Collective Subject Discourse Research Articles

HIV POSITIVE DIAGNOSIS AND THE REORGANIZATION OF LIFE

This article is the result of a qualitative study that aimed to understand how the lives of people living with HIV (PLHIV) were reorganized after at least one year of living with the disease. For this purpose, interviews were conducted with some generating questions preceded by characterization of the subjects. The methodology chosen for organizing the data was the Collective Subject Discourse (CSD), having as theoretical reference psychoanalysis and scientific productions related to the theme. The result refers to a thematic axis named “Subjective experience and adaptation from the disease”, which constituted three collective subject discourses (CSD), these were named by the central ideas (ICS): (1) resignification from the disease, (2) biopsychological repercussions of the diagnosis; and (3) silence with self-protection. It was concluded that there is not just one way to reorganize life from the diagnosis, but it is correct to state that the stigma of the disease has a direct influence on all subjects.

Tecendo a rede de capitais cultural e de ciência em museus de ciência no Rio de Janeiro

Museums are places for potentially promoting emotions and creating memories from the experiences they provide. In this regard, this article investigates why people visit science museums, intending to unveil the public’s diversity and facilitate the understanding of their interests and motivations for this cultural practice. Data were collected by means of a printed and self-applied questionnaire filled out by adult visitors over 30 years old during visits to five science museums located in the metropolitan region of Rio de Janeiro, Brazil. Based on the concepts of cultural capital, science, interest and motivation, the applied analytical approach was qualitative and quantitative aided by the Collective Subject Discourse method. The findings bring contributions to the field of public and cultural leisure studies. Processes of acquiring, expanding and transmitting these forms of capital to children, family, and friends emerge from the discourses during interaction with exhibitions and educational and dissemination activities offered by science museums. This understanding can help to develop museum strategies to attract and retain their spontaneous visiting public.

Informational Modeling of Cities: Method and Challenges for Institutional Implementation

ABSTRACT Although cities are increasingly permeated by information and communication technologies (ICTs), these urban centers still face theoretical and practical obstacles regarding the application of 3D technologies as a tool for urban planning and management. This study aims to ontologically structure an informational model as an urban management tool and assess the perceived challenges for implementing this model in the municipal public management of Curitiba, Brazil. The study was carried out through the collective subject discourse, the interviews’ thematic saturation, and Delphi techniques. The results indicate that the technical capacity, technological infrastructure, and financial resources for the development of a city information modeling (CIM) exist, although its activation for such development depends on a more significant political and managerial entrepreneurship in the decision-making in arrangements of multilevel governance, and, consequently, there is a need to develop public policies for staff training to stimulate and promote advanced technological innovations for urban management and planning. Implementing a CIM in large cities seems to face more management and planning problems due to the lack of institutional ontologies than technological, infrastructural, or knowledge limitations.

THE PHENOMENON OF THE "INFORMED PATIENT": ACCESS TO HEALTH-CARE CONTENT AVAILABLE ON THE WEB AND RECONFIGURATIONS IN THE RELATIONSHIPS BETWEEN HEALTH-CARE PROFESSIONALS AND USERS

The popularization of the internet has significantly expanded access to information, giving rise to a more active and well-informed society. In the health area, it is possible to find, on the web, more and more information available about diseases, symptoms, diagnoses, prevention, medicines, treatment, professionals, etc. This has given rise to a more informed, active, questioning and critical user, who seeks information about their health on the internet, in order to gain more autonomy in the face of these processes: the “expert patient” or the “informed patient”. This research aims to identify and analyze the forms of interaction between people (users and health professionals in general) and health content available on the internet, seeking to understand the changes and reconfigurations that access to this information has been promoting in relationships between users of health systems, professionals and services in general. This is a qualitative research of an ethnomethodological nature, which was based on a bibliographical review and a field study, organized in two stages: an exploratory one, with the application of an online questionnaire, and a systematic one, with interviews in depth. The analysis of the research results was based on the methodology adapted from the Collective Subject Discourse (CSD), according to Lefèvre, which made it possible to create the categories. Through a cross-sectional analysis of the collected material, it was possible to identify numerous aspects that surround the search for health information on the web. Among them, the autonomy and “empowerment” of users, who, in an attempt to move towards the humanization of health care, begin to seek contributions from external means, in order to satisfy their desires and needs, to fill the gaps left by the services of health and to find other agents to place trust and credibility.

O CUIDADO AO PACIENTE COM CÂNCER SOB A ÓTICA DE ENFERMEIROS DA ATENÇÃO PRIMÁRIA À SAÚDE

ABSTRACT Objective: To describe nurses’ perceptions of cancer patient care in Primary Health Care. Method: A qualitative study was conducted in 26 Family Health Centers in a municipality in western Santa Catarina - Brazil, between September and October 2022. A total of 33 nurses took part and completed an online questionnaire. The text was interpreted based on the conceptual precepts of organizational culture from Chiavenatto’s administrative theory. The frequency of responses analyzed objective questions; the Collective Subject Discourse was used for the essay questions. Results: Nurses perceive themselves as unprepared and identify a lack of protocols and organizational flows. Final considerations: In primary Health Care, there is a belief consolidated in everyday work and becomes part of the organizational culture of health services, that cancer patients should go on to specialist care. There is a lack of knowledge of health policies, which implicates professionals in caring for cancer patients.

PERCEPÇÃO DE PESSOAS COM DEFICIÊNCIA FÍSICA ACERCA DO EXERCÍCIO DA AUTONOMIA EM UMA UNIVERSIDADE FEDERAL

ABSTRACT Introduction: preconceptions towards people with disabilities are still present in our society; they arise from ancient behaviors and from the biomedical model, both rooted in human attitudes. Objective: to describe the potentialities/strengths and inabilities/weaknesses faced by people with disabilities to exercise their autonomy and to show the ways in which people with disabilities exercise their autonomy. Method: this is a single-case study with a qualitative approach. Twenty-two individuals with physical disabilities were interviewed, with students and employees from a university in southern Brazil among them. Data analysis was performed by means of the Collective Subject Discourse The comprehensive and interpretive analysis of the meanings that emerged from the participants' statements were associated with the theoretical framework of autonomy by Adela Cortina, Diego Gracia and Lawrence Kohlberg. Results: potentialities/weaknesses can be observed in the exchange spaces and in the information provided by the university. At the same time, inability/weakness is perceived in preconception, welfarism and all the ableism faced by people with disabilities. Conclusions: lack of information is one of the main elements that foster preconception and it is essential to fight against it for the inclusion of people with disabilities.

Avaliação da atuação da gestão em saúde no desastre-crime de derramamento de petróleo na costa do estado do Pernambuco

ABSTRACT This study aimed to analyze the actions taken by health management to deal with the criminal disaster of an oil spill off the coast of Pernambuco in 2019. It is a case study investigating the health sector’s actions in four municipalities in Pernambuco. Data was collected through interviews with 16 health department managers (municipal and state), using a semi-structured script with questions about performance, impacts, actions taken, difficulties, challenges, and lessons learned. The Collective Subject Discourse analysis revealed four thematic axes: a) managers’ perception of the impacts of the crime disaster; b) actions taken in the process of risk management of the disaster crime by the health sector; c) difficulties faced in the process of mitigating the disaster; d) evaluation of management actions during the disaster crime and future preparation. Weaknesses in health management were identified in disaster mitigation actions due to the need for more preparation of health services and professionals. The lack of instruments and coordination between the federated entities intensified the difficulties, generating calamity in the territory. This points to the need to build instruments and protocols to guide such actions in these situations so that activities can be carried out more efficiently and effectively.

Competency mapping of primary healthcare nurses on the Brazil-Paraguay border.

To map the competencies of Primary Health Care nurses in border regions of Brazil and Paraguay. Exploratory qualitative studyconducted between February and July 2020, with 64 nurses from six Brazilian municipalities bordering Paraguay. It was conducted in three stages: 1. Documentary study: analysis of legal documents to identify the nurse's competencies. 2. Application of instrument to the study population .3. Mapping of competencies, through the competencies expressed by nurses analyzed using the collective subject discourse technique. Twenty-eight general competencies were identified, categorized as assistance and management, and five specific competencies required to work in border regions: conducting a situational diagnosis of the border community; attending to foreign users with active and humanized listening; communicating appropriately with foreign users; identifying the epidemiological profile of the border; and, understanding the health policies of the neighboring country. The competencies required for the work from the participants' perspective were included in the mapping. The competence gap identified in the mapping refers to educational practices in communities. The study identified the necessary competencies for nurses to work in border regions, but pointed out gaps in the training and continuing education of these professionals.

PROFESSORES DE ADOLESCENTES EM CONFLITO COM A LEI: RECURSOS, DIFICULDADES E PERCEPÇÕES

ABSTRACT Adolescents who comply with a socio-educational measure of probation have to attend school as an obligation. In this scenario, the teacher has a central role in promoting close relationships that help these students. The objective was to characterize the resources and difficulties reported by teachers regarding the teaching-learning process of adolescents on probation. Ten teachers of students on probation participated, from public schools in a city in the countryside of the state of São Paulo, who provided answers to a semi-structured interview. The analyzes were based on the Collective Subject Discourse technique, pointing out the teachers’ resources regarding planning, teaching, and establishing bonds; as the difficulties reported were the family’s absence at school, learning gaps and the lack of value for education. It is concluded that interventions that enhance the teachers’ social educational skills and promote relationships between the family and school microsystems of students on probation are important.

CUIDADO DE ENFERMAGEM HUMANIZADO EM TERAPIA INTENSIVA EM ANGOLA: FACILIDADES E DIFICULDADES DESVELADAS

ABSTRACT Objective: to describe the aspects that facilitate and hinder the work of nursing professionals regarding the humanized care in an intensive care unit in Angola. Method: descriptive, qualitative research, conducted in an Intensive Care Unit of a general hospital in Huambo, Angola, Africa, with 15 nursing professionals, in 2020, through semi-structured interviews. The Collective Subject Discourse to analyze the data was used; and to organize the data, the QualiquantiSoft software was used. Results: five central ideas emerged from the statements: two involving the facilitating factors; and three involving the difficulties in providing humanized care. The facilitating factors refer to the involvement of the multidisciplinary healthcare team and the interpersonal relationships of the nursing team. The hindering factors are linked to the lack of material resources, equipment, and supplies; the scarcity of human resources; and the poor specialized skills of the nursing team. Conclusion: when referring to the humanization of nursing care, its facilitating factors are linked to behavior and professional relationships, while the difficulties, for the most part, involve management aspects that are not under the professionals’ responsibility, thus requiring attention from the managers of the institution.

The perception of oncology ICU professionals regarding the practice of palliative extubation

Introduction: Palliative extubation is an ethically and legally supported practice; however, there are still difficulties in understanding the concept, erroneously relating palliative extubation to euthanasia.Objective: To analyze the perception of oncology ICU professionals of a private hospital in São Paulo regarding palliative extubation procedure and the interfaces in the care provided by the team.Methods: This is a descriptive exploratory study with a qualitative approach, in which a semi-structured interview was used; and as a data processing technique, the Collective Subject Discourse (CSD), which analyses empirical data of a verbal nature, in order to configure a collective subject with a social discourse.Results: The analysis of the interviews culminated in 13 categories of discourse, which described the practice of palliative extubation in the oncology ICU, the insertion of palliative care, the difficulties that permeate the multi-professional team, and the approach to the family.Conclusion: The conceptual description of palliative extubation is well known by the team, as they know how to distinguish palliative extubation from euthanasia. However, there are difficulties in practical performance, which can have a direct impact on patient care, communication with the family and the safety and well-being of the professional involved.

Skin donation for transplantation: Social representations of family members who (do not) give consent for collection

Despite the advantages of using deceased donor skin in the treatment of burns, it is not easy to obtain these grafts due to low tissue donation rates. In order to discover the social representations of family members of organ donors regarding skin donation and to analyze the convergences and divergences of these representations between family members who consented and those who refused to allow skin to be donated for transplantation, we conducted interviews with 20 family members of organ donors in a situation of brain death. Data were obtained through interviews and submitted to the Collective Subject Discourse Analysis Technique. This study shows that in the opinion of family members who consented and those who did not authorize skin donation, the consideration contains both positive and negative representations, which can have different weights and influence decision-making. This study also highlights, in an unprecedented way, the representation of the animalization of the donor, which can be a reason for the refusal to allow skin to be donated.

Social representations attributed to prostate cancer by men undergoing follow-up at an in-hospital Oncology service

Objective: to understand the social representations of prostate cancer by men undergoing follow-up at an in-hospital oncology service. Methods: a qualitative study, developed using the Collective Subject Discourse method, with 30 men over the age of 18 undergoing treatment for prostate cancer. The data were collected through semi-structured interviews and analyzed using the Theory of Social Representations. Results: the most shared central ideas in the studied community were as follows: A curable disease; Worry, fear, annoyance and sadness; Loss/Impairment of sex; Nothing, something normal/common; A minor ailment that doesn't shake/shook me, it was faced head on, without fear; Something/Disease that is bad, difficult, serious, intense, dangerous, that ends life and kills. Conclusion: the social representations found in this study denoted intense and difficult experiences in dealing with the disease and treatment, but also showed coping, with potential for overcoming/resilience. Contributions to practice: understanding these representations enables the implementation of integrated and interprofessional education, assistance and management actions.

Food handlers’ lack of knowledge, and misunderstanding of safe food temperatures: An analysis using the theory of social representations

Comprehension is the ability to understand and be familiar with situations and facts. A critical factor causing foodborne diseases is the inadequate temperature during food storage and handling; food handlers often fail to understand this. Therefore, in this study, we investigated how technical language and everyday knowledge operate in the comprehension of safe food temperatures among food handlers in food services. To achieve this, data collection was carried out in two stages. In the first stage, a survey was conducted to 206 food handlers from 14 food service working in the city of São Paulo. Through this survey, we gathered information to characterize the socio-demographic profile of the sample, details about participation in training, and knowledge of technical terms related to safe food temperatures. In the second stage, individuais interviews were conducted on the same day following the questionnaire administration in each food service. A total of 29 interviews were carried out An interview script was developed containing two storylines based on the Fourth Key: “Keep food at safe temperatures,” which is part of the WHO's “Five Keys to Safer Food” manual. Further, the collective subject discourse technique, which is based on the theory of social representations, was employed to analyze each interview and construct a representative collective discourse. Analysis of the results indicated that lack of knowledge about safe food temperatures is mainly a result of the misunderstanding of technical terms. The collective discourses obtained results reinforced that food handlers had diverse and erroneous information about food defrosting, and they exhibited low confidence and clarity about safe food temperatures. Overall, psychological, social, and cultural factors affect the formation of social representations that guide food handlers’ decision-making.

Shared management in emergency care services: mixed methods study

Objective: To analyze the management model adopted in Emergency Services in municipalities that are part of a Regional Health Department. Methods: Mixed methods study with a concomitantly incorporated design. It was conducted in 2017 with six managers and 223 health workers (physicians, nurses and nursing technicians/assistants) from ten Emergency Care Units in eight municipalities of the Regional Health Department XIII, São Paulo. The data collection instrument composed of six closed questions and four open questions was delivered to participants. Quantitative data were analyzed using descriptive statistics; qualitative data were developed using the Collective Subject Discourse technique and analyzed using the DSCSoft® software. Results: There was a predominance of female professionals, 173 (75.2%), in the position of nursing assistants, 78 (33.9%). Managers evaluated the institution’s management model as contemporary and participatory, enabling workers to participate in decision making and giving them autonomy to decide on day-to-day issues, while workers evaluated it as traditional management, highlighting its formal structure. Conclusion: It was observed that managers and workers have a different view of the management model of health institutions. The assumptions of the shared management model encompass valuable concepts, such as dialogic communication, decentralization of power and greater autonomy for decision making. However, when analyzing the opinion of most workers who participated in this study, the wide use of a hierarchical model in institutions is still observed.

Milk Moon and the Building of Bonds to be Born and to Live: A Necessary Reflection in the 21st Century

This is a qualitative study that presents the concept of the Milk Moon, based on collective subject discourse and elements of the Winnicottian theory in the construction of maternity. The technique consisted of analysing the verbal material collected with the methodological figures, key expressions and central ideas, to generalise the result and reveal a collective opinion.

Patrones de aprendizaje de estudiantes de posgrado en salud pública: relaciones con la identidad, la formación y el trabajo de profesores enBrasil

IntroductionThe relationships between the learning patterns of postgraduate students and their social representations of professional identity, teaching work and pedagogical training at the postgraduate level in health at a Brazilian institution are analyzed. Method166 graduate students who responded to the ILS questionnaire participated in the study. Cluster analysis was performed to identify learning patterns. In addition, 25 teachers were interviewed in focus group sessions to identify professional identity, pedagogical training and teaching work. The data are analyzed using the Collective Subject Discourse technique. The study was approved by a Brazilian ethics committee. ResultsCluster analysis revealed four patterns of student learning: RD-flexible (28.3%), AD (31.9%), MD (25.4%) and UD (14.5%). The focus groups made it possible to infer certain categories for each of the dimensions analyzed in the teachers: Professional identity (socio-political context and commitment to public services, credibility and diversity of the institutional environment, teaching experience and practice), Teaching work (work management, conditions and process) and pedagogical training (needs and demands, student profile and interpersonal relations). ConclusionThe perceptions on the dimensions of professional identity, teaching work and pedagogical training made it possible to incorporate intersubjective and contextual elements to the understanding of learning patterns; and based on this, guidelines are defined for the design of training itineraries in higher education in health that promote a critical and reflective education with active participation of students.

Measurement model of the projected and perceived image through the organizational identity of the Volvo Ocean Race Brazil event

PurposeWorld Tourism Organization (WTO) recognizes image as the main aspect to be considered by a destination in its promotion and marketing process. Cities try to build valued and recognized images, established from an identity defined based on their own values. One of the strategies adopted for this construction is to hold events, through which it is possible to promote tourism, move the economy, improve the infrastructure, change the image and influence intentions to visit the destination. From the point of view of supply and demand, theorists have proposed two categories of destination image: the projected image and the perceived image. In this context, the objective of the research was to propose a model for measuring the Projected and Perceived Image through the Organizational Identity of the Volvo Ocean Race Brazil.Design/methodology/approachWith a quali-quantitative approach, the study universe is composed of in-depth interviews with the main members of the organizing committee, documentary and netnographic analysis of the event's social networks. For the analysis and interpretation of qualitative data, the collective subject discourse was used. Documentary and netnographic analysis were by means of deductive content analysis and correspondence analysis.FindingsThe results supported the three secondary hypotheses of the research, leading to confirm the central hypothesis that the constructed organizational identity, projected by the image, is perceived by visitors to the event studied.Originality/valueIt is understood as fundamental the expansion of studies regarding projected and perceived image, identity and the possibility of its application in tourist events, as social representations, as support also for the definition of management and marketing strategies.

(De)construction of the meanings of work: experiences of suffering in hospital emergency wards

Objective: To investigate the experiences of suffering in the work of nurses in a hospital emergency service. Methods: Qualitative study with 15 nurses from a public hospital emergency unit in a municipality in Bahia, Brazil. Data were obtained through in-depth interviews, analyzed by the Collective Subject Discourse and anchored in the theoretical framework of Work Psychodynamics. Results: There is professional suffering in the work of nurses in the Hospital Emergency Unit and it is permeated by the (de)construction of the meanings of work, the way work is organized, professional recognition, psychological illness, and the coping strategies developed and available to them. Final considerations: The suffering that emerges from work relationships presents specificities of the organization and professional practice in nursing in the emergency sector, which makes up the context, causes and consequences of the phenomenon and impacts on the different dimensions of life.

Educational strategies in oral healthcare for the disabled and their effects on dental students' training.

To evaluate the effects of didactic and clinical training of dental students in treating Persons with Disabilities (PwD) on their self-perceptions about treating PWD. A pre-and postevaluation of a didactic-clinical educational strategy targeting oral health care of PwD was conducted among fourth-year undergraduate dental students at a Brazilian dental school. Semi-structured questionnaires were used to assess the following work environment parameters: technical, organizational, social, ethical, and managerial acumen. Data were analyzed using Fisher's exact and chi-square tests, with a significance level of 5% (p<0.05), to verify possible associations between the quantitative variables. A qualitative analysis was conducted through collective subject discourse. Significant differences were found in the self-perception of students' knowledge and abilities in providing low-complexity care for PwD before and after the training program (p=0.025). Students were more confident about managing and organizing the work environment (p=0.007) and providing humanized care to PwD (p=0.042) posttraining program. Additionally, a decrease in the feeling of insecurity (p=0.014) and feelings of pity, fear, or prejudice toward PwD (p<0.001) were observed posttraining program. Didactic and clinical training interventions for treating PwD improved the work environment of undergraduate dental students in technical, managerial, organizational, and ethical/social dimensions.