Expectativas de mães e cuidadoras sobre participação em um programa de prevenção à violência / Expectations of mothers/caregivers regarding the participation in a violence prevention program / Expectativas de madres/cuidadoras sobre la participación en un programa de prevención de la violencia

O presente estudo qualitativo objetivou compreender as expectativas de mães e cuidadoras sobre a sua participação no Programa ACT para Educar Crianças em Ambientes Seguros na versão remota, no período da pandemia de covid-19. Também visou identificar a percepção das participantes sobre educar uma criança em um ambiente seguro. Foram realizadas entrevistas semiestruturadas on-line com doze mães e cuidadoras, antes da participação no Programa ACT. Os resultados indicaram diferentes expectativas sobre a participação no Programa ACT, entre elas: adquirir novos conhecimentos, aprimorar as habilidades parentais, trocar experiências, receber auxílio no momento da pandemia de covid-19 e possibilitar para a criança um desenvolvimento saudável. Na percepção das mães e cuidadoras, a versão remota do Programa ACT apresenta aspectos positivos; entre eles, a participação de pais e cuidadores que não residem na cidade em que é oferecida a intervenção. No entanto, apontaram como fatores negativos a ausência do contato físico e as interrupções que podem acontecer a partir das falhas de internet. Para as mães e cuidadoras, educar a criança em um ambiente seguro estava relacionado a promover os direitos estabelecidos no Estatuto da Criança e do Adolescente (ECA), como educação, saúde, lazer, cuidado, afeto, assim como protegê-la de situações de violência. Considera-se que as expectativas das participantes estavam alinhadas aos objetivos do Programa ACT. Torna-se prioritário oferecer programas de prevenção à violência aos pais e cuidadores, em especial em momentos adversos como o da pandemia de covid-19, a fim de promover o desenvolvimento e a saúde das crianças, assim como prevenir situações de violação de direitos.(AU)

This qualitative study aims to understand the expectations of mothers and caregivers about participating in the ACT Raising Safe Kids Program in its remote version, during the COVID-19 pandemic period. It also aims to identify the participants' perception of raising a child in a safe environment. Semi-structured on-line interviews were conducted with 12 mothers/caregivers, prior to participation in the ACT Program. The results indicated different expectations regarding the participation in the ACT Program, for example: acquiring new knowledge, improving parenting skills, exchanging experiences, receiving support during the COVID-19 pandemic, and enabling the child to have a healthy development. In the perception of mothers and caregivers, the remote version of the ACT Program has positive aspects, such as the participation of parents and caregivers who do not live in the city where the intervention is offered. However, they pointed out as negative factors absence of physical contact and interruptions due to internet failures. For the mothers/caregivers, educating children in a safe environment was related to promoting the rights established by the Brazilian Child and Adolescent Statute, namely education, health, leisure, care, affection, as well as protecting them from situations of violence. The expectations of the participants were aligned with the objectives of the ACT Program. Offering violence prevention programs to parents and caregivers is a priority, especially in adverse moments such as the COVID-19 pandemic, in order to promote the development and health of children, as well as prevent situations of violation of rights.(AU)

Este estudio cualitativo pretendió comprender las expectativas de madres y cuidadoras sobre la participación en el Programa de ACT para Educar a Niños en Ambientes Seguros en la versión remota, en el periodo de la pandemia de la COVID-19. También se propuso identificar la percepción de las participantes sobre educar a un niño en un ambiente seguro. Se llevaron a cabo entrevistas semiestructuradas en línea con 12 madres/cuidadoras, antes de la participación en el Programa ACT. Los resultados señalaron diferentes expectativas con la participación del Programa de ACT, entre ellas: adquirir nuevos conocimientos, perfeccionar las habilidades parentales, intercambiar experiencias, recibir auxilio en el momento de la pandemia de la COVID-19 y posibilitar al niño un desarrollo saludable. En la percepción de las madres y cuidadoras, la versión remota del Programa de ACT presenta aspectos positivos, como la participación de padres y cuidadores que no residen en la ciudad donde es ofrecida la intervención. Sin embargo, señalaron como factores negativos la ausencia del contacto físico y las interrupciones, que pueden ocurrir por fallas en Internet. Para las madres/cuidadoras, educar al niño en un ambiente seguro estaba relacionado a promover los derechos establecidos en el Estatuto del Niño y del Adolescente de Brasil, como educación, salud, ocio, cuidado, afecto, así como protegerlo de situaciones de violencia. Se considera que las expectativas de las participantes estaban alineadas con los objetivos del Programa de ACT. Es prioritario ofrecer programas de prevención a la violencia a los padres y cuidadores, en especial en momentos adversos como el de la pandemia de la COVID-19, con el fin de promover el desarrollo y la salud de los niños, así como prevenir situaciones de vulneración de derechos.(AU)

Relationships between Spirituality, Religious Fundamentalism and Environmentalism: The Mediating Role of Right-Wing Authoritarianism.

According to past research, religious attitudes can strongly influence individuals' beliefs and behaviors. The purpose of this study was to assess the relationships between spirituality (the Scale of Spirituality; dimensions include religious spirituality, expanding consciousness, searching for meaning, sensitivity to art, doing good, and sensitivity to inner beauty), religious fundamentalism (the Religious Fundamentalism Scale), support for right-wing authoritarianism (the Right-Wing Authoritarianism Scale), climate concerns (the Environmental Concern Scale), and pro-environmental behavior (the Pro-Environmental Behavior Scale). The cross-sectional study involved 512 Poles aged 18-63 (M = 34.63, SD = 5.96; Mdn = 33), including 51% females. Multiple regression analysis revealed that two dimensions of spirituality (sensitivity to art and doing good) and religious fundamentalism are significant and opposite predictors of climate concern and pro-environmental behavior. Spirituality appeared to foster increased climate concern and caring behavior, while religious fundamentalism negatively predicted the same variables. Mediation analysis revealed that the relationship between religion and environmentalism could be explained in part by differences in support for right-wing authoritarianism (authoritarianism itself was negatively related to environmental outcomes). In addition, analysis of variance revealed that believers (70% of participants in the study were Catholic) showed significantly lower scores regarding climate concerns and pro-environmental behavior than non-believers, yet the inclusion of support for right-wing authoritarianism as a covariate in the equation reduced intergroup differences to statistical insignificance. The data obtained suggest that religious attitudes and socio-political views may play important roles in solving environmental problems.

Knowledge and attitude towards mental illness among primary healthcare nurses in Brunei: A cross-sectional study.

BACKGROUND: Mental Health problems are one of the leading disabilities worldwide. Individuals seeking help for their mental illness expect nurses to be cognisant of their needs without prejudice and discrimination. Existing evidences suggest a growing number of patient referral from primary healthcare to psychiatric consultations. This study aimed to explore primary healthcare nurses' knowledge and attitude towards mental illness and people with mentally illness. METHODS: A cross-sectional study using the Mental Health Problem Perception and the Community Attitudes to Mental Illness questionnaires. Descriptive and multivariate regression using maximum likelihood procedures were applied. RESULTS: Regression analysis showed significantly high correlation between knowledge and authotarianism (ß = 0.775, p = 0.007) and moderate inverse correlation with social restrictiveness (ß = -0.517, p < 0.001). However, no significant correlation with benevolence (ß = -0.057, p = 0.181) was detected. Nurses with higher educational level were significantly associated with authotarianism attitude. CONCLUSIONS: This is the first study examining knowledge and attitude of primary healthcare nurses in Brunei. The relationship between the study variables as well as demographic factors, in comparison to other countries, were discussed. Overall, negative attitude among nurses is still a challenging issue; therefore, developing re-education initiatives and increase contact time, especially for healthcare front liners with negative attitudes regardless of education level, to favour change of attitude, is important to foster holistic care to people with mental illness and promote mental health in the population.

Women's autonomy in the process of labour and childbirth: integrative literature review. / Autonomia feminina no processo de parto e nascimento: revisão integrativa da literatura.

OBJECTIVE: To identify the available evidence in scientific literature on healthcare practices that interfere with the autonomy of Brazilian women in the labour and delivery process. METHOD: The search for papers was conducted in the databases LILACS, Scopus and PubMed, between 1996 and 2015, according to a guiding question and exclusion criteria, resulting in the selection of 22 papers to compose the analytic body. RESULTS: The main practices that favoured the exercise of women's autonomy were out-of-hospital care practices; care practices of support and comfort; and educational care practices. By contrast, the practices that limited autonomy were authoritarian care practices; standardised or routine care practices; care practices that intensify the painful sensation of childbirth; and impersonal and cold care practice. CONCLUSION: There was an alarming contrast between the daily healthcare routine and ministerial recommendations.

Autonomia feminina no processo de parto e nascimento: revisão integrativa da literatura / Autonomía femenina en el proceso de parto y nacimiento: revisión integradora de la literatura / Womens autonomy in the process of labour and childbirth: integrative literature review

RESUMO Objetivo Identificar as evidências disponíveis na produção científica acerca das práticas de assistência à saúde que interferem no exercício da autonomia das mulheres brasileiras no processo de parto e nascimento. Método A busca dos artigos foi desenvolvida nas bases de dados LILACS, Scopus e PubMed, no período entre 1996 e 2015, tendo como eixo orientador a questão norteadora e os critérios de exclusão, sendo selecionados 22 artigos como corpus de análise. Resultados Foram evidenciadas como práticas que favorecem o exercício da autonomia feminina: práticas assistenciais extra-hospitalares; práticas assistenciais de apoio e conforto; e práticas assistenciais educativas. Em contrapartida, revelaram-se como práticas limitantes ao exercício da autonomia: práticas assistenciais autoritárias; práticas assistenciais padronizadas ou rotineiras; práticas assistenciais que intensificam a sensação dolorosa do parto; e prática assistencial impessoal e fria. Conclusão Revelou-se uma situação de alerta relativa ao grande descompasso existente entre o cotidiano assistencial e as recomendações ministeriais.

RESUMEN Objetivo Identificar la evidencia disponible en la literatura científica acerca de las prácticas de atención de salud que interfieren con el ejercicio de la autonomía de las mujeres brasileñas en el proceso de parto y el nacimiento. Método La búsqueda de artículos se desarrolló en las bases de datos LILACS, Scopus y en PubMed, en el período comprendido entre 1996 y 2015, con el principio rector de los rectores criterios de interrogación y exclusión, y seleccionó 22 artículos como un corpus de análisis. Resultados Hemos puesto de relieve las prácticas que favorecen el ejercicio de la autonomía de la mujer: las prácticas de atención ambulatoria; prácticas de apoyo y consuelo; prácticas educativas y atención. Por el contrario se han demostrado como una limitación del ejercicio práctico de la autonomía: las prácticas de atención autoritarias; prácticas de cuidados estandarizados o de rutina; cuidado prácticas que mejoran la sensación dolorosa del parto; y la práctica de la atención impersonal y fría. Conclusión Se puso de manifiesto una situación de alerta en el gran desajuste entre su vida cotidiana y recomendaciones ministeriales.

ABSTRACT Objective To identify the available evidence in scientific literature on healthcare practices that interfere with the autonomy of Brazilian women in the labour and delivery process. Method The search for papers was conducted in the databases LILACS, Scopus and PubMed, between 1996 and 2015, according to a guiding question and exclusion criteria, resulting in the selection of 22 papers to compose the analytic body. Results The main practices that favoured the exercise of women’s autonomy were out-of-hospital care practices; care practices of support and comfort; and educational care practices. By contrast, the practices that limited autonomy were authoritarian care practices; standardised or routine care practices; care practices that intensify the painful sensation of childbirth; and impersonal and cold care practice. Conclusion There was an alarming contrast between the daily healthcare routine and ministerial recommendations.

The application of the Practitioners in Applied Practice Model during breaking bad news communication training for medical students: a case study.

BACKGROUND AND AIMS: Breaking bad news is a key skill within clinical communication and one which can impact outcomes for both the patient and practitioner. The evidence base for effective clinical communication training in breaking bad news is scarce. Frameworks have been found to assist the practitioner, such as SPIKES; however, the pedagogical approach used alongside such frameworks can vary. This study sought to examine the impact of utilising the Practitioners in Applied Practice Model (PAPM) alongside the SPIKES framework for training undergraduate medical students in breaking bad news. METHODS AND RESULTS: A case study approach is used to highlight the impact of training based on the PAPM and SPIKES on patient-centred communication and simulated patient satisfaction with the clinical communication behaviour. Results showed that following training, both patient-centred behaviour and patient satisfaction improved. With detailed communication behaviour changes, a balance was established between rapport building behaviour, lifestyle and psychosocial talk alongside biomedical information. CONCLUSION: This case study shows how the PAPM could be utilised alongside the SPIKES framework to improve breaking bad news communication in medical undergraduate students and describes the behavioural basis of the improvement. Further research is required to show the generalisability of this training intervention.

Ethnic syndromes as disguise for protest against colonialism: three ethnographic examples.

Historical connections are suggested between the domination of 1 culture by another and dissociative spiritual and religious responses to that oppression. Connections are drawn between colonial oppression, trauma, and 3 examples of dissociation and spirit possession: the Zar cult of Southern Sudan, "Puerto Rican syndrome" or ataque, and the Balinese trance dance. Discussed by means of these examples are the role and functions of spirit possession as a means of escape from unbearable reality, where it becomes a form of the expression of needs and desires forbidden by authorities, a way of entering an identity not subject to traditional authorities, and reenactment of traumatic experience.

Religiosidad, espiritualidad y escepticismo: la mediación del autoritarismo / Religiosity, spirituality and skepticism: mediation of authoritarianism

Inicialmente la Religiosidad y la Espiritualidad fueron categorías utilizadas indistintamente en la literatura académica. Sin embargo, actualmente se plantean como categorías independientes, tanto en términos de opuestos como complementarios. En este sentido, ciertos aspectos de la religiosidad ûen mayor medida que de la espiritualidadû se han asociado históricamente a fenómenos como el autoritarismo en términos de pensamiento dogmático. El objetivo principal de este trabajo fue, en primer lugar, describir las autoidentificaciones que realizan los sujetos evaluados religiosos, espirituales y escépticos, para luego observar si existen diferencias entre estos grupos y el autoritarismo. Para tal fin, se trabajó con una muestra de tipo intencional, no probabilística, compuesta por 359 estudiantes universitarios. Los datos fueron recolectados a través de un instrumento de evaluación autoadministrable que indagaba la autoidentificación ReligiosoûEspiritualûEscéptico, la Escala de autoritarismo del ala de derechas (RWA) y Variables sociodemográficas. En primer lugar, se observa que la muestra, en su gran mayoría, se autoidentifica como religiosa o espiritual (92.7%). En segundo lugar, se observan mayores niveles de autoritarismo entre los que se identifican a sí mismos religiosos.(AU)

Religiosidad, espiritualidad y escepticismo: la mediación del autoritarismo / Religiosity, spirituality and skepticism: mediation of authoritarianism

Inicialmente la Religiosidad y la Espiritualidad fueron categorías utilizadas indistintamente en la literatura académica. Sin embargo, actualmente se plantean como categorías independientes, tanto en términos de opuestos como complementarios. En este sentido, ciertos aspectos de la religiosidad –en mayor medida que de la espiritualidad– se han asociado históricamente a fenómenos como el autoritarismo en términos de pensamiento dogmático. El objetivo principal de este trabajo fue, en primer lugar, describir las autoidentificaciones que realizan los sujetos evaluados religiosos, espirituales y escépticos, para luego observar si existen diferencias entre estos grupos y el autoritarismo. Para tal fin, se trabajó con una muestra de tipo intencional, no probabilística, compuesta por 359 estudiantes universitarios. Los datos fueron recolectados a través de un instrumento de evaluación autoadministrable que indagaba la autoidentificación Religioso–Espiritual–Escéptico, la Escala de autoritarismo del ala de derechas (RWA) y Variables sociodemográficas. En primer lugar, se observa que la muestra, en su gran mayoría, se autoidentifica como religiosa o espiritual (92.7%). En segundo lugar, se observan mayores niveles de autoritarismo entre los que se identifican a sí mismos religiosos.

The reluctance to self-disclose: reflexive or reasoned?

Despite a growing body of clinical literature advocating the thoughtful and judicious use of self-disclosure in psychoanalysis, there remains a reflexive reluctance to intervene in this way by many analysts of various theoretical persuasions. Why is this the case? Four motives for this reflexive reluctance to self-disclose are discussed: (1) theoretical reasons; (2) psychoanalytic authoritarianism; (3) fears of influencing the patient through suggestion; and (4) the analyst's personality characteristics. Examining the reasons for this state of affairs should help to reduce the rigidity or orthodoxy with which clinical psychoanalysis is practiced.

Free the dinosaurs into butterfly gardens: in a search for changing the profile of the academic professional.

In the present debate about academic medicine in crisis, I argue that the problem is partly the consequence of a global process of alienation and depersonalization. Technology-based medicine is one of the key players which creates unsuitable role models. In its wake and as a consequence, the profile of the academic professional must be redesigned. Academic professionals should influence more strongly not only the quality of health care but the whole mentality in our socialized world. Academia itself should also become an arena for advanced ideas, and creative power pervaded by the humanities -- a facet which has been lost.

Empowerment: reformulation of a non-Rogerian concept.

The authors present a reformulation of empowerment based upon historical and current perspectives of empowerment and a synthesis of existing literature and Rogerian thought. Reformulation of non-Rogerian concepts familiar to nurses is proposed as a strategy to accelerate the mainstreaming of Rogerian thought into nursing practice and research. The reformulation of empowerment as a participatory process of well-being inherent among human beings may provide nurses with new insights for practice. This paper may also serve as a model for reformulating other non-Rogerian concepts and theories for wider dissemination across the discipline.

At the intersection of micro and macro: opportunities and challenges for physician-patient communication research.

The health care relationship model is undergoing dramatic change. Micro-level communication patterns yield health care relationship models (e.g. paternalism, mutual participation, consumerism). At the same time, macro-level systems appear increasingly likely to influence the nature of micro-level interaction. The intersections of health care communication micro-level and macro-level phenomena provide important venues for research and interventions. This essay identifies theoretical premises regarding the relationships between communication and health-related behavior; explores three prominent and growing macro-level phenomena that observers argue likely influence the physical-patient relationship and communication therein: complementary and alternative medicine, the Internet, and direct-to-consumer advertising of prescription drugs; and offers a research agenda for exploring macro-level influences on micro-level physician-patient communication.

'Great fleas have little fleas': Irish student midwives' views of the hierarchy in midwifery.

BACKGROUND: Many studies have investigated the world of the student nurse, but there is little work into the lives and experiences of student midwives. Studies of Irish midwives' provision of care have demonstrated that they are not fulfilling their complete role, and research into their education was deemed to be necessary. AIM: To explore the opinions, feelings and views of student midwives as they progressed through their 2-year education programme in Ireland. METHODS: Both quantitative and qualitative methods were used and the qualitative sections of the study were guided by the phenomenological approach. Ethical approval was granted. All students in the first intake of 1995 in all seven midwifery schools in Southern Ireland agreed to take part (n=125). Individual and group interviews, diary-keeping and questionnaires collected data. RESULTS: The findings presented in this paper describe the students' views of the hierarchical structures in midwifery, and the role and behaviours of the 'Matron'. The data describes a subculture of nursing/midwifery subordination. DISCUSSION: One reason for the hierarchical nature of the midwifery profession may be because it is an almost totally female-dominated profession, with the female hierarchy exercising control over other women within a male-based power structure. Many hospitals preferred to employ their own students as staff, ensuring a continuation of the hierarchical regime. CONCLUSION: The recurring nature of this problem may be because midwives now fear change more than they desire it. Further research is required to ascertain whether the reason for the strong hierarchy is because of the continuation of midwifery from the male-dominated profession of nursing, to the existence of the industrial/economic model of maternity care or to the impact of the medicalization of childbirth.

Pudor, honor, and autoridad: the evolving patient-physician relationship in Spain.

The expression of emotion and the sharing of information are determined by cultural factors, consultation time, and the structure of the health care system. Two emblematic situations in Spain - the expression of aggression in the patient-physician encounter, and the withholding of diagnostic information from the patient - have not been well-described in their sociocultural context. To explore these, the authors observed and participated in clinical practice and teaching in several settings throughout Spain and analyzed field notes using qualitative methods. In this paper, we explore three central constructs - modesty (pudor), dignity (honor), and authority (autoridad) - and their expressions in patient-physician encounters. We define two types of emotions in clinical settings - public, extroverted expressions of anger and exuberance; and private, deeply held feelings of fear and grief that tend to be expressed through the arts and religion. Premature reassurance and withholding of information are interpreted as attempts to reconstruct the honor and pudor of the patient. Physician authority and perceived loyalty to the government-run health care system generate conflict and aggression in the patient-physician relationship. These clinical behaviors are contextualized within cultural definitions of effective communication, an ideal patient-physician relationship, the role of the family, and ethical behavior. Despite agreement on the goals of medicine, the behavioral manifestations of empathy and caring in Spain contrast substantially with northern European and North American cultures.

Burma: the political economy of violence.

Protracted conflict and violence in Burma have been conducive to the growth of the opium industry, Burma's single financial success in recent years of economic crisis and authoritarian rule. This in turn has fed violence and subsequent humanitarian crisis. This paper argues that the underlying political economy of the conflict has been overlooked, while conflict itself has been treated as a peripheral factor in questions of 'development', and further that the opium dynamic is a vital factor in continued violence and vulnerability for non-combatants in the region. A political economy approach, identifying the beneficiaries of violence, will offer a more holistic and effective approach to the protracted crisis.

Medical communication and gender: a summary of research.

Communication patterns between physicians and patients during the medical visit reveal behavioral gender differences. Studies suggest varying satisfaction levels depending on physician gender. The communication style of female physicians often includes slightly more focus on the patient's emotional and psychosocial concerns, more positively toned communications, and a more egalitarian style reflected in increased levels of patient participation. However, because patients' satisfaction with female physicians does not typically exceed that for male physicians, other factors may influence satisfaction ratings.

The "Bantu Clinic": a genealogy of the African patient as object and effect of South African clinical medicine, 1930-1990.

This paper is about power, medicine and the identity of the African as a patient of western medicine. From a conventional perspective and as encoded in the current "quest for wholeness" that characterises South African biomedical discourse, the African patient--like any other patient--has always existed as an authentic and subjectified being, whose true attributes and experiences have been denied by the "mechanistic," "reductionistic" and "ethnocentric" practices of clinical medicine. Against this liberal humanist perspective on the body as ontologically independent of power, this paper offers a Foucaultian reading of the African patient as-like any other patient--contingent upon the force relations immanent within and relayed through the clinical practices of biomedicine. A quintessential form of disciplinary micro-power, these fabricate the most intimate recesses of the human body as manageable objects of medical knowledge and social consciousness to make possible the great control strategies of repression, segmentation and liberation that are the usual focus of conventional investigations into the place and function of medicine in society. Since the 1930s when the African body first emerged as a discrete object of a secular clinical knowledge, these have repeatedly transformed the attributes and identity of the African patient, and the paper traces this archaeology of South African clinical perception from then until the 1990s to show how its "quest for wholeness" is not an end point of "discovery" or "liberation," but merely another ephemeral crystallization of socio-medical knowledge in a constantly changing force field of disciplinary power.