A inclusão do aluno com deficiência mental no ensino médio: um estudo de caso

La défense d une école inclusive dans les forums internationaux du monde entier a stimulé l adoption de politiques éducationnelles d inclusion et la pratique d inclusion dans les écoles, de sorte à ce que la scolarisation des élèves aux besoins éducatifs spéciaux dans les classes comunes est devenue une réalité dans la majorité des systèmes d éducation. Et pourtant, l inclusion scolaire, au Brésil, avance à pas lents et pose d innombrables questions, notamment quand il s agit de l inclusion des personnes qui présentent une déficience mentale dans les niveaux d enseignement plus avancés. Basé sur ce fait, et tout en considérant que les études et recherches sur ce thème, au Brésil, sont centrées majoritairement sur l éducation enfantine et les séries initiales de l enseignement fondamental, cette étude se propose d analyser l inclusion d une élève ayant une déficience mentale, inscrite dans l Enseignement Moyen, dans une école appartenant au réseau d enseignement de l Etat, dans la ville de Natal RN. Pour répondre aux questions proposées dans cette étude nous avons fait appel aux méthodologies qualitatives, du genre Etude de Cas, et au cours de sa réalisation avons utilisé l interview demi-structurée et l observation libre dans l ambiance naturelle de l école. Ont participé de l étude, en plus de l élève qui présentait une déficience mentale, sa mère et deux segments de l école, desquels ont fait partie trois professionnels de l équipe administrative pédagogique et quatre enseignants. L analyse des données a mis en relief la résistence de l école à répondre au projet pédagogique d éducation inclusive, aspect qui a un rapport très étroit avec les spécificités de l Enseignement Moyen, la structure traditionnelle d un enseignement basé sur l idée d une classe homogène, et le bas niveau d attentes des éducateurs concernant les possibilités d apprentissage et de développement de l élève handicapée mentale. De surcroît, le manque de directives pour conduire les adaptations pédagogiques et du curriculum à l école ont rendu fragile l action des enseignants, dont le résultat est une pratique d intégration rudement malmenée. Au travers des points de refléxions suscités par cette étude, nous considérons que l inclusion des élèves qui présentent une déficience mentale doit être centrée sur une pratique pédagogique qui repousse l idée de soumettre tous les élèves à des procédures universelles cristalisées sur des pratiques imposées par les contraintes d homogénéisation, et qui, contrairement, puisse trouver à l école des conditions favorables au développement de chacun, au travers des processus d apprentissages formés par des instances de médiation et d interaction sociales

Representações sociais de familiares sobre o atendimento das emergências psiquiátricas

The reformist movements in the field of mental health have pointed battle flags, among which the prioritization of production of mental health care out of the asylum environment should be highlighted, aiming the reduction of psychiatric beds, greater control over the hospitalization, family co-participation and the rescue of the citizenship of the social players involved. With the progressive reduction of asylum beds, associated with a lot of structural problems in the health services, the occurrence of crises outside the hospital environment has been increasingly frequent, thus giving the family an important therapeutic role. In face of this scenario, there is an urgent need to understand the social construction of the care for psychiatric emergencies, identifying the meanings assigned by family members to their constituent aspects. This study seeks to answer the following research question: what are the social representations of family members about the care of psychiatric emergencies in the city of Mossoró, Rio Grande do Norte? Therefore, the aim is to analyze the social representations of family members about the care of psychiatric emergencies in the city of Mossoró, Rio Grande do Norte. This is an exploratory and descriptive study, with a mixed approach, making use of multimethods: for collection, the semi-structured interview and the Technique of Free Association of Words; for data analysis, the Thematic Analysis of Bardin and its steps was used, with the informational support of the softwares ALCESTE (Analyse Lexicale par Contexte d'un Ensemble de Segments de Texte) and Iramuteq (Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires); and the theoretical support of social representations. The study participants totaled 72, and they were selected from the following criteria: older than18 years, with degree of kinship with users suffering from some mental and behavioral disorder, and who have already witnessed a situation of crisis, rescued by the SAMU or other means and taken to the psychiatric hospital or general emergency room. Preliminary results point out: 1.Previous note of the research project with the aim to disseminate it in the scientific community and ensure the intellectual property of the work; 2.The contextual analysis of the care for emergencies in the study place. Reflection about the phenomenon provide a name to the care for the psychiatric emergencies, which is called immediate context; the technical and operational aspects that influence the care, as a specific/ general context; and mental health policies in Brazil are identified as metacontext; 3. The systematic review from randomized clinical trials in the databases PubMed, COCHRANE, LILACS, SciELO and SCIRUS, with the use of the descriptors: ‘Physical restraint’, ‘Psychiatric emergency services’, ‘Restraint’, ‘Physical and Emergency Services’, ‘Psychiatric’. Only one work met the search protocol criteria: a short-term essay that records limited results about the proportion of people who are in restraint and seclusion. It does not show statistically significant results in relation to indications, contraindications and risks of the use of physical restraint; 4. The social representations of the care for psychiatric emergencies. The study results point to the presence of five thematic categories: 1. feeling in the face of the crisis/care; 2. thoughts and perspectives about the crisis/care; 3. centrality of care in the medical- medication-hospitalization triad; 4. the thinking/acting in the face of the use of physical restraint and police force; 5. periodicity of crises. The central core of the representation is in the first category, whilst the peripheral elements are in the third and fifth categories. The contrast zone is in the second and fourth categories. The sadness is the most prominent element of the structure. The social representations about the care for psychiatric crises are at a time of transition between the hegemonic and reformist models, with the traditional aspects being predominant, but already showing peripheral and contrast elements that point to a possible change in the representational field.

Avaliação do cuidado de enfermagem na perspectiva da segurança do paciente em unidades de terapia intensiva: na visão de profissionais, pacientes e familiares

Technological advances combined with healthcare assistance bring increased risks related to patient safety, causing health institutions to be environments susceptible to losses in the provided care. Sectors of high complexity, such as Intensive Care Units have such characteristics highlighted due to being spaces designed for the care of patients in serious medical condition, when the use of advanced technological devices becomes a necessity. Thus, the aim of this study was to assess nursing care from the perspective of patient safety in intensive care units. This is an evaluative research, which combines various forms of data collection and analysis in order to conduct a deepened investigation. Data collection occurred in loco, from April to July 2014 in hospitals equipped with adult intensive care unit services. For this, a checklist instrument and semi-structured interviews conducted with patients, families, professionals were used in order to evaluate the structure-process-outcome triad. The instrument for nursing care assessment regarding Patient Safety included 97 questions related to structure and processes. Interviews provided data for outcome analysis. The selection of interviewees/participants was based on the willingness of potential participants. The following methods were used to collect data resulting from the instrument: statistical analysis of inter-rater reliability measure known as kappa (K); observations from judges resulting from the observation process; and added information obtained from the literature on the thematic. Data analysis from the interviews was carried out with IRAMUTEQ software, which used Descending Hierarchical Classification and Similarity analysis to aid in data interpretation. Research steps followed the ethical principles presented by Resolution No. 466 of December 12, 2012, and the results were presented in three manuscripts: 1) Evaluation of patient safety in Intensive Care Units: a focus on structure; 2) Health evaluation processes: a nursing care perspective on patient safety; 3) Patient safety in intensive care units: perception of nurses, family members and patients. The first article, related to the structure, refers to the use of 24 items of the employed instrument, showing that most of the findings were not aligned with the adequacy standards, which indicates poor conditions in structures offered in health services. The second article provides an analysis of the pillar of Processes, with the use of 73 items of the instrument, showing that 50 items did not meet the required standards for safe handling due to the absence of adequate scientific guidance and effective communication in nursing care process. For the third article, results indicate that intensive care units were safe places, yet urges for changes, especially in the physical structure and availability of materials and communication among professionals, patients and families. Therefore, our findings suggest that the nursing care being provided in the evaluated intensive care units contains troubling shortcomings with regards to patient safety, thereby evidencing an insecure setting for the assistance offered, in addition to a need for urgent measures to remedy the identified inadequacies with appropriate structures and implement protocols and care guidelines in order to consolidate an environment more favorable to patient safety.