Lia Carneiro Silveira

Acerca do conceito de loucura e seus reflexos na assistência de saúde mental

This is a theoretical reflection on the historical perception and conceptualization of madness and, consequently, on ways of acting towards it. We start from ancient Greek conceptions and move up to the present days, focusing mainly on those periods when perceptions and actions towards madness changed. We conclude that getting to know the historical forms of the madness concept is important to be able to denaturalize our conceptions and reflect about our current practice in care for patients going through mental suffering.Trata-se de reflexao teorica acerca de como se deram historicamente a percepcao e a conceituacao da loucura e, consequentemente, das formas de agir perante ela. Essa reflexao reconstroi a trajetoria a partir da concepcao da Grecia Antiga ate os dias atuais, enfocando principalmente os periodos onde ocorreram mudancas na forma de se perceber e atuar perante essa experiencia. Conclui-se que a importância em se conhecer as formas historicas do conceito de loucura reside na possibilidade de se poder desnaturalizar as concepcoes e refletir acerca da pratica que sao realizadas hoje na assistencia as pessoas em sofrimento mental.

Subjectivity and Sexuality Production in Women Living With HIV/Aids: a Sociopoetic Production

The study aims to apprehend the subjectivity production possibilities concerning sexuality in a group of women living with HIV/aids, based on the sociopoetic method. The subjects were nine women with HIV/aids attended at the public referral hospital for infectious diseases in Fortaleza-CE. The results appoint that sexuality appears in several dimensions: in the sexual act, in knowing their own body, in professional accomplishment, in feelings of desire and love, besides the feeling of freedom. We concluded that sexuality is present in the individuals totality; it is not limited to the sexual act, but goes much further and is characterized as a dynamic reality.O objetivo deste estudo foi apreender as possibilidades de producao de subjetividade acerca da sexualidade em um grupo de mulheres vivendo com o HIV/AIDS, a partir do metodo da sociopoetica. Os sujeitos foram nove mulheres com HIV/AIDS assistidas no hospital publico de referencia para doencas infecciosas de Fortaleza, CE. Os resultados apontam que a sexualidade aparece em varias dimensoes: no ato sexual, no conhecer o proprio corpo, na realizacao profissional, nos sentimentos de desejo e amor, alem do sentimento de liberdade. Conclui-se que a sexualidade se encontra na totalidade do individuo, ela nao se limita a questao do ato sexual, vai muito mais alem e se configura como realidade dinâmica.

A sexualidade das mulheres atendidas no programa saúde da família: uma produção sociopoética

The concept of promotion of health is one of the main axes of current health policies in Brazil. The adoption of this concept implies a change in the care model involving valuing a greater autonomy of subjects to work improving their conditions of life. From this perspective, several elements of health practices have to be reviewed, sexuality among them. Thus, we aimed at producing sexuality concepts as of the knowledge of women cared for in a health unity. This is a qualitative study adopting a social poetic approach. The results pointed out several affections that involve the concept of sexuality going beyond the biological aspect. We understand that this study may help professionals caring for women in a health unity because it broadens the concept of sexuality allowing for reflection on the nursing practice in collective health.O conceito de promocao da saude e um dos eixos centrais das atuais politicas de saude no Brasil. A adocao desse marco conceitual implica em reversao do modelo assistencial, envolvendo a valorizacao de maior autonomia dos sujeitos para atuarem na melhoria de suas condicoes de vida. A partir dessa perspectiva, diversos elementos das praticas de saude precisam ser revistos, entre eles o da sexualidade. Sendo assim, objetivou-se, aqui, produzir conceitos de sexualidade a partir dos saberes das mulheres atendidas numa unidade de saude. O estudo e qualitativo, utilizando a abordagem sociopoetica. Os resultados apontam para a diversidade de afetos que envolvem o conceito de sexualidade, que vao alem do aspecto biologico. Entende-se que este estudo pode trazer contribuicoes para o profissional que atende mulheres em unidade de saude, a medida que amplia o conceito de sexualidade, permitindo reflexao acerca da pratica desenvolvida pela enfermagem na saude comunitaria.

Sexuality of women attended in family health program: a social poetic production

The concept of promotion of health is one of the main axes of current health policies in Brazil. The adoption of this concept implies a change in the care model involving valuing a greater autonomy of subjects to work improving their conditions of life. From this perspective, several elements of health practices have to be reviewed, sexuality among them. Thus, we aimed at producing sexuality concepts as of the knowledge of women cared for in a health unity. This is a qualitative study adopting a social poetic approach. The results pointed out several affections that involve the concept of sexuality going beyond the biological aspect. We understand that this study may help professionals caring for women in a health unity because it broadens the concept of sexuality allowing for reflection on the nursing practice in collective health.O conceito de promocao da saude e um dos eixos centrais das atuais politicas de saude no Brasil. A adocao desse marco conceitual implica em reversao do modelo assistencial, envolvendo a valorizacao de maior autonomia dos sujeitos para atuarem na melhoria de suas condicoes de vida. A partir dessa perspectiva, diversos elementos das praticas de saude precisam ser revistos, entre eles o da sexualidade. Sendo assim, objetivou-se, aqui, produzir conceitos de sexualidade a partir dos saberes das mulheres atendidas numa unidade de saude. O estudo e qualitativo, utilizando a abordagem sociopoetica. Os resultados apontam para a diversidade de afetos que envolvem o conceito de sexualidade, que vao alem do aspecto biologico. Entende-se que este estudo pode trazer contribuicoes para o profissional que atende mulheres em unidade de saude, a medida que amplia o conceito de sexualidade, permitindo reflexao acerca da pratica desenvolvida pela enfermagem na saude comunitaria.

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.

Produção de subjetividade e sexualidade em mulheres vivendo com o HIV/Aids: uma produção sociopoética

The study aims to apprehend the subjectivity production possibilities concerning sexuality in a group of women living with HIV/aids, based on the sociopoetic method. The subjects were nine women with HIV/aids attended at the public referral hospital for infectious diseases in Fortaleza-CE. The results appoint that sexuality appears in several dimensions: in the sexual act, in knowing their own body, in professional accomplishment, in feelings of desire and love, besides the feeling of freedom. We concluded that sexuality is present in the individuals totality; it is not limited to the sexual act, but goes much further and is characterized as a dynamic reality.O objetivo deste estudo foi apreender as possibilidades de producao de subjetividade acerca da sexualidade em um grupo de mulheres vivendo com o HIV/AIDS, a partir do metodo da sociopoetica. Os sujeitos foram nove mulheres com HIV/AIDS assistidas no hospital publico de referencia para doencas infecciosas de Fortaleza, CE. Os resultados apontam que a sexualidade aparece em varias dimensoes: no ato sexual, no conhecer o proprio corpo, na realizacao profissional, nos sentimentos de desejo e amor, alem do sentimento de liberdade. Conclui-se que a sexualidade se encontra na totalidade do individuo, ela nao se limita a questao do ato sexual, vai muito mais alem e se configura como realidade dinâmica.

Análise das dissertações e teses de enfermagem sobre saúde mental, Brasil, 1979-2007

Se trata de un estudio bibliografico, con el objetivo de analizar los textos cientificos divulgados en la base de datos CEPEn en el area de salud mental (1979-2007). El total de resumenes estudiados fueron 280, de los cuales 208 eran disertaciones de maestria. Los sujetos que se destacaron fueron los profesionales (57) y pacientes (50). Entre las tematicas abordadas se evidenciaron (2000-2007): el Cuidado de Enfermeria en Salud Mental (40) y la Percepcion en Salud Mental (37). Este trabajo posibilito obtener una vision panoramica sobre la produccion cientifica en salud mental en los cursos de Posgraduacion en Enfermeria en Brasil. Esperamos que el estudio incentive la reflexion sobre las practicas de cuidado en salud mental y posibilite nuevos abordajes en enfermeria con el objetivo de promover la salud y prevenir danos, de forma a favorecer la ciudadania, la autonomia y la calidad de vida de los sujetos envueltos.This bibliographic study analyzes scientific texts published in the CEPEn database in the mental health field (1979-2007). A total of 280 abstracts were investigated, of which 208 were Masters theses. The individuals investigated in these studies were professionals (57), patients (50), and professors and/or students (18). Among the themes addressed between 2000 and 2007 were the following: Nursing Care in Mental Health (40), Perception in Mental Health (37); and Transversality in Mental Health Care (27). This study provided an overview of the scientific research produced in the mental health field in Brazilian nursing graduate programs. We expect this study to elicit reflections concerning mental health care practice and enable new approaches for nursing promoting health and the prevention of diseases in order to enable patients to recover their citizenship, autonomy and quality of life.

About the concept of madness and its reflexes on mental health care

This is a theoretical reflection on the historical perception and conceptualization of madness and, consequently, on ways of acting towards it. We start from ancient Greek conceptions and move up to the present days, focusing mainly on those periods when perceptions and actions towards madness changed. We conclude that getting to know the historical forms of the madness concept is important to be able to denaturalize our conceptions and reflect about our current practice in care for patients going through mental suffering.Trata-se de reflexao teorica acerca de como se deram historicamente a percepcao e a conceituacao da loucura e, consequentemente, das formas de agir perante ela. Essa reflexao reconstroi a trajetoria a partir da concepcao da Grecia Antiga ate os dias atuais, enfocando principalmente os periodos onde ocorreram mudancas na forma de se perceber e atuar perante essa experiencia. Conclui-se que a importância em se conhecer as formas historicas do conceito de loucura reside na possibilidade de se poder desnaturalizar as concepcoes e refletir acerca da pratica que sao realizadas hoje na assistencia as pessoas em sofrimento mental.

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.  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.