Dulcian Medeiros de Azevedo

Oficinas terapêuticas como instrumento de reabilitação psicossocial: percepção de familiares

Resumen Los talleres terapéuticos permiten la posibilidad de la proyección de los conflictos internos / externos a través de actividades artísticas, con la valorización del potencial creativo, imaginativo y expresivo del usuario. El objetivo fue identificar la percepción de las familias acerca de los talleres terapéuticos realizados. Investigación descriptiva, con delineación cualitativa, desarrollada en los Centros de Atención Psicosocial (CAPS) en Natal-RN, Brasil, entre agosto y septiembre de 2007. Entrevistamos a 28 familiares que asistieron regularmente a los servicios. Los miembros de la familia destacaron el efecto positivo de CAPS en sus trayectos de terapéutica y de vida, en mejorar la armonía familiar. En los talleres terapéuticos, detectaron las deficiencias y las contradicciones, revelando y apuntando maneras para superarlos. Ellos perciben los espacios para la participación en CAPS como instrumentos esenciales para la observación de su usuario familiar, además de un crecimiento mutuo. Los talleres terapéuticos representan un importante instrumento de socialización e integración individual en grupos, al paso que se propone trabajar, pensar y actuar colectivamente, conferido por la lógica inherente al paradigma psicosocial. Palabras claves: Terapia con Arte. Servicios de Salud Mental. Familia. Enfermería Psiquiátrica. Trastornos Relacionados con Substancias. 1Enfermeiro. Mestre em Enfermagem (PGENF-UFRN). Professor Assistente II do Curso de Graduação em Enfermagem (UERN), Campus do Seridó, Caicó-RN, Brasil. Líder do Grupo de Pesquisa “A enfermagem no processo saúde-doença individual/coletiva, na educação em saúde e na assistência/gerência de serviços de saúde”. E-mail: professordulcian@gmail.com ,2Enfermeiro. Doutor em Enfermagem Psiquiátrica (EERP/USP). Professor Adjunto III do Departamento de Enfermagem (Graduação e Pós Graduação UFRN), Campus Central, Natal-RN, Brasil. Líder do Grupo de Pesquisa “Ações promocionais e de atenção a grupos humanos em Saúde Mental e Saúde Coletiva”. E-mail: farnoldo@gmail.com The therapeutic workshops allow the possibility of projection of internal / external conflicts through artistic activities, highlighting the creative, imaginative and expressive potential of the user. We aimed to identify the families’ perception of the therapeutic workshops undertaken. The research descriptive, with qualitative design, developed in the Psychosocial Care Centers (CAPS) from Natal/RN between August and September 2007. We interviewed 28 families who regularly attended services. Family members emphasized the positive impact of CAPS in the course of their treatment and life, in improving family harmony. On the therapeutic workshops, were identified failures and contradictions, exposing and pointing ways to overcome them. They realize the opportunities for participation in CAPS as important ways of monitoring their family user, in addition to mutual growth. The therapeutic workshops represent an important instrument of socialization and integration in individual groups, while it proposes working, acting and collective thinking, conferred by an inherent logic of the psychosocial paradigm.Los talleres terapeuticos permiten la posibilidad de la proyeccion de los conflictos internos / externos a traves de actividades artisticas, con la valorizacion del potencial creativo, imaginativo y expresivo del usuario. El objetivo fue identificar la percepcion de las familias acerca de los talleres terapeuticos realizados. Investigacion descriptiva, con delineacion cualitativa, desarrollada en los Centros de Atencion Psicosocial (CAPS) en Natal-RN, Brasil, entre agosto y septiembre de 2007. Entrevistamos a 28 familiares que asistieron regularmente a los servicios. Los miembros de la familia destacaron el efecto positivo de CAPS en sus trayectos de terapeutica y de vida, en mejorar la armonia familiar. En los talleres terapeuticos, detectaron las deficiencias y las contradicciones, revelando y apuntando maneras para superarlos. Ellos perciben los espacios para la participacion en CAPS como instrumentos esenciales para la observacion de su usuario familiar, ademas de un crecimiento mutuo. Los talleres terapeuticos representan un importante instrumento de socializacion e integracion individual en grupos, al paso que se propone trabajar, pensar y actuar colectivamente, conferido por la logica inherente al paradigma psicosocial.

Práticas profissionais e tratamento ofertado nos CAPSad do município de Natal-RN: com a palavra a família

El Centro de Atencion Psicosocial para el tratamiento de los usuarios de alcohol y de otras drogas (CAPSad) representa la principal estrategia para la atencion de la salud relacionada con el consumo de sustancias psicoactivas. El objetivo fue investigar la percepcion que tienen los familiares sobre el tratamiento ofrecido en CAPSad norte y este de la ciudad de Natal-RN. Entrevistamos a 14 familiares que participaban regularmente las actividades propuestas. Las entrevistas fueron realizadas en agosto y septiembre de 2007, y transcritas en su totalidad para la preparacion del corpus y para su presentacion al ALCESTE. El material discursivo produjo tres temas: Tratamiento - Mejoras y Expectativas; Convivencia - Usuario Antes y Despues; Condiciones Terapeuticas - Agradecimientos, Consejos y Vulnerabilidad. Los miembros de la familia identificaron que el trato recibido en CAPSad favorece mejoras sustanciales en las condiciones de vida y de salud de su familiar usuario y las relaciones familiares dentro y fuera de la casa, y notaron que existe la necesidad de realizar ajustes y de aumentar la oferta de actividades terapeuticas.The Center for Psychosocial Care for treatment of users of alcohol and other drugs (CAPSad) is the main healthcare strategy related to the consumption of psychoactive substances. The objective was to investigate the perception of relatives about the treatment offered in northern and eastern CAPSad in the city of Natal-RN. We interviewed 14 families who regularly attended the proposed activities. The interviews were conducted in August and September 2007, and full transcribed for the corpus preparation and submission to ALCESTE. The discursive material originated three thematic categories: Treatment - Improvements and Expectations; Living - User Before and After; and Therapeutic Conditions - Thanks, Tips and Vulnerability. The family members identified that the treatment received in CAPSad favors substantial improvements in living and health conditions of their relative and in family relationships within and outside the home, being detected the need for adjustments and increasing the supply of therapeutic activities.

Fragmentos históricos da assistência psiquiátrica no Rio Grande do Norte, Brasil

This article aims to rescue aspects of the performing therapeutic of the Day Hospital (HD) Dr Elger Nunes, Natal, Rio Grande do Norte, Brazil, during its term, and analyze the results regarding to the number of patients assisted from 1996 to 2004. This is an empirical, descriptive and exploratory study, ex post facto with a quantitative approach, carried out through the analysis of the records of 910 people attended in the hospital. The data was submitted to the informational resource software Microsoft Excel and converted into diagrams. The results show a greater accessibility to this treatment modality, decreasing in hospitalization-time length and improving hospital discharge conditions for users, with reduction in number of patients who interrupted treatment. It focus on the importance of the Day Hospital in the process of psychiatric reform, with care grounded on the use of the humanized therapeutic practices, and still not losing the bond with family and society.O presente artigo objetiva resgatar aspectos do funcionamento terapeutico do Hospital-Dia (HD) Dr. Elger Nunes, em Natal, Rio Grande do Norte, durante sua vigencia, e analisar os resultados referentes ao numero de usuarios atendidos no periodo de 1996 a 2004. Trata-se de um estudo empirico, descritivo, exploratorio, ex posto facto de abordagem quantitativa, realizado a partir dos registros e prontuarios de 910 usuarios atendidos no HD. As informacoes foram submetidas ao recurso informacional Microsoft Excel e transformadas em graficos. Os resultados constataram uma maior acessibilidade a modalidade de tratamento, diminuicao no tempo de permanencia e melhoria das condicoes de alta dos usuarios com reducao no numero de interrupcoes no tratamento. Salienta se a importância do HD no processo de reforma psiquiatrica, com atendimento pautado na utilizacao de praticas terapeuticas humanizadas e sem perda do vinculo com a familia e a sociedade.

Percepções de familiares sobre o portador de sofrimento psíquico institucionalizado

Resumen 1Enfermeiro. Mestre em Enfermagem pela Universidade Federal do Rio Grande do Norte (UFRN). Professor Assistente I do Curso de Graduação em Enfermagem, Universidade do Estado do Rio Grande do Nor te (UERN), Campus do Seridó Caicó. Brasil. E-mail: professordulcian@gmail.com, 2Enfermeiro. Doutor em Enfermagem Psiquiátrica (USP). Professor do Depar tamento de Enfermagem da UFRN. Brasil. E-mail: farnoldo@gmail.com, 3Enfermeira. Mestre em Saúde Coletiva pela UEPB. Professora Titular do Departamento de Enfermagem UEPBBrasil. E-mail: merciagaudencio@bol.com.br PESQUISA RESEARCH INVESTIGACIÓN The objective was to investigate the perception of mental suffering in the family vision. Descriptive study with a qualitative approach held in June 2005, in a midsize psychiatric hospital. It was interviewed 15 relatives who accompanied the treatment and assistance in hospital. The speeches were submitted to content analysis, in thematic categories. In that sense, the families have demonstrated the knowledge of behavioral changes resulted from mental suffering and its beginning time. Also reported a distressing and difficult journey when searching for help, saying they don’t know to whom or what to look for, appealing, initially, to magical-religious aid, and subsequently, to medical and scientific knowledge. Within the family environment, the conflicts exist and reinforce the commitment in interpersonal relationships and social ties. It is a challenge for mental health professionals to establish therapeutic relationships with family members of individuals with psychological distress, providing a redirection of care practices, especially, in health education.

Predisposição ao uso e abuso de álcool entre estudantes de graduação em enfermagem da UFRN

Estudo de natureza exploratoria descritiva com abordagem quantitativa, avaliou a predisposicao para o uso e abuso do alcool na Graduacao em Enfermagem/UFRN. A amostra foi composta por 42 alunos regularmente matriculados, sendo 76% do genero feminino. Utilizou-se o questionario CAGE acrescido de itens sobre a sindrome da abstinencia alcoolica. Metade (50%) faz uso de alcool, com idade entre 21 e 22 anos (41%). O maior consumo esta no quinto periodo (38%), seguido do terceiro (19%). Dentre os pesquisados, 34% sentem-se fisicamente mal apos beberem, 33% tropecam, cambaleiam e trancam as pernas, e 33% sentem calor e suam. No que se refere aos sintomas mentais e emocionais, 50% referiram lentidao do raciocinio, 25% sensacoes estranhas e assustadoras quando bebem, e 25%, perda da memoria. Conclui-se que ha predisposicao para o uso e abuso do alcool, e uma tendencia ao alcoolismo feminino.

A CRISE DE PARADIGMAS NA CIÊNCIA E AS NOVAS PERSPECTIVAS PARA A ENFERMAGEM

Se entiende el paradigma como un patron a seguir, e incluye el conjunto de creencias, valores, tecnicas y teorias para compartir, y esta influenciado por factores culturales, politicos, economicos y sociales vigentes. El objetivo fue realizar un analisis sobre la crisis paradigmatica del conocimiento cientifico y sus implicaciones en la enfermeria, presentando un panorama general del desarrollo de la investigacion en este ambito. Se necesita con urgencia de nuevos principios que guien la practica cientifica que estan surgiendo en la etica, la sostenibilidad ambiental, la interdisciplinariedad, la apreciacion de la complejidad, y el respeto de la subjetividad. Para fortalecer la enfermeria como una ciencia, profesion y la practica social es esencial utilizar las herramientas disponibles en la promocion de acciones sociopoliticas que apuntan a una mejor calidad de vida de la sociedad. El proceso de trabajo en salud y sus paradigmas requieren percepcion de los enfermeros de sus limites de actuacion, la intervencion y la capacidad para construir nuevos conocimientos, promoviendo la innovacion en la produccion de salud.Resumen The paradigm is understood as a pattern to be followed, and includes the set of beliefs, values, techniques and shared theories and is influenced by cultural, political, economic and social laws. The objective was to conduct an analysis about the paradigmatic crisis of scientific knowledge and its implications in nursing, providing an overview of the development of a research in this area. The need for new guiding principles of scientific practice is urgently needed, which are emerging in ethics, environmental sustainability, interdisciplinary, appreciation of complexity, and respect for subjectivity. For nursing to become stronger as a science, profession and social practice is essential to use the tools available in promoting socio-political actions that point to a higher quality of life of society. The work process in health and its paradigms require from the nurse clarity of its limited scope, intervention, and ability to build new knowledge, promoting innovation in the health production.

A reforma psiquiátrica na visão de quem cuida: percepções de profissionais do serviço residencial terapêutico

Resumen ABSTRACT The Therapeutic Residential Services (TRS) has emerged as a key to the realization of the deinstitutionalization process and psychosocial rehabilitation. The objective was to investigate the perception of nursing professionals working in the TRS on the Psychiatric Reform, and your relationship with the technical and scientific training and professional practice. Descriptive study with a qualitative approach, being interviewed six nursing professionals working in TRS at Caicó/RN. The data collection was conducted between October and December 2009. The Psychiatric Reform was noticed as a complex movement that aims to modify the work in the field of psychiatry, and from it, the professional is “encouraged” to take a new position in relation to the patient, a more horizontal and humanized posture. This study contributed to a better understanding of the reality studied, regarding the change in the mental health network.The Therapeutic Residential Services (TRS) has emerged as a key to the realization of the deinstitutionalization process and psychosocial rehabilitation. The objective was to investigate the perception of nursing professionals working in the TRS on the Psychiatric Reform, and your relationship with the technical and scientific training and professional practice. Descriptive study with a qualitative approach, being interviewed six nursing professionals working in TRS at Caicó/RN. The data collection was conducted between October and December 2009. The Psychiatric Reform was noticed as a complex movement that aims to modify the work in the field of psychiatry, and from it, the professional is “encouraged” to take a new position in relation to the patient, a more horizontal and humanized posture. This study contributed to a better understanding of the reality studied, regarding the change in the mental health network.

As novas práticas em saúde mental e o trabalho no serviço residencial terapêutico

The objective was to investigate the perception of caregivers about their work in Therapeutic Residential Services (TRS) of Caico-RN. It was a descriptive and qualitative research, conducted in 2009 with six nursing professionals working as caregivers, through a semi-structured interview. Two categories were discovered: the work performed at TRS and its achievements; Difficulties and challenges encountered in the dynamics of the SRT. The SRT was deployed in order to (re) socialize the residents in community life, to increase the autonomy and capacity for social interaction. The address and their routine enable users to make daily changes in their lifestyle and quality of life, despite the existence of severe problems such as instability of the physical infrastructure, inadequate human and material resources. The work of the caregivers comes from the unanimous incorporation of the psychosocial approach, but still needs improvement in order to emphasize the role of the residents as active subjects.

A representação social de familiares nos centros de atenção psicossocial

The Psychosocial Care Centers (CAPS) are foreseen as the ports of entry and regulation in mental health, and were created with the intention of replacing the hospitalization in asylum for the community care service. The objective was to understand the social representations of family members of the CAPS users from Natal-RN, about their participation in the activities of these services. Descriptive research with qualitative approach, developed with 28 family members, through semi-structured interviews between August and September 2007. The data received informational support of ALCESTE software. The family members build their social representation in the face of a need for change and hope in the health care of their relatives, crystallized by taking and positioning behavior, supported in the presence of the environmental space of CAPS. The family participation still does not gather, in the scenarios investigated, conditions to promote the inclusion of their relative, once the physical established presence is not yet enough.Los Centros de Atencion Psicosocial (CAPS) estan previstos como las puertas de entrada y de regulacion en materia de salud mental, y fueron creados con la intencion de sustituir las internaciones en hospitales psiquiatricos para la atencion abierta a la comunidad. Nuestro objetivo es comprender las representaciones sociales de los familiares de los usuarios de un CAPS de la ciudad de Natal-RN, sobre su participacion en las actividades de estos servicios. Estudio descriptivo, cualitativo, desarrollado con 28 miembros de las familias, a traves de entrevistas seme-estructuradas entre agosto y septiembre de 2007. Los datos obtenidos recibieron soporte del software ALCESTE. Las familias estructuraran su representacion social con base en una necesidad y esperanza de cambio en el cuidado de la salud de sus parientes, cristalizada mediante la adopcion de la posicion y el comportamiento, con el apoyo de la presencia del espacio ambiental del CAPS. En las situaciones investigadas, la participacion de la familia no cumple las condiciones para promover la inclusion del usuario, ya que la presencia fisica no existe aun suficiente.

Práticas discursivas e o silenciamento do doente mental: sexualidade negada?

ResumenEl objetivo del estudio fue identificar la Representaciones Sociales en profesionales enfermeros sobre la sexualidad del paciente mental. Es una investigacion de naturaleza exploratorio-descriptiva, con el acercamiento cualitativo. El recurso usado fue la Tecnica Investigacion en las Situaciones Diarias (TSC), aplicada a 17 enfermeros que trabajaron en los servicios psiquiatricos de Ribeirao Preto/SP. En las manifestaciones discursivas, se verifico que la enfermera niega la sexualidad del paciente mental, como una forma de silencio, estableciendo los limites para la censura en ese asunto. En esta perspectiva, pasa el silenciamiento sobre la sexualidad del paciente mental, mientras estableciendo abajo una politica del sentido adelante el mismo. El tal posicionamiento revela la estrategia adoptada en ese conocimiento e impulsa, mientras logrando las determinaciones de su estatuto profesional que es ir al encuentro a las expectativas institucionales y sociales.