conclusion, patient participation needs to be reconsidered in health care regulations and in clinical settings: patients’ defi nitions of participation, found to be close to the dictionaries’ description of sharing, should be recognised and opportunities provided for sharing knowledge and experience in two-way-communication.

Un estudio de la interferencia lingüística del uso del verboser + estado civil del castellano hablado por catalanes

This thesis aims to study the phenomenon of linguistic interference in the use of the verb ser in different marital status (single, married and divorced) in spanish spoken by catalans living in different territorial areas of Catalonia. Our theory is that individuals who reside in territorial areas where catalan is the most spoken language tend to use the verb ser + marital status rather than the verb estar + marital status due to the influence of catalan. We have used a quantitative methodology, i.e. we have collected data through a survey. The results of our study confirm our theory that individuals who reside in territorial areas where catalan is the most spoken language tend to use the verb ser + marital status rather than the verb estar + marital status due to the influence of catalan.

Reflection of matter waves in potential structures

In this paper the behavior of matter waves in suddenly terminated potential structures is investigated numerically. It is shown that there is no difference between a fully quantum mechanical treatment and a semiclassical one with regards to energy redistribution. For the quantum case it is demonstrated that there can be substantial reflection at the termination. The neglect of backscattering by the semiclassical method brings about major differences in the case of low kinetic energies. A simple phenomenological model is shown to partially explain the observed backscattering using dynamics of reduced dimensionality.

Ne videt, ne znat – det direkta objektets kasus vid två negerade ryska verb

This essay examines the case of the direct object in Russian sentences with the negated verbs не видеть and не знать. For each verb, 50 contexts were downloaded from the newspaper corpus of the Russian National Corpus and analysed with respect to the semantic properties of the direct object and the negated verb. The theories and concepts used for the analysis have been outlined in Padutjeva, 2006. The analysis of не видеть suggests that the main difference between the genitive and the ac-cusative case is to be found in the notion of non-existence or absence implicated by the verb’s semantics. In utterances with не видеть as a predicate, this notion is always present and is expressed by the genitive case. The speaker may also choose to ignore it by using the accusa-tive and thus emphasize some other aspect of the described situation. The examined properties of reference, definiteness and denotative status of the direct object seem to play a secondary role for how case is used. Their influence is to delimit the meaning of the objective genitive to either non-existence or absence. No similar conclusions could be drawn from the examination of не знать. The reason for this is that the concept of private sphere, used by Padutjeva to explain the use of objective geni-tive with this verb, could not be properly established during the analysis. Just as the notion of absence is crucial for the understanding of the objective genitive when it occurs with не видеть, the concept private sphere seems to be the key to understand it when it occurs with не знать.

Can therapy dogs evoke awareness of one's past and present life in persons with Alzheimer's disease?

BACKGROUND: Persons with Alzheimer's disease (AD) sometimes express themselves through behaviours that are difficult to manage for themselves and their caregivers, and to minimise these symptoms alternative methods are recommended. For some time now, animals have been introduced in different ways into the environment of persons with dementia. Animal-Assisted Therapy (AAT) includes prescribed therapy dogs visiting the person with dementia for a specific purpose. AIM: This study aims to illuminate the meaning of the lived experience of encounters with a therapy dog for persons with Alzheimer's disease. METHOD: Video recorded sessions were conducted for each visit of the dog and its handler to a person with AD (10 times/person). The observations have a life-world approach and were transcribed and analysed using a phenomenological hermeneutical approach. RESULTS: The result shows a main theme 'Being aware of one's past and present existence', meaning to connect with one's senses and memories and to reflect upon these with the dog. The time spent with the dog shows the person recounting memories and feelings, and enables an opportunity to reach the person on a cognitive level. CONCLUSIONS: The present study may contribute to health care research and provide knowledge about the use of trained therapy dogs in the care of older persons with AD in a way that might increase quality of life and well-being in persons with dementia. IMPLICATIONS FOR PRACTICE: The study might be useful for caregivers and dog handlers in the care of older persons with dementia.

Gestão de pessoas em organizações em processo de transformação: a experiência da Rede Ferroviária Federal em liquidação

This study apprehends the living experiences of the RFFSA employees who still remain in the organization until its final moments of existence. In order to comprehend and analyze these experiences to generate knowledge related to personnel relationships in critical management realities as it is the case in a process of organizational liquidation. Due to the fact that the case study focus on a railroad enterprise, the presence of which is inherent to the history of the nation, social implications related to that liquidation process were investigated under cultural concepts, new organization context, added to a phenomenological approach. Through the consideration of that philosophical dimension of the relationships which constituted the object of this study, the railroader being could be more broadly understood. The employed methods include bibliographic and documental research to describe the organization and to reinforce sources for a deeper study of the railroad employee¿s culture and values. The posture assumed in that investigation was participation with the subjects including the researcher. Some characteristics were extracted out of questionnaires and interviews as a means of answering questions which would not come out trough numbers. What emerges as a fundamental learning in the conclusions can be summarized as follows: the understanding of an organization as a slice detached from society, is a deviation from human relevance paths, since implications of human actions in leabenswelt are ignored and their impacts are not considered concrete. That especial learning which the case study helped to clarify and which is an alert to liquidators and employees, independently of hierarchy, is not limited to liquidation processes. The phenomenon which shows itself in that strategic category of management is that its deviation from human relevance appears in higher dramaticism.

La interculturalidade como estratégia competitiva de las organizaciones brasilenãs frente a la globalización

Este estudo aborda o emprego de estratégias interculturais para conseguir competitividade organizacional em diferentes situações, tais como fusões alianças para negócios internacionais, servIços a clientes internacionais e comércio exterior. Em busca desse objetivo, a pesquisa de campo foi realizada em cinco diferentes organizações, entre as quaIs duas são instituições de ensmo, nas quaIs estudantes em comércio e negócios internacional foram entrevistados individualmente e em grupos. Nessa busca por fundamentos para postura educacional e habilidades interculturais, Simón Bolívar foi considerado urna inspiração, em especial devido à sua preocupação com o mútuo entendimento entre as nações latino-americanas, uma questão que está nas raízes de qualquer possibilidade de superar desafios interculturais. Além disso, os ideais daquele reconhecido líder emergem fortemente, quando essas nações estão decididas a estabelecer o MERCOSUL. As conclusões deste estudo não simplesmente mostram que esforços interculturais estão atualmente presentes nas estratégias de gestão e de negócios nas organizações e grupos enfocados, mas também encontra uma orientação, o que em termos fenomenológicos é um sentido voltado á compreensão intercultural, a qual é vista como uma atitude básica para fusões e negócios internacionais serem bem sucedidos.

Impactos dos valores pessoais no trabalho em equipe em organizações do terceiro setor

This study had the main purpose to answer to the following issue: How far the social projects experts's values contribute to a specific manner of working as a team? Searchin g for this answer, bibliography and field researches, with deep interviews and the picture construction technique were accomplieshed. The data analysis was carried out under a phenomenological view. This research report is structured in two pivots: The understanding of the individual, and of his relationship within the group. Firstly, I dealed with the formation of the Individual and his values; secondly, I focused the relations of the Individual with the group and more specifically, the team concept and the main characteristics and conditions that guarantee an efficient teamwork. Both chapters were developed through interpaticipating analysis this is by showing transcriptions of the most relevant parts of the interviews and of the works produced by the groups to as well as data from the bibliographic research. I concluded that, in the case of the researched sample, personal values really act on the way the Third Sector experts work in team, and that these experts are cooperative and committed to their respec tive projects.

Privatização da Vale do Rio Doce: valores, manifestações e implicações

Este estudo investigou, na Companhia Vale do Rio Doce (CVRD), como os funcionários perceberam as mudanças ocorridas na empresa, as ações da alta administração e o que ocorreu com os valores na organização após o processo de privatização. O objetivo final da pesquisa foi verificar que valores norteiam as propostas administrativas da Vale após a privatização, e como se manifestam nas ações e na postura dos agentes na sede da empresa. O referencial teórico incluiu mudança organizacional, teoria dos valores e responsabilidade das ações administrativas, para compreender o contexto atual da empresa após a privatização. A pesquisa de campo foi concebida sob o paradigma do construtivismo, em busca de percepções e sentimentos subjacentes e manifestos em entrevistas e questionários a fim de explicitar os valores passados e presentes na organização e possibilidades de uma nova realidade. Uma abordagem fenomenológica complementar favoreceu a inserção da autora no mundo da vida dessa organização, facilitando a fluência do diálogo para a apreensão de manifestações e implicações dos valores das pessoas no processo de transição. As reflexões finais indicam a necessidade de um trabalho organizacional que envolva funcionários e alta administração com o propósito comum de redescoberta do significado próprio da organização. O Programa Vale Viver surge como uma tentativa nessa direção. Os valores "vestir a camisa", "valorizar a prata da casa" e "vencer desafios" acompanham o tempo de vida da cultura da Vale. O valor "vestir a camisa," cujo significado é compartilhamento autêntico, na atualidade é mais uma expectativa a ser retomada do que uma vivência. O valor "vencer desafios" está mais presente na área operacional e o valor "valorizar a prata da casa" aparece mais relacionado a programas como o Banco de OpOliunidades, reavivado pelo Vale Viver. Não significa que o Vale Viver seja a única saída para a retomada da confiança, da elevação da auto-estima e de uma articulação empregados e nova administração na construção de uma base comum de valores, mas é a possibilidade mais visível no momento em que a retomada do espírito da V ALE é fundamental para essa nova etapa de sua vida.

Um caso de aprendizagem organizacional: exame conceitual e de aplicabilidade no contexto público

This research has a practice-oriented focus on the concept of Organizational Learning. The basic approach is a learning organization perspective, and some references to the concepts and concerns of organizational learning were included whenever necessary and proper. Organizational Learning is researched mainly from a management techniques and strategy point of view, with a smaller emphasis on the innovation and accumulation of technological capabilities and theoretical research points of view. A broad approach has been used, based mainly on the study of a successful case using action research in a private telecommunication company operating nationwide in Brazil. This study involved a small group, as it is common with pilot groups for learning organizations. The main purpose of this research is to provide a broad and updated survey about the idea of Organizational Learning. Results presented in the related literature are compared with findings from the field, and that literature is cited throughout the text. The interactions of Organizational Learning with the Brazilian context and with the public administration context are analyzed; important data, ranging from the historical origins and bases of the concept, to details of the activities in a real life learning organization, are shown. Some essential aspects, that should be considered or used when applying this type of management, are analyzed. The action research has shown a close proximity between Organizational Learning and a phenomenological perspective, servant leadership, and managerial model, respectively in the fields of philosophical approach, leadership, and management models.

Impactos emocionais causados pela mudança de estilo de gestão em um hospital na cidade de São Luis-MA

The objective of this study is to identify how a health institution can minimize the emotional impacts caused by the change of a style of classic management for a participative administration, that the workers and controllers can see the institution as a dynamic organization, that must be faced as an alive system, mobile and adaptable, where they is beings that have the right to react and to answer to the stimulatons. For that, the institution can handle motivator¿s instruments that develop in the people the potential to react of adequate way to the changes proposals, as well as increasing the perspective of possible technological improvements and interpersonal relationship between the internal and external customers. To change the style to manage, to hear the staff of support and user, are not part of the routine of the heads that develop classic management. This decision demands adaptation and flexibility, study, update and psychological preparation, to face common feelings to the new. It fits to the new directors, to visualize these feelings and work to minimize, avoiding future upheavals and the confrontation of situations that can harm the production of the company, as well as the quality of the communication between the diverse dimensions of the organization people. In this study case, based in phenomenological methodology, was possible to verify, through half-open interviews and comments, how was faced the feelings caused at the old direction time, composed for military who withheld the power and determined the actions of the hospital in study, was replaced by health professionals, that saw in the work team the best option to solve the problems and the potential to carry through an administration based in adequate strategies the reality of the moment, with the objective of reaching the satisfaction of the customer. Through this work, is possible to prove the theory that the changes cause impacts that affect the behavior of the people involved and cause stress, as well as conclude that despite the new direction show themselves, during the change, much made use to make right and involve all the workers, didn¿t have traced strategies to minimize the emotional impacts caused by the changes, what made all face their feelings of doubts and anxiety without no special care. Many obtained, by themselves, to face and to adapt the new proposals, but some could not assimilate the new administrative methodology and had been moved away definitively from the institution.

Responsabilidade social empresarial no mercado de seguros brasileiro: influências culturais e implicações relacionais

The Brazilian insurance market is the ambience in which this research study takes place in search for a better understanding of how cultural characteristics are related with organizational signs, practices and expectations on social responsibility. The concepts of social responsibility as well as the concept of culture are presented and discussed from different points of view, in accordance with different authors and trough several methodological approaches, in order to establish a coherent theoretical basis for qualitative data analysis. The phenomenological attitude assumed by the researcher in especial dialogues situations during the field research phase added new possibilities of apprehension or emergence of each studied organization self orientation in terms of pre-occupation with social issues intimately related with their insurance activities in the market place. Final reflections show the complexity of the insurance cultural context in the studied Brazilian segment, in which cultural and subcultural national and organizational singularities appear. However leaving space for common values and coherent orientation toward the peculiar understanding of social responsibility as inherent to any insurance company activities, themselves. Last comments point out that future research studies may give additional contribution for the continuity of the discussions initiated in this dissertation, expecting that some changes in the organizational posture and practices may happen, especially those related with risk taking and broad processes of communication with clients and society as a whole.

Racionalidade instrumental e mediação organizacional: um estudo sobre a percepção dos gestores da Caixa

o objetivo dessa dissertação é identificar e analisar a percepção dos gestores da CAIXA, frente à Empresa, tendo como referência os conceitos de Racionalidade Instrumental e Mediação Organizacional. De início, fez-se uso de um Método Fenomenológico, de forma a defmir as questões que deveriam ser respondidas, a partir das experiências práticas de gestão desta pesquisadora, decorrentes do relacionamento existente junto aos Gerentes de Mercado do Segmento de Pessoas Físicas de Média e Alta Renda da CAIXA ECONÔMICA FEDERAL. Em seguida, foi defmido o referencial teórico adequado à sustentação do objeto de pesquisa, estruturado nos conceitos de Racionalidade Instrumental, incluindo traços característicos da Síndrome Comportamentalista e os mecanismos de Mediação Organizacional. Fez-se uso de uma pesquisa descritiva, para referendar as percepções iniciais, junto ao mesmo público. Concluiu-se, sob a percepção desses gestores, que eles se vêem sujeitos aos valores de uma sociedade centrada no mercado, assumem seus códigos e são operados por ela, independente de trabalharem numa empresa pública. No nível organizacional, as mediações na dimensão ideológica respondem como o mais poderoso mecanismo de subjugação, na medida em que o tipo de atuação da CAIXA provoca em seus gestores, orgulho, senso de utilidade e de diferenciação. Em troca, os empregados seduzidos e submetidos a esse poder, se prestam a garantir o alcance dos objetivos organizacionais, de forma ampliada e recorrente, reforçando os princípios da racionalidade instrumental. Esse processo se auto-alimenta continuamente. Por fim, o questionamento que fica é: Como alterar o curso dessa história e resgatar o verdadeiro sentido das relações humanas?

"Cultura" pedagógica: a influência do status do professor

O objetivo deste estudo foi o de investigar a criação de uma "cultura" pedagógica, com e sem a influência do professor, sujeito de status definido institucionalmente. Com tal finalidade, foi montado um cenário experimental com sujeitos distribuídos em Grupos de Controle e Experimentais, estes últimos contando com a participação de uma professora, previamente instruída, para exercer influência. Segundo a estratégia usada, os sujeitos realizaram o Exercício de Decisão por Consenso, através de interpretações e classificações, que foram consideradas as "culturas" criadas pelos grupos, com e sem a influência do professor. Os dados empírico recolhidos e analisados segundo uma Abordagem Fenomenológica permitiram concluir que a atuação do professor é decisiva para influenciar o comportamento dos alunos e que esta influência pode ser atribuída preponderadamente ao status a ele conferido. A literatura revista possibilitou ainda uma análise crítica do papel de modelador exercido pelo professor (Abordagem Modernizante), bem como do processo de reprodução da cultura dominante nesta tarefa (Abordagem Alternativa). Desta forma, os dados empíricos e as teorias analisadas permitiram concluir que a "cultura" pedagógica, criada seja na presença seja na ausência do professor, não é isenta e tampouco apolítica.

O mobralense e o domínio do léxico

Na presente pesquisa de campo, abordou-se, primeir~ mente, o estudo da comunicação entre os homens por códigos verbais, as relações entre a linguagem e o pensamento e a visão do mundo percebida pelo individuo ou pela comunidade através do uso da lin guagem. A seguir examinou-se o sistema escola, comprometido com a transmissão de uma determinada cosmovisão, caracteristica de uma nacionalidade dada, e/ou com a manutenção de valores e modos de vi da que identificam uma certa comunidade. As considerações feitas justificam a importância dada à alfabetização e aos programas de alfabetização em massa nos paises em desenvolvimento, c omo o Brasil. Levando-se em conta estas colocações, planejou-se investigar o vocabulário corrente de trinta e sete alunos do MOBRAL, em Nova Friburgo, relacionando-o com os indices sociais dos informantes (procedência, anos de vida na área geográfica considerada, idade, sexo e profissão), com as variáres temáticas (alimentação, saúde/ doença, profissão/afazeres, expectativas de vida, lembranças de vi da, lazer/diversões), escolhidas após sondagem prévia das condições de vida e dos interesses dos informantes, e com as variáveis lingüisticas, ou seja, as classes de palavras. Neste estudo explQ ratório, propôs-se ainda verificar em que medida o material escri to dos livros de leitura continuada do MOBRAL e dos jornais clas se A (Jornal do Brasil) e C (O Dia e Oltima Hora) se relacionam com o vocabulário utilizado pelos alunos do MOBRAL, em Nova Fribur go. Visando ao levantamento do vocabulário dos entrevistados,foram gravadas cinqüenta falas de acordo com a metodologia utilizada em trabalhos de natureza sociolingüistica . Os dados obtidos neste "corpus" gravado foram anali sados quantitativamente, aplicando-se um programa computacional cQ nhecido como SPSS. O estudo das rel ações entre as variáveis(classi ficação morfológica, tema, idade, sexo, profissão) conduziu à for mação de tabelas de contingência multivariada . A análise dos resultados ofereceu algumas conclusões como o uso constante de substantivos e verbos nas elocuções . Embora se tenha introduzido a técnica de captar as palavras disponíveis durante as entrevistas, não foi alterado o número de substan I tivos nesta pesquisa, porque os informantes não indicaram o nome das coisas isoladamente, fizeram-no por enunciados completos. Ba seando-se neste resultado, propuseram-se algumas sugestões de in teresse pedagógico para utilização do MOBRAL: a primeira -- nao en fatizar os nomes (processo estático da língua) em detrimento dos verkos (processo dinâmico); a segunda -- o uso de frases nas estra tégias de alfabetização. No exame das relações entre as variáveis, a grande variação detectada deveu-se ao tema. Quando se investigou a variedade dos vocábulos usa dos pelos entrevistados em Nova Friburgo, observou-se que das 11.337 ocorrências de substantivos, encontraram-se 2.222 substanti vos diferentes e 1.590 vocábulos; das 17.604 ocorrências de verbos, encontraram-se 2.365 verbos diferentes e 588 vocábulos; das 1.980 ocorrências de adjetivo~, encontraram-se 660 adjetivos diferentes e 488 vocábulos. Concluiu-se que o vocabulário deste grupo pode ser diferente dos de outras áreas, dos de outras cfu~adas sociais inse ridas em outros contextos, mas não é limitado, nem re stri to.Expre~ sa a visão e a expectativa do mundo que os cerca. Outra recomendação ao MOBRAL: a escolha das palavras a ensinar seria colhida nas diversas comunidades, onde funcionam as classes de alfabetização e a motivação para sua seleção deveria estar ligada às necessidades cotidianas dos adultos com a palavra geradora integrada em frases.