Beyond inclusion: collective social spaces of safety, communion, and recognition / Além da inclusão: espaços sociais coletivos de segurança, comunhão e reconhecimento

Abstract This paper unsettles taken-for-granted understandings of social inclusion in the field of occupational therapy and links with the concept of radical inclusion developed in social occupational therapy. It traces the ways that, over time, inclusion has been reduced to a position within the inclusion/exclusion binary. Pierre Bourdieu's reflexive theory of practice is introduced to expand understandings of how the negative value accorded to disability is reproduced through exclusionary social conditions and relations. Drawing on the results of a qualitative study that examined the everyday lives, practices and occupations of 13 Canadian youth who used augmentative and alternative communication (AAC) modes as a result of physical impairments, three elements of more inclusive social spaces - safety, communion, and recognition - are presented alongside implications of each for occupational therapy. These alternative approaches for thinking beyond inclusion are grounded by narratives illustrating elements of social spaces that can foster a sense of belonging and connection. The perspectives shared by youth in the study add complex insights into how they made 'practical sense' of prevailing calls for social inclusion. Their stories show how even as they struggled for inclusion, they were subject to and internalized negative valuations of disability. Importantly, the paper highlights strategies employed by youth to reformulate inclusion on their own terms. These reformulations go beyond over-simplified conceptions of inclusion and hold potential to inform the ways that occupational therapists work alongside individuals and collectives to improve life chances, expand occupational possibilities, and support flourishing for disabled children and youth.

Resumo Este artigo desestabiliza os entendimentos aceitos sobre a inclusão social no campo da terapia ocupacional e relaciona-os com o conceito de inclusão radical desenvolvido na terapia ocupacional social. Traça as maneiras pelas quais, ao longo do tempo, a inclusão foi reduzida a uma posição simplificada dentro do binário inclusão/exclusão. A teoria reflexiva da prática de Pierre Bourdieu é introduzida para expandir a compreensão de como o valor negativo atribuído à deficiência é reproduzido por meio de condições e relações sociais excludentes. Com base nos resultados de um estudo qualitativo que examinou a vida cotidiana, práticas e ocupações de 13 jovens canadenses que usam modos de comunicação aumentativa e alternativa (AAC), em decorrência de suas deficiências físicas, três elementos de espaços sociais mais inclusivos são apresentados juntamente com as suas implicações para a terapia ocupacional: segurança, comunhão e reconhecimento. Essas abordagens para pensar além da inclusão são fundamentadas em narrativas que ilustram elementos dos espaços sociais que podem promover um sentimento de pertencimento e conexão. As perspectivas compartilhadas pelos jovens acrescentam percepções complexas sobre como eles deram "sentido prático" aos apelos predominantes por inclusão social. Suas histórias mostram como, mesmo enquanto lutavam pela inclusão, foram submetidos e internalizaram avaliações negativas sobre a deficiência. Importante ressaltar as estratégias empregadas pelos jovens para reformular a inclusão em seus próprios termos, que vão além de concepções simplificadas de inclusão e têm potencial para informar as maneiras pelas quais os terapeutas ocupacionais trabalham com indivíduos e coletivos para melhorar as oportunidades de vida, expandir a ocupação.

Impairment, disability, and handicap associated with hearing problems and voice disorders among Colombian teachers / Deficiencia, discapacidad y minusvalía asociadas a los problemas de voz y audición en profesores colombianos

Objectives: 1. define the occurrence of work-related hearing problems and voice disorders among teachers that have contacted the Colombian National Board of Disability Assessment (NBDA) for follow-up; 2. identify individual associated factors of hearing problems and voice disorders among teachers; 3. assess the limitations and restrictions due to hearing problems and voice disorders among these participants. Methods: Retrospective study. The National Database of the Colombian NBDA was reviewed. Information on distributions of occupation, individual characteristics, and diagnosis code (ICD-10) was analyzed. Results: Communication disorders among teachers that have contacted the Colom-bian NBDA for follow-up included voice disorders, with a prevalence of 51%, and hearing problems, with a prevalence of 7%. Female teachers who have contacted the Colombian NBDA for follow-up were 4 times more likely to be identified as having voice disorders compared with their male colleagues. Conclusions: While teachers that have contacted the Colombian NBDA for fol-low-up have a high occurrence of voice disorders, hearing problems are more likely to be stated as a debilitating condition. One possible explanation is that teachers who contacted the Colombian NBDA for follow-up continued working even when many voice symptoms were evident, while hearing problems would prevent a teacher from interacting with students, thereby affecting the teaching-learning process soon-er. Nevertheless, with both voice and hearing problems, work performance and social interaction is affected, and, therefore, quality of life is reduced.

Objetivos: 1. definir la ocurrencia de problemas de audición y de voz relacionados con el trabajo de docentes que contactaron la Junta Nacional de Evaluación de la Discapacidad de Colombia (NBDA) para su seguimiento; 2. identificar los factores individuales asociados a los problemas de audición y voz entre los profesores; 3. eva-luar las limitaciones y restricciones debidas a problemas de audición y voz asociados al trabajo entre los participantes.Métodos: estudio retrospectivo. Se revisó la Base de Datos Nacional de la NBDA colombiana. Se analizó información sobre distribuciones de ocupación, característi-cas individuales y código de diagnóstico (CIE-10).Resultados: Los trastornos de comunicación entre los docentes que han contacta-do a la NBDA colombiana para seguimiento incluyeron problemas de la voz, con una prevalencia del 51%, y problemas de audición, con una prevalencia del 7%. Las pro-fesoras que se han puesto en contacto con la NBDA colombiana para el seguimiento tenían 4 veces más probabilidades de ser identificadas con trastornos de la voz en comparación con sus colegas masculinos.Conclusiones: Si bien los maestros que contactaron a la NBDA colombiana para el seguimiento tienen una alta incidencia de trastornos de la voz, es más probable que los problemas de audición se consideren una condición debilitante. Una posible ex-plicación es que los maestros que se comunicaron con la NBDA colombiana para el seguimiento continuaron trabajando incluso cuando muchos síntomas vocales eran evidentes, mientras que los problemas de audición evitarían que un maestro inte-ractuara con los estudiantes, afectando así el proceso de enseñanza-aprendizaje. Sin embargo, tanto con los problemas de voz como de audición, el desempeño laboral y la interacción social se ven afectados y, por lo tanto, la calidad de vida se reduce.

Qualitative research about the influence of communication disabilities caused by dialects on the safety of ophthalmic surgery and its solution / 中国实用护理杂志

Objective To explore the influence of dialect-based communication obstacle on the safety of ophthalmic operation room and to provide the basis for improving the safety of ophthalmic operation room. Methods An in-depth interview was taken on 10 medical staff by qualitative research. The information was arranged and analyzed by phenomenology method. Results The interview with the surgical doctors on the communication barriers were extracted to three themes, including lower surgical efficiency, decreased patient satisfaction, increased risk of surgical complications, the interview with the surgical nurses on the dialects leading to communication barriers were extracted three themes, including surgical verification difficult to carry out, affect the perioperative care, hinder the postoperative mission to carry out, the extracted themes about the impact on patients include increased stress and anxiety affect the surgical outcome, poor intraoperative experience reduced satisfaction, the extracted themes about solution include the organization of medical staff to learn the dialect of the common language, recruit staff diversification, to provide professional translation, standardized body language to instruct the patient. Conclusions In this study, the experience of communication disorder caused by doctors and nurses in the ophthalmic operating room reflects the shortcomings of the safety management of the ophthalmic operating room. These deficiencies can be reduced by the independent study of the medical staff.