O ambulatório de Saúde Mental no contexto da Reforma Psiquiátrica em Natal/RN

The years 1990 disclose the consolidation of the Brazilian Psychiatric Reform project, assumed as official politics by the Health Department, also stirring up discussions, lines of direction and new ways of care. Substitutive services to the psychiatric hospital as CAPS, conviviality centers, therapeutical residences and ambulatory clinics are implemented. This work analyzes the relations that the Specialized Ambulatory Clinic of Ribeira establishes to the services of Mental Health of the public system in the city of Natal/RN, as well as its adjustment to the proposal of the Psychiatric Reform. Through semi-structured interviews and observation, it was possible to gather data which allowed picturing a general characterization of the service: activities, technical group, joint with other institutions, daily routine organization. Such institution develops activities that surpass the traditional character of a clinic- in other words, the psychological/medical appointments - and it mainly greets the ones proceeding from CAPS and psychiatric hospitals. It offers group activities, psychiatric appointments, therapeutical workshops, sheltering and strolls, among others. The institution is composed by a multi-professional team of psychiatrists, psychologists, occupational therapists, nurse s aide and art-educator. The joint of this service with others that make part of the Mental Health Assistance network in Natal is incipient. Due to this fact, some actions and activities that could and should be developed together are just not. Although facing difficulties, the professionals of the Ambulatory Clinic of Ribeira are able to achieve good results and establish care in Mental Health that prioritize sheltering, listening and respect to the user s individuality. The Ambulatory Clinic of Ribeira is organized according to the paradigm of the Psychiatric Reform. Therefore, it offers an attention that stimulates the re-socialization of the users and the exercise of the citizenship and autonomy of those

Masculinidade a prova: um estudo de inspiração fenomenologico - hermeneutico sobre a infertilidade masculina

Culturally, childbearing is understood as a situation that subjects will experience at some point in their lives, especially people who are married or have a similar affectionate relationship. Thus, to realize the inability to meet such a fate seems to be a natural cultural trigger of suffering, frustration and feelings of inadequacy and helplessness. Specifically for men, infertility is closely related to loss of masculinity, virility. He fails in his role as a male. This study sought to understand the impact that infertility have on the existence of a man who receives such a diagnosis, both in self-image as in their marital, sexual and professional roles. This study sets up as a hermeneutic phenomenological research based on the ideas of the philosopher Martin Heidegger. Participants were seven heterosexual, married and infertile men. Two interviews were conducted. The analysis of the material included both the material of the narratives, as the affectation of the researcher when interacting with the participants and their narratives, through phenomenological-hermeneutic interpretation. The results corroborate the literature that states the difficulty of the men, immersed in a context that defines them as virile, powerful and invulnerable to worry about issues related to health and disease. The possibility of any condition that impairs the reproductive capacity exceeds the acceptable limits of daily life for these men, not being recognized as a model of masculinity present in the condition in which they recognize. This leads to questions about their masculinity, role in the marital relationship and their existence. Thus, to recognize themselves as infertile surpass a medical diagnosis and is associated with the construction of meaning for their existence from the approximation with the infertility condition, which helps in redirecting their choices, restoring the project to be self and allowing further recognition as men. In the marital relationship, doing what they can to ensure, theirs happiness. Through these actions, they remain playing the role of family provider, showing that they are able to protect their wives and taking in assisted reproduction or adoption of children viable alternatives to fulfill the desire to leave a legacy and give a child to their wives and to society. Another result observed, refers to the ontological condition of care that characterizes the human being. The ways in which men are treated socially demonstrates a type of care that focuses on the development of characteristics such as strength, virility and determination but does not allow them to cope with the suffering of emotionally difficult situations, such as the diagnosis of infertility. At the end, the study gives rise to reflections on the need to provide a 12 space for men and their expressions of suffering, as well as to recognize their ability to overcome the painful and difficult situations

Da acusação às professoras pelo aprisionamento do sujeito em um diagnóstico a uma interrogação acerca da posição do analista

This study arises with two questionings: what is the usefulness of a diagnosis in school? And what moves that demand for diagnosis? Such questions were drawn up in answer to a diagnostic demand produced in the context of our internship in Scholar/Educational Psychology. On the perspective of working these issues, we conducted a literature research on diagnosis, with regard to its history, as a review of the psychoanalytic literature about the subject. This venture led us to a new interrogation: what are the elaborations that teachers produce from the child diagnosis, which place her as having special educational needs? The need of deciding the method that would lead us to answer such question, taking as reference the psychoanalytic theory, led us to an incursion to the subject research in psychoanalysis. This tracking points us that, according to Freud, on what comes to psychoanalysis, theory and research go together and that psychoanalysis is not a totalitarian world vision. On Lacan, the research is from the analysand, research that always implies the analyst and its praxis. Such path forced us to position a change to question the positions we occupy, in this experience, guided by an analytical listening. To discuss our position, we started from two cases and submitted them to construction and analysis. As a result, we found out that there is no way to know in advance what will be done from a diagnosis, which will be its uses. Point we used to considerate devastating to a child. So, to us, all children that received a diagnosis would be destined to a tragedy and what the research has shown us is that not always, not all of them. Thus, more than knowing what moves the demand, the important is the subject uses and our position towards it so they can generate a work

Prática de coordenação pedagógica e concepções acerca da atuação em psicologia escolar: desvendando um contexto, repensando caminhos

Considering the necessary approaches with the quotidian of the pedagogical field mentioned in the recent productions in Psychology about the insertion of psychologists in the school field, the objective of this work was to know and to understand the dynamics of functioning of a team of pedagogical coordination, intending to produce reflections on the possibilities of action in school psychology with these professionals. Our field of research was the Municipal School Teacher Emília Ramos (EMPER), considering its peculiar history, distinguished by a constant effort of achievement of the school success by its pupils. As subject of the study, six pedagogical coordinators participated, who worked at the school in the diurne turns, where regular classrooms of 1º cycle of basic education functioned. As procedures, we use participant observations and open interviews, focusing the activities performed by the coordinators and its possible demands to psychology. We use the analysis of content for the production of results. These results evidenced a work of coordination realized on a structured routine, but flexible, centered around the activity of conduction of groups of studies with the teachers. We grouped the demands to psychology in four thematic groups: diagnosis and attending the pupils; orientation to the families, contribution in the formation of the professionals and clinical listening of the professionals of the school. In this way, it is made clear that, in a context where happens a well articulated and consistent pedagogical work, the possible performance in school psychology is not scrumbled or confused with social and pedagogical practical others which many times takes attendance. With these information, we expect to contribute for the theoretical and practical elaborations, in Psychology and the Pedagogy, compromised with the success of the educative work realized in the public schools

Os significados de ludoterapia para as protagonistas do processo: crianças em atendimento

The ludic therapy in a Phenomenological-Existential perspective is conceived as a psychotherapeutic process in which, the listening and talking, mediated by playing activities, allow the child to deal with their grief/suffering. This study is based on the need to broaden the understanding of this modality of clinical intervention by emphasizing the speech of the protagonists in the process: children in therapy. The objective was to understand the ludic therapy from the children s perspective, knowing the meanings assigned to the therapeutic process, to the psychologist and to the involvement of the children in clinical consultations. The main ideas that underlie this research are presented in three theoretical chapters covering, respectively, the suffering of children and the demand for psychotherapy, the Phenomenological-Existential clinical psychology, and the psychotherapy for children, in Brazil, under this theoretical-methodological approach. The study was qualitative, on a phenomenological basis, and included six children as participants, aged between six and ten years, undergoing ludic therapy for at least six months, and referred by their own therapists. In the research s corpus construction, individual meetings were held and mediated by tools to support expressiveness (ludic and pictures/figures boxes), added by the storytelling of an incomplete story about a child s visit to the therapy session, and the request for the elaboration of a message to be passed to a child who will go to see a psychologist. The analysis of the data was based on a variant of the phenomenological method proposed by Amedeo Giorgi. The results reveal a lack of knowledge by the children about the psychologist s activities. Thus, the children develop fantasies about this intervention modality because of lack of information. These observations are consistent with the historical meanings assigned to clinical psychology, involving ideas of normality and guilt. The meanings associated with the motives for a referral to a psychologist highlight the conflict "be a problem versus having a problem" and an elitist conception of clinical psychology. Children understand the characteristics of the therapeutic process, such as the specifics of the therapist-client relationship and the notion of freedom. They also demonstrate remarkable pleasure in the therapeutic process. Finally, it was concluded that the meanings attributed to the ludic therapy by the children are consistent with that proposed in the literature about the children s psychotherapy process in the Phenomenological-Existential perspective. Moreover, the relevance of both the children s experience in the therapeutic setting and the meanings of these proceedings understood by the children are highlighted by the listening to the protagonists in the ludic therapeutic process. The comprehension of these aspects and their transference from the clients experience to the reflective field, promote advances in the understanding of child psychotherapy and indicate the need for further studies with children using this approach.

Identificações e escolhas profissional na adolescência:um estudo psicanalítico

This work seeks to understand the difficulties and dilemmas that pervade the career choice of teenagers. For this, we take investigative via psyquic unconscious determinations that, as observed in present clinical practice, it is also confirmed important in the reviewed literature. In the last one, the most important findings signaled an important relationship between identification processes and the various choices we make throughout life. These findings led us to question about how psychoanalysis understands these processes and how they are involved in building the career choice of teenagers. From the referential Freudian and Lacanian, we have studied the concepts of adolescence and identification, which articulated the process of career choice and fragments of clinical cases, allowed us to reach conclusions that point to the deep involvement of the dimension of desire and the unconscious in issues regarding career choices and the possibility of building a listening, of the difficulties found there, more attentive to the psychic determinations and singular responses that each presents in front of these determinations

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

A inclusão escolar da subjetividade do professor à constituição de um lugar de aluno

The move to include students with special needs (NEE) in the schools presents a paradigm that raises continual discussion about how to implement this proposal. Considering that learning is built from the weaving of socially constructed knowledge and the field of knowledge concerning subjectivity, this research explores the difficulties that occur with the later in the process of inclusion in the schools. Admittedly, the promise implicit in the school does not guarantee that the student learn, but the envisioning of this learning, when the student s educator discredits him, is such that the person is then not taken on as an actual student, being excluded from the transmission of knowledge, even within the school. The project implemented at the Instituto Educacional Casa Escola IECE, for the last three years, shows us that the possibility and sustainability of this envisioning is intimately linked to the subjectivity of the educator, as well as how one relates to the institutional culture. We question then, how this perspective is formed in the educator this perspective capable of denying the offer of a place as student, allowing him to advance while learning. With this in mind, we explore the paradoxical elements present in the paradigm of inclusion, as well as analyzing theoretically, through the body of conceptual psychoanalysis, the process of subjective constitution. We intend to bring to light how this process coincides with the construction of the educator s perspective of exemption from teaching the special needs students. We question, through the formative functions of subjective structuring (The Mirror Stage and the Oedipus Complex), how to form a perspective capable of promoting inclusion of special needs students in educators. Finally, we show how it is possible to bring to light, with the concepts of the I ideal and the ideal I, the subjective difficulties in the practicing instructor

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

Ações educativas com portadores de diabetes Mellitus através da educação popular em saúde

Popular Health Education in its emancipatory dimension refers to individuals and groups to exchange knowledge and experiences, allowing them to associate health to the outcomes of their living conditions. Under this view, health workers and health users are subjects of the educative process. Thus, this study aims to identify the key clinical and socio sanitary attributes and promote educational activities with patients with Diabetes Mellitus (DM) in a Family Health Care Unit of the Western Sanitary District, in the city of Natal / RN. It is an action research which uses the references of the Theory of Liberating Education, which is based on a problem-solving pedagogy and that values dialogue in the process of understanding oneself and the world. Thirty-six diabetics, who are residents of the area covered by the health care unit, and thirty health workers participated in the survey. Each group had an average of twelve participants, and the meetings took place at the Unit´s hall, using conversation wheels, group dynamics, life narratives, experiences telling, movie exhibition and discussions, music, knowledge telling, desires, limitations, beliefs and values socially constructed. Data collection took place during the second half of two thousand and thirteen through Free Word Association Technique (FWAT), recordings of conversation wheels, participative observation, group dynamics, testimonies, questionnaires, life narratives and photographs. The empirical material was organized and subjected to three analyzes: thematic content (Bardin), textual statistics analysis by software IRAMUTEQ (Ratinaud), and photographic analysis (Edmund Feldman). The data analyses originated words, expressions, categories, themes and creative situations showing that popular health education is in process of construction, but still very incipient in primary care. The National Policy on Popular Health Education shows us the necessary ways for the transformation of health practices and the build of a more shared and solidary society. The meetings could be place to reverse that normative logic that has been happening over the years in primary care, but that by itself is not enough. It is possible to conclude that the use of active practices, increasing of listening and training on Popular Health Education will enable changes in the scenario where users and health workers deal with diabetes mellitus. Thus we see the popular health education is being timidly incorporated to the educational process of the subjects involved in this study, and far away from the principles of participation, organization of political work, increase opportunities for dialogue, respect, solidarity and tolerance among different actors involved in addressing the health problems that are fundamental to the improvement in building healthy practices of primary care

A humanização da saúde no cotidiano de usuários da estrategia saúde da família

This research assumes that for changes in health practices directed to an integral care, is crucial humanization, participation and autonomy of service users. In this sense, the research had investigated the issue of humanization involving users of the Family Health Strategy (FHS) in city of Mossoró, having as objectives: to analyze the perceptions of users on humanization in the production of health care in daily of Family Health Strategy, from these perceptions, identify elements featuring humanized and non-humanized in everyday practices related to production of health care; relate perceptions of users about humanization with the notions of extended clinic and social participation present in the National Humanization Policy (NHP); identify difficulties and potentialities in the production of health care from the perspective of humanization. It was a qualitative approach to data collection and it was used the methodology of Network Analysis of Everyday Life (NAEL), which allowed the questioning of health practices through an interactive discussion involving participants subjected. The analysis of data through the technique of content thematic analysis was performed and the results were interpreted related the Extended Clinic references and the users participation, related with the Gift Theory discussed by Marcel Mauss. The results indicated senses humanization linked to affection, reciprocity and honesty, highlighting as essential to humanized practices the trust, bonding, listening, dialogue and accountability. Were also mentioned other elements related to the organization of health services such as access and good functioning of the health services. The difficulties and potentialities show structural deficiencies of the health system and changes in the labor process. The participation of users deconstructing and reconstructing concepts remainder humanization in the production of health care is a key factor for the sedimentation of what is proposed in the HNP. Using the privileged space of the FHE to create more active people and understanding their needs and demands, is possible path to build a participative management

Vivências ludopoiéticas no jogo de areia: a tatilidade na autoformação humanescente

This study presents the ludopoietic experiences in Sandplay and the expression of tactility in humanescente self-training of future teachers of geography. The overall objective was to analyze and interpret as the tactility in the ludopoietic experiences with Sandplay facilitates the sentipensar and boosts the humanescent self-training. The qualitative research approach follows the principles of existential research-action into the etnofenomenologic perspective, that considers studies of the ethnography and the phenomenology with ethnomethodology. In this study we used the sedimentary rock called sandstone and your mineral grains as cognitive operator to stimulate the discussions of the ludopoietic experiences in Sandplay. The members of research were students of the Geography degree of IFRN. To achieve the research objectives were organized experiential meetings and virtual meetings. The ludopoietic experiences in Sandplay revealed the impact of tactility to humanescente self-training, indicating the importance of touch for apprehend and experience the world with beauty, joy and tenderness. These experiences showed the ludopoietic system properties, the threads of embodiment and the meaning of the sentipensar of tactility as a phenomenon that drives the humanescent self-training, evidenced by etnofenomenologie. Data were obtained through Sandplay, sensitive listening, experiential diary, photographic and movie records. In the process of data analysis were revealed the of etnofenomenological principles of experientiality indiciality, reflexivity, self-organizability, filiability, archetypality and humanescencialidade. Through the tactility, the Sandplay favors the awareness of the condition of being, takes life stories, providing the construction of knowledge in a meaningful and contextual way

Avaliação de serviços de assistência ambulatorial em aids, Brasil: estudo comparativo 2001/2007

OBJETIVO: Avaliar os serviços do Sistema Único de Saúde brasileiro de assistência ambulatorial a adultos vivendo com aids em 2007 e comparar com a avaliação de 2001. MÉTODOS: Os 636 serviços cadastrados no Ministério da Saúde em 2007 foram convidados a responder a um questionário previamente validado (Questionário Qualiaids) com 107 questões de múltipla escolha sobre a organização da assistência prestada. Analisaram-se as frequências das respostas de 2007 comparando-as com as obtidas em 2001 na forma de variação percentual (VP). RESULTADOS: Responderam o questionário 504 (79,2%) serviços. Cerca de 100,0% dos respondentes relataram ter pelo menos um médico, suprimento sem falhas de antirretrovirais e de exames CD4 e carga viral. Vários aspectos mostraram melhor desempenho em 2007 comparados a 2001: registro de número de faltas à consulta médica (de 18,3 para 27,0%, VP: 47,5%), agendamento de consulta em menos de 15 dias no início da terapia antirretroviral (de 55,3 para 66,2%, VP: 19,7%) e participação organizada do usuário (de 5,9 para 16,7%, VP: 183,1%). Houve manutenção de dificuldades: pequena variação na disponibilidade de exames especializados em até 15 dias, como endoscopia (31,9 para 34,5%, VP: 8,1%), e a piora de indicadores como tempo ideal de acesso a consultas especializadas (55,9 para 34,5% em cardiologia, VP negativa de 38,3%). O tempo médio despendido nas consultas médicas de seguimento manteve-se baixo: 15 minutos ou menos (52,5 para 49,5%, VP negativa de 5,8%). CONCLUSÕES: A avaliação de 2007 mostrou que os serviços contam com os recursos essenciais para a assistência ambulatorial. Houve melhoras em muitos aspectos em relação a 2001, mas persistem desafios. Pouco tempo dedicado à consulta médica pode estar vinculado ao número insuficiente de médicos e/ou à baixa capacidade de escuta e diálogo. A acessibilidade prejudicada a consultas especializadas mostra a dificuldade das infraestruturas locais do Sistema Único de Saúde.

Dinâmica da avifauna em fragmento de mata na Fazenda Rio Claro, Lençóis Paulista, São Paulo, Brasil

Discute-se a importância do levantamento qualitativo e quantitativo da comunidade de aves da Fazenda Rio Claro (22°27'S, 48°51'W), Lençóis Paulista, para a avaliação de um fragmento de mata mesófila do interior de São Paulo. Tais levantamentos foram realizados entre agosto de 2001 a julho de 2002. Para o estudo quantitativo utilizou-se da metodologia de Pontos de Escuta. Foram analisados os índices de diversidade e de freqüência de ocorrência dessa comunidade, sendo as suas espécies organizadas tanto em função das categorias alimentares quanto sob o aspecto da ocupação do estrato vegetal. O levantamento qualitativo registrou 216 espécies. Já o quantitativo registrou 74 espécies em 761 contatos, com uma média de 12,7 contatos/amostra. O índice pontual de abundância (IPA) variou de 0,001 (um contato) a 0,07 (53 contatos); aquele da diversidade foi de H' = 3,10, mostrando um aumento significativo entre setembro e novembro; a eqüitatividade média no período foi de E = 0,95. Os insetívoros constituem quase a metade das espécies registradas no levantamento quantitativo (44,6%), seguido por frugívoros (24,9%), onívoros (16,4%), carnívoros (8,5%), nectarívoros (4,2%) e uma pequena proporção de detritívoros (1,4%). A categoria mais abundante no sub-bosque foi a de insetívoros, enquanto que os frugívoros foram os mais abundantes no solo e na copa. A comunidade de aves no fragmento estudado mostrou o mesmo padrão encontrado em outros fragmentos de mata mesófila de mesmo tamanho relativo. Algumas espécies ameaçadas foram encontradas na área de estudo.

Análise comparativa da assembléia de aves em dois remanescentes florestais no interior do Estado de São Paulo, Brasil

Realizou-se o levantamento quantitativo e qualitativo da comunidade de aves de dois fragmentos de floresta estacional semidecídua no interior do estado de São Paulo de julho de 2004 a julho de 2005. Para o estudo quantitativo utilizou-se da metodologia de Pontos de Escuta. Foram analisados os índices de diversidade e de freqüência de ocorrência dessa comunidade. O levantamento qualitativo registrou 181 espécies na Fazenda Rio das Pedras - FRP (Itapetininga, 350 ha) e 126 espécies na Fazenda Santa Maria II - FSM (Buri, 480 ha), enquanto que o levantamento quantitativo registrou a presença de 73 espécies em 988 contatos e 64 espécies em 1019 contatos para FRP e FSM, respectivamente. O índice pontual de abundância (IPA) variou de 0,01 (1 contato) a 1,32 (132 contatos), para FRP e na FSM variou entre 0,01 (1 contato) a 0,97 (97 contatos). A diversidade do fragmento da FRP foi de H = 3,04 e na FSM de H = 2,85 onde a eqüitatividade em ambas áreas foi de 0,91. A comunidade de aves nos fragmentos estudados mostrou o mesmo padrão encontrado em outros fragmentos de floresta estacional semidecídua de tamanhos relativos. As categorias alimentares mais representativas nos dois remanescentes foram insetívoras (53% na FSM e 50% na FRP) e frugívoras (23% na FSM e 26% na FRP). Dentre os insetívoros, destacaram-se as famílias Tyrannidae na FSM e Thamnophilidae na FRP. Tanto na FSM como na FRP os insetívoros de sub-bosque foram mais representativos (53% e 51,4% respectivamente), seguidos pelos frugívoros de sub-bosque (50%) na FSM e frugívoros de copa (52,6%) na FRP. A importância do estudo de comunidade de aves esta ligada à elaboração do plano de manejo e conservação das áreas naturais.