O cuidado em cenas: nas trilhas de Dona Violeta / Care in scenes: on the trail of Dona Violeta / El cuidado en escenas: en los caminos de Doña Violeta

Discutem-se as possibilidades reflexivas e práticas para compreensão do cuidado nas práticas de saúde com base na exploração de narrativas, inspiradas em vivências práticas, e em um filme, orientadas pela tríplice concepção de mimeses, que medeia tempo e narrativa (Paul Ricoeur). Essas histórias permitiram problematizar os limites de intervenções exclusivamente voltadas ao alcance de finalidades técnicas, evidenciando múltiplas possibilidades de conceber-se a noção de sucesso prático. Ao se abrirem para elementos significativos na vida dos personagens, as narrativas, como refiguração das experiências, possibilitaram cogitar sobre lacunas e projetar outros porvires, inclusive para o cuidado.(AU)

This article discusses reflective and practical possibilities for understanding care in health practices, drawing on the analysis of narratives inspired by practical experiences and a film guided by Ricoeur's theory of triple mimesis, which mediates time and narrative. The stories allowed us to problematize the limits of interventions exclusively geared towards achieving technical ends, evidencing multiple possibilities of conceiving the notion of practical success. By opening up significant elements of the protagonists' lives, the narratives, as a reconfiguration of experiences, allowed us to cogitate on gaps and project other futures, including those for care.(AU)

Se discuten las posibilidades reflexivas y prácticas para comprensión del cuidado en las prácticas de salud, a partir de la exploración de narrativas, inspiradas en vivencias prácticas y en una película orientadas por la triple concepción de mimesis, presente en tiempo y narrativa (Paul Ricoeur). Esas historias permitieron problematizar los límites de intervenciones exclusivamente enfocadas en el alcance de finalidades técnicas, poniendo en evidencia múltiples posibilidades de concebir la noción de éxito práctico. Al abrirse para elementos significativos en la vida de los personajes, las narrativas, como reconfiguración de las experiencias, posibilitaron pensar sobre lagunas y proyectar otros porvenires, incluso para el cuidado.(AU)

"O escuro das cores, na pele afrodescendente, herdeira das dores": dimensões do racismo no contexto de assistência ao parto / "The dark of colors, in the afro-descendant skin, heir of pain": dimensions of racism in the context of childbirth care

Resumo Partindo de uma pesquisa mais ampla sobre as vivências de mulheres negras na assistência ao período gestacional e parto, este artigo aborda alguns aspectos do racismo na rotina de atenção à mulher negra durante este ciclo. Trata-se de uma pesquisa empírica de abordagem qualitativa com mulheres e mães que se autodeclaram negras e antirracistas. Nas narrativas, os pontos apresentados envolviam, na sua maioria, estereótipos associados ao corpo negro construídos sob um imaginário social racista. Nas relações interpessoais, discursos permeados por estereótipos racistas desumanizam a mulher negra, gerando barreiras na sua saúde reprodutiva.

Abstract Starting from a broader research on the experiences of black women in assisting the gestational period and childbirth, this article addresses some aspects of racism in the routine of care for black women during this cycle. This is an empirical research with a qualitative approach with women and mothers who declare themselves black and anti-racist. In the narratives, the points presented involved, for the most part, stereotypes associated with the black body constructed under a racist social imaginary. In interpersonal relationships, speeches permeated by racist stereotypes dehumanize black women, creating barriers in their reproductive health.

In Their Own Words: Experiences of Caregivers of Adults With Cancer as Expressed on Social Media.

PURPOSE: To explore caregivers' writings about their experiences caring for adult individuals with cancer on a social media health communication website. PARTICIPANTS & SETTING: Journal entries (N = 392) were analyzed for 37 adult caregivers who were posting on behalf of 20 individuals with cancer. CaringBridge is a website used by patients and informal caregivers to communicate about acute and chronic disease. METHODOLOGIC APPROACH: A retrospective descriptive study using qualitative content analysis of caregivers' journal entries from 2009 to 2015. FINDINGS: Major categories identified in caregivers' online journals included patient health information, cancer awareness/advocacy, social support, caregiver burden, daily living, emotions (positive and negative), and spirituality. IMPLICATIONS FOR NURSING: Nurses often recommend using social media as a communication strategy for patients with cancer and their caregivers. The findings from this study provide potential guidance nurses may wish to offer caregivers. For example, nurses may talk with caregivers about how and what to post regarding treatment decisions. In addition, nurses can provide support for caregivers struggling with when and how often to communicate on social media.

The point of a bullet journal.

Bullet journaling - described by its creator as 'mindfulness disguised as productivity' - has grown in popularity in recent years. For vet student Alexia Yiannouli, it's a way to express creativity and escape from pressure while also getting organised. Here she explains more.

Narratives of Violence, Pathology, and Empowerment: Mental Health Needs Assessment of Home-Based Female Sex Workers in Rural India.

This study explores the narratives of psychological distress and resilience among a group of female sex workers who use residential spaces to attend to clients in rural India. The narratives reflect the lived experiences of these women. They describe the women's reasons for opting into sex work; guilt, shame, and stigma related to their sex worker status; experiences with intimate partner and domestic violence; health-related problems; communication with their family members about their sex worker status; mental health referral practices among the women; and elements of resilience and strength that they experience within themselves and within their community of fellow sex workers. The article also offers elements of our own experiences of recruiting the women to participate in the focus group, training local outreach workers in conducting focus group discussions, and forging a collaboration with a local community-based organization to highlight important barriers, challenges, and strategies for planning a group-based discussion to explore the mental health needs of home-based sex workers.

Histórias de mulheres cuidadas por práticas integrativas e complementares: um estudo etnográfico / Stories of women cared by integrative and complementary practices: an ethnographic study

As transformações socioeconômicas e culturais da sociedade engendraram, nas últimas décadas, uma cultura de individualismo e exclusão. Essas mudanças atingem, principalmente, as mulheres ao lhes provocarem desamparo, baixa autoestima e solidão. Tais sentimentos são revelados, muitas vezes, sob a forma de dor ou doença. Como consequência dessas agressões sociais, as mulheres vêm buscando recursos terapêuticos que possam dar uma resposta as suas necessidades físicas, psicológicas e espirituais. As práticas integrativas e complementares trazem essa proposta de cuidado integral e vêm sendo cada vez mais procuradas pelo público feminino. Nesse sentindo, esse trabalho teve como objetivo principal: analisar as histórias de mulheres que buscaram práticas integrativas e complementares, ressaltando os aspectos que foram significativos para a compreensão e participação delas no processo de cuidado. O estudo obedeceu os preceitos da Resolução 466/12, sendo aprovado pelo Comitê de Ética em Pesquisa sob CAA:39806114.0.0000.5188. Esta pesquisa foi conduzida segundo um referencial antropológico e de acordo com o método etnográfico. Para a produção de material empírico, utilizou-se a técnica da História Oral temática com 8 mulheres, usuárias do Centro de Práticas Integrativas e Complementares, no município de João Pessoa/PB. A análise e a interpretação do material foram feitas com base nas unidades de significado (temas) mais evidentes e constantes nas narrativas e no tom vital de cada história. Assim, foram elaboradas as seguintes categorias: a) Fontes e manifestações do sofrimento feminino, b) Itinerários terapêuticos e rituais de cuidado das mulheres e c) A reconstrução da identidade e produção de alteridade: caminhos para o protagonismo feminino. Nas histórias relatadas, observou-se que as mulheres buscaram cuidados pois referiam tristeza, baixa autoestima, solidão, cansaço, dor, desamparo, ansiedade e insegurança. Essas queixas estavam associadas aos sofrimentos vivenciados relativamente às perdas afetivas, sobrecarga de cuidados, migração, interrupção de projetos de vida, sobrecarga laboral e conflitos familiares. Os caminhos traçados na procura de cuidados foram influenciados, principalmente, pelo contexto sociocultural de cada colaboradora, de modo que muitas delas recorreram, primeiramente, aos serviços biomédicos. Embora nem todas as colaboradoras tivessem passado por esses serviços antes de recorrerem às práticas integrativas e complementares, elas evidenciaram divergências entre a abordagem da medicina alopática e as PICs, principalmente no que se refere à terapêutica empregada, à relação profissional-usuária e à crença na eficácia terapêutica. O cuidado por meio das práticas integrativas e complementares propiciaram, a essas mulheres, uma maior autonomia; favoreceram a construção de vínculos; o resgate da autoestima; promoveram o emponderamento e as levaram a ressignificarem suas vidas e suas histórias.(AU)

Socioeconomic and cultural changes of society engineered in recent decades a culture of individualism and exclusion. These changes mainly affect women, causing them to helplessness, low self-esteem and loneliness. Such feelings are often embodied in the form of pain or disease. As a consequence of these social aggressions, women come seeking therapeutic resources that can respond to their physical, psychological and spiritual needs. Integrative and complementary practices bring this proposal for integral care and are being increasingly sought after by women. In this sense, the aim in this work was: analyzing stories of women who sought integrative and complementary practices. The study followed the precepts of Resolution 466/12, being approved by the Research Ethics Committee under CAAE: 39806114.0.0000.5188. This research was conducted according to a benchmark according to the anthropological and ethnographic method. For collection and production of the empirical material, there was used the technique of Oral History of life with 8 women users of the Center for Integrative and Complementary Practices, in the municipality of João Pessoa/PB. The analysis and interpretation of the material were made on the basis of units of meaning (themes) more evident and constants in the narratives and the vital tone of each story. Thus, the following categories have been developed: a) sources and manifestations of female suffering, b) therapeutic itineraries and rituals of care for women and c) reconstruction of identity and otherness: paths for the female protagonism. In the stories reported, it was observed that women have sought care, because they reported sadness, low self-esteem, loneliness, fatigue, pain, helplessness, anxiety and insecurity. These complaints were associated with the sufferings experienced in respect of affective loss, workload of care, migration, interruption of life projects, and family disputes. The paths in search for care were influenced mainly by the socio-cultural context of each contributor, so that many of them resorted primarily to biomedical services. While not all employees had been through these services before resorting to integrative and complementary practices, they showed differences between the approach of allopathic medicine and the PICs, especially with regard to the applied therapy, to the professional-user relationship and the belief in the therapeutic efficacy. Care through integrative and complementary practices provided to these women greater autonomy; favored the construction of bounds; the rescue of self-esteem; promoted the empowerment and took them to reassure their lives and their stories.(AU)

Stories of liminality: living with life-threatening illness.

PURPOSE: The purpose of the study is to examine liminal experiences of living with the uncertainty of life-threatening illness. Increasing numbers of people with life-threatening illness live in-between the promise of treatment and the threat of recurrence or progression of disease, and yet this experience is not well understood. DESIGN: A narrative inquiry methodology within a constructionist frame was used. METHOD: Semistructured in-depth interviews were conducted with 32 participants from three populations of interest: (a) 10 people living with cancer, (b) 13 people with chronic renal disease, and (c) 9 people living with HIV/AIDS. FINDINGS: An overarching theme of "pervasive liminality" and four narratives are identified: storying into fear(lessness), being alive but not living; knowing and not knowing, and the (in)visibility of disease. CONCLUSIONS: Over time, living with a life-threatening illness produces complex and paradoxical experiences that do not easily fit within familiar categories of experience. Findings highlight pervasive liminal experiences as in-between narratives that are neither problematic nor need to be resolved, and endure over time.

An online narrative archive of patient experiences to support the education of physiotherapy and social work students in North East England: an evaluation study.

BACKGROUND: Patient narratives are a viable process for patients to contribute to the education of future health professionals and social workers. Narratives can facilitate a deeper understanding of the self and others through self-reflection and encourage transformative learning among students. Increasingly, accounts of health and care are available online but their use in health and social work education requires evaluation. This study explored the experiences of stakeholders who contributed to, developed and used an online narrative archive, which was developed in collaboration with five universities and healthcare providers in the North East of England (CETL4HealthNE). METHODS: Realistic evaluation principles were used to underpin data collection, which consisted of semi-structured interviews, a focus group and observations of educators using narrative resources in teaching sessions with different professional groups in two universities. Participants included educators, storytellers, narrative interviewers, students and a transcriber. Data were analysed thematically by two researchers and verified by a third researcher. FINDINGS: Stakeholders reported that listening to patient narratives was challenging. The process of contributing the story was a positive cathartic experience for patients, and the powerful storyteller voice often evoked empathy. Students commented on the ability of the online audio-visual narratives to enable them to see the patient holistically, and educators reported that narratives provided a means to introduce sensitive topics. CONCLUSIONS: The use of a locally generated online narrative archive is beneficial for storytellers, students and educators, providing an opportunity to influence healthcare professional training. Care needs to be taken when exposing individuals to potentially sensitive narratives.

The experience of a diagnosis of advanced lung cancer: sleep is not a priority when living my life.

PURPOSE/OBJECTIVES: To describe common practices and shared meanings of sleep-wake disturbances in individuals with newly diagnosed non-small cell lung cancer (NSCLC) before treatment and evaluate their preexisting sleep disturbances. RESEARCH APPROACH: Open-ended interviews of patients newly diagnosed with lung cancer. SETTING: A Veterans Administration hospital and a comprehensive cancer center in the northeastern United States. PARTICIPANTS: 26 patients newly diagnosed with NSCLC who chose chemotherapy treatment. METHODOLOGIC APPROACH: Interpretive phenomenology based on Heideggarian hermeneutics. MAIN RESEARCH VARIABLES: Meaning of diagnosis on life experiences and sleep practices. FINDINGS: Participants described four related themes: (a) the diagnosis as devastating yet not surprising, (b) treatment as hope for more time, (c) keeping life normal, and (d) sleep patterns as long lived. CONCLUSIONS: Although participants did not complain about sleep difficulties, they described a history of sleep disturbances and poor sleep hygiene. Participants focused their trust on the treatment, giving them more time to follow their priorities and ignoring the effects of sleep deprivation on their quality of life. INTERPRETATION: Healthcare professionals may design interventions to encourage keeping life as normal as possible, focusing on improving sleep, which may ultimately prolong patients' lives.

Quiet healing.

Both physicians and patients want deeply healing doctor-patient relationships. Too often, though, the ever-expanding demands of medical practice combine with the defenses of the patient to create doctor-patient isolation. Eastern and Western cosmologies and traditions may encourage different approaches to human interaction and healing. At times, probing the patient with more questions may open up a story vital to transformative healing. However, this narrative essay uses a personal experience as a patient of a Japanese traditional healer and Zen practitioner to explore the value of a quiet approach to patient care.

People living with serious illness: stories of spirituality.

AIMS AND OBJECTIVES: To examine stories of spirituality in people living with serious illness. BACKGROUND: Although knowledge about the experience of people with various chronic illnesses is growing, there is little known about peoples' beliefs and perspectives relating to spirituality where there is a diagnosis of a serious chronic and life-limiting illness. DESIGN OF THE STUDY: A social constructionist approach to narrative inquiry was used. METHODS: In-depth narrative interviews were conducted on one occasion with 32 participants. This included 10 people with cancer, 14 people with end stage renal disease (ESRD) and eight people with HIV/AIDS. They ranged in age from 37-83 and included 18 men and 14 women. RESULTS: The themes were reflecting on spiritual religious and personal beliefs, crafting beliefs for their own lives, finding meaning and transcending beyond words. Participants melded various belief systems to fit their own lives. They also looked to find meaning in their illness experience and described what gave life meaning. For some aspects of these belief systems, participants could not or would not express themselves verbally, and it seemed that aspects of their experience were beyond language. CONCLUSIONS: The stories revealed considerable depth relating to perspectives on life, illness and existential questions, but many participants were not comfortable with the term 'spirituality'. RELEVANCE TO CLINICAL PRACTICE: Nurses must remain open to learning about belief systems of each individual in their care, regardless of that individual's declared religious affiliation or declaration of no religious affiliation, given that personal beliefs and practices do not always fit into specific categories.

A percepção de idosas institucionalizadas sobre o uso do cão durante o atendimento fisioterapêutico / The perception of institutionalized elderly about physical therapy session assisted by a dog

Introdução: A Cinoterapia é uma Terapia Assistida por Animais,especificamente com cães e é utilizada em diferentes faixas etárias,incluindo idosos. Objetivo: Identificar a percepção de idosas institucionalizadas sobre o uso do cão no atendimento fisioterapêutico. Métodos: Para esta pesquisa descritiva qualitativa utilizou-se uma ficha de avaliação e entrevista narrativa individual. Durante 8 sessões(2 vezes na semana, uma com e outra sem o cão) realizou-se uma pista de exercícios com 5 idosas. Resultados: Após análise, elencou-se duas categorias: O cão como aliado a fisioterapia: percepções de idosos institucionalizados e Idoso institucionalizado: questões a considerar. A primeira trouxe como elementos os benefícios e dificuldades encontradas,como a dificuldade de conduzir o animal e o auxílio do mesmo no aprendizado dos exercícios. A segunda mostrou o caráter emocional ao cão (remetendo-as a experiências com seus animais) e contradições nas falas (pode ser explicado pelo comprometimento cognitivo destas). Conclusão: Entende-se que o cão pode ser um recurso a ser utilizado pela fisioterapia, porém requer animal treinadoe capacitação profissional. Ao ser incorporado no atendimento, as participantes trouxeram mais componentes benéficos como a vivência de relação de carinho e estímulo ao aprendizado, sugerindo que esta técnica deva ser mais utilizada para este público.

Introduction: Cinotherapy is an animal-assisted therapy, mainlywith dogs and it is used at different ages, including old people. Aim: To identify perception of institutionalized elderly about physical therapy session assisted by a dog. Methods: This is a qualitative descriptive research which used an evaluation form and personal narrative interview. During 8 sessions (twice a week, one day assisted by the dog and the other day without), we performed a circuit exercises with five old women. Results: After analysis, we determined two categories: Dog-assisted physical therapy: perception of institutionalized elderly and institutionalized elderly: questions to consider. The firs thas brought as elements the Benefits and difficulties found, such as difficulty to carry the animal and the help in learning exercises. The second showed the love and affection with the dog (they remember about experiences with their own animals) and contradictions in their speeches (can be explained by the cognitive impairment). Conclusion: We can understand that the dog is a resource to be used by the physical therapy, but the animal should be already trained and professionally qualified. It was observed that sessions with dog-assisted therapy brought more benefits to the participants such as love and affection relationship and encouragement for learning,suggesting that this technique should be more used for those clients.