Accountability and participation: how to overcome the tutelary character in the psychosocial care center for alcohol and drug users? / Responsabilização e participação: como superar o caráter tutelar no centro de atenção psicossocial álcool drogas?

OBJECTIVE: Analyze the degree of accountability and participation of user under treatment at the Psychosocial Care Center for Alcohol and Drug Users (CAPS-ad) from the harm reduction policy perspective. METHODS: It is a qualitative approach study, case study type, with 12 users and four professionals from CAPS-ad in a county of Minas Gerais state. Data were collected from April to September 2017, by means of semi-structured interview, participant observation and documental analysis. RESULTS: Based on content analysis, information was organized in two thematic categories: treatment objectives and motivation for treatment. Conclusions: the study's findings revealed that users should be more held accountable and empowered with regard to their treatment. CONCLUSIONS: More professional listening is suggested, favoring the constructions of goals befitting users' interests, as contracts.

Object and technologies in the working process of an itinerant team in mental health. / Objeto e tecnologias do processo de trabalho de uma equipe itinerante em saúde mental.

Objective To analyze the work object and the technologies in the working process of a Mental Health Itinerant Team in the attention to drug users. Methods Qualitative case study, carried out in a municipality in the South of Brazil. The theoretical framework was the Healthcare Labor Process. The data was collected through participant observation and semi-structured interviews with the professionals of an itinerant team in the year of 2015. For data analysis we used the Thematic Content Analysis. Results In the first empirical category - work object - the user is considered as a focus, bringing new challenges in the team's relationship with the network. In the second category - technologies of the work process - potentialities and contradictions of the team work tools are highlighted. Conclusions As an innovation in the mental health context, the itinerant team brings real possibilities to reinvent the care for the drug user as well as new institutional challenges.

[The network of mental health care from the family health strategy service]. / A rede de atenção à saúde mental a partir da Estratégia Saúde da Família.

The Family Health Strategy Service (FHSS) is an important ally in the mental health system, contributing to the completeness and effectiveness of care. This study aimed to discuss the mental health care network as compared to the daily routine of an FHSS. It is an evaluative study with a qualitative methodological approach. It was developed in an FHSS in Porto Alegre-RS, Brazil. Data was collected between July and December of 2010 through interviews with 16 workers and ten relatives. We identified important resources in primary health care, such as partnerships with academia. However, the constitution of this care is still based on specialty, following the logic of patient referral. Our intention for this study was to contribute to the operationalization of the mental health care network, consolidating the partnership with the FHSS and developing activities in the territorial space, raising awareness, demystifying health care service in the area, and countering the perception that it is uniquely specialized.

[The experience lived by clients' family members of a child psychosocial care center]. / O tipo vivido de familiares de usuários de um centro de atenção psicossocial infantil.

The objective of this study was to understand the lived experiences of family members of children attending a Child Psychosocial Care Center. This study is a qualitative research with a phenomenological approach, developed at a Child Psychosocial Care Center (CAPSi as per its acronym in Portuguese) located in the municipality of Cascavel, State of Paraná. Participants were eleven family members of clients attending the above mentioned service and who, more actively, took part in the clients' care. Semi-structured interviews were performed and the gathered data were then analyzed by means of social phenomenology methodology The experience lived by the family members of children attending the Child Psychosocial Care Center included experiences in dealing with clients' behavior; seeking referrals to other services; waiting for treatment; hoping to see an improvement in the clinical profile of the patient and experiencing the service support provided to the family. Thus, this present study may contribute to a reflection on mental health nursing practice in caring for clients and their families.

Narrative interview and reconstruction of biographic case: methodological alternative in nursing research.

OBJECTIVE: To present the biographical narrative interviews and biographical case reconstruction as methodological alternatives in nursing research. METHODS: Theoretical-reflective study that presents the aspects of the biographical narrative method and of reconstruction of biographical cases according to the German interpretive social research framework developed by the sociologist Gabriele Rosenthal. RESULTS AND DISCUSSION: The reflection was organized into three topics: conceptual interpretative aspects of biographical research; biographical narrative interview in the production of data; reconstruction of biographical case. This framework proved to be adequate to access and understand the perspective of the social agents in the face of practices and phenomena in the field of Nursing. CONCLUSION: Approach of biographical narratives is an important tool for research in Nursing, since it makes it possible to understand the lives of individuals based on their own actions and interpretations.

Family motivations and expectations in the care for psychoactive substance users.

OBJECTIVE: To understand the motivations and expectations of family members for the care of users of psychoactive substances. METHOD: This is a qualitative study using Alfred Schutz's phenomenological sociology framework. Data was collected through semi-structured interviews with family members of substance users treated in the inpatient and outpatient clinic of a university hospital in southern Brazil. Data was interpreted through comprehensive phenomenological analysis. RESULTS: Five categories of motivation were identified: for fear and insecurity with the situation; for obligation; due to the relationship of love and connection; to stop suffering; to promote independent living. CONCLUSION: The motivations of the family members aim to avoid the helplessness of the substance user and to achieve positive changes in the construction of a life without the use of substances, projecting a self-sufficient future for the user.

Experiences lived by family members of people who committed suicide: approach to biographic narratives.

OBJECTIVE: To understand the experiences of family members of people who committed suicide and describe the typologies of the biographical cases through the approach of biographical interviews and analysis. METHOD: Qualitative research, with a reconstructive approach to Rosenthal's biographical cases, based on Schutz's phenomenological sociology. Biographical narrative interviews were conducted between November/2017 and February/2018, in a city in southern Brazil, with eleven family members of people who survived suicide. The analysis followed the phases of Rosenthal's biographical case reconstruction. RESULTS: The reconstruction of two biographical cases were presented. The results point to two distinct typologies: maternal role in the face of suicide and social stigmatization; use of the cultural meaning of family as a resource for coping with suicide. CONCLUSION: It is important to listen to these family members, as the understanding of their experiences can support health professionals in the implementation of care actions.

[Characterization of the assistance practices in mental health care networking: an integrative review]. / Caracterização das práticas de assistência na rede de atenção em saúde mental: revisão integrativa.

This study is an integrative literature review that aims to identify and analyze the characteristics of assistance practices in mental health Primary Health Care in Brazil. The sample consisted in nine articles, from databases consulted in the period between 2001 and 2009. In data analyses, results were grouped in two themes: activities and principles of psychiatric reform. Results show that even when the substitute services adopt some activities/principles from psychiatric reform, yet there is a valorization of physician-focused activities, which lead to a persistence of the old paradigms and practices. The multidisciplinary team of mental health, needs to restructure its assistance and its knowledge, so that practices focused on the principles of psychiatric reform can be permanent.

Spirituality and religiosity expressed by relatives of drug users: contributions to health care.

OBJECTIVE: to analyze the expressions of spirituality and religiosity of relatives of people who abuse or are dependent on psychoactive substances. METHODS: exploratory-descriptive research that dialogues with the spirituality and religiosity conceptual framework. It was performed at an outpatient clinic specialized in drug treatment in southern Brazil. Semi-structured interviews conducted with 11 relatives of patients undergoing treatment were analyzed by content analysis. RESULTS: the findings were grouped into two categories: forms of expression of spirituality and religiosity practices; and their influence on relatives' lives. Spirituality and religiosity almost always serve as a protective factor against feelings of anguish, conflicts and loneliness. FINAL CONSIDERATIONS: despite the important role of expressions of spirituality and religiosity for many relatives, not everyone seems to benefit from them. Health professionals should consider these expressions in the construction of comprehensive health care for relatives.

The significance of the nursing actions in psychiatric hospitalization of female adolescent users of psychoactive substances.

OBJECTIVE: To understand the significance of the actions developed by the nursing team in a Psychiatric Inpatient Unit for adolescent female users of psychoactive substances in the light of Alfred Schutz's phenomenological sociology framework. METHOD: Qualitative study with Alfred Schutz's Phenomenological Sociology approach. Four nurses and 17 nursing assistants and technicians from a General Hospital in the city of Porto Alegre participated in the study. RESULTS: Three concrete categories emerged: nursing actions as being-with-the-other; collective nursing actions as a potential for shared act and nursing actions as expectations and challenges. FINAL CONSIDERATIONS: The actions developed by the nursing team are established through intersubjective relationships, based on bonding and dialogue, but there is still a need for nursing to enhance its actions by expanding the offer of collective therapeutic activities aligned with the psychosocial care model.

Singular therapeutic project in mental health: an integrative review.

OBJECTIVES: to analyze the Singular Therapeutic Projects' characteristics in mental health care used to assist the subject with psychological distress. METHODS: it is an Integrative Literature Review study conducted in July 2017. The following databases used to collect the data were LILACS, MEDLINE and BDENF. After applying the inclusion and exclusion criteria, 12 articles were selected. RESULTS: there was divergence between what was recommended by the Ministry of Health for PTS elaboration with that described in the studies analyzed. Emphasis is placed on the low participation and co-responsibility between team/user in PTS elaboration, excessive referrals to specialized mental health services, fragmentation of knowledge within the multidisciplinary team, and difficulty sharing and discussing information about cases. FINAL CONSIDERATIONS: it is pointed out the need to adapt PTS elaboration, and its respective steps, to the needs of each individual.

Spiritual care performed in a drug user clinic.

OBJECTIVE: To know the spiritual care practices of health workers in the context of an inpatient unit for the treatment of addictive disorders, aiming to incorporate an expanded care practice. METHOD: Qualitative study considering the Convergent Care Research theoretical framework. The data collection occurred using semi-structured interviews, with three rounds of conversations and informal chats with 14 health professionals, from July to November 2017. The analysis followed the steps of apprehension, synthesis, theorization and transference. RESULTS: Four categories emerged: respect for user ethical values; addressing the beliefs and values of professionals; the health professional-user relationship; and collective spiritual care. The main actions highlighted were individual (relaxation and prayer) and collective (meditation, spirituality and the 12 steps). CONCLUSION: The rounds of conversations carried out in this research allowed workers to talk about spiritual care in addiction, to better understand its relevance to meet the needs of the patient.

Assessment of components of crack users' attention network.

OBJECTIVE: Assess components of the Psychosocial Attention Network (RAPS) in crack user care in a Rio Grande do Sul municipality. METHOD: Qualitative study based on Fourth Generation Evaluation. Data collection occurred in 2014, through participating observation and interviews based on the Hermeneutic-Dialectic Circle. Ten uses, eleven family members, seven managers and eight workers at a Psychosocial Attention Center participated. The Constant Comparative Method was used for data analysis. RESULTS: Difficulties were observed in the network articulation with the general hospital, due to prejudice and the lack of structure of the team. SAMU's (Mobile Emergency Care Service) dependence on the Military Brigade for the service indicates a frailty of the network. The need to re-think the way therapeutic farms operate in the network is a consensus. CONCLUSION: RAPS is being implemented and its concretization depends on the involvement of professionals, managers and social control of users and family members.

Matrix support in mental health in primary care: the vision of supporters and nurses.

OBJECTIVE: To understand the view of supporters and nurses on matrix support mental health actions in Primary Health Care. METHOD: A qualitative and phenomenological study, with Alfred Schutz's framework of phenomenological sociology. The study was conducted with five supporters and 22 nurses from Basic Health Care Units in the city of Porto Alegre. The participants' intentions and expectations, captured through a phenomenological interview, made up the corpus of analysis. RESULTS: The supporters have the intention, given the actions of the matrix support, to improve mental health care for the user. On the other hand, the nurses expect support to the health units, which reveals nonconformities in the mental health practices instituted in the basic network. FINAL CONSIDERATIONS: Knowing the motivations of supporters and nurses can be a powerful strategy for consolidating public policies with a view to the psychosocial way in the territory.

[A psychosocial care center team's work from a family perspective]. / O trabalho da equipe de um Centro de Atenção Psicossocial na perspectiva da família.

The objective of this study was to understand the experiences of family members of patients seen at a Psychosocial Care Center (PSCC) in terms of the work performed by the mental health team. The theoretical-philosophical framework used was phenomenological sociology. Data collection took place by means of an interview performed with 13 family members in October and November, 2006 at a PSCC in the city of Porto Alegre, Brazil. The comprehensive analysis yielded three categories. This article focuses on one of those categories: work as a project, action, and act. The analysis permitted to consider that the PSCC team's work has concrete results in mental health care; the team's actions are user-centered; and that the team's work should increase family-service integration. These considerations could serve as support for mental health teams to reflect about their practice regarding involving the patient's family in their work.

[Using the Fourth Generation Evaluation in a Center of Psychosocial Attention]. / Utilização da Avaliação de Quarta Geração em um Centro de Atenção Psicossocial.

The study reports the use of the Evaluation of Fourth Generation in a Center of Psychosocial Attention (CAPS). A qualitative evaluation was carried through with the purpose of learning the service dynamics, the ways the actors interact and how the senses are built by those people in relation to their practice. The data collection was made in a CAPS in Porto Alegre, Rio Grande do Sul, Brazil, during the period between October and November of 2006. The applied methods were: observation, which made possible to experience the service context, interviews with 13 service users, 13 relatives and 13 mental health care professionals. The fieldwork experience allowed us to accomplish the joint of different methods of data collection in the search of service evaluation through a constructivist perspective. The evaluation allowed a problematization of mental care health in Centers of Psychosocial Attention and contributed to the emancipatory process of the involved subjects.

[Conceptions of a mental health team about interdisciplinary work]. / Concepções de uma equipe de saúde mental sobre interdisciplinaridade.

The objective of this study was to understand the conceptions of a mental health team from a Psychosocial Care Center about interdisciplinary work. This is a qualitative study, of a descriptive type, developed in a mental health service in Porto Alegre, Rio Grande do Sul, Brazil. The subjects of the study were eight professionals (psychiatrist, nurse, nutritionist, psychologist social worker occupational therapist, physical education teacher and nursing auxiliary). It was included professionals from the health service available to participate of the research. Data were collected through a semi-structured interview and the information had been analyzed by the content analysis technique. The interdisciplinary work revealed itself as a group of professionals with different formations, grouping specific knowledge, in a conflict area where there are negotiation and support between the professionals. The formation of the team by workers of different professions enriches the care practice, favors the assistance innovation and makes possible the interchange of experiences and knowledge.

Psychiatric hospitalization of alcoholists from rural areas in a general hospital: expectations of families.

OBJECTIVE: to know the expectations of family members of alcoholics living in rural areas under treatment in a Psychiatric Hospitalization Unit. METHOD: qualitative research, through interviews with 15 relatives of alcoholics living in rural areas and hospitalized in a Psychiatric Unit. Information was interpreted in the light of Phenomenological Sociology. RESULTS: two concrete categories emerged: Expectations that the family member quits using alcohol and Projects of family members for the alcoholic after discharge. Relatives expected the alcoholic to maintain abstinence and planned post-discharge care, which involved everything from welcoming them to projects with a prospect of control or even fear of not being able to care for the alcoholic. FINAL CONSIDERATIONS: most participants have positive expectations regarding psychiatric hospitalization, but some relatives are not confident about caring for the alcoholic and mentioned alternatives such as hiring a caregiver or nursing homes.

Family motivations and expectations in the care for psychoactive substance users / Motivaciones y expectativas familiares en la atención a usuarios de sustancias psicoactivas / Motivações e expectativas de familiares no cuidado ao usuário de substâncias psicoativas

ABSTRACT Objective: To understand the motivations and expectations of family members for the care of users of psychoactive substances. Method: This is a qualitative study using Alfred Schutz's phenomenological sociology framework. Data was collected through semi-structured interviews with family members of substance users treated in the inpatient and outpatient clinic of a university hospital in southern Brazil. Data was interpreted through comprehensive phenomenological analysis. Results: Five categories of motivation were identified: for fear and insecurity with the situation; for obligation; due to the relationship of love and connection; to stop suffering; to promote independent living. Conclusion: The motivations of the family members aim to avoid the helplessness of the substance user and to achieve positive changes in the construction of a life without the use of substances, projecting a self-sufficient future for the user.

RESUMEN Objetivo: Comprender las motivaciones y expectativas de los familiares para el cuidado de los usuarios de sustancias psicoactivas. Método: Se trata de un estudio cualitativo con enfoque en la sociología fenomenológica de Alfred Schutz. Los datos fueron recolectados a través de entrevistas semiestructuradas con familiares de usuarios de sustancias atendidos en la clínica de hospitalización y consulta externa de un hospital universitario en el sur de Brasil. Los datos se interpretaron mediante un análisis fenomenológico integral. Resultados: Se identificaron cinco categorías de motivación: por miedo e inseguridad con la situación; por obligación; por la relación de amor y vínculo; para dejar de sufrir; para promover la vida independiente. Conclusión: Las motivaciones de los familiares incluyen evitar el desamparo del usuario de sustancias y lograr cambios positivos en la construcción de una vida sin uso de sustancias, proyectando un futuro autosuficiente para el usuario.

RESUMO Objetivo: Compreender as motivações e expectativas de familiares para o cuidado ao usuário de substâncias psicoativas. Método: Trata-se de um estudo qualitativo com a abordagem da Sociologia Fenomenológica de Alfred Schutz. Os dados foram coletados mediante entrevista semiestruturada com familiares de usuários de substâncias psicoativas atendidos na internação e no ambulatório de um Hospital universitário no sul do Brasil. Os dados foram interpretados por meio da análise compreensiva fenomenológica. Resultados: Foram identificadas cinco categorias de motivação: por medo e insegurança com a situação; por obrigação; pela relação de amor e vínculo; para interromper o sofrimento; para promover uma vida independente. Conclusão: As motivações dos familiares visam evitar o desamparo do usuário de substâncias psicoativas, alcançar mudanças positivas na construção de uma vida sem o uso de substâncias, projetando um futuro autossuficiente para o usuário.

Implicações da atuação da enfermagem no enfrentamento da COVID-19: exaustão emocional e estratégias utilizadas / Implicaciones del trabajo de enfermería en la lucha contra el COVID-19: agotamiento emocional y estrategias utilizadas / Implications of nursing performance in coping with COVID-19: emotional exhaustion and strategies used

Resumo Objetivo analisar as implicações autopercebidas e as estratégias utilizadas por trabalhadores de enfermagem de unidades dedicadas e não dedicadas à COVID-19 acerca da atuação profissional no enfrentamento da pandemia. Método estudo multicêntrico, descritivo-exploratório, com abordagem qualitativa, desenvolvido em quatro hospitais do sul do Brasil, entre janeiro e maio de 2021. Foram entrevistados 19 trabalhadores da equipe de enfermagem, sendo 10 lotados em unidades dedicadas à COVID-19 e 9 em unidades não dedicadas. Fez-se análise de conteúdo do tipo temática. Resultados emergiram duas categorias: (1) Exaustão emocional e seu impacto no trabalho, devido à gravidade dos pacientes e ao elevado número de óbitos nas unidades dedicadas e às mudanças organizacionais e à sobrecarga de trabalho nas não dedicadas; e (2) Estratégias de enfrentamento utilizadas, semelhantes nas unidades quanto ao autocuidado, lazer, atividade física e espiritualidade, mas diferente quanto a realização profissional, presente nas unidades dedicadas à COVID-19. Conclusão e Implicações para a Prática a pandemia incrementou a exaustão dos trabalhadores da enfermagem que utilizaram estratégias atenuantes, com destaque para a diferença na compreensão da origem da exaustão e na realização com o trabalho sentido pelos trabalhadores das unidades dedicadas. Evidencia a necessidade de acompanhamento à saúde dos trabalhadores de enfermagem atuantes na pandemia.

Resumen Objetivo analizar las implicancias autopercibidas y las estrategias que utilizan los trabajadores de Enfermería de unidades dedicadas y no dedicadas a COVID-19 en la actuación profesional para enfrentar la pandemia. Método estudio multicéntrico y descriptivo-exploratorio con enfoque cualitativo, desarrollado en cuatro hospitales del sur de Brasil entre enero y mayo de 2021. Se entrevistó a 19 trabajadores del equipo de Enfermería, 10 de los cuales fueron asignados a unidades dedicadas a COVID-19 y 9 a unidades no dedicadas. Se realizó análisis de contenido temático. Resultados surgieron dos categorías: (1) Agotamiento emocional y su impacto en el trabajo, debido a la gravedad de los pacientes y a la alta cantidad de muertes en unidades dedicadas y a los cambios organizacionales y a la sobrecarga de trabajo en unidades no dedicadas; y (2) Estrategias de afrontamiento utilizadas, similares en las unidades en cuanto a autocuidado, ocio, actividad física y espiritualidad, pero diferentes en cuanto a la realización profesional, presentes en las unidades dedicadas a COVID-19. Conclusión e implicancias para la práctica la pandemia aumentó el agotamiento de los trabajadores de Enfermería que utilizaron estrategias para atenuarlo; se destaca la diferencia que hay en la comprensión del origen del agotamiento y en la realización que sienten los trabajadores de las unidades dedicadas con su trabajo. Cabe destacar que es necesario monitorear la salud de los trabajadores de Enfermería que actúan en la pandemia.

Abstract Objective to analyze the self-perceived implications and strategies used by Nursing workers from COVID-19 and non-COVID-19 units regarding professional performance in coping with the pandemic. Method a multicenter and descriptive-exploratory study with a qualitative approach, developed at four hospitals in southern Brazil between January and May 2021. 19 workers from the Nursing team were interviewed, 10 of which were assigned to COVID-19 units and 9 to non-COVID-19 units. Thematic content analysis was performed. Results two categories emerged: (1) Emotional exhaustion and its impact on work, due to severity of the patients and high number of deaths in COVID-19 units and organizational changes and work overload in non-COVID units; and (2) Coping strategies used, similar in the units in terms of self-care, leisure, physical activity and spirituality, but different in terms of professional fulfillment, present in the COVID-19 units. Conclusion and implications for the practice The pandemic increased exhaustion in the Nursing workers who used mitigating strategies, highlighting the difference in understanding the cause of exhaustion and in carrying out the work felt by workers in COVID-19 units. The need to monitor the health of Nursing workers that were active during the pandemic is highlighted.