Estratégias de cuidados por familiares de portadores de transtornos mentais severos residentes na zona rural do alto sertão paraibano

In the current configuration of the Brazilian Psychiatric Reform, family plays a key role in mental health care: shared responsibility and active participation in the process of rehabilitation of people with severe mental disorders. It´s considered that the family member who cares can help users in their daily tasks and articulating trajectories, networks and ways to potentiate social connections. This research was motivaded by interest in the subject and by the lack of research and studies about this reality in rural areas. This study aimed to identify ways of mental health care by relatives of severe mental disorder patients living in rural zone located at sertão of Paraiba. Methodologically was made a work with qualitative research structured in two moments. In the first one, was held a Documentary Research in CAPS II in order to identify: a) users living in rural that had a history of at least one psychiatric hospitalization, b) users who no longer use the reference service (CAPS II) for at least one year. The second stage consisted by home visits and semi-structured interviews with eleven families in rural areas. Results pointed out a profile composed by 56 users: 56 women and 26 men aged between 50 and 64 years, unmarried, without study, farmers and housewives, living six miles from CAPS II and carriers with severe mental disorders. Strategies and resources used by the families for mental health care were: religion, work, medication and help from relatives, neighbors and community. Factors related to non-use of substitute services were lack of internment in CAPS II and lack of money and transportation. The hospital, the house arrest, the police aid and religion were strategies used by family members as support to psychiatric crises. The data pointed to non-solving of care offered by psychosocial support network and the importance of redirecting practices aligned to the asylum model in favor of psychosocial strategies that aimed at rehabilitation and community participation in mental health care

Trajetos de exclusão e reclusão: oral temática de familiares atingidos pelo tratamento asilar da hanseníase

A história da hanseníase é marcada por preconceito, exclusão social, estigma, abandono e medo, por ter sido conhecida durante muito tempo como incurável e contagiosa. Além dos agravos inerentes às alterações dermatoneurológicas e consequentes incapacidades físicas, são ressaltadas as repercussão emocionais, alterações nos hábitos cotidianos e mudanças na configuração familiar. Atualmente a hanseníase é conhecida como doença negligenciada, com alta incidência e prevalência, considerada como um problema de saúde alvo de incentivos e mobilizações das políticas públicas. Ao estudar a história da hanseníase, parte-se do pressuposto de que pouco se sabe sobre as repercussões da doença do passado na vida dos familiares de ex-doentes tratados em regime asilar, assim como a visão e os sentimentos dos mesmos familiares diante da hanseníase na atualidade. Portanto, objetivou-se narrar a história de familiares de ex-doentes de hanseníase que foram tratados em hospital colônia. Os objetivos específicos são: Identificar se familiares de pacientes com hanseníase tratados em hospitais colônia eram atingidos pelo preconceito, estigma e exclusão que permeava a vida dos portadores da doença; Verificar se o tratamento de ex-doentes de hanseníase em hospitais colônia alterou a efetivação de laços familiares tais indivíduos e os membros de sua família; Averiguar qual a compreensão que familiares de ex-doentes de hanseníase tratados em hospitais colônia têm sobre a hanseníase; Promover, junto aos participantes da pesquisa, atividade de promoção da saúde sobre hanseníase. Adotou-se o estudo exploratório e descritivo, com abordagem qualitativa com suporte na História Oral de Temática como técnica e referencial metodológico. Os 52 familiares de ex-doentes de lepra que foram segregados no Hospital Colônia São Francisco de Assis, cadastrados no MORHAN-Potiguar, constituíram a colônia. A partir do ponto zero houve o recrutamento dos participantes que compuseram a rede, totalizando 10 colaboradores, de ambos os sexos e idade de 44 a 76 anos. Após aprovação pelo Comitê de Ética em Pesquisa - UFRN, sob o protocolo 650.654/2014 e CAAE 25922214.3.0000.5537, realizou-se a coleta de dados por meio de entrevista, utilizando instrumento de identificação da rede e questões abertas. As entrevistas foram gravadas, transcritas, conferidas pelos colaboradores e posteriormente transcriadas. Tratou-se as histórias, narradas pela técnica de Análise Temática de Conteúdo, segundo Bardin, emergindo três eixos temáticos: Impacto nas relações sociais (Estigma e preconceito; Exclusão social); Impacto nas relações familiares (Desagregação familiar; Restrições para visita; Compartilhamento e construção de uma nova família; Consequências familiar geradas pelo isolamento; Reconstrução do vínculo familiar); e Pensamentos frente a lepra e a hanseníase (A história no passado; A história no presente). O fato de ter um familiar doente de hanseníase segregado em hospital colônia gerou empecilhos nas relações sociais vivenciadas pelos colaboradores do estudo, que embora não tivessem a doença, foram vitimados pela exclusão social, estigma e preconceito. O internamento compulsório também gerou modificações na estrutura familiar, com distanciamento, alteração no vínculo e tentativa de reestruturação familiar. Os colaboradores também refletiram sobre política de controle da lepra no passado, assim como a adotada no presente frente à hanseníase.

Segurança alimentar e nutricional dos agricultores familiares da associação dos produtores e produtoras orgânicas de Ceará Mirim/RN

The proposition of this research is supported by the definition of Food Safety and Nutrition (FSN), established by the II FSN National Conference. Taking this concept as reference, the research instrument aimed to analyze strategies and actions related to FSN, developed by members of Ceará Mirim Organic Producers Association, located in Rio Grande do Norte state (Brazil), from aspects related to family feeding, as well as means of access, quantity and food culture. It was aimed to answer the following questions: Do the families benefited from Ceará Mirim Organic Producers Association have strategies that assure their FSN? If so, do these strategies originate from public policies or own actions? Do these strategies focus on family revenue? In expenses with food and proper feeding? How do these strategies articulate together and which social networks do they form? In this research, there were also approached questionings which comprise market opening through the declaration of the products as Organization of Social Control (OSC), aggregate value and participation in agroecological fairs, aiming to identify and characterize if these strategies contribute for Food Safety and Nutrition of these families. The data here analyzed were obtained from semi-structured interviews, conducted in the production sites of each farmer, and have a qualitative approach. 21 questionnaires were applied to the family farmers, in seven projects of agrarian reform settlements (Carlos Marighella, Nova Esperança II, Aliança, Marcoalhado I, Santa Águeda, Santa Luzia and União). From this study, it was concluded that most of FSN strategies result from a series of distinct public policies, which potentiate the existing strategies and create new ones, such as in the case of organic production, which is the main motivation, even for the organization of the studied group. These strategies brought improvements in feeding and caused changes in eating habits, especially in the diversification of production for own consumption. This, on the other hand, is assuring greater food autonomy and increasing marketing channels, through fairs or institutional markets. It was also verified that reciprocity relations increased after the organic production, and they are indispensable to assure food in difficult times, also contributing to incentive organic production itself, through supplies exchange.

Os fios da memória: presença afro-brasileira em Acari no tempo do algodão

La historia de la expansión colonial en los sertónes del Seridó del siglo XVIII y el asentamiento de los primeros pobladores alrededor de las haciendas de ganado y más tarde de la cultura de algodón, oculto la presencia afrodescendiente que ya regia esa vasta región. Por otro lado, la esclavitud se observaba como un fenómeno de segunda prioridad y leve, por el hecho de tener un número de esclavos muy reducido en relación al litoral azucarero; sin embargo no se puede minimizar las marcas que dejaron más de tres siglos de dominación colonial, pues la violencia simbólica en su descripción aun existe. Este trabajo tiene como objetivo reflexionar sobre las causas y consecuencias de la extinción precoz de la presencia afro-brasileña y de la invisibilidad de los núcleos familiares en el municipio de Acari. A través de las memorias de las familias Nunes, Inácio y Pereira, antiguos moradores del Saco de los Pereira y de las familias Pedros, Paula, Higinos y Félix outroras moradores de las haciendas de la región, pretendemos reflexionar sobre las actividades de sobrevivencia, las relaciones de trabajo, la propiedad de la tierra y los robos ocurridos en los siglos XIX – XX, así como mostrar la importancia de las tradiciones familiares en la elaboración de los discursos sobre el pasado y de las variadas identidades. La metodología utilizada durante la investigación, mantuvo como foco las entrevistas que contemplan historias de la vida y las memorias de nuestros interlocutores, en particular los afrodescendientes. Los relatos colocan una luz sobre las vivencias en el período algodonero, los oficios realizados en las haciendas (vaquero, bordado, culinaria, losa) donde se muestra la importancia de las familias negras para entender el escenario Acarienses. También fotos y documentos cartoriáles que ayudaron a componer las historias de vida. El estudio revela la presencia de muchas familias negras vinculadas a las haciendas, demostrando que existe otra versión de la historia local, teniendo como protagonistas aquellos cuya memoria fue silenciada y quedando así marcados por el estigma de la esclavitud.

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.

Trajetórias familiares e envelhecimento ativo

Assistimos a um acelerado processo de envelhecimento demográfico. A população está cada vez mais envelhecida, surgindo a necessidade de promover e incentivar o Envelhecimento Ativo. Este é contínuo, difere de pessoa para pessoa, podendo ser compreendido e influenciado por diversos fatores. As alterações familiares levam a uma reorganização na própria visão do indivíduo ao longo da sua trajetória de vida. O objetivo deste estudo é compreender de que modo as trajetórias familiares influenciam o envelhecimento ativo. A metodologia utilizada foi qualitativa e a recolha de dados obteve-se através de entrevistas semiestruturadas. Foram selecionados 4 sujeitos, 2 homens e 2 mulheres, entre os 70 e os 77 anos, residentes em meio rural e urbano. A análise incidiu sobre as trajetórias familiares ao longo da infância, juventude, idade adulta e pós-reforma. Os resultados constatam que, na infância, a família foi um suporte sólido. Apesar da educação rígida típica da época, os progenitores incentivaram a escolaridade e autonomia dos sujeitos. Na juventude, o fenómeno da emigração esteve presente, tendo sido uma etapa marcada pela falta de liberdade, pela diferença de género e entrada no mundo laboral. Na fase adulta, todos namoraram, primando o respeito, casaram e constituíram família. Nesta fase, também marcada por algumas perdas, todos eles se mantiveram ativos profissionalmente e ao nível do lazer. A entrada na reforma foi vivida com naturalidade, sem implicações familiares, continuando ativos. As conclusões revelam que a família foi importante em todo o ciclo vital, destacando-se a relação mantida com os seus ascendentes, descendentes e cônjuges.

Estrategias familiares de vida en hogares con jefes dedicados a la pesca. Una experiencia en Puerto Quequén

Fil: Rispoli, María Florencia. Universidad Nacional de La Plata. Facultad de Humanidades y Ciencias de la Educación; Argentina.

Reproducción campesina y conocimiento local en contextos de fragilidad social y ambiental : Estrategias familiares y comunitarias en la cordillera del Tentzo, México

El artículo presenta resultados de investigación realizada en la localidad de San Antonio Juárez, municipio de Tzicatlacoyan, en el estado de Puebla, México. El objetivo fue conocer las estrategias de reproducción de los grupos domésticos campesinos, asentados en entornos ambientales adversos, que presentan restricciones severas para el desarrollo de la agricultura. A partir de técnicas cualitativas y cuantitativas, se pudo constatar la presencia de estrategias de reproducción distinta, a nivel de barrio, basada en el conocimiento local, la división genérica del trabajo y la organización a nivel de grupo doméstico y comunidad.

Reproducción campesina y conocimiento local en contextos de fragilidad social y ambiental : Estrategias familiares y comunitarias en la cordillera del Tentzo, México

El artículo presenta resultados de investigación realizada en la localidad de San Antonio Juárez, municipio de Tzicatlacoyan, en el estado de Puebla, México. El objetivo fue conocer las estrategias de reproducción de los grupos domésticos campesinos, asentados en entornos ambientales adversos, que presentan restricciones severas para el desarrollo de la agricultura. A partir de técnicas cualitativas y cuantitativas, se pudo constatar la presencia de estrategias de reproducción distinta, a nivel de barrio, basada en el conocimiento local, la división genérica del trabajo y la organización a nivel de grupo doméstico y comunidad.

Estrategias familiares de vida en hogares con jefes dedicados a la pesca. Una experiencia en Puerto Quequén

Fil: Rispoli, María Florencia. Universidad Nacional de La Plata. Facultad de Humanidades y Ciencias de la Educación; Argentina.