Moradores crônicos de hospital psiquiátrico: um desafio à desinstitucionalização

The existence of chronic inhabitants in the psychiatric hospitals imposes a challenge to the Psychiatric Reform, that proposes things such as the gradual and progressive way to extinct mental institutions, once the permanence of the hospital in the system is only necessary because there is not a net of well structured substitute services capable of receiving that demand. This work considered relevant to deepen the knowledge about those people who passes their lives jailed by the walls of psychiatric hospitals and compose significant part of the world population. It also aimed to investigate the problem relative to the condition of being an inhabitant of a psychiatric hospital the Dr. João Machado Hospital (HJM), in the city of Natal/RN. The paper used different points of view (patients , families and professionals ) to define the profile of the inhabitants, to identify the possibility of insertion in substituting social equipment, to know the expectations of the inhabitants and their relatives regarding to the exit of the life shelter, to investigate the demands related to the net of cares social support for making feasible the discharge and to identify the difficulties that are involved in the exit of the chronic inhabitant of the hospital. There were defined three methodological phases: delineation of the identification, socio-economic and clinical profile of the inhabitants of the HJM; semi-structured interviews with professionals; and open interviews with inhabitants and family. It concluded that the psychiatric institutionalization contributes to the generation of chronic inhabitants in the psychiatric hospitals. Among the professionals, it was detached the defense of desospitalization, but an existence of devices of the asylum model. The relatives showed a resistance to participate in the care and the inhabitants exposed their desire to leave the hospital, as well like the wish of permanence. It was considered important: the construction of an extra-hospital net that enables to desinstitutionalization; the qualification of the technical; orientation to the family, stimulating its participation in the process of caring; give freedom to the individuals in mental suffering, enabling them to be ahead of their lives and express their desires and opinions; the implementation of an extended clinic that is capable of building new possibilities; and a subjectivity guided by the social enclosure

Ser-no-mundo com a criança portadora de câncer compreendendo a experiência de psicólogos nos serviços de oncologia pediátrica de Natal-RN

Cancer goes on to be a frightening disease by humanity, simetimes,it is considered as death, suffering and stigma synonym. Occurring at childhood, this meaning seems to acquire a more intense conotation, having in view of the perplexity and godliness feeling in the presence of the precocity of events, nearly always associated to the death. A psychologist co-existence with the cancer children is going acquiring, thus, a permeated sense by incognitas , fears and fantasy, which raised us the following question: how does the psychologist that answers children with cancer lives this experience? Therefore, the aim this research was to understand this co-existence experience. Our theoretical perspective comes from an existencial fenomenology and, more specifically, the Humanistic Approach and Martin Heidegger Existencial Ontology. The metodology is qualitative of phenomenological character. The access instrument to the experience was the narrative, such as purpose by Walter Benjamin. They were carried out nine semi-open interviews with psychologists who work on pediatric oncology services of Natal-RN city. Such interviews were recorded in cassette, transcripted and later, re-educated. These interviews were recorded, transcribed and later on edited with the help of the interviewee and turned into a text. The narrative comprehension was carried out on Heidegger Existencial Ontology, on dada exaustive reading and the clipping of indicative passages of experience sense of being psychologist on this area. The research suggests that the experience is oriented of clinic kowing-doing, being crossed by implications of key thematics which indicate the care as central ontologic element that orientates the way as these professionals come being in the world in association with the clientèle. Besides, the caring experience of these children acquire the sense of true living experience, since the cancer undoes the immortality illusion, launching the psychologist to his/her condition of being to the death and with that, calling him/her the authenticity. Is is only not dealt with to experience the anguish and the death imminence, but above all, re-meaning them in favour of a continual learning, of quality answering , besides other possibilities. Working with child cancer brings news perspectives and world views, making the psychologist a more human people and sensitive to the distracted needs. And we believe that, regardless of area which actuates, being psychologist is a particular way which choose to be citizen. Is is a project that will be delimited by society, history and culture and after all, by us like human being. Therefore, we understand that the results this research suggest the discussed thematic deepening on this intervention field in order to new sense possibilities can arise giving origin to other reflections about the clinical practice, the professional formation in Psychology and other possible developments

O oncologista clínico diante da morte: implicações para a produção do cuidado

It is undeniable that all the extraordinary technological advances in contemporary society have increased the severe patients expectation and quality of life, especially cancer patients. On the other hand, it is easily verifiable by many researches that it was not possible to advance in the same proportion in caring for the human experience of death. Much is said about the anguish of a man facing death, of cancer patients in terminal stage, about their families, and very little about the feelings, anxieties and ways of coping with the medical professional who deals with this situation, specifically the clinical oncologist. Little is known about the experience of the doctor who has learned to take death as an enemy to be defeated, and increasingly is compelled to live at length with his advertisement. However, we started to watch in recent years a growing interest of researchers in this issue. This study seeks to add to this interest in order to understand the experience of clinical oncologists that accompany dying patients, the meanings they attach to death, ways of coping and the implications for providing care. This is a qualitative study in which was used as a tool for data collection an in-depth interview with the projective using script and scenes. Gadameriana Hermeneutics was used for analysis and interpretation of narratives. The subjects were 10 clinical oncologists who work at two institutions from cancer treatments in the state of Rio Grande do Norte, chosen from a variation in the time working in the specialty (minimum of one year, even old ones). However, you can bring some initial results for the dialogue. It was found that the death is still a topic that causes many difficulties in the daily lives of these professionals, the choice for oncology involves dealing with death without preparation in medical education; being close to the patient in the final moment, supporting the family, coping with own pain of loss and the inability to heal. These are central elements of the narratives. We also have investment in medical training and continuing education in setting up a demand that permeates the discourse of participants. Being able to listen to the subjective world of clinical oncologists will support the work not only for them as other professionals who deal with patients with advanced cancer, providing evidence to understand to what extent the meanings attributed to its know-how before patients on the verge of death interfere with the production of care and allow identify coping strategies in everyday life of these professionals that hinder or facilitate coping with death, promote or preclude the care with others and with themselves. It is hoped that research can contribute to the field of knowledge about the know-how in clinical oncology and their terminal-care-death oncologist-patient relationships, bringing runways capable of promoting a better quality of care in the production of all involved in this process: professionals, patients and families

Os agentes funerários e a morte: o cuidado presente diante da vida ausente

The present time is marked by the art of escape from death, which has become synonymous with failure, its exposure has become intolerable and the care of the dead body were assigned to third parties who market this practice through services and products that shape the market undertaker. In this context, in which death is an object of study, has arisen funeral officers, as professionals dealing with a dead body, with the pain of relatives and their reactions, often being the first to have contact with the death scene. As professionals in the health area, the morticians also deal with death. The first attempt to prevent the arrival of death, funeral officers already has begun their work routine from there. Death and its surrounding part of their profession. What about those professionals whose work demands as a feared and denied by society? This study aims to understand the intents, meanings and implications for the mortician to deal with death in their daily work in order to focus renewed attention to the care of these professionals. To this end, it was carried out a qualitative research grounded in the theoretical framework of Gadamerian hermeneutics for production and interpretation of narratives. It was used two methodological strategies for data collection: in-depth interview with script and workshop with the use of "scenes". Research participants were nine morticians funeral of two funeral agencies of the city of Natal. It was possible to detect the presence of the social imaginary of interdiction on the theme of death from living with feelings of his presence daily, from the need of respondents to naturalize their contacts with death, a requirement of their office to deal with the difficulties of manipulating body fluids and odors, sometimes in a state of decomposition; allied to wishes to achieve the goal of delivering to family-customers a "embellished" body for the final farewell. Being a mortician, in addition to not being a professional motivation, involves facing difficulties related to heavy routine work, low salaries, unprofitable work materials and equipments, besides having to deal with the social gaze that devalues the profession. In turn, they also deal with the pain coming especially from contact with family members, either when they are targets of these feelings of anger, whether they identify with the pain of the bereaved ones. On the other hand, when the recognition and gratitude of the families occur, they find meaning and beauty in their profession of caring for the dead body. The present study by giving voice to morticians has become possible to understand better their profession, the pain that surrounds and care needs of these workers. Finally, it has argued that the mortician may be recognized as a care professional for the way exercising caution with the dead body and their families.

As fontes de desgaste físico e emocional e a Síndrome de Burnout no setor de transporte coletivo urbano de Natal

Recognizing the importance the workplace has on mental health of the individual, the objective of this study was to investigate the relationship between the burnout syndrome and the sources of physical and emotional wear which permeate the work conditions of the urban public transport system of the city of Natal. Although existent in international literature, research on burnout in the professional transport category and studies directed to this category are not a tradition in Brazil. The research was carried out using 412 drivers and money-changers of two transport companies of Natal. To collect the data, two questionnaires and a semi-structured interview were used. The first instrument, developed and validated during the research, investigated the sources of wear and the second, the syndrome of burnout. As its main results, two sources of empirical wear were identified as follows: (1) the Conflict of Values and the Lack of Justice at the Workplace, (2) Union and Reward. Besides these, it was observed that there is an incidence of the syndrome of burnout among the drivers and money-changers of urban transport by bus, not only in the caring occupations studied before in Natal and Brazil and that this incidence is related to the sources of wear which permeate the work conditions of these professionals

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

O Serviço Residencial Terapêutico: cartografias de um híbrido no contexto da desinstitucionalização em saúde mental

This thesis seeks to uphold the idea that the therapeutic residential service, as hybrid device and recent process of deinstitutionalization in mental health, works as a problem producer while it also indicates challenges and potentialities in this process, the attention on mental health and on its own care production. To that end, we work with the prospect map with which we approach reality as the subjectivities production field which transformations and intensities are the major thought propellants. From this perspective, it was possible to produce three "purpose maps" from meetings with actors and groups involved with the TRS and the theoretical study carried out. On the first map we mapped the conditions of possibility of this device and its design in the midst of the process of institutionalization and health policies. We indicate on it the TRS configuration as a hybrid and we hassled its proposition as a means of "social rehabilitation" that can work as a social homogeneity mechanism. On a second map, we cartographied mental captures through images and ways historically built from madness presented in the biopolitical contemporary game and we indicated that the resistance to such catches should be built on a politic daily basis as important vectors of the institutionalization process in mental health. Finally, on a third map we mapped the carefulness produced in the TRS, by analyzing the transition psychiatric hospital - TRS and the caregivers´ team work. On this mapping, the care, for the weakness in the coresponsibility field, is reveled crossed by mental, disciplinary and normality elements, but it is also built in resistance born from links in the intersubjective field of the caring work. We conclude, then, that the TRS power and the deinstitutionalization process itself were in building and strengthening affective labor micro political networks of life and liberty producers

Tratamento do Centro de Atenção Psicossocial para usuários de álcool e outras drogas CAPSad II Leste Natal/RN : uma avaliação da efetividade

The treatment for abusive users of alcohol and other drugs suffered significant modifications until arriving to the psychosocial model that is used by Centro de Atenção Psicossocial CAPSad II Eastern Natal/RN (Psychosocial Support Center). That model appears starting from Brazilian sanitary and psychiatric reforms which are expressed in the principles and propositions of Sistema Único de Saúde SUS (Unique System of Health). The Psychiatric Reform meant a rupture with the mental hospital and hospital centered treatment pattern which was destined to the abusive users of alcohol and other drugs. The new proposal offers the universalization, democratization, regionalization and completeness of the actions in the field of mental health. It gathers a strictly interdisciplinary health staff. The purpose of this study is to evaluate the effectiveness of the treatment for abusive users of alcohol and other drugs offered by CAPSad II Eastern Natal/RN. The evaluation used, as priority, the qualitative social research through an evaluating study starting from the non-experimental model. The methodological process used different instruments of data collection: bibliographical and documental researches, systematic observations at CAPSad II Eastern Natal/RN and, mainly, the semistructured interviews (21) that were accomplished with the professionals, users and relatives of CAPSad II Eastern Natal/RN. The investigation showed the effectiveness of the service and, therefore, CAPSad II Eastern Natal/RN constitute itself as the main confronting strategy to the mental hospital and hospital centered treatment pattern of caring the abusive users of alcohol and other drugs

Avaliação de arquitetura de agentes emocionais : uma abordagem baseada em métrica de qualidade e na influência das emoções sobre usuários

There is a need for multi-agent system designers in determining the quality of systems in the earliest phases of the development process. The architectures of the agents are also part of the design of these systems, and therefore also need to have their quality evaluated. Motivated by the important role that emotions play in our daily lives, embodied agents researchers have aimed to create agents capable of producing affective and natural interaction with users that produces a beneficial or desirable result. For this, several studies proposing architectures of agents with emotions arose without the accompaniment of appropriate methods for the assessment of these architectures. The objective of this study is to propose a methodology for evaluating architectures emotional agents, which evaluates the quality attributes of the design of architectures, in addition to evaluation of human-computer interaction, the effects on the subjective experience of users of applications that implement it. The methodology is based on a model of well-defined metrics. In assessing the quality of architectural design, the attributes assessed are: extensibility, modularity and complexity. In assessing the effects on users' subjective experience, which involves the implementation of the architecture in an application and we suggest to be the domain of computer games, the metrics are: enjoyment, felt support, warm, caring, trust, cooperation, intelligence, interestingness, naturalness of emotional reactions, believabiliy, reducing of frustration and likeability, and the average time and average attempts. We experimented with this approach and evaluate five architectures emotional agents: BDIE, DETT, Camurra-Coglio, EBDI, Emotional-BDI. Two of the architectures, BDIE and EBDI, were implemented in a version of the game Minesweeper and evaluated for human-computer interaction. In the results, DETT stood out with the best architectural design. Users who have played the version of the game with emotional agents performed better than those who played without agents. In assessing the subjective experience of users, the differences between the architectures were insignificant

Taking care as a relationship: a phenomenological view

The purpose of this study was to understand and analyse the meanings given to caring of patients on the isolation ward by nursing students, focusing particularly on the aspects of communication and interpersonal relationships. The data were collected from individual interviews with 18 nursing students who were performing nursing practice on the isolation ward. The results, analysed and interpreted according to existential phenomenology, describe the structure of the phenomenon 'taking care on the isolation ward' from a relational perspective. The students described their difficulties and anxieties, as well as their willingness to take care of isolated patients, resulting in the overcoming of obstacles and in contacting and becoming involved when taking care of these patients.

Interagindo com a criança hospitalizada: utilização de técnicas e medidas terapêuticas

O presente trabalho procura descrever a experiência vivenciada por aluna de graduação ao cuidar de criança hospitalizada numa unidade pediátrica. Utilizando-se das técnicas de comunicação terapêutica e medidas terapêuticas de enfermagem, a aluna desenvolveu relacionamento de ajuda com a criança, o que lhe permitiu prestar assistência de enfermagem de forma integral, envolvendo-se com ela e compartilhando experiências benéficas para ambas.

Imageamento digital de paleocavernas colapsadas com georadar

In this study, the methodological procedures involved in digital imaging of collapsed paleocaves in tufa using GPR are presented. These carbonate deposits occur in the Quixeré region, Ceará State (NE Brazil), on the western border of the Potiguar Basin. Collapsed paleocaves are exposed along a state road, which were selected to this study. We chose a portion of the called Quixeré outcrop for making a photomosaic and caring out a GPR test section to compare and parameterize the karst geometries on the geophysical line. The results were satisfactory and led to the adoption of criteria for the interpretation of others GPR sections acquired in the region of the Quixeré outcrop. Two grids of GPR lines were acquired; the first one was wider and more spaced and guided the location of the second grid, denser and located in the southern part of the outcrop. The radargrams of the second grid reveal satisfactorily the collapsed paleocaves geometries. For each grid has been developed a digital solid model of the Quixeré outcrop. The first model allows the recognition of the general distribution and location of collapsed paleocaves in tufa deposits, while the second more detailed digital model provides not only the 3D individualization of the major paleocaves, but also the estimation of their respective volumes. The digital solid models are presented here as a new frontier in the study of analog outcrops to reservoirs (for groundwater and hydrocarbon), in which the volumetric parameterization and characterization of geological bodies become essential for composing the databases, which together with petrophysical properties information, are used in more realistic computer simulations for sedimentary reservoirs.

A percepção de enfermeiros sobre o cuidar de pacientes com problemas físicos que interferem na autoimagem: uma abordagem fenomenológica

O presente estudo tem como objetivo compreender a percepção e o significado do cuidar de pacientes com problemas de auto-imagem, resultantes de alteração física, por enfermeiros de um hospital universitário. A trajetória metodológica foi a fenomenologia, os sujeitos da pesquisa foram oito enfermeiros. Para a análise dos depoimentos, realizou-se a transcrição e as leituras, buscando a essência das unidades, expressão dos significados, tematizando e interpretando as falas, buscando convergências, divergências e idiossincrasias e a síntese do fenômeno. Os temas desvelados foram: (não)aceitação da enfermidade; trabalho em equipe; limitações conseqüentes da doença; sentimentos e comportamento do enfermeiro e equipe; vínculo entre equipe, paciente e família; a família; auto-imagem do paciente; idade dos pacientes; o preconceito; (re) conhecimento da doença; nível e cuidados mais intensos; a religião e capacitação. Pela amplitude do fenômeno outros ângulos podem ser desvelados e outras perspectivas habitadas.

O papel da solidariedade desempenhado por familiares visitantes e acompanhantes de adultos e idosos hospitalizados

Este estudo objetivou compreender o papel da solidariedade desempenhado por familiares visitantes e acompanhantes de adultos e idosos internados. Utilizou-se como referencial teórico a teoria de enfermagem como cuidado solidário e como referencial metodológico a Grounded Theory. Foram entrevistados nove familiares de adultos e idosos hospitalizados no período de abril a setembro de 2002. Dos resultados identificou-se o fenômeno: assumindo o papel de familiar visitante ou de familiar acompanhante, que congrega os temas: querendo desempenhar um papel solidário e compreendendo o estar junto como uma interdependência emocional. Acredita-se que quando a enfermeira reconhece a singularidade da relação de solidariedade e de interdependência familiar, também exerce seu trabalho pautado na solidariedade, visto que colabora para o restabelecimento do doente, alivia seu sofrimento e de seus familiares e, portanto, promove a saúde do grupo familiar.

Cuidar de pacientes em fase terminal: a experiência de alunos de medicina

O objetivo deste estudo foi compreender os significados que alunos de medicina atribuem à experiência de cuidar de pacientes em fase terminal. Os dados foram coletados mediante entrevistas individuais com vinte e quatro estudantes de medicina de uma universidade paulista. As convergências dos depoimentos dos participantes foram agrupadas em três categorias: a) deparando-se com o mundo da doença terminal/morte; b) relação com o paciente e sua família; c) reflexão sobre o cuidar do paciente terminal. Nos depoimentos, os estudantes expressam ansiedade ao cuidar deste tipo de paciente, assim como as dificuldades em lidar com os próprios sentimentos. Consideram-se pouco preparados para relacionar-se com esses pacientes, mas aprenderam com a experiência vivida. Os resultados do estudo apontam para a necessidade de se introduzirem, na formação médica, conteúdos visando desenvolver competências interpessoais e capacidade de reflexão sobre questões de ética e deontologia médica, envolvendo a terminalidade da vida.