Laura Vilela e Souza

Avaliação como construção social: investigação apreciativa

In this article we propose a view of evaluation as a process where positive and generative aspects of the interactive context are explored. Drawing on a social constructionist discourse, Appreciative Inquiry is presented as an alternative form of evaluation that promotes change. The use of Appreciative Inquiry as a strategy of evaluation has been used in different contexts and cultures, yet is not widely known in Brazil, as a research and evaluation methodology. This article attempts to introduce Appreciative Inquiry as a valid and useful approach of evaluation in different contexts.

A participação da família no tratamento dos transtornos alimentares

El objetivo de cuesto estudio fue comprender los sentidos sobre la participacion de la familia en el tratamiento producido en un grupo de apoyo a los familiares de personas diagnosticadas con anorexia y bulimia. Hicieron parte del estudio familiares atendidos en el contexto de un servicio especializado. El corpus fue constituido por los registros audio grabados de sesiones de grupo, en los cuales se busco delimitar los segmentos interaccionales relevantes para el alcance del objetivo. El enfoque del construccionismo social fue utilizado como suporte teorico-metodologico y fundamento el analisis de los datos. Los resultados permitieron comprender que las diversas descripciones sobre las relaciones de la familia con trastornos alimentarios permiten delimitar diferentes posibilidades de significar la participacion de los familiares en el tratamiento. Concluye que los grupos pueden funcionar como un espacio privilegiado para acompanar esa produccion de sentidos in statu nascendi, permitiendo explorar la construccion, desmanche y reconstruccion de los significados alternativos, que pueden enriquecer los horizontes de interpretacion de cada participante.This study aims to understand the meanings about the family participation in the treatment produced in a support group for the families of people diagnosed with anorexia and bulimia. The participants of this study were families attended at a specialized health care service. The data was constituted by the audio recorded registrations of the group session, which were analyzed through the delimitation of its different interactional sections according to this study purposes. The social constructionism approach was used as theoretical and methodological reference and was used to data analysis. The results permitted understanding that the different descriptions about the relation between the family and the treatment can restrict the different possibilities to give meanings to the families’ participation in the treatment. We conclude that the group may function as a significant space to observe the meaning production in statu nascendi, making possible to explore the construction and reconstruction of alternative meanings, that may enrich the interpretative possibilities of each participant.

A construção de si em um grupo de apoio para pessoas com transtornos alimentares

Este estudo teve como objetivo compreender a construcao de si mesmo a partir do discurso de pessoas diagnosticadas com anorexia e bulimia, participantes de um grupo de apoio psicologico. Participaram 14 jovens atendidas em um servico publico de saude de um hospital universitario. A partir do referencial historico-cultural bakhtiniano, analisaram-se qualitativamente as transcricoes audiogravadas de 10 sessoes consecutivas do grupo. Constatou-se que os discursos produzidos socialmente sobre os transtornos alimentares sao evocados nas falas das participantes e encontram no grupo um espaco para que possam ser contestados, negociados ou aceitos, promovendo a desconstrucao de mitos erigidos em torno da enfermidade. A analise empreendida aponta o grupo como uma ferramenta terapeutica significativa para a producao de novos sentidos, nao patologizantes com relacao aos transtornos alimentares e seus portadores.

A construção social de um grupo multifamiliar no tratamento dos transtornos alimentares

The aim of this study was to analyze the meanings produced and negotiated by the relatives of people diagnosed with Anorexia and Bulimia who participated in a family support group. Using the Social Constructionism theoretical-methodological approach, the meanings about the family participation in group work, the social discourses that sustain such meaning constructions and their consequences to the group interaction were enlightened. When the meanings were taken as absolute truths, segregation movements among the participants were produced. However, those meanings could be revisited promoting the appearance of alternative ones, showing the negotiated and constructed character of the group space. This knowledge may contribute to a successful planning for the treatment of eating disorders.

Vivências e discursos de mulheres mastectomizadas: negociações e desafios do câncer de mama

This article investigates the mastectomized womens experiences and discourses about breast cancer, and also their strategies of negociation about the diseases challenges. 11 sessions of a support group for these women, carried out in a public service, were analyzed. The sessions were analyzed using thematic analysis and the dialogism and polyphony notions, within an historical and cultural approach that showed the opposition between the scientific knowledge (medical verdict) and the popular knowledge (possibility of cure), also the social stigma of the disease and the feminine gender . The group offered the setting for different knowledge to be updated and conveyed, reflecting a joint construction of the ideas about cancer and giving new meanings to facing and living with the disease.Mastectomized women’s experiences and discourses: negotiations and challenges of breast cancer. This article investigates the mastectomized women’s experiences and discourses about breast cancer, and also their strategies of negociation about the disease’s challenges. 11 sessions of a support group for these women, carried out in a public service, were analyzed. The sessions were analyzed using thematic analysis and the dialogism and polyphony notions, within an historical and cultural approach that showed the opposition between the scientific knowledge (medical verdict) and the popular knowledge (possibility of cure), also the social stigma of the disease and the feminine gender . The group offered the setting for different knowledge to be updated and conveyed, reflecting a joint construction of the ideas about cancer and giving new meanings to facing and living with the disease.

Familiares de pessoas diagnosticadas com transtornos alimentares: participação em atendimento grupal

O objetivo desse estudo foi compreender de que maneira sentidos produzidos em grupo de apoio aos familiares de pessoas diagnosticadas com Anorexia e Bulimia constroem diferentes possibilidades de estar no grupo e usufruir de sua potencialidade terapeutica. Dez sessoes de grupo foram audio-gravadas e transcritas, sendo uma escolhida por sua riqueza polissemica. O Construcionismo Social foi utilizado como suporte teorico-metodologico para analise do material empirico. Os resultados mostraram que possibilidades e limites do grupo como espaco de apoio foram construidas por meio dos modos pelos quais os participantes significavam suas diferencas. O funcionamento do grupo mostrou-se dependente das especificidades das pessoas engajadas, do contexto no qual o grupo se insere, das relacoes de poder presentificadas e negociacoes de sentidos possiveis.

Proximidade afetiva no relacionamento profissional-paciente no tratamento dos transtornos alimentares

Few spaces are available for listening how patients diagnosed with eating disorders understand the discourse of a need for an emotional distance between professional and patient. We seek to understand how the request made by patients for greater emotional bonding with the health professional can participate in building a good relationship with doctors, nutritionists and psychologists. Patients from a service of assistance in eating disorders were interviewed. The theoretical and methodological proposal of discursive practices and meanings production, underpinned by a social constructionist discourse, guided the analysis of the material. Discourses, meanings and positioning games involved in these discursive productions were highlighted. Participants constructed their proximity to the professional as a key ingredient for overcoming the disorder. The arguments in favor of a more intimate contact with the professionals and the use of the discourse of neutrality by the professional were discussed in its context of production.Pocos son los espacios para escuchar como los pacientes diagnosticados con trastornos alimentarios entienden el discurso que preconiza la necesidad de alejamiento afectivo entre el profesional y el paciente. Tratamos de entender como la solicitud por parte de los pacientes por mayor proximidad afectiva en relacion al profesional de salud puede participar de la construccion de una buena relacion con medicos, psicologos y nutricionistas. Los pacientes de un servicio de asistencia en trastornos alimentarios fueron entrevistados. La propuesta teorico-metodologica de las practicas discursivas y la produccion de sentidos, defendida por el discurso construccionista social, oriento el analisis del material. Se destacaron los sentidos y discursos y los juegos de posicionamiento que participan en dichas producciones discursivas. Las participantes construyeron la proximidad con el profesional como ingrediente fundamental para una posible superacion del trastorno. Los argumentos a favor de un contacto mas intimo con los profesionales y el uso del discurso de la neutralidad por el profesional fueron problematizados en su contexto de produccion.

Quem é o especialista? lugares ocupados por profissionais e pacientes no tratamento dos transtornos alimentares

Who is the specialist? Places occupied by professionals and patients in the treatment of eating disorders. The social constructionist epistemology repositions professional and patient as coauthors in health care. Assuming this perspective, we sought in this study to understand the discursive practices of people diagnosed with Anorexia Nervosa and Bulimia about the position of patient and professional in the construction of the treatment. Individual audio taped interviews were conducted with patients from one service center in eating disorders. The social construcionist discourse guided the investigation. For the analysis of this material we used the following proposals: thematic-sequential boundaries, discursive practices and production of meanings, and positioning theory. Thus, we discussed on how the standards of professional-patient coordination can sediment positions and provide little room for negotiations. Proposals such as open dialogue and collaborative partnership were offered as possibilities for building new professional-patient relationships, understanding that the conquest of welfare is a product of joint action.

Histórias de Sucesso de Profissionais da Saúde no Tratamento dos Transtornos Alimentares

O objetivo deste artigo e descrever as historias de sucesso de profissionais de saude no atendimento de pessoas diagnosticadas com transtornos alimentares, entendendo que essas narrativas criam contraponto aos sentidos mais amplamente propagados na literatura da area que qualificam negativamente esse relacionamento. Participaram seis profissionais de um servico de assistencia ambulatorial em anorexia e bulimia de um hospital-escola. As entrevistas abertas foram analisadas a partir do discurso construcionista social. Os sentidos realcados abordam a ressignificacao do paciente considerado dificil, importância do foco na relacao profissional-paciente e nao nos sintomas dos transtornos, aprendizado do profissional com o paciente, proximidade afetiva nessa relacao, busca de alternativas para o embate de verdades entre profissional e paciente, e a psicoterapia para o profissional como abertura para autoreflexividade no atendimento ao paciente. Esses sentidos convidam a transformacao do que vai ser considerado melhora e como o profissional participa do seu alcance.

Decisões em saúde no relacionamento entre o profissional e o paciente com transtorno alimentar

The patient diagnosed with an eating disorder can be seen as a target for guidance or can be positioned, together with the professional, as a specialist in the performance of the treatment. We sought to understand, from the discursive practices of people diagnosed with these disorders, how professionals and patients construct decisions about treatment. Interviews were conducted with 12 patients in a specialized service and four of these were selected for analysis, based on the social constructionist discourse. The analysis allowed us to investigate the denunciative movements of the participants regarding the unilateral decisions taken by the healthcare professionals, and their demand for greater patient participation in treatment decisions. These relational realities were discussed considering the social discourses privileged in the discursive practices undertaken in the physician-patient relationship, the structuring of public health policies in our country, and the functioning of hospitals.