Marilene de Castilho Sá

Limites do cuidado: representações e processos inconscientes sobre a população na porta de entrada de um hospital de emergência

This article presents some results from a study aimed at analyzing the limits and possibilities defined by inter-subjective and unconscious processes of solidarity, cooperation, and life care production in health services. A public hospital with an emergency department in the city of Rio de Janeiro, Brazil, was selected as a case study. The French school of psychosociology, oriented by the psychoanalytical clinical approach, the psychoanalytical theory on inter-subjective and group processes, and work psychodynamics provided the basis for the studys methodological strategies and analysis of the results. The study analyzed health professionals psychological representations and unconscious processes related to emergency department users and their demands, and their consequences for the health care provided to this clientele. Some particularly important images such as need were used as a category that conceals the diversity of demand, in an unconscious process with multiple reductions: from denial of social suffering to denial of the patients human condition.

Individuals and changes in health organizations: a psychosociological approach

The Brazilian health sector has undergone a severe crisis, affecting the case-resolving capacity, efficiency and governability of the health system as a whole and health organizations in particular. Although innovative management systems and tools have been encouraged, such innovations are limited in their ability to spawn organizational change, especially with regard to the challenge of enabling individual adherence to institutional projects and relations involving individuals and organizations. This paper focuses on the French psychosociological approach for analyzing and intervening in organizations, one of whose main thinkers is Eugène Enriquez. In its view of contemporary organizations, this approach focuses on the conflict between reproduction and creation as the main problem to be solved by management processes. While an organization is essentially seen as a place of order and repetition, organizational change implies the challenge of bringing creative individuals into the organizations project, avoiding the trap of controlling their minds and behavior.

Possibilidades de aplicação do enfoque estratégico de planejamento no nível local de saúde: análise comparada de duas experiências

This paper presents the preliminary results from a study on the limits and possibilities of the strategic planning approach for local health organizations. A comparative analysis is developed between two experiences concerning the application of the strategic situational planning method (PES method) in the management of a health center and hospital. Questions include the following: difficulties with the use of the category actor in local health organizations; possibility of drafting a collective project based on the multiple rationalities existing in such organizations; possibility of improving communications processes with the use of the PES method; difficulties related to organizational culture; and low levels of responsibility, as well as difficulties pertaining to the methods complexity and the possibility of simplifying it, maintaining strategic situational analysis and improving organizations managerial capacity.

Um olhar sobre a atenção psicossocial a adolescentes em crise a partir de seus itinerários terapêuticos

This study analyzes the care provided to adolescents in crisis in a municipality in Greater Metropolitan Rio de Janeiro, Brazil. The article reports on a qualitative health study that used Therapeutic Itinerary and Life Narratives as the methodological resources. The principal theoretical reference was psychoanalyst René Kaës. Based on the adolescents own verbal accounts, the study aimed to grasp the collective realities that could potentially shed light on the different types of logic and professional practices applied to care for adolescents in psychosocial crisis situations. The underlying assumption was that an approach to the dialectical nature of the crisis required maintaining a framework that would allow establishing a space for transition within which to develop the necessary conditions for disruptive and paradoxical elements to be elaborated. However, crisis care in the context studied here proved to be hampered by infrastructure issues, institutional rigidity, and fragmentation of activities, with little orientation towards inter-sector work.O artigo analisa a assistencia a adolescentes em crise em um municipio da regiao metropolitana do Rio de Janeiro, Brasil. Trata-se do relato de uma pesquisa qualitativa em saude, que utiliza como recursos metodologicos o Itinerario Terapeutico e as Narrativas de Vida, adotando como principal referencia teorica o psicanalista Rene Kaes. Buscou-se, valendo-se de relatos orais, apreender realidades coletivas que lancassem luzes sobre as distintas logicas assistenciais e praticas profissionais de cuidado a adolescentes em situacao de crise psicossocial. Partiu-se do pressuposto de que, ao ser tomada em seu carater dialetico, a crise exige a existencia e a manutencao de um enquadre que permita o estabelecimento de um espaco de transicao, no qual se construam condicoes necessarias para que elementos disruptivos e paradoxais sejam elaborados. No entanto, a atencao a crise no contexto estudado mostrou-se atravessada por dificuldades de infraestrutura e baseada em certa rigidez institucional e fragmentacao das acoes, com pouco direcionamento para um trabalho intersetorial.

Un examen de la atención psicosocial a los adolescentes en crisis desde sus itinerarios terapéuticos

This study analyzes the care provided to adolescents in crisis in a municipality in Greater Metropolitan Rio de Janeiro, Brazil. The article reports on a qualitative health study that used Therapeutic Itinerary and Life Narratives as the methodological resources. The principal theoretical reference was psychoanalyst René Kaës. Based on the adolescents own verbal accounts, the study aimed to grasp the collective realities that could potentially shed light on the different types of logic and professional practices applied to care for adolescents in psychosocial crisis situations. The underlying assumption was that an approach to the dialectical nature of the crisis required maintaining a framework that would allow establishing a space for transition within which to develop the necessary conditions for disruptive and paradoxical elements to be elaborated. However, crisis care in the context studied here proved to be hampered by infrastructure issues, institutional rigidity, and fragmentation of activities, with little orientation towards inter-sector work.O artigo analisa a assistencia a adolescentes em crise em um municipio da regiao metropolitana do Rio de Janeiro, Brasil. Trata-se do relato de uma pesquisa qualitativa em saude, que utiliza como recursos metodologicos o Itinerario Terapeutico e as Narrativas de Vida, adotando como principal referencia teorica o psicanalista Rene Kaes. Buscou-se, valendo-se de relatos orais, apreender realidades coletivas que lancassem luzes sobre as distintas logicas assistenciais e praticas profissionais de cuidado a adolescentes em situacao de crise psicossocial. Partiu-se do pressuposto de que, ao ser tomada em seu carater dialetico, a crise exige a existencia e a manutencao de um enquadre que permita o estabelecimento de um espaco de transicao, no qual se construam condicoes necessarias para que elementos disruptivos e paradoxais sejam elaborados. No entanto, a atencao a crise no contexto estudado mostrou-se atravessada por dificuldades de infraestrutura e baseada em certa rigidez institucional e fragmentacao das acoes, com pouco direcionamento para um trabalho intersetorial.

An analysis of psychosocial care for adolescents in crisis based on their therapeutic itineraries

This study analyzes the care provided to adolescents in crisis in a municipality in Greater Metropolitan Rio de Janeiro, Brazil. The article reports on a qualitative health study that used Therapeutic Itinerary and Life Narratives as the methodological resources. The principal theoretical reference was psychoanalyst René Kaës. Based on the adolescents own verbal accounts, the study aimed to grasp the collective realities that could potentially shed light on the different types of logic and professional practices applied to care for adolescents in psychosocial crisis situations. The underlying assumption was that an approach to the dialectical nature of the crisis required maintaining a framework that would allow establishing a space for transition within which to develop the necessary conditions for disruptive and paradoxical elements to be elaborated. However, crisis care in the context studied here proved to be hampered by infrastructure issues, institutional rigidity, and fragmentation of activities, with little orientation towards inter-sector work.O artigo analisa a assistencia a adolescentes em crise em um municipio da regiao metropolitana do Rio de Janeiro, Brasil. Trata-se do relato de uma pesquisa qualitativa em saude, que utiliza como recursos metodologicos o Itinerario Terapeutico e as Narrativas de Vida, adotando como principal referencia teorica o psicanalista Rene Kaes. Buscou-se, valendo-se de relatos orais, apreender realidades coletivas que lancassem luzes sobre as distintas logicas assistenciais e praticas profissionais de cuidado a adolescentes em situacao de crise psicossocial. Partiu-se do pressuposto de que, ao ser tomada em seu carater dialetico, a crise exige a existencia e a manutencao de um enquadre que permita o estabelecimento de um espaco de transicao, no qual se construam condicoes necessarias para que elementos disruptivos e paradoxais sejam elaborados. No entanto, a atencao a crise no contexto estudado mostrou-se atravessada por dificuldades de infraestrutura e baseada em certa rigidez institucional e fragmentacao das acoes, com pouco direcionamento para um trabalho intersetorial.