Clara Costa Oliveira

Suffering and salutogenesis

In considering pain and suffering, some considerations will appear about epistemological beliefs shaping the clinical practices of health-care workers. With this, we try to understand the usual omission of human suffering in the training of many health professionals. So, we emphasize the role of the pathogenic paradigm in how human suffering is viewed in health care. In contrast to those who see suffering only as pathogenic, we defend that suffering can be a source of significant learning for both the sufferer as well as those who undertake caring in certain circumstances. We therefore argue that it is necessary to educate for health and not only for illness, choosing a holistic paradigm: Aaron Antonovkys salutogenic model that encloses positive aspects of human suffering when it is lived with an internal sense of coherence.

Confluências e divergências conceituais em educação em saúde

A educacao em saude conheceu, no ultimo seculo, profundas mudancas, tanto no plano conceitual como no das praticas dele decorrentes, fruto das transformacoes por que passou a humanidade em termos politicos, economicos e sociais. O conceito de educacao desviou-se da perspectiva instruidora e escolarizadora de criancas e jovens, centrada na transmissao-assimilacao de conhecimentos, para uma perspectiva mais abrangente e integradora, centrada na criacao de condicoes que permitem aos individuos desenvolverem-se holisticamente na sua multidimensionalidade, em permanente interacao com os outros. Por sua vez, o conceito de saude perdeu o seu pendor negativo de ausencia de doenca, passando a ser entendido positivamente como um estado de completo bem-estar fisico, mental, social e espiritual, em constante mutacao ao longo da vida. Nesse sentido, a educacao em saude deixou tambem de ser vista como a transmissao de informacao de carater higienista-sanitario, orientada para a prevencao ou o tratamento da doenca, efetuada em contextos formais, para passar a ser entendida como a capacitacao dos individuos para controlarem os seus proprios determinantes de saude, atraves da criacao ou do desenvolvimento de competencias de acao. A educacao e a saude passam, pois, a apresentar-se como duas faces de um mesmo processo. Neste trabalho pretendemos, pois, analisar a evolucao conceptual em torno da saude e da educacao no seculo XX, tentando perceber ate que ponto essas mudancas conceptuais se tem refletido ao nivel das praticas.

Auto-organização e psicoterapia

Neste artigo, resultado de uma pesquisa de tipo qualitativo, hermeneutico e documental, procuramos mostrar como as Ciencias Cognitivas, desde a sua constituicao, tem contribuido para a compreensao do ser humano. Fazemos referencia as visoes mais racionalistas da mente, que a entendem semelhante a um sistema computacional, ate a visao menos (nao) racionalista que lhe confere valor cognitivo, envolta em emocoes e afetos, que numa visao mais construtivista - ou pos-racionalista - se diria que traduz significados, traduz uma vivencia ou uma historia narrativa (e) pessoal. Assim, apresentamos o modelo de terapia cognitiva pos-racionalista de Vittorio Guidano, refletindo sobre os fundamentos epistemologicos do Movimento da Auto-organizacao (MAO), nos quais ele se fundamenta. Descrevemos sumariamente os alicerces epistemologicos do MAO, os quais garantem a este modelo uma dimensao holista e explicativa do processo de construcao da identidade humana, que pode ser descrita como processo de conhecimento, capaz de vivenciar e ao mesmo tempo perceber e avaliar a sua propria experiencia (autoconsciencia). O ser humano age na intersubjetividade, num mundo pluralista, com os seus congeneres, partilhando experiencias e interpretando acoes (complexificando-se atraves desses acoplamentos). Pretendemos, tambem, ilustrar que a matriz de funcionamento interno de cada ser humano, a qual lhe permite ordenar essa multipla e facetada realidade, assim como formar/construir/ordenar significados pessoais, e o vinculo emotivo-afetivo.

A generalized resistance resource: faith. A nursing view.

Based on Aaron Antonovskys salutogenic model, the authors of this article aim to analyze the term Faith as a Generalized Resistance Resource (GRR) of peoples health and to delve the relevance of this construct to clinical practice in Nursing. The authors consider that, in order for nurses to intervene in the promotion of faith so as to bring health benefits to people, a solid educational training in this subject area is required by nursing students.

Reprodução medicamente assistida: questões bioéticas

This paper focuses on the technological advances concerning medically assisted procreation, investigating bioethical dilemmas that arise in this respect. We deepened the various positions on legal and ethical issues that this field of scientific research raises, which appears consensual from the start (the right to parenthood). We focused on European Community legislation (countries constituting the European Community), which includes Portugal. The most significant conclusions are: there is usually common legislation in the various countries on medically assisted procreation; there are, however, differences, which we made explicit in the text. The most consensus situation refers to medically assisted procreation up to 14 days of fertilization. The bioethical arguments on the issues raised by medically assisted procreation are mainly founded on the principle of autonomy (parents), at the expense of other principles, such as non-maleficent and human dignity.Este articulo se centra en los avances tecnologicos en la procreacion medicamente asistida, investigando los dilemas bioeticos que surgen en esta materia. Profundizamos en las diversas posiciones sobre situaciones eticas y legales que este campo de la investigacion cientifica plantea lo que parece consensuado desde el principio: el derecho a la paternidad. Nos centramos en la legislacion de los paises que constituyen la Comunidad Europea. Por lo general hay una legislacion comun en los diferentes paises sobre la procreacion medicamente asistida; hay, sin embargo, diferencias, lo que hizo explicita en el texto. La situacion de mas consenso se refiere al procreacion medicamente asistida hasta 14 dias de la fecundacion. Los argumentos bioeticos se fundamentan principalmente en el principio de autonomia (de los padres), a expensas de otros principios, como el de la no maleficencia y de la dignidad humana.Medically assisted procreation: bioethical issues This paper focuses on the technological advances concerning medically assisted procreation, investigating bioethical dilemmas that arise in this respect. We deepened the various positions on legal and ethical issues that this field of scientific research raises, which appears consensual from the start (the right to parenthood). We focused on European Community legislation (countries constituting the European Community), which includes Portugal. The most significant conclusions are: there is usually common legislation in the various countries on medically assisted procreation; there are, however, differences, which we made explicit in the text. The most consensus situation refers to medically assisted procreation up to 14 days of fertilization. The bioethical arguments on the issues raised by medically assisted procreation are mainly founded on the prin ciple of autonomy (parents), at the expense of other principles, such as non-maleficent and human dignity.

What Bateson had in mind about 'mind'?

G. Bateson believed that the scientific school of the future would be ‘ecology of mind’. The first aim of this paper is to understand what he meant by ‘mind’, and the other is to understand how this concept emerged in his thought, i.e., how its meaning would become more flexible throughout his life and work. Furthermore, we will approach the epistemological implications of ecology of mind for scientific education in the West. Bateson’s concept of mind emerged when he became aware (in 1926) of his own way of thinking, i.e., of his immense abductive capacity. This led him to search for patterns of similarity and difference between organisms (like in homology). Later, he identified this thought process as being abstract and formal, relating not just facts but also ideas. Afterwards, Bateson developed criteria for us to consider a system as being mental, with special emphasis on living and cybernetic systems.

Psychometric properties of the suffering assessment questionnaire in adults with chronic diseases or life-threatening illness

BACKGROUND Suffering has been considered by many authors to be a difficult concept to assess and measure, as it is subjective and unique. However, to guide the diagnosis and decision-making of healthcare professionals, it is important to develop an instrument that differentiates the different suffering dimensions, namely, intra- and interpersonal suffering, awareness of suffering and spiritual suffering. AIM The aim of this study was thus to design and validate an instrument for the assessment of the dimensions of suffering in adult patients with chronic diseases or life-threatening illnesses. METHOD A methodological study was developed. The data were collected from two self-help organisations and a palliative care unit. The theoretical model was tested using confirmatory factor analysis. The study sample consisted of 251 patients with chronic diseases or life-threatening illnesses. The Sense of Coherence Scale, the Spiritual Assessment Scale and the Suffering Assessment Questionnaire in Adults with Chronic Diseases or Life-Threatening Illness (SAQ) were applied to each participant and were later returned for analysis. RESULTS An SAQ version with 12 items showed adequate psychometric characteristics of validity and internal consistency after being adapted to a four-dimensional structure that assesses the four dimensions of suffering. CONCLUSION The results of confirmatory analysis indicated a good model fit that suggested that the advocated theoretical model is plausible.

Educação salutogênica de cidadãos doentes mentais: a APPACDM de Braga – Portugal

We present a study of the Portuguese Association of Parents and Friends of Mentally Handicapped Citizens (APPACDM), at Braga - Portugal, aiming to understand how formal and non-formal education of this type of person is salutogenically taken and shared, particularly in terms of space and environment. We proceeded to the Institutions documental analysis, to direct observation and to an interview with the person responsible for the administration of the institution. The data collected are favorable to salutogenesis dimension, although we may refer some critics.

Understanding pain and human suffering

In the twentieth century the knowledge regarding pain, especially at the neurophysiological level, and in particular neuropathic pain, has increased. But more knowledge and analgesic medication devalued the doctor-patient relationship, sometimes ignoring the complexity of human suffering, far beyond pain. This is associated with a huge investment in biochemical research at the expense of training health professionals, especially doctors, in communication and caring skills. Several researchers have highlighted the need to (re) evaluate suffering in the formal and informal training of caregivers. The main purpose of this article is to recognize the potential that suffering can bring to the development of personal identity, stressing the role of communities in understanding these human experiences.

Para comprender el sufrimiento humano

In the twentieth century the knowledge regarding pain, especially at the neurophysiological level, and in particular neuropathic pain, has increased. But more knowledge and analgesic medication devalued the doctor-patient relationship, sometimes ignoring the complexity of human suffering, far beyond pain. This is associated with a huge investment in biochemical research at the expense of training health professionals, especially doctors, in communication and caring skills. Several researchers have highlighted the need to (re) evaluate suffering in the formal and informal training of caregivers. The main purpose of this article is to recognize the potential that suffering can bring to the development of personal identity, stressing the role of communities in understanding these human experiences.