Perfis e práticas dos profissionais de saúde mental em dois hospitais psiquiátricos de grande porte

In the Brazilian network of psychosocial care, health professionals are important actors in the process of transformation of mental health public policies among various services. In the reality of psychiatric hospitals, one should understand the need to expand the debate about the current context of practices developed. This study aimed at analyzing the process of psychiatric reform and the mental health policy in the State of Rio Grande do Norte (RN) from the profiles and practices of higher-level professionals in two psychiatric hospitals. This is a cross-sectional and descriptive research, with quantitative and qualitative data, conducted in two psychiatric hospitals of RN. The universe of the target population was 95 professionals, taking into account the margin of error of 8%, non-response rate and the inclusion criteria: holding effective link with the institution by means of approval in public examination for, at least, six months, being state or municipal servant; having a minimum weekly workload of 20 hours in service; participating in care and/or activities with patients and families in a direct way. The final sample consisted of 60 professionals. The tool for data collection was a questionnaire with closed and semi-open questions about socioeconomic profile, and mental health policies, practices and training. Quantitative data were tabulated in the statistical software SPSS, and simple and bivariate statistics, chi-square type, was used for analysis by adopting the significance level with the value p<0,05. In order to analyze data, the content analysis of Bardin was used. The qualitative findings obtained with the semi-open questions in Analyse Lexicale par Context d'un Ensemble de Segments de Texte (ALCESTE) were grouped into four thematic axes: Professional action in mental health; Mental health training; Scenarios of psychiatric reform and psychiatric hospitals; Mental health policies and practices: challenges for professionals in hospitals. The profile of professionals has revealed the majority of women (89,7%), nurses (36,7%), aged 50-59 years (42,9%), weekly workload of 40 hours (52,4% ), time of completion of graduation from six to 15 years (57%), and 21,4% reported to have specialization in mental health. Regarding the practices developed in individual care, it was found an association between those who do not build or partially conducts the therapeutic project and those who conduct care related to observation and annotation. In family care, it was obtained care consultation during crisis; and, in group care, recreational activities. In the analysis of thematic axes, it was noted that, despite changes identified in the profiles and practices of higher-level professionals in care services for mental health, with the implementation of new public policies for this field, the findings indicate the confluence of asymmetries and divergences in the actions of the teams in psychiatric hospitals, difficulties in managing services, frequent readmissions, reduced quantitative of available services and equipment, high demand of users, disarticulation of the network of psychosocial care, and the very shortage of skilled human resources to compose these services. Accordingly, the evidenced scenarios partially outline the current political and ideological mismatch of the national process of psychiatric reform that denies the role of care actions conducted within hospitals, although it has not gone far enough with the creation of new services that justify the total extinction of this institution

Processo de construção do conhecimento a partir do diálogo ensino-serviço na ótica dos profissionais de saúde

INTRODUCTION: In Brazil, the health training policies have been going through deep changes, which are the fruits of the sanitary reform and of the breakage with the biomedical model, still hegemonic. Nevertheless, the paradigm of comprehensiveness is being introduced in health and, in order to consolidate this concept, the training has been gaining new methodological approaches. One can mention the teaching-service interaction (education-health system/citizenship health), whose proposal enables the expansion of the perception of the health-disease process, as well as the warranty of compromises of training in relation to SUS. OBJECTIVE: Understand, from health professionals, the relevance of teaching-service-community interaction, vocational training of students of the Faculty of Health Sciences / UFRN. METHODOLOGICAL PROCEDURES: This study is grounded on qualitative approach. The technique used to obtain research data was the focus group. Two focus groups (FG) were accomplished in two family basic health units of the municipality of Santa Cruz – RN, where there is participation of professionals of the Family Health Strategy. The discussions were performed from a previously elaborated script. The analysis of results was held from the categorical thematic content technique. RESULTS: The study had the participation of 18 health professionals, and 13 (72%) were females. For these professionals, the teaching-service interaction enables the student to understand the model of comprehensive health care, since the contact with the community enhances its perception about the health-disease process, but also enables recognizing the importance of teamwork to comprehensive health care. FINAL CONSIDERATIONS: The results highlight the importance of a policy of reorientation within the context of training so that students have an early contact with the service and therefore develop technical skills within the context in which they are inserted.

Preceptoria em profissionais de saúde: viabilizando meios para uma formação pedagógica em hospitais públicos em Natal-RN

This study aimed to construct and carry out a distance course of pedagogical training for health professional performing preceptorship functions in public health institutions. The preceptorship in health is a pedagogical practice that occurs in workplace, led by assistance professionals with teaching position or not, where the vast majority of these acts intuitively, reproducing their own training, confusing transmitting information with education. These preceptors often do not dominate the pedagogical knowledge, necessary for the organization of training activities, such as the various teaching-learning processes and the different assessment types. Student supervision is essential in the training process of students in the health field, and on the occasion of supervised internships that the teaching-learning process is based on practical experience with participation in real life situations and professional work. It was realized an exploratory study, descriptive with qualitative approach, with the development of tutoring teaching course in health as final product. Applied semi structured research instrument from may to july 2014. It were evaluated 162 health professionals who perform the preceptorship, which made it possible define the preceptor's profile and identify the educational requirements related to the educational process, which justified the construction of the program content and the professionals’ perception analysis about preceptorship through identification of three categories: clinic knowledge valuation; valuation of professional orientation and valuation of professional future. The course was available on distance mode through Moodle platform with forty hours of work load from October to November 2014. With the aim of capacitate the health professionals to development of necessary abilities and skills to tutoring performance through thoughts about tutoring concepts, professional training within the curricular guidelines and SUS precepts, the role of health professionals as educators, application of active teaching methodologies, and evaluation methods. The applications were done online through the provided link; 300 vacancies offered, 243 professionals applied, chosen 134 that works on tutoring, where 49 represented professionals that works on the location of the study. The course lasted 45 days, and counted with tutors responsible to interact and evaluate the students. 28 professionals joined the course, 12 concluded. Opportunities were identified to stimulate the involvement, however the professionals’ satisfaction shows that, make an investment on tutors education, starting from the Permanent Education precepts, will provide a bigger appropriation of the knowledge to the education and therefore the awareness of their role as an educator on work ambit, proportioning essential tools to tutors act while enabler of integration between theory and practice and result better teaching-learning process.

Reanimação neonatal: capacitação de profissionais de saúde com base na aprendizagem baseada em problemas

In whole world, including in Brazil, there is an absence of professionals who are able to be present at the moment of birth and give to the newborn the cares that they need to because either an absence of opportunity or inappropriate training to those professionals. This master´s thesis describes a construction and application of a neonatal resuscitation course that uses the problem based learning (PBL) methodology. The course has done in two meetings, one for the tutorial session, and another for practice session. The students were divided in groups of eight students each, under supervision of two teachers with experience in PBL methodology. The experience was considered successfully because there were students involvement and motivation. Some course aspects were rebuilt for its upgrading, like the correct use of methodology and building of custom educational material for students learning necessity. It suggests that the course can be used by the medical and nursing schools and perhaps other kind of health courses.

Visão dos profissionais de saúde frente à possibilidade de infecção de HIV/Aids em idosos

The HIV/Aids epidemic is today, in Brazil, a phenomenon of great magnitude and extent. The disease progresses over a physically weakened, and with more complex approach, portion of the population: the elderly. This study has the objective to know the vision of health professionals facing the possibility of HIV/Aids in the elderly. It is a cross-sectional observational study conducted in the city of Uberlandia, Minas Gerais, Brazil, from November 2013 to December 2015, with the participants Doctors, Dental Surgeons and nurses stationed in the Municipal Network of Primary Care, with a sample of 220. Using factor analysis, factors unrelated to the training of health professionals and others directly related; only the latter showed differences between the professions. The investigation of the professional view on the possibility of infection of HIV/Aids in the elderly should be crafted specifically for each type of professional, meeting the specific difficulties of training each degree course. It is crucial the need to update each professional in the health care field in order to be able to make an early diagnosis aimed at protecting the elderly patient's integrity affected by HIV/Aids.

Representações Sociais da Doença Mental: um estudo qualitativo com profissionais da Saúde Mental

Este trabalho pretende conhecer as representações sociais de Psiquiatras, Internos de Psiquiatria, Pedopsiquiatras e Psicólogos Clínicos sobre a doença mental em quatro dimensões: (1) conceptual – conceitos de saúde e doença mental, (2) explicativa – causalidade da doença mental (3) interventiva – modelos de intervenção e objetivos da prática clínica, e (4) contextual – influência do contexto na prática clínica. É um estudo qualitativo de carácter exploratório, pontuado epistemologicamente pelo construcionismo social e teoricamente pelo quadro das representações sociais. Participaram 30 profissionais (13 Psicólogos, 10 Psiquiatras, 5 Internos de Psiquiatria e 2 Pedopsiquiatras) aos quais foi aplicada uma entrevista semi-estruturada que foi analisada quanto ao seu conteúdo (através do software NVivo 10). Da análise dos resultados salienta-se que as representações dos profissionais quanto à conceptualização da doença mental são heterogéneas. A saúde mental é equacionada como flexibilidade, adaptação, funcionalidade e bem-estar biopsicossocial do indivíduo. A causalidade atribuída à doença mental assenta no modelo interacionista biopsicossocial. Quanto à intervenção, os participantes utilizam estratégias e modelos de intervenção ecléticos, salientando-se como objetivos a promoção do bem-estar e diminuição do sofrimento, a promoção do funcionamento e autonomia e a “cura”. O contexto institucional surge como comprometedor da liberdade de atuação na prática pública e como facilitador da liberdade de atuação do clínico na prática privada. Conclui-se que a análise individual (disposicional) do comportamento patológico é privilegiada em detrimento da análise contextual (situacional). Implicações do presente estudo para o quadro teórico das representações sociais da doença mental são consideradas. / The present aims to acknowledge the social representations about mental disease of Psychiatrists, Psychiatrist Interns, Child Psychiatrists and Clinical Psychologists. Four dimensions were considered: (1) conceptual - concepts about health and mental disease; (2) descriptive – mental disease causes; (3) intervention – models for clinical intervention and clinical procedures; and (4) context – influence of the context in clinical procedures. A qualitative and exploratory study was developed based, epistemologically, on social constructionism and social representations. Through the course of the research 30 semi-structured interviews were conducted (13 psychologists, 10 psychiatrists, 5 Internal Psychiatry and 2 child psychiatrists) to which it was applied a semi-structured interview. A content analysis of the interviews was performed by NVivo 10. Results showed that the social representations of mental disease are heterogeneous. Mental health is conceptualized according to the flexibility, adaptation, functionality and the biopsychosocial well-being of the individual. The causality of mental disease is explained by the interactionist biopsychosocial model. Professionals mainly adopt eclectic intervention models and strategies in clinical practice. Participants refer that their goals are to promote the well-being, diminish the suffering and promote the functioning, the autonomy and “cure”. The public institutional framework compromises the flexibility in the clinical procedures. Private practices increases the procedural possibilities of the professionals. Concludes that the individual analysis (dispositional) of the pathological behavior is privileged in detriment of the contextual analysis (situational). Implications of this study to the theoretical framework of social representations of mental illness are considered.

Condições de trabalho e saúde na perspectiva de bem-estar : um estudo realizado com os profissionais de saúde da Policlínica Zona Oeste de Natal/RN

This study had like general objective analyzed the relation observed between working conditions and healthy, in the welfare perspective, by the Policilínica Zona Oeste´s healthy professionals. Were used like theoretical bases the categories of working conditions of Borges et al. (2013): working conditions and contractual legal; physical working conditions and materials; working conditions and characteristics of the work processes and working conditions and social management. For the analise of personal wellness in the job, were used the categories of Dessen and Paz (2010): friendship relations, relationship with the organization, growth opportunity, relations with customers , valuation and realization. For this, this research use the descriptive statistic and Bardin (1977) ´s content analysis besides the help of Manyeyes software, using the word clouds and trees words. Was possible identify that the working conditions have strong relations with the health of the health professionals of Policlínica, mainly about the physical and materials conditions that are precarious and influences the other dimensions of working conditions and conditions health. The welfare professionals is spoiled in the dimensions of realization and growth opportunity and influences the professional´s health

Percepção dos profissionais de saúde do Hospital Municipal do Huambo-Angola sobre a fisioterapia: projecto de implementação de um serviço de fisioterapia

Mestrado em Fisioterapia.

Profissionais de saúde VS formação contínua: nas tecnologias da saúde

O presente trabalho tem por objectivo descobrir as estratégias utilizadas pelos Técnicos de Diagnóstico e Terapêutica Coordenadores das áreas das Tecnologias da Saúde, na avaliação da gestão da formação contínua dos colegas que coordenam. O estudo é qualitativo e enquadra-se numa metodologia de estilo etnográfico exploratório, que tem por finalidade, aprofundar e descrever as estratégias utilizadas para a avaliação da gestão da formação contínua dos Técnicos de Diagnóstico e Terapêutica. Os dados foram obtidos através de entrevistas aos Técnicos de Diagnóstico e Terapêutica Coordenadores de um hospital de Portugal continental. Os resultados revelaram que os Técnicos de Diagnóstico e Terapêutica Coordenadores não aplicam estratégias para avaliação da gestão da formação contínua dos colegas que coordenam, e ainda, constatou-se a falta de informação sobre o processo de gestão da formação contínua. Os resultados obtidos evidenciaram lacunas relativamente às estratégias de avaliação da gestão da formação contínua dos Técnicos de Diagnóstico e Terapêutica, para as quais sugerirmos um modelo e algumas medidas de intervenção que vão de encontro à problemática aflorada no presente trabalho. ABSTRACT; The purpose of this work is to discover the strategies used by the Technicians of Diagnosis and Therapy, coordinators of the areas of Health Technologies, in the evaluation of management of continuous formation of the colleagues they coordinated. The study is qualitative and fits an ethnographic exploratory stylized methodology, its purpose based on developing and describing the strategies used to evaluate the management of the continuous formation of the Technicians of Diagnosis and Therapy. The data was obtained through several interviews to the Technicians of Diagnosis and Therapy coordinators of and hospital of the Continent of Portugal. The results revealed that the Technicians of Diagnosis and Therapy do not enforce strategies for the evaluation of management of continuous formation of the colleagues they coordinated; furthermore, it was made evident the lack of information about the process of the management of continuous formation. The data obtained revealed gaps concerning the strategies of the management of the continuous formation of the Technicians of Diagnosis and Therapy, to which we suggest a model and some measures of intervention which will meet the problematic explained in this work.

Angústia de morte sentida pelos profissionais de saúde, face aos doentes em fase terminal

O presente trabalho aborda as dificuldades sentidas pelos profissionais de saúde perante os doentes em fase terminal. É importante percebermos como é que os profissionais de saúde se preparam psicologicamente para tratar dos pacientes com o profissionalismo que lhes é pedido. O trabalho recai, na tentativa de verificar, a forma como conseguem “escapar” a esta ligação directa com a morte. Participaram neste estudo do tipo exploratório, 4 enfermeiras e 1 médica da Unidade da Dor do Hospital Garcia de Orta, que através de entrevistas semi-directivas, descreviam as suas experiências. Abordámos o percurso profissional, as dificuldades no dia-a-dia, as situações mais gratificantes, a função da equipa e o processo de luto. Nos resultados obtidos, utilizámos como método a análise de conteúdo. Os resultados destacaram a identificação, como a maior dificuldade, lembrando desta forma que os profissionais de saúde, também sofrem com a perda dos doentes, como se de alguém próximo se tratasse, complicando a relação profissional e levando a que normalmente se usem mecanismos do evitamento. Concluímos que é indispensável o apoio da equipa multidisciplinar, de forma a acolher todos os acontecimentos que provocam desconforto e angústia em relação à morte, por mais mecanismos utilizados é impossível dissociar a relação profissional da pessoal.

A perspectiva dos profissionais de saúde nas inovações de gestão: Estudo de caso numa unidade de saúde

A necessidade de conciliar uma procura cada vez maior com as restrições de recursos humanos e financeiros levou a que se implementasse um conjunto de inovações que permitisse alcançar maior eficiência. No presente estudo aborda-se uma dessas iniciativas: os Hospitais SA. As implicações originadas por esta medida, ocorreram em termos de alterações de gestão e adopção de novos conceitos. Estas são algumas das dimensões estudadas. Em termos metodológicos pretende-se perceber como é que alguns dos profissionais de Saúde avaliam as modificações que ocorreram. Para tal, optou-se por levar a cabo um estudo de caso de um Hospital SA da região de Lisboa e Vale do Tejo, numa abordagem qualitativa, visando identificar a perspectiva dos profissionais de saúde nas inovações de gestão, relacionadas com as novas tecnologias, das quais se destacam: • Utilização da Internet; • Implementação e utilização da Intranet; • Desenvolvimento de Arquivos Digitais relativos a processos médicos; • Cartão Vital; • Aplicação Medivital. Para a recolha de dados será utilizada uma entrevista sarni-estruturada “que atribui maior liberdade ao investigador para conduzir a entrevista como achar ser mais conveniente, para a obtenção de dados que se revelem pertinentes" (Patton, 1990). Abstract; The need to conciliate the increasing search for healthcare over time with the restrictions of human and financial resources conducted to the implementation of a set of innovations that allowed a greater efficiency. ln the present study, one of those initiatives is presented: in the Hospitais SA. The implications of this measure occurred in terms of management modifications and in the adoption of new concepts. These are some of the studied dimensions. ln methodological terms, it’s intended to perceive how health professionals evaluate the modifications that occurred. For such, it was opted to present a case study of a Hospital SA from Lisboa e Vale do Tejo region, in a qualitative approach, aiming to identify the health professionals perspective of the management innovations related to the new technologies, from which the following, stand out: • Internet usage; • Implementation and use of Internet; • Development of Digital Archives related to medical processes; • Vital Card; • Medivital application. For data gathering a half-structuralized interview will be used "which gives greater freedom to the researcher to conduct the interview as he finds most convenient, in order to obtain relevant data" (Patton, 1990).

Condições de trabalho e saúde na perspectiva de bem-estar : um estudo realizado com os profissionais de saúde da Policlínica Zona Oeste de Natal/RN

This study had like general objective analyzed the relation observed between working conditions and healthy, in the welfare perspective, by the Policilínica Zona Oeste´s healthy professionals. Were used like theoretical bases the categories of working conditions of Borges et al. (2013): working conditions and contractual legal; physical working conditions and materials; working conditions and characteristics of the work processes and working conditions and social management. For the analise of personal wellness in the job, were used the categories of Dessen and Paz (2010): friendship relations, relationship with the organization, growth opportunity, relations with customers , valuation and realization. For this, this research use the descriptive statistic and Bardin (1977) ´s content analysis besides the help of Manyeyes software, using the word clouds and trees words. Was possible identify that the working conditions have strong relations with the health of the health professionals of Policlínica, mainly about the physical and materials conditions that are precarious and influences the other dimensions of working conditions and conditions health. The welfare professionals is spoiled in the dimensions of realization and growth opportunity and influences the professional´s health

As atitudes e conhecimentos dos profissionais de saúde mental face aos grupos de ajuda mútua na doença mental no contexto público e privado

Dissertação de Mestrado apresentada ao Instituto Superior de Psicologia Aplicada para obtenção de grau de Mestre na especialidade de Psicologia Clínica.

Atitudes e crenças acerca da hipnose em profissionais de saúde portugueses

Dissertação de Mestrado apresentada ao Instituto Superior de Psicologia Aplicada para obtenção de grau de Mestre na especialidade de Psicologia Clínica.

Burnout em profissionais da saúde portugueses: Uma análise a nível nacional

Introdução: O burnout é uma síndrome psicológica, caracterizada por elevada exaustão emocional, elevada despersonalização e baixa realização profissional, que conduz à erosão dos valores pessoais, profissionais e de saúde. Este estudo reporta a prevalência do burnout em profissionais de saúde Portugueses. Material e Métodos: Os níveis de burnout foram estimados pelo Maslach Burnout Inventory - Human Services Survey numa escala ordinal de zero (nunca) a seis (sempre) pontos. A amostra foi constituída por 1 262 enfermeiros e 466 médicos com médias de idade de 36,8 anos (DP = 12,2) e 38,7 (DP = 11,0), respetivamente. Os participantes foram provenientes de todos os distritos nacionais (35% Lisboa; 18% Porto; 6% Aveiro, 6% Setúbal, 5% Coimbra; 5% regiões autónomas), com atuação em meio hospitalar (54%), centros de saúde (Unidade de Saúde Familiar - 30%; Unidades de Cuidados de Saúde Primários - 8%) e outras instituições públicas/privadas (8%). Resultados: A análise dos níveis de burnout revelou que ambas as categorias profissionais apresentaram níveis moderados a elevados de burnout (M = 3,0; DP = 1,7) não sendo significativas as diferenças entre as duas profissões. Vila Real (M = 3,8; SD = 1,7) e a Madeira (M = 2,5; DP = 1,5) são as regiões onde os níveis de burnout são mais e menos elevados, respetivamente. Os níveis de burnout não diferiram significativamente entre Hospitais, Unidades de Cuidados de Saúde Personalizados e Unidades de Saúde Familiares. Os profissionais com maior tempo na função são menos acometidos por burnout (r = -0,15) não ocorrendo associação significativa com a duração da jornada de trabalho (r = 0,04). A má qualidade das condições de trabalho foi o melhor preditor do burnout (r = -0,35). Discussão: A ocorrência da síndrome de burnout em profissionais de saúde portugueses é frequente, estando associada à percepção de más condições de trabalho e à menor duração do tempo de serviço. A incidência de burnout apresenta diferenças regionais que podem estar associadas ao aumento do stress imposto pelo exercício da profissão em condições sub-ótimas para a prestação dos cuidados de saúde. Os resultados alertam para a necessidade de intervenções para melhorar as condições de trabalho e formação inicial dos profissionais de saúde de forma a garantir a qualidade do serviço prestado aos utentes e o bem-estar pessoal destes profissionais. Conclusões: A nível nacional, entre 2011 e 2013, 21,6% dos profissionais de saúde apresentaram burnout moderado e 47,8% burnout elevado. A perceção de más condições de trabalho foi o principal preditor da ocorrência de burnout nos profissionais de saúde Portugueses.