Identification of rehabilitation needs after a stroke: an exploratory study

Affiliation: Jacqueline Rousseau : École de réadaptation, Faculté de médecine, Université de Montréal

What are the components of humanized childbirth in a highly specialized hospital? : an organizational case study

Many studies have focused on the concept of humanization of birth in normal pregnancy cases or at low obstetric risk, but no studies, at our knowledge, have so far specifically focused on the humanization of birth in both high-risk, and low risk pregnancies, in a highly specialized hospital setting. The present study thus aims to: 1) define the specific components of the humanized birth care model which bring satisfaction to women who seek obstetrical care in highly specialized hospitals; and 2) explore the organizational and cultural dimensions which act as barriers or facilitators for the implementation of humanized birth care practices in a highly specialized, university affiliated hospital in Quebec. A single case study design was chosen for this thesis. The data were collected through semi-structured interviews, field notes, participant observations, selfadministered questionnaire, relevant documents, and archives. The samples comprised: 11 professionals from different disciplines, 6 administrators from different hierarchical levels within the hospital, and 157 women who had given birth at the hospital during the study. The performed analysis covered both quantitative descriptive and qualitative deductive and inductive content analyses. The thesis comprises three articles. In the first article, we proposed a conceptual framework, based on Allaire and Firsirotu’s (1984) organizational culture theory. It attempts to examine childbirth patterns as an organizational cultural phenomenon. In our second article, we answered the following specific question: according to the managers and multidisciplinary professionals practicing in a highly specialized hospital as well as the women seeking perinatal care in this hospital setting, what is the definition of humanized care? Analysis of the data collected uncovered the following themes which explained the perceptions of what humanized birth was: personalized care, recognition of women’s rights, humanly care for women, family-centered care,women’s advocacy and companionship, compromise of security, comfort and humanity, and non-stereotyped pregnancies. Both high and low risk women felt more satisfied with the care they received if they were provided with informed choices, were given the right to participate in the decision-making process and were surrounded by competent care providers. These care providers who humanly cared for them were also able to provide relevant medical intervention. The professionals and administrators��� perceptions of humanized birth, on the other hand, mostly focused on personalized and family-centered care. In the third article of the thesis, we covered the dimensions of the internal and external components of an institution which can act as factors that facilitate or barriers that prevent, a specialized and university affiliated hospital in Quebec from adopting a humanized child birthing care. The findings revealed that both the external dimensions of a highly specialized hospital -including its history, society, and contingency-; and its internal dimensions -including culture, structure, and the individuals present in the hospital-, can all affect the humanization of birth care in such an institution, whether separately, simultaneously or in interaction. We thus hereby conclude that the humanization of birth care in a highly specialized hospital setting, should aim to meet all the physiological, as well as psychological aspects of birth care, including respect of the fears, beliefs, values, and needs of women and their families. Integration of competent and caring professionals and the use of obstetric technology to enhance the level of certainty and assurance in both high-risk and low risk women are both positive factors for the implementation of humanized care in a highly specialized hospital. Finally, the humanization of birth care approach in a highly specialized and university affiliated hospital setting demands a new healthcare policy. Such policy must offer a guarantee for women to have the place of birth, and the health care professional of their choice as well as those, which will enable women to make informed choices from the beginning of their pregnancy.

Réorganiser les services de réadaptation destinés aux enfants : utilisation d'une recherche-action participative pour documenter un nouveau modèle de services

Cette thèse a pour but de documenter la réorganisation des services effectuée au programme Enfants et adolescents (PEA) du Centre de réadaptation Estrie, Sherbrooke. Une démarche de recherche-action participative (RAP) est utilisée afin de collaborer au développement, à l’implantation et à l’évaluation d’un nouveau modèle de services visant à accroître l’accessibilité et la qualité des services de réadaptation offerts aux enfants ayant une déficience physique. Spécifiquement, les objectifs sont : 1) de documenter les retombées de la réorganisation des services; 2) de réaliser une analyse critique du processus de changement. Des méthodes quantitatives et qualitatives sont utilisées afin d’atteindre ces objectifs. Tout d’abord, la Mesure des processus de soins (MPOC) documente la perception de la qualité avant (2007), pendant (2008) et après (2009) l’implantation du nouveau modèle de services. Au total, cet outil est employé auprès de 222 familles et 129 intervenants. À quatre reprises, les intervenants et les gestionnaires répondent également à un questionnaire sur leurs perceptions des forces, des faiblesses, des opportunités et des menaces au PEA. En 2008 et en 2009, des focus groups et des entrevues téléphoniques sont réalisées auprès des familles (n=5), des intervenants (n=19) et des gestionnaires (n=13) afin de documenter leurs perceptions sur le processus de changement et sur les retombées de la réorganisation des services. Quant à l’observation participante, elle permet de recueillir de l’information sur le processus de réorganisation des services tout au long de ces trois années. Enfin, les informations recueillies sont analysées à l’aide de différentes approches, dont des tests statistiques et des analyses de contenu utilisant une grille de codification inspirée de la théorie des systèmes d’actions organisées. Les résultats indiquent que davantage d’enfants reçoivent des services en 2009 en comparaison à 2007. De plus, la qualité des services s’est maintenue selon les perceptions évaluées par la MPOC (article 1). L’utilisation d’interventions de groupe contribue fort probablement à augmenter le nombre d’enfants qui reçoivent des services, mais plusieurs défis doivent être adressés afin que cette modalité d’intervention soit réellement efficiente (article 2). Les résultats font ressortir que le processus de réorganisation des services est complexe. L’évaluation des forces, des faiblesses, des opportunités et des menaces d’un programme, de même que l’implication des acteurs dans le processus de développement d’un nouveau modèle de services, favorisent l’amélioration continue de la qualité (article 3). Or, les facilitateurs et les obstacles à l’implantation du nouveau modèle de services évoluent durant la réorganisation des services. Considérant cela, il est important de poser les actions nécessaires afin de soutenir le changement tout au long du processus (article 4). En résumé, cette thèse contribue à l’avancement des connaissances en réadaptation en comblant une lacune dans les écrits scientifiques. En effet, peu de projets visant le développement et l’implantation de nouveaux modèles de services sont évalués et documentés. Pourtant, des modèles tels que celui développé par le PEA semblent prometteurs afin d’améliorer l’accessibilité, et éventuellement, la qualité des services de réadaptation chez l’enfant.

Facteurs associés à l’implantation d’un programme de formation interprofessionnelle au sein d’un Centre de santé et de services sociaux au Québec

INTRODUCTION: La collaboration interprofessionnelle a émergé comme étant l’un des aspects essentiels à consolider pour améliorer l’organisation de la première ligne de soins et assurer un accès adéquat aux ressources disponibles. Pour favoriser l’accroissement de la collaboration interprofessionnelle, il est suggéré que les professionnels des sciences de la santé soient formés en interdisciplinarité, particulièrement à l’occasion des stages cliniques. OBJECTIFS: Ce projet vise à mesurer le degré d’implantation du programme de formation interprofessionnelle (PFI) du Centre de santé et de services sociaux (CSSS) à l’étude comparativement au modèle proposé initialement. De plus, ce projet vise à comprendre comment les facteurs systémiques, les facteurs organisationnels et les caractéristiques du programme de formation mis en place influencent l’implantation du PFI. MÉTHODOLOGIE : Il s’agit d’une étude de cas unique effectuée au sein d’un CSSS situé dans la grande région de Montréal au Québec, Canada. Les données ont été recueillies à l’aide de 11 entrevues semi-dirigées qui ont été réalisées auprès de professionnels et administrateurs responsables de l’implantation du PFI et d’un étudiant en stage ayant participé au PFI. Une analyse des documents administratifs et cliniques écrits concernant l’implantation du PFI a également été effectuée. RÉSULTATS : L’implantation du PFI est toujours en évolution comme le traduit la présence des différentes composantes définissant la mise en œuvre du PFI qui est de moyenne à élevée et l’intensité des différentes composantes qui est généralement faible. Les facteurs systémiques, les facteurs organisationnels et les caractéristiques du programme de formation mis en place influencent l’implantation du PFI en milieu clinique et il existe des interrelations entre ces différents facteurs. L’analyse des facteurs influençant l’implantation d’un PFI en milieu clinique doit également s'attarder aux différents facteurs influençant le développement des pratiques collaboratives dans ce milieu.

Bioethics in Health Policy Development: A Primer for Decision-Makers

Article

“When I Grow Up I Want to be a Doctor”: Promoting Atikamekw Children’s Interest for Health Professions Through a Book Collection

Introduction: Aboriginal peoples are underrepresented within the healthcare professions, and recruitment of Aboriginal students has become a priority for medical schools in Canada. Because of very low high-school completion rates among youth living on-reserve, the Université de Montréal’s Faculty of Medicine launched in 2011 the Mini-école de la santé, a program where health sciences students visit aboriginal schools. Through activities and games, students introduce children to the discovery of health professions. In 2014, the Health Library joined the project with the development of a science books collection for the school libraries and by having a librarian participate in the school visits. Description: In collaboration with the two Atikamekw elementary schools to be visited in 2014, 70 children books on science, human anatomy and the health professions were selected and purchased for each school by the Health Library. A librarian joined the health sciences students during the schools visits and the book collection was integrated in the activities organised during the day. The books were afterwards donated to the school library. Outcomes: Children, school teachers and administrators greatly appreciated the collection. The books were integrated in the library school collections or in the classrooms collections. Discussion: Quality school libraries play an important role in student learning, and access to science and health sciences books could enhance children‘s interest for the health professions. By participating in this project, the library is supporting the Health sciences faculties in achieving their goal of reaching out to Aboriginal children and making them aware that a career in health sciences is possible for them. The collaboration has been successful and will be pursued: the Health library will work with the high schools in the same Atikamekw communities to develop science book collections and the schools will be visited in 2015. A Masters in Library and Information Science student will be joining the Mini-école. Upgrading all donated collections is planned as well.

Benefits of Linked & Open Data

Presentation to ARMA2013 (Association of Research Managers and Administrators)

Ayer mineros, hoy eco-guías y concesionarios: tensiones en torno a la conservación ambiental, el uso de la tierra y el trabajo en Guasca, Cundinamarca

En Guasca, Cundinamarca, se han configurado cambios profundos en el uso de los recursos naturales y el trabajo. En la misma área donde operó una mina de cal a cielo abierto por más de sesenta años, hoy en día existe una reserva biológica. Este proceso ha conllevado transformaciones y negociaciones entre las formas locales de uso de los recursos naturales y los usos propuestos por la conservación ambiental. Por su parte, el trabajo en la vereda se ha visto afectado por el cambio reciente en el usufructo de los recursos ambientales y las precariedades económicas del agro en Colombia. El argumento central de este texto es que la declaratoria de áreas protegidas privadas, como práctica suscrita al discurso ambientalista global, más que un proceso neutro, es una fuente de tensión constante entre pobladores locales y administradores de las zonas de conservación ecológica por cuenta del manejo territorial y ambiental, el entendimiento del uso de los recursos naturales y la naturaleza, la propiedad, el empleo y la descentralización del poder estatal. Así las cosas, este trabajo se preocupa por analizar las tensiones e implicaciones que supone la declaratoria de áreas protegidas para las poblaciones locales, en particular en su economía, trabajo y formas de apropiarse de la naturaleza y sus recursos.

Uneven playing field or falling standards? Chinese students' competence in English.

This paper explores student and teacher perspectives of challenges relating to the levels of competence in English of Chinese students studying overseas from the perspective of critical pedagogy. It draws on two complementary studies undertaken by colleagues at the University of Reading. The first—a research seminar attended by representatives from a wide range of UK universities—presents the views of teachers and administrators; the second draws on four case studies of the language learning of Chinese postgraduate students during their first year of study in the UK, and offers the student voice. Interview and focus group data highlight the limitations of current tests of English used as part of the requirements for university admission. In particular, university teachers expressed uncertainty about whether the acceptance of levels of written English which fall far short of native-speaker competence is an ill-advised lowering of standards or a necessary and pragmatic response to the realities of an otherwise uneven playing field. In spite of this ambivalence, there is evidence of a growing willingness on the part of university teachers and support staff to find solutions to the language issues facing Chinese students, some of which require a more strategic institutional approach, while others rely on greater flexibility on the part of individuals. Although the studies reported in this paper were based on British universities, the findings will also be of interest to those involved in tertiary education in other English-speaking countries which are currently attracting large numbers of Chinese students.

Local politico-administrative perspectives on quality improvement based on national registry data in Sweden : a qualitative study using the Consolidated Framework for Implementation Research.

Background. Through a national policy agreement, over 167 million Euros will be invested in the Swedish National Quality Registries (NQRs) between 2012 and 2016. One of the policy agreement¿s intentions is to increase the use of NQR data for quality improvement (QI). However, the evidence is fragmented as to how the use of medical registries and the like lead to quality improvement, and little is known about non-clinical use. The aim was therefore to investigate the perspectives of Swedish politicians and administrators on quality improvement based on national registry data. Methods. Politicians and administrators from four county councils were interviewed. A qualitative content analysis guided by the Consolidated Framework for Implementation Research (CFIR) was performed. Results. The politicians and administrators perspectives on the use of NQR data for quality improvement were mainly assigned to three of the five CFIR domains. In the domain of intervention characteristics, data reliability and access in reasonable time were not considered entirely satisfactory, making it difficult for the politico-administrative leaderships to initiate, monitor, and support timely QI efforts. Still, politicians and administrators trusted the idea of using the NQRs as a base for quality improvement. In the domain of inner setting, the organizational structures were not sufficiently developed to utilize the advantages of the NQRs, and readiness for implementation appeared to be inadequate for two reasons. Firstly, the resources for data analysis and quality improvement were not considered sufficient at politico-administrative or clinical level. Secondly, deficiencies in leadership engagement at multiple levels were described and there was a lack of consensus on the politicians¿ role and level of involvement. Regarding the domain of outer setting, there was a lack of communication and cooperation between the county councils and the national NQR organizations. Conclusions. The Swedish experiences show that a government-supported national system of well-funded, well-managed, and reputable national quality registries needs favorable local politico-administrative conditions to be used for quality improvement; such conditions are not yet in place according to local politicians and administrators.

Organizações orientadas para os clientes: fatores indicativos de sua atuação no comércio varejista de produtos de beleza

This work is about the organizations guided to attend the clients/customers in all aspects focusing their characteristics, needs and expectations and that do their best to produce goods or do services which can permanently increase their clients' satisfactions. To reach this aim has been the challenge of their managers and administrators who work to make them be considered as state-of-the-art by other organizations and their clients or customers. Many different strategies have been taken to achieve it; since having the focus on the process , then on the products, and more recently on the clients/customers, meaning that their satisfaction has turned to be their new target; as their are the ones who will rate or evaluate their quality. This work is more especifically about the organizations in the make-up and beauty products retail market which carry out researches with the customers of stores, managers and members of their demonstration and sales teams. This research identifies the attributes the customers/clients appreciate most in the stores and how hard their managers and business owners work to satisfy their needs and expectations, showing how far they follow the principles of the organizations guided to clients/customers. Key words: Attributes, attributes evaluation, beauty products, beauty products retail shops; clietns/customs oriented organizations; process oriented organizations; product oriented organizations.

Estabelecimentos isolados de ensino superior: um estudo das fundações educacionais de SC

Este estudo centra-se na análise das Instituições Isoladas de Ensino Superior. O universo da análise são as Fundações Educacionais de Santa Catarina e suas unidades de ensino superior. Estas Fundações, instituídas pelos poderes públicos Estadual e Municipais, foram responsáveis pelo processo de interiorização e regionalização do ensino superior em Santa Catarina, detendo, à época da pesquisa, mais de 2/3 do alunado deste nível de ensino. A legislação sobre o ensino superior, vigente em nosso País, adota a Universidade como norma e o Estabelecimento Isolado como exceção. Mas a exceção, segundo a lei, estatisticamente, ocupa posição modal. A Universidade e o Estabelecimento Isolado são realidades distintas e, normalmente, situadas em ambientes diferentes. Se diferente é a realidade de ambas não se pode enquadrá-las no mesmo "figurino" conceptual. O Estabelecimento Isolado de Ensino Superior deve buscar sua identidade institucional, sua vocação. Na busca da identidade dos Estabelecimentos Isolados de Ensino Superior, é analisada a experiência de Santa Catarina, através de suas Fundações Educacionais. A análise aborda essas instituições sob três aspectos: seus objetivos, sua estrutura organizacional e as formas de interação com o meio ambiente. A análise dos objetivos situa-se numa tríplice dimensão: os fins e funções do Ensino Superior, preconizados pela Lei, os fins e funções das Fundações Educacionais e suas unidades de ensino, expressos em seus documentos legais, e os resultados alcançados por estas instituições. Tanto na análise dos objetivos propostos, como dos resultados alcançados, são enfocados os três tipos de participantes: o pessoal docente admi-nistrativo das Instituições, os alunos e as comunidades a que servem. Estabelecem-se relações entre os objetivos propostos frente aos alcançados e as aspirações do pessoal docente-administrativo frente às dos alunos e comunidades, visando avaliar a coerência entre o proposto e o alcançado e a discrepância dos objetivos dos participantes. Para explicar a falta de coerência encontrada entre objetivos e resultados, são analisadas a estrutura formal e as práticas administrativas das instituições. Parte-se do pressuposto de que estruturas formais sofisticadas, além de complexidade da organização, geram "formalismos", entendidos como a discrepância entre o prescrito e os comportamentos. Os " formalismos" tendem a explicar a falta de coerência entre o proposto e o alcançado, no campo dos objetivos. Os dados mostram existir relação entre tipo de estrutura (formal-concreto) e coerência de objetivos com resultados. Para explicar as discrepâncias dos objetivos dos participantes, são analisadas as interações com o ambiente, entendidas como a atuação das IES sobre o meio e deste sobre aquelas, em termos de "trocas". Encontra-se, aqui, também, relação entre as variáveis analisadas. Os dados obtidos levam a conclusões no sentido da busca de vocação própria, da especificidade das Instituições Isoladas do Ensino Superior. São levantadas alternativas de ação, na busca da identidade das IES isoladas, propondo novos e mais aprofundados estudos sobre o assunto.

A saúde psíquica de quem faz saúde: uma análise crítica sobre a humanização direcionada ao profissional de saúde

It is noticeable that pressure, tension and overwork are frequent in health professionals routine. The work related to the ward area demands deep attention and surveillance. Because of that, it is essential to have a specific look at the humanization directed at health professionals, considering that taking care of other human beings is the essence of their job. This study has analyzed the psychic health levels, as well as the stress health professionals are submitted to, providing a debate about the humanization in 06 public hospitals (03 of them awarded by actions of humanization, and 03 not awarded) in Rio Grande do Norte state, Brazil. A study with 126 active health professionals (doctors, nurses, psychologists, nutritionists and social workers) in ward areas in their respective institutions was carried out. The thesis presented, with multi-disciplinary characteristic, counted on the support of statisticians (to calculate samples and data analysis), psychologists, social workers and administrators (linked to the human resources sector in each hospital). A cross-sectional study was performed, taking into consideration both quantitative and qualitative factors. The tools used for that were a semistructured questionnaire with socio-demographic characteristics, work and humanization; Lipp's Stress Symptoms Inventory for Adults (ISSL), and the Goldberg s General Health Questionnaire (QSG). The workers are predominantly women (84,9%), married (54,8%), between 46 and 55 years old (40,5%), working in the same institution for more than 20 years (22,2%), and between 16 and 20 years (20,6%), respectively. They work 40 hours a week (71,4%) and have multiple jobs (61,9%). Although most of these individuals global psychic health is in a good level, there are a significant number of people that is gradually getting worse concerning psychic stress (F1) showed by QSG (54,7%), and stress showed by ISSL(42,1%). Observing the categories, nurses (41,5%). Nutritionists (20,8%), doctors and social workers (18,9%), were among the most affected. About general health (F6), 63% of the awarded hospitals and 70% of the not awarded ones, presented good health levels (ranging from 5 to 50%). It was also noticed that, in the groups mentioned above, 25 and 20% respectively, were inserted in scores between 55 to 90%, what means that they are in worsening phase. The fact that the hospital is awarded or well recognized doesn t interfere in health professionals stress level and in their psychic health. Through what was heard from these individuals, it was possible to verify that they know little about humanization, once few of them identify or know that the service they offer is in an adoption process by Ministerial Policies. It was also detected the necessity of developing actions aimed at worker s health. Such results showed the importance of have more investments in programs that are directed to workers well-being, because they deal with other people s health and it is known that it is difficult for them to offer high-quality assistance if there are not suitable physical, psychological and material conditions to help them develop their jobs. As a warning, it is fair to say that investments in actions that provide humanized care to health professionals, mainly concerning preventive care for their health and life quality in their work

PROEJA FIC/Fundamental no IFRN-Campus Mossoró: das intenções declaradas ao funcionamento de um curso em espaço prisional

This research aims to analyze the FIC Course of Assistant Technician in Service Management and Quality, integrated to elementary education / EJA form developed by IFRN MO Campus between 2011 and 2013 in the form of a PROEJA FIC / AT ELEMENTARY SCHOOL LEVEL. We seek to understand the adhesion between the national guidelines postulated for the Program, established in PPC and mediations with the process conceived in the run of the course. Guiding by the socio-critical approach and the dialogical paradigm, the theoretical-epistemological mark is especially buoyed by the theoretical contributions of Ciavatta (2005) , Rock (2011) , Haddad and Di Pierro (2000), Freire (2005), Marx (1982), Ramos (2005), Frigotto; Ciavatta; Ramos (2005), Moura (2012), and also on education in prisons by Onofre (2007, 2011), Bueno (2007), Julião (2011) and Foucault (2001). We assume that an action that enables professional qualification as FIC courses articulated to the EJA in the context of education in prisons have conceptual, methodological, political and pedagogical implications for it focuses challenges, weaknesses and opportunities on the same area of education., We have developed four techniques of data collection based on procedures and tools of qualitative research, such as document analysis, a student survey, the conduction of focus groups with teachers and administrators of the course and on-site observation. Mediated by the investigated context, results showed that the consolidation of PROEJA FIC / AT ELEMENTARY SCHOOL LEVEL goes beyond the intentions officially declared. It is inferred that after seven years of its creation, even though it keeps some potential, this program is not being satisfactorily developed and it shows weaknesses national and locally, it is set at low capillarity, it has a limited scope, and dissolved essential public commitments to the course development. The effectiveness of PROEJA FIC / AT ELEMENTARY SCHOOL LEVEL as part of an emancipatory inclusion social policy, according to official statement, entails approximating the legal logic with social logic, so as not only to propagate discourses and enforce worship to specific and successful experiences that reach only a minority, but to provide actual and necessary conditions to promote the breadth and social quality of the offered deals in this program format

A produção das perdas dentárias: narrativas de usuários do SUS

For a complete comprehension of the effect of tooth loss is necessary to listen to the patients that have it. This study, of qualitative approach, investigate, in the dental history of users of SUS, listening to his/her experiences with the services of dental care, the reason that lead his/her to dental lost and the repercussion of this in his/her life. The collect of data was made by narrative interview, obeying to a pre-defined schema. The subjects interviewed were six (three of urban zone and three of rural zone), all of them were users of Family Health Units. The criterions of inclusion were the followings: the presence of tooth lost (total lost in both dental arch or in one of them, or partial lost in at least six elements in one of the arches); age between 25 and 59; male or female; to live in municipal district of São Tomé/RN or Natal/RN. Based on previous interviews was elaborated the odontological history of each patient. Such narratives, systemized in odontological history, were analyzed taking as base the studies of Souza71 and the proposal of Schutze, suggested for Jovchelovitch, Bauer34. The results show that toothache was the main reason for the search of odontological care. The patients confront the ache with home-made medicaments, allopathic ones, and searching for dental care. The searching for exodontics was stimulated for geographic access difficulties or for repressed demand, which as a result produced the aggravation of the lesions and the discredit in restoration s treatment. The self-care practice of tooth-brush with juá or toothpaste and the controlled ingestion of sugar was not sufficient to avoid dental lost. Guilty sentiments were identified in relation with lack of care with teeth. The acceptance of dental lost as a natural factor is an important motivation in lack of pain and in the belief that it was a simple part of life in old age. Life with dental prosthesis makes clear the difference between which was natural and which was unnatural, and difficulties with the prosthesis appeared. The limitation of the prosthesis in its functional aspect can be compensated by esthetic restitution, making possible smiling expression. Starting with this study and considering the high number of dental lost, mainly in low-rent population, which live with toothless limitations or bad-quality prosthesis which do not rehabilitate adequately, we suggested the realization of qualitative researches which include, also, another actors in heath care services such as professionals and administrators