Cuidados paliativos e ser-para-morte: reflexões sobre um atendimento psicológico

Death is a theme that fascinates, though at the same time, frightens and uneasy the human being, despite the finitude being present at our daily lives. In each historical time, death has been represented in a peculiar way, from familiar death (at Middle Ages), to interdicted death (at contemporary times). Through this path it‟s possible to recognize several attitudes and stages front of death and the process of dying as possibilities of coping and the understanding of these occurrences. In other hand, the palliative care proposal came as a humanized attention, front of the human finitude, recognizing death as a part of the vital cycle. The Brazilian reality, in this context, still faces a lot of political, economic and social barriers that makes difficult the consolidation of palliative care at the death process in the Brazilian Health Care policies. Currently, according to the Brazilian Palliative Care Association, Brazil presents an average of 40 services with this proposal. Such data portray our inexpressive condition in relation to these cares when considering the territorial extension and population of our country. Considering this scenario is relevant think about death and the process of dying at contemporary times, at a health context in which palliative care, when trying to humanize the process of dying, bring to light the issue of human finitude and the beingtowards- death, as thought by the philosopher Martin Heidegger. According to him, the human being (Dasein) is constituted as a being-towards-death, once death is its most own potentiality-for-bein and its last possibility to be lived. In view of the ideas presented, the proposed study appears as a qualitative research of existential-phenomenological inspiration and aims to understand the experience of being-toward-death from the psychological care to a person out of possibilities of cure living on palliative cares. The psychological care happened at the patient‟s home, understanding the clinical process of being-with-the-other from the written reports of the psychology/researcher, by the accompanying sessions, configured as an experience report. These reports are focused on the experiences lived by the patient, as well as apprehended by the psychologist at the intersubjectivity relation and its own experience with Dasein and, therefore, being-toward-death. The reports were hermeneutically interpreted, from the senses that emerged in this process, considering the notion of being-toward-death proposed by Heidegger. Furthermore, it was important to dialogue with other authors that approached the studied theme. It is perceived, through brief and meaningful reflections about the clinical treatments started, that the experience of illness with no possibilities of cure makes the Dasein revises feelings and experiences that were marked at the temporality and historicity of existence. It is a stage of life in which the cultural dimension and the common sense of finitude, often gains ground in the human condition, taken in its ordinary sense, unlike the way it has been thought from an ontological and existential perspective of death. Thus, there are singulars and revealing paths in the palliative care scenery as possible ways for authenticity of being-toward-death

Sofrimento solitário, mal-estar compartilhado :um estudo sobre a doença dos nervos

Nerves has been perceived as generalized suffering with multiple complaints, such as pain and other physical sensations, usually followed by symptoms of anxiety and/or depression. Even after medications have been prescribed, mainly psychotropic drugs to reduce these symptoms, exams aiming to discover the causes of the disorders, and a significant referral to health services, the problem tends to get progressively worse. The objective of this study is to characterize the diseases of clients who complain of nerves at the Unidade Mista de Felipe Camarão, Natal/RN, through in depth interviews, allowing for the clarification of ideas, beliefs and the meanings attributed to nerves by that person; to identify the symptoms and to know how they interfere in daily activities; to investigate the causes attributed to the problem and their relation to the biographical and psychosocial context of the patient. Thirteen women, health service clients, aged 30 to 59 years old, participated in the research. It was observed that they perceive, feel and act in unique ways with relation to symptoms, as well as to the attributed explanations and treatments given, showing the influence of life conditions, family context and their own subjectivity. Daily concerns and overwhelming responsibilities in the domestic environment, which usually stem from their precarious survival conditions, as well as marital conflicts motivated by the inequity of gender relations, contribute to trigger this type of suffering. The methodology of the research itself proved to be crucial to the comprehension and understanding of the meanings attributed to the complaints as well as to the argumenting process and the redefinition of the illness experience. Therefore, the importance of interdisciplinary intervention must be emphasize and specially the role of listening as relevant intervention resource

O psicólogo e os serviços de acolhimento institucional para crianças e adolescentes

The Shelters are responsible for caring for children and adolescents whose families or guardians are temporarily unable to fulfill his role as care and protection. The activities to be developed by psychologists in these services are greatly important for the elaboration and development of political- pedagogical project of the same, and for reasons pertaining to the present and future of children and adolescents received judgments. The psychologist puts up the challenge of contributing to a better care of children, also cooperating with the implementation of the new care standards of childcare. The aim of this study was to investigate the role of the professional psychologist in assistance to children and adolescents in 13 Shelters in the Metropolitan Region of Natal/RN. For both set out to make visits to the institutions to know how it is organized the field work of the psychologist, his routine work and activities developed. Nine psychologists interviewed according to a semi-structured interview script. The data analysis is supported by the theoretical aspects of dialectical materialism historical and theme content analysis was used. Results were presented from three angles: psychologists and institutional framework; activities, resources and methods of work; psychologists and legal frameworks of the Institutional Hospitality. The study points out the recent entry of the psychologist in Shelters, combined with considerable turnover of these professionals. This work has been organized through the Individualized Service Plan, prioritizing the return to family of origin. Moreover, in general, perform joints with the service network, reporting, individual consultations and follow-adoption processes . Staff members, however, feel a lack of specific and continuing training on special protection, including due to the distance between the proposed theory and practice. It was thus observed a movement of psychologists distance themselves from welfare or repressive practices, however the structural difficulties of services and lack of continuing education appear to limit the development of a performance focused on the transformation of the reality of children and adolescents treated and their families

A clínica que se vive: reflexões sobre a prática da Psicologia clínica na contemporaneidade

The increasing search for the psychological attendance, express in the waiting list in the clinics, clinic-school and in the private clinics, beyond the increase of the choice of psychology as professional career among the pre-college students, allows us to reflect about the place that is occupied by the Psychology, nowadays. The main focus of this study is the clinical Psychology, an area of psychology. The interest in to deepen the reflection regarding of the place that the psychologist and his acting had been assumed in our society, emerged from our own actuation as clinical psychologist. Reflections concerning the suffering of man of our time, accompanying our inquietude while researcher and made us question about the actuation of clinical psychology, nowadays. This research aimed to understand how the clinical psychologists perceive their practice, attempting to get appointments regarding of what is to be clinical psychologist in contemporaneity, more specifically, in the face of the psychic suffering. Based on a phenomenological perspective of research were accomplished semi-structured interviews and a discussion group with clinical psychologists. From the obtained results, we arrived to the following conclusions: a) the most of participants considered the academic formation of the psychologist insufficient and far from social reality; b) the speeches revealed that there is still a relation between the practice of clinical psychologist and the medical model of attendance. Nevertheless, was observed a change in the new psychologists conception of clinic, but is still in development; c) in the most of speeches, we founded consensus about the idea of that the social context which the contemporaneous world lives, had generated new demands of suffering; d) the clinical listening is considered the specificity of the clinical psychologist. We believe that this study had been contributed to fomenting the discussion about the academic formation of clinical psychologist and, the concepts and models of clinic that now base the actuation of the professionals that are inserted on the work market

Impacto do trabalho em profissionais de Saúde Mental de serviços de saúde do município de Mossoró-RN, 2012

The Psychiatric Reform has brought profound changes in assistance to people affected by mental disorders and behavior. In this context, mental health workers have played decisive roles of great impact, acting driving the process. Objective: To evaluate the impact felt by working professionals, because of the daily work with people who have psychiatric disorders. Methodology: This is a search field, a quantitative approach, sectional, descriptive and applied. Data collection occurred through the Assessment Scale Impact of Working in Mental Health Services (IMPACT-BR) applied to mental health researchers city Mossoró - RN. Results: Participants in this study 87 professionals, mostly female married, which took charge of higher education, working on a single service, working in the area for more than six years, aged between 25 and 64 years. There were a low effect of overloading the professionals surveyed. Discussion: Our results corroborate findings in other surveys conducted previously, not identifying large impact load at work among professionals of mental health teams studied. Subscales studied the highest score was observed in measuring the impact of work on team functioning. It was observed that the greater age and duration of action, reduced the emotional impact at work, suggesting that the experience enhances safety in decisions made and the possibility of greater control over the demands of work. Final Thoughts: The work presented showed that the interactive relationships between professionals and users are not the causes of greatest impact in the workplace, although it revealed overload in relation to specific aspects such as: fear of being assaulted by a patient and the feeling of physical exhaustion the end of the workday. Further investigations should be conducted on this topic in order to contribute to the implementation of psychiatric reform proposed by advances both in terms of assistance to individuals and the quality of life in the work of the professionals involved

Avaliação da satisfação das usuárias sobre a atenção à saúde da mulher no Rio Grande do Norte

This work discusses the evaluation of the satisfaction of the users on the women health care focusing on the quality of the primary care in the State of Rio Grande do Norte-BR. The main objective of this research is evaluate the satisfaction of the users about the actions applied to women health in the primary health care in Rio Grande do Norte, observing the information available through the Programa de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB). The specific objectives are: the evaluation of aspects related to women health; the evaluation of the specific actions related to welcoming the pregnant and; the evaluation of the information related to the postpartum. This dissertation is characterized as an evaluative research made through a multicentric transversal study, using a quantitative approach, which is part of the External Evaluation of the PMAQ-AB in the State of Rio Grande do Norte, made by the Federal University of Rio Grande do Norte. Some secondary data of the interviews with the users who were in the Basic Health Units were used during the External Evaluation of the PMAQ-AB in Rio Grande do Norte. The sample was collected following these criteria: the users that were in the Basic Health Units to attend to any procedure; they must had used the services for at least one year; and they must had agreed to participate the research. The ones that were attending to the services for the first time and the ones that did not use the services for at least 12 months were excluded from the sample. To the data collection it was used a chart of variables/indicators with the following information to the analysis: Women Health Care, Specific Care of the Pregnant and Information about he postpartum. The descriptive analysis of the data were made through absolute and relative frequencies of the variables using the software Statistic Package for Social Sciences (SPSS) for Windows, version 22.0.0. The results show a positive picture of the satisfaction of the users about the actions of the primary healthcare in women health in the State of the Rio Grande do Norte. Another important analysis is the integration of the primary health care with other points of the Healthcare System aiming to reorient the Model of Healthcare as a starter of the access and quality of the services given to the users. Therefore, the evaluation of the satisfaction of the users in health care is essential among all the agents involved in the process of consolidation of the Unified Health System SUS. Also having the need of rethinking the professional practice, reorganizing the processes of work of the multiprofessional teams in health care, enabling financial resources, inputs and materials, planning and systematizing new actions of healthcare aiming to ensure a perfect health care to the people

Serviço Social e terceiro setor: considerações sobre as atuais relações e condições de trabalho para o Assistente Social em Natal

The present study analyses the actual relations and work conditions found in the third sector in Natal city, in the context of productive restoration and increasingly retraction from the State in providing Social Service before the new approach that has been destined to the social issue. The study talks about the work of the social worker when fighting the different expressions the social issue has, such as social service provision as a way of teamwork associated to work relations and conditions, to accessible resources and quality control management. These are elements that affect and interfere in the accomplishment and in the work of the social worker itself. The State s improvement, according to neoliberal-political precepts and increasingly retraction from the public investment in the areas of social concern (health, social welfare, assistance) and in the wage and employment policy, besides expanding the partnership with the public and private areas, in search for social services with quality, it has diversified the structures of the professional work with the growth of the so called third sector institutions. However, the absorption of the social workers by the third sector groups in general, has as major features the impoverishment of work relations, the maintenance of an unequal salary model, pointing out the deadline contracts and/or single tasks that generate work instability. The research debates, with a critical view and full perspective, over the conception of the third sector, interpreted as an action that expresses functions and values, treated as a real phenomenon generated from the restoration of the capital based on neoliberal principles. This study aims for responding what the established work relations are and under what work conditions the social worker has been fitting in the third sector and how such a reality echoes in the current work conditions for a social work in the city of Natal, before this new model of state intervention that transfers part of the social service provision to distinctive divisions of society, among them the so called third sector. The research results have shown that like the other workers the social worker passes through the same crises, dilemmas, advances and challenges that occur in the world of employment and which are expressed in the drop of salary average in the growth of contemporary contracts, unemployment, and in the ever more selective requirements to one be included in the social spaces, where the professional work is done, having as a result a greater impoverishment of work relations and conditions as well as more vulnerability as a salaried occupation

Câncer de mama: vivência das usuárias dos serviços prestados pela Liga Norte Riograndense Contra o Câncer

This study is about the users' experiences of the services offered by League Against Câncer that are in treatment of breast cancer, focusing on how the health/illness process develops. It is distinguished, in this context, the National Politics of Health, approaching the sprouting, implantation and consolidation process of the Unified Health System and its shocks on the installment of health services to the low-income population as a legit right from Citizen Constitution. It has as an objective to analyze how the social-economic extract of these women intervenes with such process, the aspects who involve the cancer while a pathology, approaching the signals, symptoms, forms of prevention, diagnosis, among other aspects that configure themselves as important points to the understanding of these experiences, since the diagnosis, treatment and control phases. The research was carried out with 25 women, between the months of January and February of year of 2005. The used technique was the scriptstructured interview, whose universe was defined through intentional sample. The following distinguishes as a result of the research: The majority of the women has its origins on the interior of the state, possesses a familiar income from one to three minimum wages and didn't make any kind of prevention before diagnosis, currently make treatment, beyond other aspects. It becomes necessary posterior studies on this social problematic, with respect to the personal, professional, familiar and social daily behavior of these women. It is worth mentioning that the role of the social assistant in the developed work with these women, understanding all the impediments associated with such experiences, as well as giving information about the rights of the patients with cancer, conquered through the years

Análise da percepção da qualidade ambiental e de serviços turísticos em João Pessoa/PB

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

Características econômicas do valor de uso e de não uso de parques sobre dunas

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior

A CRONIFICAÇÃO NOS SERVIÇOS SUBSTITUTIVOS NA REDE DE SAÚDE MENTAL DE NATAL/RN

Brazilian Psychiatry Reform, through Psychosocial Care Strategy, has intended to build insane people care practices from community care services which contemplates the subjects complete lives. However, to change the traditional care ways demands the facing of a series of epistemological, political and cultural obstacles. One of the current challenges deals with patients aggravation processes, with management ways, with devices and with professionals, as well as with the assistance network. The purpose of this thesis was to investigate how these aggravation processes has been constituted in Natal mental healthcare network, understanding its effects in the work teams and patients. Theoretical and methodological perspective used was Institutional analysis was, subsidizing the usage of concept-tools as the implication analysis, selfmanagement and self-analysis, and restitution. The research was carried out at the Natal East Sanitary District Mental Healthcare Clinic, with the participation of technicians and patients. The research procedures were: literature and document research on the attendance and the analyzed theme; attendance registers analysis; participating observation of the institutional routine for three months and field log entries; talking groups, one with the team and one with the patients. Two main discussion points are shown: 1. The mental healthcare clinic organization logic and the intersector politics; 2. The work and management processes developed at the mental healthcare clinic. The analysis show diversity in the attended demands in the service, which has favored the patients aggravation, this device and the substitute network processes. The work processes are apart from the political sphere and from the managements processes. In this sense, we show the need to reevaluate the clinic device as well as the management models adopted in the Brazilian Psychiatry Reform context

A erosão costeira e sua influência sobre a atividade petrolífera: alternativas sustentáveis na mitigação de impactos ambientais

The study area consist in high sensitivity environments located on the northern coast of Rio Grande do Norte, Northeast Brazil. The barrier island are the main geomorphological features on the coastal landscape, being naturally instable and surrounded by industrial activities like oil fields, salt industry, shrimp farms and urban areas sometimes installed parallel to the coast, combined with coast engineering interventions. High energy hydrodynamic process are responsible for the morphological instability of the coast. The study was based on remote sensing data obtained between 1954 and 2007 which consist in orbital images from Landsat, CBERS and Ikonos satellites and aerial photos. With all data integrated on GIS environment it was possible to update thematic maps of geology, geomorphology, vegetation, soil and landuse and development of multitemporal maps pointing areas with erosion and depositions of sediments, defining the critical erosion process on this region. The bigger morphological changes are related to changes on wind patterns during the year, terrestrial and sea breezes during the day, with spits and barrier island migration, opening and closing of channels like the one parallel to the coast on the area of Serra and Macau oil fields. These factors combined with the significant reduction on sediment budgets due to the loss of natural spaces to sediment reworking contribute to the low resilience which tends to be growing on the area of Serra and Macau oil fields. In front of such scenery a detailed monitoring was done in order to find technological possibilities for coastal restoration. A pilot area was defined to start the project of mangrove restore together with beach nourishment in order to minimize the effect of the erosion caused by the channel parallel to the coast, contributing to stabilize the northeast channel as the main one. It s expected that such methodology will aid the coastal environments restoration and the balance between industrial activities and coastal erosion

Sobre pedras, entre rios: modernização do espaço urbano de Caicó/RN (1950/1960)

thèse de maîtrise, qui a été idealizée et exécutée à partir de la réunion et les relations dialogiques établies entre la géographie et l'histoire, et l'espace et le temps, a considéré l'environnement urbain comme le thème général et, comme la référence empirique, l'espace urbain de Caicó, incrusté dans les terres semi-arides du Sertão do Seridó Potiguar, plus précisément à la mi-sud de l'État du Rio Grande do Norte. Dans cet espace, à travers de recherche des fragments de mémoires acquis de diverses sources historiques, on a tenté de faire des investigations sur les transformations urbaines qui ont eu lieu dans la ville au cours des années 50 et 60 du XXe siècle. Ces transformations, dans l espace urbain de Caicó à un moment du pic de l'activité de développement de coton, reflétaient et conditionnaient les propres projets de modernization urbaine qui représentants des élites locales eurent conçu avec l'objectif de la construction d une ville idéal dans les regions isolées du Seridó: moderne, civilisé, progressive et capitale régionale du Seridó. Pour cette construction, les nouveaux équipements et services urbains ont passé du plan imaginaire à l espace réel, installés dans plusieurs quartiers de la ville en transformant le paysage urbain. Face à cette situation, cinémas, magasins, station de radio, énergie électrique, institutions de l'éducation, téléphonie, maison de soins infirmiers, usine de bénéficiement de coton, banques, politiques urbaines, hygiéniques et sanitaires, modes de comportement, sociabilités urbaines distincttes, parmi d'autres éléments géographiques se sont institués à travers la réalisation de certains idéaux de progrès social et dans un esprit de modernité urbaine, dans de nouveaux espaces et pratiques inventés, tramés et éprouvés sur les rochers et entre le cours d eau au milieu d'un quotidien urbain marqué par ruptures et permanence de certaines coutumes et habitudes antiques et de certains paysages et environnement ridé

A reafirmação do bairro:um estudo geo-histórico do bairro do Alecrim na cidade de Natal-RN

By the end of the 21st Century, economy globalization trends to show a velocity process through which market being expanded characterized by an intense going on of the internationalization of finance, after that marginalizing the periphery of the social spaces. It is clear to see that this process occurred in those less developed countries happens in an accentuated way just because income distribution that is so regressive and also because the insufficient enclosing of the social programs, we find this situation in a big part of Brazilian cities. The marginalizing social economical process observed in Natal, a city located in the east coast part of Northeast region in Brazil and that owns a population upper to 778 thousand in habitants is nearly linked to the extension of goods and services commerce. The installation of new urban activities in the city pointed out tourist activity as the greater impulsive thing in the phenomenon promotion, most of them aiming to promote Natal to the national and international scenery. It privilege strongly in the South zone with economical implementations such as shopping s centers, supermarkets, and home buildings condominiums leading to a loss of functionality of some traditional district located in central areas of the city. Notwithstanding, some spaces, for instance Alecrim district officially created in 1911, has notably resisted to the expansion of the urban process pointed out in Natal in the last years. So that this put Alecrim District as a district with originally characteristics reaffirmed along the historical process form old times. The predominance of some residential characteristics such as the incidence of some villages and a concentration of a big and confuse popular commerce distributed along streets puts Alecrim District as a resistant space in Natal. The same way analyze Alecrim District under the prism of Historic Geography because we understand this way it accomplishes a fundamental role in the theoretical methodological development of our work, just when we analyze the time as a variant in our object of study. It is still inside this theoretical field that we carry out a brief reviewing about quarter/district definition, under the optic from several registered and scientific resources taken into account along this work, because we understand that it was necessary to think this important spatial unit especially to know exactly what we are referring to as a district and so we can reaffirm Alecrim as an important and traditional district to Natal and it has been resisting to spatial transformation verified in the last years in Natal city. To give support to our reflection we used methodological tools related to inhabitants lifestyles knowledge and also the study of Alecrim District as a space that promote a certain centrality in Natal as some indicators to keep original characteristics in the district in Natal

O circuito espacial produtivo e os círculos de cooperação da carcinicultura do Rio Grande do Norte

Suponiendo que la dinámica territorial del período histórico actual se caracteriza por la nueva división territorial del trabajo, por la especialización regional productiva y por la racionalidad que preside el movimiento de las mercancías y de la información, la teoría de los circuitos espaciales de producción se convierte fundamental para la comprensión de la organización, regulación y del uso de territorios por las actividades productivas. Así, teniendo en cuenta este supuesto y aplicando esta teoría para analizar el área de la producción de camarón en el estado de Rio Grande do Norte, se llega a comprender la dinámica del territorio Potiguar. Por lo tanto, en nuestro trabajo pretendemos entender el movimiento, la secuencia de los casos que geográficos que separan la producción, distribución, intercambio y consumo de camarón Potiguar, en este momento, sobre todo a partir de la década de 1990, sucede la expansión del cultivo de camarón en la costa norte Riograndense. La investigación ha demostrado que a pesar de la presencia de un gran número de agentes en la actividad, hay un control y una concentración del circuito en las manos de grandes empresas. Este control se pasa por el reducido número de agentes de venta de larvas, alimentación, maquinaria e insumos. Y con respecto a la concentración, esto ocurre sobre todo en la etapa de producción en las haciendas de engorde. En este caso, podemos decir que hay un predominio de los pequeños productores en números absolutos en el cultivo de camarón potiguar, ya que gran parte de los emprendimientos tienen dimensiones inferiores a 10 ha. Sin embargo, cuando analizamos las empresas de gran escala, éstos, a pesar de representar un porcentaje menor del total, concentran casi la mitad de las áreas cultivadas, además de tener en el control de gran parte del movimiento establecido por el circuito espacial productivo de la producción de camarón. Así, aparecen en el circuito espacial productivo de la producción de camarón de Rio Grande do Norte, las diferencias cualitativas de los usos del territorio entre los agentes que participan de este circuito. Porque un número limitado de agentes tienen las mayores áreas productivas, son dotados de un mayor nivel de tecnificación y tienen, hasta cierto punto, el control del movimiento de su producto, mientras que, eso no se reproducen por otros agentes, especialmente aquellos dedicados a la producción, efectiva, en las haciendas de engorde