Christine Wetzel

Satisfação dos usuários dos centros de atenção psicossocial da região Sul do Brasil

OBJETIVO: Avaliar a satisfacao dos usuarios com o atendimento nos centros de atencao psicossocial. METODOS: O estudo foi realizado em centros de atencao psicossocial dos estados: Parana, Santa Catarina e Rio Grande do Sul, em 2006. A estrategia de investigacao foi dividida em metodos quantitativo e qualitativo. Para avaliacao quantitativa foram utilizados dados epidemiologicos do tipo transversal de amostra 1.162 usuarios de 30 centros de atencao psicossocial. O instrumento utilizado para avaliar a satisfacao dos usuarios foi a Escala Brasileira de Avaliacao da Satisfacao (SATIS-BR), de 1 a 5 pontos. Para avaliacao qualitativa foram realizados cinco estudos de caso, utilizando-se metodologia de avaliacao de quarta geracao. Os dados foram obtidos em observacao de campo e entrevistas (entre dez e 13 usuarios em cada campo, totalizando 57 usuarios) e apresentados aos usuarios em oficinas de validacao e negociacao. RESULTADOS: A escala SATIS-BR indicou avaliacao positiva de todos os itens, com media de 4,4 (desvio-padrao, DP=0,4). A comunicacao e o relacionamento com a equipe apresentaram media 4,5 (DP=0,5); o acesso a informacoes a partir da equipe apresentou media 4,8. A satisfacao com o servico apresentou a menor media, com 4,1; as condicoes gerais de instalacao do servico apresentaram media 3,9. No estudo qualitativo, o tratamento no servico foi bom e o resultado satisfatorio. O reposicionamento do usuario contribuiu para satisfacao, assim como o acesso ao atendimento, a ruptura com o isolamento fisico e social, o acolhimento de suas demandas e ajuda para organizar a vida. CONCLUSOES: Os resultados complementares de ambas as estrategias do estudo mostram satisfacao dos usuarios com o atendimento nos centros estudados.

Avaliação de serviços em saúde mental no contexto da reforma psiquiátrica

RESUMO: O presente trabalho tem como proposta discutir a avaliação de serviços no campo da saúde mental, atrelando-a à proposta de reformulação do modelo assistencial, realizando uma reflexão crítica. Entendemos que a avaliação toma, juntamente com a sua função técnica, a função política de servir como instrumento de apoio na efetiva implantação dos serviços substitutivos ao modelo psiquiátrico hospitalocêntrico, como um dispositivo, entre outros, na busca da consolidação do modelo de reforma psiquiátrica proposto. PALAVRAS-CHAVE: Saúde mental. Serviços de saúde mental. Avaliação de serviços.El presente trabajo discute la evaluacion de los servicios en el campo de la salud mental, arrastrandola a la propuesta de la reformulacion del modelo asistencial, atraves de una reflexion critica. Entendemos que la evaluacion conjuntamente con su funcion tecnica, la funcion politica de servir como instrumento de apoyo en la implantacion efectiva de los servicios substitutivos al modelo hospital-centrico psiquiatrico, como un dispositivo de busqueda en la consolidacion del modelo de la reforma psiquiatrica propuesta.

Avaliação de quarta geração: contribuições metodológicas para avaliação de serviços de saúde mental

This paper reports on the theoretical-methodological course of the evaluation of Psychosocial Care Centers in southern Brazil, developed starting from fourth-generation evaluation. The data collection was carried out through observations and interviews among users, family members and the team. The first stage in the analysis took place alongside data collection, thereby allowing the results to be presented to the study subjects at the end of data collection, in negotiation workshops. In the second stage, workshops were held with the researchers, with the aim of constructing a collective data analysis process. Among the contributions towards fourth-generation evaluation, we highlight its participative nature and formative dimension. This makes it possible for interest groups to have better-qualified capacity for data analysis and intervention, to improve the service. As a limitation, we highlight the great volume of data obtained in the process and the need to prioritize questions through negotiation with interest groups.Este artigo relata o percurso teorico-metodologico da avaliacao dos Centros de Atencao Psicossocial da regiao sul do Brasil, desenvolvida a partir da Avaliacao de Quarta Geracao. A coleta de dados foi realizada por meio da observacao e de entrevistas com usuarios, familiares e equipe; e a primeira etapa de analise ocorreu concomitante a coleta, permitindo que os resultados fossem apresentados ao final da mesma aos sujeitos do estudo em oficinas de negociacao. Na segunda etapa, foram realizadas oficinas com os pesquisadores, visando construir um processo coletivo de analise de dados. Como contribuicoes da Avaliacao de Quarta Geracao, destacamos o seu carater participativo e a sua dimensao formativa, possibilitando aos grupos de interesse uma capacidade de analise e de intervencao mais qualificada para a melhoria do servico. Como limite, destacamos o grande volume de dados obtidos no processo e a necessidade de priorizacao de questoes mediante a negociacao com os grupos de interesse.

Avaliação qualitativa da relação de atores sociais com a loucura em um serviço substitutivo de saúde mental

This study aims to evaluate qualitatively the relationship between social actors and the madness. It was based in experiences produced in a Psychosocial Care Center in the Southern Brazilian context. This is a clipping from an evaluative and qualitative study. Was utilized the Fourth Generation Evaluation as a theoretical-philosophical framework. The methodological device applied was a adapted version of the Hermeneutic-dialectic circle. The statements haunt deinstitutionalization as a paradigm of mental health care, highlighting the need to combat the vices born of crystallized and exclusionary conduct, the typical model asylum. However, we can still see in practice a mixture of models, responsible for enhanced and innovative practices, and other crystallized and exclusive. Hopefully he can discuss the daily life of them, opening the way for understanding best madness, crazy and their relationships.Este estudo tem por objetivo avaliar qualitativamente a relacao de atores sociais com a loucura a partir das experiencias produzidas em um Centro de Atencao Psicossocial no contexto brasileiro. Trata-se de um recorte de um estudo de avaliacao qualitativa realizado em um Centro de Atencao Psicossocial do Sul do Brasil. Baseou-se na utilizacao do referencial teorico-filosofico da Avaliacao de Quarta Geracao. Como dispositivo metodologico, aplicou-se uma versao adaptada do Circulo Hermeneutico-Dialetico. Os depoimentos perseguem a desinstitucionalizacao como paradigma da atencao em saude mental, evidenciando a necessidade de combater os vicios carregados de condutas cristalizadas e excludentes, tipicas do modelo manicomial. No entanto, ainda e possivel visualizar na pratica uma mescla de modelos, responsaveis por praticas ampliadas e inovadoras, alem de outras cristalizadas e excludentes. Esperamos que ele possa problematizar o cotidiano dos mesmos, abrindo caminhos para compreender melhor a loucura, o louco e suas relacoes.

Avaliação de um Centro de Atenção Psicossocial: a realidade em Foz do Iguaçu

This is an excerpt of the study An evaluation of the Psychosocial Care Centers in Southern Brazil. The objective is to evaluate the ambience of a Level II Psychosocial Care Center (CAPS, abbreviation in Portuguese) as a place for comfort. This case-study was performed using a qualitative approach and the Fourth Generation Evaluation. The following was used for data collection: interviews with 10 professionals from the health team, 11 patients, and 11 relatives, and 297 hours of field observation. The closed door and the reduced team had repercussions on the work process at the Care Center. These critical nodes have a direct effect on the ambience, producing tension and antagonism in services such as CAPS. The presented issuesarethemesthat demonstrate the commitment to a healthy environment, which implies comfort and subjectivity in the work at CAPS.This is an excerpt of the study An evaluation of the Psychosocial Care Centers in Southern Brazil. The objective is to evaluate the ambience of a Level II Psychosocial Care Center (CAPS, abbreviation in Portuguese) as a place for comfort. This case-study was performed using a qualitative approach and the Fourth Generation Evaluation. The following was used for data collection: interviews with 10 professionals from the health team, 11 patients, and 11 relatives, and 297 hours of field observation. The closed door and the reduced team had repercussions on the work process at the Care Center. These critical nodes have a direct effect on the ambience, producing tension and antagonism in services such as CAPS. The presented issues are themes that demonstrate the commitment to a healthy environment, which implies comfort and subjectivity in the work at CAPS.

Avaliação qualitativa do processo de trabalho em um centro de atenção psicossocial no Brasil

OBJETIVO: Este estudo teve por objetivo avaliar o processo de trabalho em um centro de atencao psicossocial. Procuramos apontar questionamentos, lacunas, falhas, potencialidades e experiencias compartilhadas pelos protagonistas que fazem a saude mental no cotidiano do servico (usuarios, familiares e profissionais de saude). METODOS: Estudo de avaliacao, de natureza qualitativa, que utilizou como referencial teorico-metodologico a avaliacao de quarta geracao. RESULTADOS: Observamos algumas caracteristicas fundamentais que revelam o modo de organizacao do processo de trabalho em saude mental, na visao dos grupos de interesse investigados. Destacam-se a utilizacao de tecnologias de cuidado inclusivas, alem de mecanismos de gestao do cuidado em equipe pautados na interdisciplinaridade e centrados no usuario. CONCLUSOES: Os resultados contribuem para uma re-leitura do processo de consolidacao da reforma psiquiatrica no contexto brasileiro, de modo a problematizar o fazer, o saber, os objetivos, filosofias e tambem o objeto de trabalho em saude.

Evaluation of intersectoral partnerships for mental healthcare in the Brazilian family health strategy

The aim of this study was to evaluate intersectoral partnerships for mental health in the Brazilian Family Health Strategy. This was an evaluative, qualitative study guided by the Fourth Generation Evaluation framework, developed in a Family Health Strategy unit in a municipality of the state of Rio Grande do Sul. A total of 39 subjects (10 patients, 10 family members and 19 employees) were interviewed. As observed, intersectoral partnerships for mental healthcare are important, as they allow for greater freedom of patients with psychological distress. Among these, the partnership with the resident association and between the Family Health Strategy and the Federal University of Rio Grande do Sul stand out. Despite the difficulties, the consolidation of inclusive projects through an intersectoral approach is emerging as a new way to construct a healthcare agenda that is linked to the needs of the territory, and driven by the premises of the Brazilian Unified Health System.

Atendimento a usuários de drogas na perspectiva dos profissionais da estratégia saúde da família

This qualitative study, using the fourth-generation evaluation, aimed to evaluate the care delivered to drug users in the context of a mental health care network. It was developed in a Family Health Strategy (FHS) unit in Porto Alegre-RS. Data were collected between September 2010 and March 2011, by means of interviews and field observations. Study participants were 19 FHS professionals. The results revealed (dis)connections of the lack of strategies aimed at the care of drug users. This study may lead to the development of devices aimed at a real transformation in health practices and the consolidation of a health care network that considers individuals in their social context. DESCRIPTORS: Public policy. Substance-related disorders. Mental health. Nursing.ABSTRACT: This qualitative study, using the fourth-generation evaluation, aimed to evaluate the care delivered to drug users in the context of a mental health care network. It was developed in a Family Health Strategy unit in Porto Alegre-RS. Data were collected between September 2010 and March 2011, by means of interviews and field observations. Study participants were 19 Family Health Strategy professionals. The results revealed (dis)connections of the lack of strategies aimed at the care of drug users. This study may lead to the development of devices aimed at a real transformation in health practices and the consolidation of a health care network that considers individuals in their social context. DESCRIPTORS: Public policy. Substance-related disorders. Mental health. Nursing. ATENDIMENTO A USUARIOS DE DROGAS NA PERSPECTIVA DOS PROFISSIONAIS DA ESTRATEGIA SAUDE DA FAMILIA RESUMO: O artigo objetivou avaliar o atendimento a usuarios de drogas no contexto da rede de atencao em saude mental a partir de uma Estrategia Saude da Familia no municipio de Porto Alegre-RS. O metodo foi qualitativo (Pesquisa Avaliativa de Quarta Geracao) e os dados foram coletados no periodo de setembro de 2010 a marco de 2011, por meio de entrevistas e observacoes de campo. Os sujeitos desse estudo foram 19 trabalhadores. Os resultados revelaram (des)conexoes do servico com outros pontos de atencao de saude mental do municipio estudado, alem de evidenciar precariedade de estrategias voltadas ao atendimento dos usuarios de drogas. Este estudo podera gerar dispositivos que vislumbrem uma real transformacao nas praticas em saude, alem da consolidacao de uma rede de cuidados que considera os individuos em seu contexto social.

Atividades terapeuticas: compreensao de familiares e profissionais de um centro de atencao psicossocial

Objective: To analyze the understanding of family members and mental health professionals concerning the therapeutic activities implemented in the routines of Psychosocial Care Centers. Aims: This qualitative study was conducted in a Psychosocial Care Center in the state of Santa Catarina, Brazil. Results: The therapeutic activities reveal many possibilities for implementing actions and practices according to new trends guiding care in the field. The results also reveal there is a risk of services adopting authoritarian and crystallized postures compatible with traditional care models, which the Psychiatric Reform campaign has struggled for more than 20 years to overcome. Conclusions: This study is expected to encourage a new perspective of Psychiatric Reform in the studied context and discussions about the teamwork processes and the relationships between services and patients. 1 PhD in Nursing. Adjunct Professor of Nursing School and Postgraduate Program in Nursing at Federal University of Rio Grande do Sul. Porto Alegre-RS. Brasil. E-mail: Lbpinho@ufrgs.br 2 PhD in Nursing. Associate Professor of Nursing Faculty and Postgraduate Program in Nursing at Federal University of Pelotas. Pelotas-RS. Brasil. E-mail: kantorski@uol.com.br 3 PhD in Nursing. Adjunct Professor of Nursing School at Federal University of Rio Grande do Sul. Porto Alegre-RS. Brasil. E-mail: cwetzel@ibest.com.br, 4 PhD in Nursing. Associate Professor of Nursing Faculty and Postgraduate Program in Nursing at Federal University of Pelotas. Pelotas-RS. Brasil. E-mail: eschwartz@ terra.com.br 5 PhD in Nursing. Associate Professor of Nursing Faculty and Postgraduate Program in Nursing at Federal University of Pelotas. Pelotas-RS. Brasil. E-mail: celmira_lange@ terra.com.br 6 PhD student at Federal University of Santa Catarina. Brasil. E-mail: juzillmer@gmail.com RESEARCH PESQUISA INVESTIGACION Atividades terapeuticas: compreensao de familiares e profissionais de um centro de atencao psicossocial Esc Anna Nery (print)2013 Jul-Sep; 17 (3):534 541 Leandro Barbosa de Pinho1, Luciane Prado Kantorski2, Christine Wetzel3, Eda Schwartz4, Celmira Lange5, Juliana Graciela Vestena Zillmer6 Actividades terapeuticas: comprension de familiares y profesionales de un centro de atencion psicosocial Psychiatric Nursing; Mental Health; Health Policies.

Avaliação das parcerias intersetoriais em saúde mental na estratégia saúde da família

The aim of this study was to evaluate intersectoral partnerships for mental health in the Brazilian Family Health Strategy. This was an evaluative, qualitative study guided by the Fourth Generation Evaluation framework, developed in a Family Health Strategy unit in a municipality of the state of Rio Grande do Sul. A total of 39 subjects (10 patients, 10 family members and 19 employees) were interviewed. As observed, intersectoral partnerships for mental healthcare are important, as they allow for greater freedom of patients with psychological distress. Among these, the partnership with the resident association and between the Family Health Strategy and the Federal University of Rio Grande do Sul stand out. Despite the difficulties, the consolidation of inclusive projects through an intersectoral approach is emerging as a new way to construct a healthcare agenda that is linked to the needs of the territory, and driven by the premises of the Brazilian Unified Health System.