Alcivan Nunes Vieira

A formação clínica e a produção do cuidado em saúde e na enfermagem

This essay proposes a discussion on the practice and academic training in nursing based on theoretical and conceptual references in the field of philosophy, taking as cues the relationships of power, knowledge, and subjectivity in the meeting between the subjects involved with the production of health care and academic education. The nursing practice was impregnated by biomedical references, which conferred it a few attributes that have imposed limitations on it: the supposed neutrality in the relationships between those who provide care and those who are cared for, the problems and needs in health that limit the analysis and possible interventions developed in order to meet them. From this perspective, they are guided in seeking to understand disease only in its organic dimension. In Spinozas philosophy, the clinical practice is a place that potentializes the subjects, a space to recreate and give new meaning to life. In Epicurus, this place also produces deviations, movements that are averse to changelessness and apathy. Based on these conceptions, we argue that the reconstruction of the clinical practice in nursing work should observe the reconstruction of the relationships among the individuals involved in the training and the production of devices that set subjectivities into motion

Cuidado clinico em enfermagem: desenvolvimento de um conceito na perspectiva de reconstrucao da pratica profissional

Nursing is a praxis that has been defined from different epistemological plans; its history is marked by constructions and deconstructions. In the course of this, the care and its clinical practice have taken on constitutions influenced by the social, economic and ideological interests of each epoch. In this text, we aimed to reflect on the construction of the conceptual plan of the nursing clinical care in a perspective that allows a change from the traditional epistemic model based in the biomedical framework and in the Cartesian model of the subject. This is a theoretical reflection in which we developed this concept, based on the conceptions adopted in the lines of research of the Academic Masters degree in Health Clinical Care of the State University of Ceara (UECE). We concluded with the presentation of the proposal of the Academic Masters degree in Clinical Care of the UECE, showing how this concept strengthens its productions in the health and nursing area.La Enfermeria es una praxis que tiene su definicion a partir de los diferentes planes epistemologicos. Su historicidad es senalada por construcciones y desconstrucciones. En esta ruta, la atencion y su practica clinica asumen constituciones cruzadas por los intereses sociales, economicos e ideologicos de cada epoca. Nuestro objetivo es reflejar sobre la construccion del plan conceptual de la atencion clinica en enfermeria a fin de permitir el desplazamiento de un modelo epistemico tradicional, basado en el referencial biomedico y en el modelo cartesiano del sujeto. Se trata de una reflexion teorica, donde desarrollamos este concepto, partiendo de las concepciones adoptadas en las lineas de investigacion del curso de Maestria Academica en Atencion Clinica en Salud, de la Universidad Estadual de Ceara, Brasil. Asi, llegamos al final con la presentacion de la propuesta de esta Maestria Academica, ejemplificando, como este concepto se ha potencializado en sus producciones en el area de la salud y de la enfermeria.La Enfermeria es una praxis que tiene su definicion a partir de los diferentes planes epistemologicos. Su historicidad es senalada por construcciones y desconstrucciones. En esta ruta, la atencion y su practica clinica asumen constituciones cruzadas por los intereses sociales, economicos e ideologicos de cada epoca. Nuestro objetivo es reflejar sobre la construccion del plan conceptual de la atencion clinica en enfermeria a fin de permitir el desplazamiento de un modelo epistemico tradicional, basado en el referencial biomedico y en el modelo cartesiano del sujeto. Se trata de una reflexion teorica, donde desarrollamos este concepto, partiendo de las concepciones adoptadas en las lineas de investigacion del curso de Maestria Academica en Atencion Clinica en Salud, de la Universidad Estadual de Ceara, Brasil. Asi, llegamos al final con la presentacion de la propuesta de esta Maestria Academica, ejemplificando, como este concepto se ha potencializado en sus producciones en el area de la salud y de la enfermeria.

O cuidado e a clínica na formação do enfermeiro: saberes, práticas e modos de subjetivação

Resumen Care and clinic are inherent to nurses’ work and the way they are conceived guides the formation and production of care. This research had as objective to identify the concepts and theoretical bases of clinic and care that guide nurses’ formation. The subjects of the research were professors and students of an undergraduate nursing course. Data were produced through par ticipant obser vation and semistructured interviews and analyzed based on discourse analysis. In the formation there is a production of senses on these concepts as disease care, although the subjects recognize they can be thought in other perspectives. Analysis showed that these concepts not only correspond to an apprehension of theoretical references, but they are consolidated based on the experience of clinic and care in the relationships between professors and students, and with health services.O cuidado e a clinica sao imanentes ao trabalho do enfermeiro, e a forma como eles sao concebidos norteia a formacao e a producao do cuidado. Esta pesquisa teve como objetivo identificar as concepcoes e as bases teoricas de clinica e de cuidado que norteiam a formacao do enfermeiro. Os sujeitos da pesquisa foram docentes e discentes de um curso de graduacao em enfermagem. Os dados foram produzidos atraves de entrevistas semiestruturadas e analisados a partir da analise do discurso. Na formacao, evidenciou-se uma producao de sentidos acerca destes conceitos enquanto atencao a doenca, embora os sujeitos reconhecam que eles podem ser pensados em outras perspectivas. A analise revelou que esses conceitos nao correspondem apenas a uma apreensao de referenciais teoricos, mas que se consolidam a partir da vivencia da clinica e do cuidado nas relacoes entre docentes e discentes, e com os servicos de saude.

Referenciais teóricos que norteiam a prática de enfermagem em saúde mental

Objective: This study aimed to identify the theoretical references that guide clinical practice in mental health nursing. Methods: Descriptive study of qualitative approach, conducted through semi-structured interviews. The study subjects were nurses working in Psychosocial Care Centers of Fortaleza/CE. It was used the analysis of content of Bardin. Results: Five categories emerged that link the theoretical references that guide the clinical practice of nurses: nursing theories referential, biomedical referential; alternative practices referential; referential of harm-reduction policy, and psychoanalysis reference. Conclusion: It was identified that the professional practice of the most of the respondents was guided by more than one of these references, although some present contradictions between them, and this was not perceived by the subjects. These references, at times, were applied only formally, without the purpose of reception of the subject in psychological distress and their care demands.Objective: This study aimed to identify the theoretical references that guide clinical practice in mental health nursing. Methods: Descriptive study of qualitative approach, conducted through semi-structured interviews. The study subjects were nurses working in Psychosocial Care Centers of Fortaleza/CE. It was used the analysis of content of Bardin. Results: Five categories emerged that link the theoretical references that guide the clinical practice of nurses: nursing theories referential, biomedical referential; alternative practices referential; referential of harm-reduction policy, and psychoanalysis reference. Conclusion: It was identified that the professional practice of the most of the respondents was guided by more than one of these references, although some present contradictions between them, and this was not perceived by the subjects. These references, at times, were applied only formally, without the purpose of reception of the subject in psychological distress and their care demands.

Los referenciales teóricos que orientan la práctica de la enfermería en salud mental

Objective: This study aimed to identify the theoretical references that guide clinical practice in mental health nursing. Methods: Descriptive study of qualitative approach, conducted through semi-structured interviews. The study subjects were nurses working in Psychosocial Care Centers of Fortaleza/CE. It was used the analysis of content of Bardin. Results: Five categories emerged that link the theoretical references that guide the clinical practice of nurses: nursing theories referential, biomedical referential; alternative practices referential; referential of harm-reduction policy, and psychoanalysis reference. Conclusion: It was identified that the professional practice of the most of the respondents was guided by more than one of these references, although some present contradictions between them, and this was not perceived by the subjects. These references, at times, were applied only formally, without the purpose of reception of the subject in psychological distress and their care demands.Objective: This study aimed to identify the theoretical references that guide clinical practice in mental health nursing. Methods: Descriptive study of qualitative approach, conducted through semi-structured interviews. The study subjects were nurses working in Psychosocial Care Centers of Fortaleza/CE. It was used the analysis of content of Bardin. Results: Five categories emerged that link the theoretical references that guide the clinical practice of nurses: nursing theories referential, biomedical referential; alternative practices referential; referential of harm-reduction policy, and psychoanalysis reference. Conclusion: It was identified that the professional practice of the most of the respondents was guided by more than one of these references, although some present contradictions between them, and this was not perceived by the subjects. These references, at times, were applied only formally, without the purpose of reception of the subject in psychological distress and their care demands.

Theoretical references that guide nursing practice in mental health

Objective: This study aimed to identify the theoretical references that guide clinical practice in mental health nursing. Methods: Descriptive study of qualitative approach, conducted through semi-structured interviews. The study subjects were nurses working in Psychosocial Care Centers of Fortaleza/CE. It was used the analysis of content of Bardin. Results: Five categories emerged that link the theoretical references that guide the clinical practice of nurses: nursing theories referential, biomedical referential; alternative practices referential; referential of harm-reduction policy, and psychoanalysis reference. Conclusion: It was identified that the professional practice of the most of the respondents was guided by more than one of these references, although some present contradictions between them, and this was not perceived by the subjects. These references, at times, were applied only formally, without the purpose of reception of the subject in psychological distress and their care demands.Objective: This study aimed to identify the theoretical references that guide clinical practice in mental health nursing. Methods: Descriptive study of qualitative approach, conducted through semi-structured interviews. The study subjects were nurses working in Psychosocial Care Centers of Fortaleza/CE. It was used the analysis of content of Bardin. Results: Five categories emerged that link the theoretical references that guide the clinical practice of nurses: nursing theories referential, biomedical referential; alternative practices referential; referential of harm-reduction policy, and psychoanalysis reference. Conclusion: It was identified that the professional practice of the most of the respondents was guided by more than one of these references, although some present contradictions between them, and this was not perceived by the subjects. These references, at times, were applied only formally, without the purpose of reception of the subject in psychological distress and their care demands.

The clinic nursing care to the psychotic subject based on psychoanalysis

Objective: to understand the clinical approach of psychosis performed through Nursing from the psychoanalytic referential. Method: this was a theoretical essay based on the works of Freud and Lacan in addition to publications in the field of mental health nursing. Results: we identified the concepts of listening, subject, and uniqueness as assumptions for this clinical approach. Conclusion: psychoanalysis can guide the clinical practice directing it to reflection about how events experienced by the subject are meant in his uniqueness; and how each one can represent their own psychic suffering. The intervention is made possible by listening the psychotic subject, welcoming his productions, writings, papers, and inventions; assisting in the process of building something that can function as a support for this subject to deal with his grief. Descriptors: Nursing; Mental Health; Psychosis; Psychoanalysis. RESUMO Objetivo: compreender a abordagem clinica da psicose realizada pela Enfermagem a partir do referencial psicanalitico. Metodo: ensaio teorico, realizado a partir de obras de Freud e Lacan, alem de publicacoes da Enfermagem no campo da saude mental. Resultados: identificaram-se enquanto pressupostos para esta abordagem clinica os conceitos de escuta, sujeito e singularidade. Conclusao: a psicanalise pode nortear a pratica clinica, direcionando-a para a reflexao acerca de como os eventos vivenciados pelo sujeito sao significados em sua singularidade; e como cada um vai poder significar seu sofrimento psiquico. A intervencao e possibilitada pela escuta do sujeito psicotico, acolhendo suas producoes, seus escritos, seus documentos, suas invencoes; auxiliando-o no processo de construcao de algo que possa funcionar como suporte para esse sujeito lidar com seu sofrimento. Descritores: Enfermagem; Saude Mental; Psicose; Psicanalise. RESUMEN Objetivo: comprender el abordaje clinico de la psicose realizado por la Enfermeria a partir del referencial psicanalitico. Metodologia: ensayo teorico, escrito a partir de las obras de Freud y Lacan, ademas de publicaciones de Enfermeria en el campo de salud mental. Resultados: fueron identificados como presupuestos para este abordaje clinico los conceptos de escucha, sujeto y singularidad. Conclusion: el psicanalisis puede guiar la practica clinica, proporcionando la reflexion sobre como los sucesos vividos por el sujeto son significados en su singularidad; y como cada persona podra significar su sufrimiento psiquico. La intervencion es posible a traves de la escucha del sujeto psicotico, en que sus producciones, sus escritos, sus documentos, sus invenciones, ayudandolo en el proceso de construccion de algo que pueda funcionar como soporte para que el sujeto pueda lidiar con su sufrimiento. Descriptores: Enfermeria; Salud Mental; Psicosis; Psicanalisis. Nurse, PhD student in the Nursing and Health Clinical Care Graduate School Program. Ceara State University/UECE. Fortaleza (CE), Brazil. E-mail: eryjosy@msn.com; Nurse, PhD in Nursing, Nursing and Health Clinical Care Graduate School Program. Ceara State University/UECE. Fortaleza (CE), Brazil. E-mail: silveiralia@gmail.com; Nurse, Master degree in Nursing and Health Clinical Care Graduate School Program. Ceara State University/UECE. Fortaleza (CE), Brazil.E-mail: camarottib@gmail.com; Nurse, PhD student in the Nursing and Health Clinical Care Graduate School Program. Ceara State University/UECE. Fortaleza (CE), Brazil. E-mail: alcivan_nunes@yahoo.com.br REFLECTIVE ANALYSIS ARTICLE Guerreiro EM, Silveira LC, Cunha BMC et al. The clinic nursing care to the psychotic... Portugues/Ingles Rev enferm UFPE on line., Recife, 8(1):192-200, jan., 2014 193 DOI: 10.5205/reuol.4843-39594-1-SM.0801201427 ISSN: 1981-8963 Psychosis is the manifestation of psychic distress that causes the emergence of a disintegrated person unable to cope with the real in confrontation with his psychic distress. In general, it is manifested by delusions and hallucinations. Unconscious ideas determine the operating mode in which the subject tries to modulate the external reality to his psychic reality. Thus, during delirium, the words are taken by things themselves. It is then, through the delusional construction, that the psychotic can articulate reality to his own psychic reality, making the second reality his own reality. Traditionally in health services, psychosis is addressed through measures of physically restraining the subject associated with a pharmacological treatment. These actions are based on the biomedical referential that arose around the 18 century, organized by the assumptions of modern science: scientific objectivity, generalization, and neutrality. In this referential, the seizure of psychic suffering is limited to a mental illness that requires medication and rebinding measures between subject and the reality in which he is inserted. The diagnosis is formulated from a professional reasoning, by framing the subject in a nosological category, a disease situation, considering him incapable of dealing with his mental condition without these interventions.Another consequence of this model is the fact that the professional, being a doctor or a nurse, is located on the side of a predetermined knowledge that will be applied to the patient. A multiplicity of theoretical concepts exists to guide the nursing clinical practice in the same institutional space. The nurse takes the place of the knowledge holder in relation to the subject in psychic distress. This knowledge gives the nurse the authority to interpret and classify complaints from those subjects based on external and objectifying knowledge. The coexistence of different and sometimes contradictory conceptions subsidize the nursing clinical practice; practice that is configured as pedagogical, prescriptive, and normalizer of the subject in relation to health services. It is noticed that the biomedical model, when addressing the psychic suffering, excludes the subjectivity inherent in this condition. With respect to the psychotic subject, this model produces an approach that disqualifies this subject as someone who can engage and commit in the caregiving relationship because he is devoid of reason. In addition, this model presents the physical restraint and pharmacological approaches as the only alternatives. Does this form of addressing the psychotic subject actually meet his unique care needs? How to care for this subject in a singular form, tending to his demands that are beyond the plane of rationality? Thus, we discuss the possibility of reworking the nursing clinical practice together with the psychotic patient based on the psychoanalytic referential. This research aims to understand the clinical approach of psychosis based on the psychoanalytic referential, performed by the nursing team. It is assumed that psychoanalysis, by proposing the recognition of the divided subject and the subject of the unconscious, producing other ways to deal with the psychotic considering the uniqueness of each case, and rescuing the dimension of subjectivity of the patient from the act of listening. It also proposes to subvert the current position of the patient (object) by returning his position to that of the speaking subject. Therefore, this study is relevant to contribute to the construction of new knowledge and practices for the nursing clinical practice in the approach of psychosis considering the psychoanalytic referential as a theoretical tool for the clinical practice. This was a theoretical essay based on psychoanalysis as a theoretical central referential that used as a source of research the complete works of Sigmund Freud, which address important elements of the clinic of psychosis, and some concepts proposed by Jacques Lacan, such as the subject Name-ofthe-Father and exclusion. uf0a8 The transition of the nursing clinical paradigm in mental health Nursing arises as a professional practice in the psychiatry field, and as the subsidiary knowledge in the medical practice. In the asylum assistantial model, the nurses were responsible for guarding, punish, and control behaviors of subjects labeled as crazy.In this context, the scientific knowledge for the fundamental tasks of nursing were considered unnecessary. The goal of treatment was to eliminate symptoms that, in the case of psychosis, were characterized by delusions INTRODUCTION

Atencion clinica en enfermeria: el desarrollo de un concepto en la perspectiva de la reconstruccion de la practica profesional

Nursing is a praxis that has been defined from different epistemological plans; its history is marked by constructions and deconstructions. In the course of this, the care and its clinical practice have taken on constitutions influenced by the social, economic and ideological interests of each epoch. In this text, we aimed to reflect on the construction of the conceptual plan of the nursing clinical care in a perspective that allows a change from the traditional epistemic model based in the biomedical framework and in the Cartesian model of the subject. This is a theoretical reflection in which we developed this concept, based on the conceptions adopted in the lines of research of the Academic Masters degree in Health Clinical Care of the State University of Ceara (UECE). We concluded with the presentation of the proposal of the Academic Masters degree in Clinical Care of the UECE, showing how this concept strengthens its productions in the health and nursing area.La Enfermeria es una praxis que tiene su definicion a partir de los diferentes planes epistemologicos. Su historicidad es senalada por construcciones y desconstrucciones. En esta ruta, la atencion y su practica clinica asumen constituciones cruzadas por los intereses sociales, economicos e ideologicos de cada epoca. Nuestro objetivo es reflejar sobre la construccion del plan conceptual de la atencion clinica en enfermeria a fin de permitir el desplazamiento de un modelo epistemico tradicional, basado en el referencial biomedico y en el modelo cartesiano del sujeto. Se trata de una reflexion teorica, donde desarrollamos este concepto, partiendo de las concepciones adoptadas en las lineas de investigacion del curso de Maestria Academica en Atencion Clinica en Salud, de la Universidad Estadual de Ceara, Brasil. Asi, llegamos al final con la presentacion de la propuesta de esta Maestria Academica, ejemplificando, como este concepto se ha potencializado en sus producciones en el area de la salud y de la enfermeria.La Enfermeria es una praxis que tiene su definicion a partir de los diferentes planes epistemologicos. Su historicidad es senalada por construcciones y desconstrucciones. En esta ruta, la atencion y su practica clinica asumen constituciones cruzadas por los intereses sociales, economicos e ideologicos de cada epoca. Nuestro objetivo es reflejar sobre la construccion del plan conceptual de la atencion clinica en enfermeria a fin de permitir el desplazamiento de un modelo epistemico tradicional, basado en el referencial biomedico y en el modelo cartesiano del sujeto. Se trata de una reflexion teorica, donde desarrollamos este concepto, partiendo de las concepciones adoptadas en las lineas de investigacion del curso de Maestria Academica en Atencion Clinica en Salud, de la Universidad Estadual de Ceara, Brasil. Asi, llegamos al final con la presentacion de la propuesta de esta Maestria Academica, ejemplificando, como este concepto se ha potencializado en sus producciones en el area de la salud y de la enfermeria.

Clinical care in nursing: development of a concept in the perspective of professional practice reconstruction

Nursing is a praxis that has been defined from different epistemological plans; its history is marked by constructions and deconstructions. In the course of this, the care and its clinical practice have taken on constitutions influenced by the social, economic and ideological interests of each epoch. In this text, we aimed to reflect on the construction of the conceptual plan of the nursing clinical care in a perspective that allows a change from the traditional epistemic model based in the biomedical framework and in the Cartesian model of the subject. This is a theoretical reflection in which we developed this concept, based on the conceptions adopted in the lines of research of the Academic Masters degree in Health Clinical Care of the State University of Ceara (UECE). We concluded with the presentation of the proposal of the Academic Masters degree in Clinical Care of the UECE, showing how this concept strengthens its productions in the health and nursing area.La Enfermeria es una praxis que tiene su definicion a partir de los diferentes planes epistemologicos. Su historicidad es senalada por construcciones y desconstrucciones. En esta ruta, la atencion y su practica clinica asumen constituciones cruzadas por los intereses sociales, economicos e ideologicos de cada epoca. Nuestro objetivo es reflejar sobre la construccion del plan conceptual de la atencion clinica en enfermeria a fin de permitir el desplazamiento de un modelo epistemico tradicional, basado en el referencial biomedico y en el modelo cartesiano del sujeto. Se trata de una reflexion teorica, donde desarrollamos este concepto, partiendo de las concepciones adoptadas en las lineas de investigacion del curso de Maestria Academica en Atencion Clinica en Salud, de la Universidad Estadual de Ceara, Brasil. Asi, llegamos al final con la presentacion de la propuesta de esta Maestria Academica, ejemplificando, como este concepto se ha potencializado en sus producciones en el area de la salud y de la enfermeria.La Enfermeria es una praxis que tiene su definicion a partir de los diferentes planes epistemologicos. Su historicidad es senalada por construcciones y desconstrucciones. En esta ruta, la atencion y su practica clinica asumen constituciones cruzadas por los intereses sociales, economicos e ideologicos de cada epoca. Nuestro objetivo es reflejar sobre la construccion del plan conceptual de la atencion clinica en enfermeria a fin de permitir el desplazamiento de un modelo epistemico tradicional, basado en el referencial biomedico y en el modelo cartesiano del sujeto. Se trata de una reflexion teorica, donde desarrollamos este concepto, partiendo de las concepciones adoptadas en las lineas de investigacion del curso de Maestria Academica en Atencion Clinica en Salud, de la Universidad Estadual de Ceara, Brasil. Asi, llegamos al final con la presentacion de la propuesta de esta Maestria Academica, ejemplificando, como este concepto se ha potencializado en sus producciones en el area de la salud y de la enfermeria.

The production of subjectivity in the nurse's training

Objective: to identify the devices for subjectivity production in the nurses training, within the undergraduate course of Nursing in Universidade do Estado do Rio Grande do Norte (UERN). Methodology: this is a descriptive study with a qualitative approach. The research subjects were the professors and students of the Nursing School of UERN. The inclusion criteria were: being a nurse and professor of the Nursing School of UERN. The exclusion criterion was being institutionally away from teaching duties. The data were produced from the courses pedagogical project and through semi-structured interviews. The research project was approved by the Research Ethics Committee of Universidade Estadual do Ceara, under the Opinion 09553053-3. Results: it was found that theres a subjectivity production going on, which is generated through established devices: the pedagogical project and the pedagogical practices. Theres also the inclusion into the health services. Conclusion: subjectivity is produced in the academic daily life, through the devices which constitute it: the courses pedagogical project and the professor-student relationship. Descriptors: nursing education; nursing professors; nursing theory. RESUMO Objetivo: identificar os dispositivos de produção da subjetividade na formação do enfermeiro, no âmbito do curso de graduação em Enfermagem da Universidade do Estado do Rio Grande do Norte (UERN). Metodologia: trata-se de estudo descritivo com abordagem qualitativa. Os sujeitos da pesquisa foram os docentes e os discente s da Faculdade de Enfermagem da UERN. Os critérios de inclusão foram: ser enfermeiro e docente da Faculdade de Enfermagem da UERN. O critério de exclusão foi estar institucionalmente afastado das atividades docentes. Os dados foram produzidos a partir do projeto pedagógico do curso e de entrevistas semiestruturadas. O projeto de pesquisa foi aprovado pelo Comitê de Ética em Pesquisa da Universidade Estadual do Ceará, com o Parecer n. 09553053-3. Resultados: identificou-se que há uma produção da subjetividade em andamento, que é gerada por dispositivos estabelecidos: o projeto pedagógico e as práticas pedagógicas. Há, ainda, a inserção nos serviços de saúde. Conclusão: a subjetividade é produzida no cotidiano acadêmico, a partir dos dispositivos que o compõem: o projeto pedagógico do curso e a relação docente-discente. Descritores: educação em enfermagem; docentes de enfermagem; teoria de enfermagem.