Assistência de enfermagem às urgências e emergências psiquiátricas no serviço de atendimento móvel de urgência em Mossoró-RN

This study aims to identify the concepts of professional nursing team on assistance in urgency and psychiatric emergencies in SAMU in Mossoró/RN, identifying the difficulties in implementing an emergency assistance to the user in psychiatric distress in this service and point strategies in pursuit of consolidation and expansion of comprehensive health care to the public. It is a descriptive research with qualitative and exploratory approach. The subjects were employees of the nursing staff of SAMU of that mentioned municipality. Semi-structured interviews are applied as tool for data collection. It was counted on the consent of the institution where the study was developed and approval by the Ethics Committee in Research of UFRN with CAAE No 17326513.0.0000.5537, besides signing the Informed Free Consent Term by the participants. Data analysis was done by means of thematic analysis proposed by Bardin. Thus , as a result of the research produced the following categories: mechanistic practice; dehumanization of care; need for qualification, barriers to assistance in urgency and psychiatric emergency and strategies in pursuit of comprehensive care, which proceeded in preparing two articles entitled "Nursing care to the emergency room and psychiatric emergencies in the mobile emergency care service" and "Barriers for emergency service and psychiatric emergencies in the mobile emergency care service". In the studied reality it was identified that nursing care offered to users in situations of urgency and psychiatric emergency is made based primarily on the use of chemical and physical restraints, as well as transportation to the general hospital, constantly using the police force support, which meets the guidelines of the Psychiatric Reform and thereby undermining the provision of an effective and humane care. This scenario is worsened by the lack of an organized network of services in mental health, where after the service the user is taken to a general hospital, considering that there is no ready or appropriate psychiatric emergency service as a Center of Psychosocial Care - CAPs III to reference it, thereby precluding the realization of a resolute and comprehensive care. Thus, it is concluded that nursing care is based on biologicist and medicine-centered model advocated by classical psychiatry, and that despite all the advances in psychiatric reform, still guides the mental health care, so the lack of service network organized in hierarchical and mental health, where the user in urgency and emergency service can be watched in full and the guidelines of the psychiatric reform can be realized in practice

Autoestima e qualidade de vida de pessoas com úlcera venosa atendidas na atenção primária

Venous ulcers (VU) is a chronic injury of the lower extremities and because of its high incidence and recurrence implies long and complex treatments, damaging the quality of life (QOL) and self-esteem (SE) of the people. This study aimed to analyze the association between self-esteem with the quality of life of people with venous ulcers treated in primary care. Cross sectional analytical study with a quantitative approach conducted with 44 people met with VU at 13 primary care units 2 and Mixed units in Natal/RN. The study was approved by the Ethics Committee in Research of the Federal University of Rio Grande do Norte (UFRN), CAAE: 07556312.0.0000.5537. Held data collection from February to April 2014 and used three instruments: a structured form covering sociodemographic, health care and clinical variables, the Rosenberg Self-Esteem Scale and the SF-36. The collected data were entered into a database and processed on computerized software for descriptive and inferential analyzes. The results showed a predominance of people with UV females (65,9%), with more than 60 years (59,1%), married or in a stable relationship (52,3%), low education (86,4%) without occupation (68,2%) and less than one minimum wage income (81,8%). Regarding assistance characteristics was observed that most patients performed the dressing with appropriate material (72,7%), professional or trained caregiver (61,4%) did not use compression therapy (81,8%), treating the injury for more than 6 months (77,3%), lack of guidelines for the use of compression therapy, elevation of legs, and regular exercise (77,3%) and consulting the angiologist last year (52,3% ). Regarding clinical features of the lesion was found that most of the recurrent lesions are (77,3%), over one year of current lesion (52,3%) medium to large lesions (54,8%), without signs of infection (61,3%) and pain (79,5%). The mean SE of respondents was 9,3 (± 5,1). The relations between the SE and the sociodemographic variables, health care and clinics showed that individuals without a partner (a) (p = 0,01), who did not wear compression therapy (p = 0,04), with more 6 months of treatment (p = 0,01) and larger lesions (p = 0,01) had a lower SE. The mean domain and the dimensions of the SF-36 were lower emphasizing the functional capacity 36.5 (± 27,6) and the physical aspects of 15.3 (± 30,6). There were significant correlations between AE people with VU and the domains and dimensions of the SF-36: physical functioning (r = -0,432), general health (r = -0,415), vitality (r = -0,573), aspects social (r = -0,517), mental health (r = -0,612) and mental health dimensions (r = -0,612) and physical health (r = -0,473). Based on these results it is concluded by rejecting the null hypothesis and accept the alternative proposed in the study in which it was found that there is a negative correlation between the SE and the QOL of people with venous ulcers

Análise do modelo de gestão implantado no Centro de Atenção Psicossocial CAPS II OESTE de 1995 a 2005, situado no distrito sanitário Oeste do município de Natal/RN, à luz da Co-gestão

This dissertation has as aim the praxis of co-management of the health service of CAPS II OESTE of Natal-RN, where health workers, family members got to materialize guidelines and principles of psychiatric Brazilian reform in real possibilities of subjectivity construction, whereas they changed social relations in daily life. The path chosen to record was from testimonials and contributions of those who meant their done. Redeeming this story from social representations of the majority of their builders was an instigating, delicate and rewarding task, emphasizing the living memory, rebuilt in a line of time which could not be found in simple documentary collections. Mainly, by knowing that service routine was intense and had as characteristic the singular mobility itself from a creation process and therefore not always its dynamic allowed adequate records. At the same time, from this occurred the field and bibliographic research which allowed the detailed information from the prior milestones and motivated to the practice here reported. The rereading of concepts in an interface with the reports of the interviewees enabled the verification that the model of mental health advocated by psychiatric reform was understood. Once noticed the presence of the beliefs and values of people in motivating energy for the progress of reform, it has gone to fetch theoretical subsidies of administrative order to understand how they saw this building and that uniqueness has been printed. The theoretical way and praxis have tracked here has allowed to analyze how occurred such a process of production and subjectivity and collectives that when organize enabled themselves for analysis and intervention, including in crisis situations. Therefore, it was revealed that ethical and multi-disciplinarity, the humanitarian sense, the coresponsibility, co-production and horizontal management were the key factors for spread from a changing protagonist. One can thus conclude that co-management from that collective has been multi-disciplinary weaving a cross

Caracterização numérica de antenas para aplicações RFID utilizando o método das ondas - WCIP

In recent years, the radio frequency identification technology (RFID) has gained great interest both industrial communities as scientific communities. Its ability to locate and monitor objects, animals and persons with active or passive tags allows easy development, with good cost-benefice and still presents undeniable benefits in applications ranging from logistics to healthcare, robotics, security, among others. Within this aspect what else comes excelling are RFID tags and the antennas used in RFID readers. Most tags have antennas omnidirectional and are usually manufactured as dipoles modified printed. The primary purpose of a project of antenna for tag is to achieve the required input impedance to perform a good marriage impedance with the load impedance of the chip. Already the objective principal in project of antennas for readers is to achieve reduced sizes and structures with good data transmission capacity. This work brings the numerical characterization of antennas for RFID applications, being these divided into tags RFID and antennas for RFID readers. Three tags RFID and two antennas for RFID readers, found in literature, are analyzed. The analysis of these structures is made using the Method of Waves - WCIP. Initial results found in the literature are compared with those obtained through simulations in WCIP with objective to show that the Method of Waves is able to analyze such structures. To illustrate the results obtained in simulations is presented the behavior of electric and magnetic fields. It also performed a literature review on the characteristics and principles of RFID technology. Suggestions for continuity to this work are presented

Ética e clínica na atenção psicossocial: contribuições da psicanálise de Freud e Lacan

O objetivo central é discutir a possibilidade de uma ética pertinente ao conjunto de ações atualmente realizadas sob o enfoque da Atenção Psicossocial no campo da Saúde Mental Coletiva. Utilizando o método do ensaio, partirei da análise de algumas proposições importantes sobre a ética na Saúde Mental, presentes na literatura recente, e da experiência de vários anos no campo da Atenção Psicossocial como trabalhador, como assessor clínico-institucional do Ministério da Saúde e como formador de psicoterapeutas. Duas vertentes de análise são consideradas: éticas disciplinares, chamadas éticas da psiquiatria, incluindo uma tentativa importante de complementá-las criticamente sob o enfoque da ética do cuidado, e éticas fundadas em concepções psicanalíticas do sujeito e seu sofrimento, que destacam as dimensões do sujeito como entre social e como entre subjetivo ou entre sentido. Com base nas diretrizes do Sistema Único de Saúde e na psicanálise do campo freudiano, procura-se fundamentar a ética da Clínica na Atenção Psicossocial como ética do cuidar-se - base necessária para a construção do protagonismo dos sujeitos do sofrimento na produção do sentido necessário à superação do sofrimento e demais impasses que motivaram a procura de ajuda, e para a possibilidade de seu reposicionamento no entre social e no entre sentido; componentes da saúde em sintonia com a subjetividade singularizada referenciada nos Ideais socioculturais e no devir desejante. Demonstra-se que essa ética exige dos trabalhadores do campo a superação dialética dos modos de produção de saúde e subjetividade em sintonia com o Modo Capitalista de Produção e seus derivados autoritários.

O psiquiatra na atenção psicossocial: entre o luto e a liberdade

No Brasil, vemos surgir, a partir da década de setenta, diversas propostas inovadoras no campo da atenção à saúde mental. A partir de então, multiplicam-se no país ambulatórios de psicologia e psiquiatria, hospitais-dia, residências terapêuticas e diversos núcleos/centros de atenção psicossocial. Transformados em política pública, os centros de atenção psicossocial espalham-se pelo país, preconizando um atendimento ambulatorial, interdisciplinar e de orientação territorial. Geralmente formado sob os auspícios de um grande hospital, o psiquiatra que se propõe a trabalhar, a partir da ótica psicossocial, imerso em uma pequena cidade, vê-se exposto às diversas contradições e ilogicidades do discurso psiquiátrico clássico. Os variados saberes locais são uma ameaça ao saber psiquiátrico medicamente constituído. Respostas, antes fáceis no interior do hospital, têm variadas implicações no território e adquirem uma complexidade para a qual o psiquiatra não se encontra preparado. Assim, este trabalho tenta demonstrar a dissonância entre essas duas espécies de psiquiatria: a clássica (afinada com a biologia, com a normatividade e com a instituição) e a psicossocial (que se volta para respostas localmente construídas e que se afina com o homem, em uma dimensão muito além do seu corpo).

Exercícios respiratórios para asma: revisão sistemática com metanálise

Introdução: A asma se tornou um problema de saúde pública devido aos seus grandes custos em cuidados de saúde. Os exercícios respiratórios constituem uma intervenção não farmacológica de baixo custo e baixo risco que vem sendo utilizada por fisioterapeutas em diferentes países no tratamento de pacientes asmáticos. Objetivo: Avaliar a eficácia dos exercícios respiratórios no tratamento de pacientes adultos com asma nos seguintes desfechos: qualidade de vida, sintomas da asma, número de exacerbações agudas, episódios de hospitalização, mensurações fisiológicas (função pulmonar e capacidade funcional), número de consultas médicas, número de faltas no trabalho devido a exacerbações da doença, avaliação subjetiva do paciente em relação à intervenção. Método: Revisão sistemática de estudos controlados randomizados com metanálise realizada em parceria com a Colaboração Cochrane. As seguintes bases de dados foram consultadas: the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, AMED, e PsycINFO, além de busca manual em revistas da área e em resumos de congressos. Os seguintes termos foram utilizados: (breath*) and (exercise* or retrain* or train* or re-educat* or educat* or physiotherap* or "physical therap*" or "respiratory therapy" or buteyko ). As listas de referências dos estudos selecionados e registros de ensaios clínicos também foram consultados. A seleção dos estudos e a avaliação do risco de viés dos estudos incluídos foram realizadas de maneira independente por dois revisores. O software Review Manager foi utilizado para análise dos dados, no qual o modelo de efeito fixo foi utilizado. As variáveis contínuas foram expressas como diferença de média ponderada com um intervalo de confiança de 95%. A heterogeneidade dos resultados dos estudos incluídos foi realizada por meio da análise dos Forest plots. O teste qui-quadrado (Chi2) com um P valor de 0.10 foi utilizado para indicar significância estatística. O Índice de heterogeneidade (I2) foi implementado com um valor acima de 50% como um nível substancial de heterogeneidade. Resultados: 13 estudos envolvendo 906 pacientes estão atualmente incluídos na revisão. Os seguintes desfechos foram mensurados pelos estudos incluídos: qualidade de vida, sintomas da asma, número de exacerbações agudas e função pulmonar. Os estudos relataram uma melhora na qualidade de vida, sintomas da asma e número de exacerbações agudas. Seis dos onze estudos que avaliaram função pulmonar mostraram uma diferença significativa favorável aos exercícios respiratórios. Não houve relato de efeitos adversos. Devido à heterogeneidade substancial encontrada entre os estudos, metanálise foi possível apenas para sintomas da asma, a qual incluiu dois estudos e mostrou uma diferença significativa favorável aos exercícios respiratórios. A avaliação do risco de viés foi prejudicada devido ao relato incompleto de aspectos metodológicos pela maioria dos estudos incluídos. Conclusão: Embora os resultados encontrados pelos estudos incluídos demonstraram individualmente que os exercícios respiratórios podem ser importantes no tratamento da asma, não há evidência conclusiva nesta revisão para suportar ou refutar a eficácia desta intervenção no tratamento de pacientes asmáticos. Este fato foi devido às diferenças metodológicas entre os estudos incluídos e à ausência de relato de aspectos metodológicos por parte da maioria dos estudos incluídos. Não há dados disponíveis em relação aos efeitos dos exercícios respiratórios nos seguintes desfechos: episódios de hospitalização, número de consultas médicas, número de faltas no trabalho devido a exacerbações da doença, e avaliação subjetiva do paciente em relação à intervenção

Psicologia e profissão: neurose profissional e a atuação do psicólogo organizacional frente à questão

Este artigo pretende fazer um levantamento bibliográfico sobre a neurose profissional, cujos sintomas são entendidos como a expressão simbólica de um conflito psíquico que se desenvolve a partir de uma situação organizacional ou profissional determinada. O diagnóstico é formado a partir das queixas mencionadas, da história de trabalho e da análise da situação de trabalho atual. Entende-se que condições estressantes de trabalho, associadas ao contexto social de desemprego e competitividade, contribuem para o aparecimento de doenças mentais como a neurose profissional. As formas de tratamento para essa doença, além da psicoterapia individual, envolvem a ação integrada de uma equipe multiprofissional capacitada para lidar com o sofrimento psíquico do trabalhador e com os aspectos sociais e de intervenção nos ambientes de trabalho. Ressalta-se a carência de literatura sobre o tema estudado e a importância de se ampliar a discussão sobre os fatores de risco no trabalho, os determinantes psíquicos para o desenvolvimento da neurose profissional e o papel do psicólogo no contexto de prevenção e promoção da saúde mental.

Programa de odontologia para bebês: uma avaliação quantitativa e qualitativa

The objective of this study was to evaluate a baby dentistry program which has been in the city of Natal for five years. The research was based on two analysis: a quantitative one, which tried to check caries prevalence in 52 children supported by the program and a qualitative one, which, through interviews carried out with the mothers, using the focus group technique, tried to realize the effect of the program their attitudes related to the care of their children´s oral health. For the quantitative analyses of caries prevalence there was the use of def-s and knutson rates and the values obtained were shown in a descritive and analytical way.The results showed that 4.2% of babies ranging 24 to 36 months old presented carie disease. Children from 36 to 48 months old and above 48 months old presented 18.2% and 16.7% carie prevalence respectively.The def-s averages found in ages 24 to 36, 36 to 48 and 48 to 60 months old were 0.08; 0.40 and 1.16 respectively, considered as being equally low, going along with Knutson rates. The qualitative analyses showed a high level of the mothers` satisfaction, considering the access,practitioner-patient relationship and opportunity to keep the oral health. Children supported by the program showed a low carie prevalence and the program turned out to be effective under the mothers` point of view

Psicose e toxicomanias: um estudo psicanalítico

This paper is a case study that aims to discuss the effects of drug abuse by a person with psychotic structure from a psychoanalytical perspective. The interest in this subject was born from an internship experience in the Mental Health area in which a psychotic patient had a drug abuse problem and the service treating him had difficulties dealing with this. In order to accomplish the objective of this work four theoretical chapters were written and the case is discussed throughout them articulating the theoretical issues with clinical practice. A literature review revealed that Freud and Lacan did not dedicate themselves to the study of the effect of drug use by psychotic patients but they made important contributions unfolding the theoretical and clinical psychoanalytical practice. Contemporary psychoanalytic authors suggest that the drug use made by psychotics differs from the use by neurotics, because of the particularity of the psychotic structure. It was found that drug use in psychosis can operate in three different ways: the first refers to drug use as substitute of a missing signifier helping the psychotic patient building a social bond. The second function is to intensify psychotic phenomena and the third function is to operate as an attempt to diminish those same phenomena. We conclude that, while the use of drugs in neurosis provides an individualist way of satisfaction, that excludes social aspects. For psychosis such use may operate differently and may play a role in social integration, among others effects. Such discussion can help move forward the direction of treatment of psychosis when the case involves drug use

A dimensão sociocultural da reforma psiquiátrica: articulando redes para a consolidação da estratégia de atenção psicossocial

This thesis aims to discuss on articulations that have been produced on the socio-cultural field in the Psychiatric Reform process and its pertinence to the streghtening of Psychosocial Care Strategy (EAPS) in Fortaleza/CE. Such interest has been justified by the need to promote not only the production of these networks, but also interfaces to enable strategies of support and sociability from the perspective of deinstitutionalization of madness. We were inspired by the cartography perspective of Deleuze e Guattari, and determined as objectives: 1) to discuss the complexity of Psychiatric Reform process and analyze the EAPS as a model for the current Mental Health policy in the country; 2) to map socio-cultural strategies connected to the CAPS network in the city, investigating experiences that already exist or may be constituted as everyday social support networks; 3) from that mapping to start, define and discuss some aspects that converge to the accomplishment for this new mental health paradigm, drawing a cartography of the issues and movements in progress. The mapping was carried out in 2009 and consisted of semi-structured interviews with the coordinators of the 14 existent CAPS and with some people connected to the Coordination of Mental Health. Besides, during the whole development of the study, we have taken part in public events that brought us clues on the connection between mental health and culture. From the survey produced, we defined three vectors for discussion (Art, Labour and Partnership with Social Movements) which have been highlighted as effective possibilities of intervention in the socio-cultural field of Psychiatric Reform in Fortaleza and reveal important paths on the fulfillment process of a new pattern of care. For each of these axes, we chose a field of empirical research (Projeto Arte e Saúde, COOPCAPS e MSMCBJ) in which we could better understand their strengths and difficulties, starting from open interviews with some of their actors and the production of a diary of sensations in 2010. We have seen that they are articulated with the proposal of EAPS, being part of the concerns to the National Mental Health Policy and also the municipal administration. However, we have noticed to be necessary to promote those dimensions further, focusing on its complexity at the macro and micro policies, with the purpose of leading the Psychiatric Reform process

O Serviço Ambulatorial Móvel de Urgência (SAMU) no contexto da reforma psiquiátrica: em análise a experiência de Aracaju/SE

This research investigated professional practices from Mobile Urgency Care Service (Serviço Ambulatorial Móvel de Urgência - SAMU) at psychiatric cases of the city of Aracaju/SE, Brazil and its possible articulations to psychosocial services network. The regulation no. 2048 of 11/05/2002 from Ministry Health establishes National Urgency Policy and designates that psychiatric cases are SAMU's responsibility. Then, it is necessary to propose an analyze of psychiatric urgency service under anti-asylums social movements standpoint, mainly because this service is responsive in assisting a person in crises. Fieldwork was developed in two phases. First one was made with SAMU workers and the information were produced by recorded semi-structured interviews. Results of this first phase indicate that urgency psychiatric conception from SAMU workers is based on aggressiveness concept; delays at psychiatric cases support and low training in mental health care which means several difficulties to emergency service. Although, we noticed that SAMU use asylum procedures at psychiatric cases like ropes and odder instruments to contain people. The second step of our research was to attend meetings to build a new psychiatric urgencies protocol for SAMU to define practices to auxiliaries, vehicular conductors and medical support regulation. Therefore, open interviews were accomplished with some participators and follows-up to psychiatric case on board of SAMU's cars. Afterwards we discussed how the urgency paradigm, that influence the protocol draw and as consequence distort what we believe is the essentially function of this device, that is to give care support to persons in crises and produce articulation to psychosocial services network

Em defesa da reforma psiquiátrica :por um amanhã que há de renascer sem pedir licença

Insanity was victim of several arbitrary acts perpetrated on behalf of the science. Psychiatric reform constitues an important movement which has attempted to rescue dignity and humanity in the treatment of mental disorder patients. Some countries have advanced in the implement of substutive models that work on the construction of a new social place for madness. The model of attention to mental health in Brazil has also suffered extensive modifications due to the wearing out of the psychiatric hospital model. In Santos, a town in the State of Sao Paulo, we have found a landmark in the development of an anti internment politics, through the creation of a dail care service, including psychosocial assistance. It is in this context that it has been founded in Natal, Rio Grande do Norte, the NAPS and CAPS ( Nucleus and Centres of Psychosocial Attention), municipal strategies that put into effect the law # 10.216/2001, which estabilishes the gradual extinction of psychiatric hospitals. This work has the purpose of carrying out a study about the historical process of psychiatric reform implantation in the State of Rio Grande do Norte, emphasizing the actors involved in process, their trajectory, achievements, improvements, and the movement s perspectives of achieving the ideal of reinstating mental disorder patients. In order to accomplish this purpose, it was necessary to understand the process occurred at the Municipal Secretary s Office for Health, since 1992, for it was the impelling experience towards the reflections about the psychiatric reform in the State of Rio Grande do Norte. The instruments used for this work were documentary analysis, through reports, legislation and handbooks, as well as the staments of people involved in this process. Through the statements analysis, we attempted to estabilish the social actors identity, their perception, emphasizing congruences and incongruences concerning the history of psychiatric reform in the State of Rio Grande do Norte. It is also analyzed the contribution of Psychology in this process, which has become a protagonist in the struggle for the rights of mental disorder patients

Ajuda mútua nos CAPS: o papel dos serviços no empoderamento dos usuários

The research objective is explore practices to mutual help between CAPS users from the east and west regions of the city of Natal, RN, in Brazil. In the mental health field, we observe the care from substitutive services is based on technical knowledge where the person of the mental health professional is predominant. The Brazilian psychiatry reform invests in equipments and mental health care protocols, but it is necessary to invest more vigorously in new strategies and actors capable of obtaining resources to achieve this goal, such as the users. If one cornerstone of the psychiatric reform consists of changing the type of relationship established with the person with mental disorders, why this relationship, nowadays, is still dominated by technique and unevenness, where on one side we have a person who knows something and who needs take care of someone, and on other side we have another who knows nothing and thus needs to be cared for? Starting from this problematization of the traditional methods of health/mental health care, an attempt was made to investigate in what ways the mutual help practices between people with mental disorders can realize potential avenues not yet explored within the scope of psychiatric reform. The objective of this research was to map possible mutual help practices among the users, and the technical understanding of such practices. For that, we took part in the daily activities of the CAPS, mapping the experiences of mutual help among users. In addition, we accompanied the users in external activities (such as return home, trips, etc), and we had roundtables with the professionals. The research was guided by theoretical methodological references of the institutional analysis. The results pointed to a lack of behaviors of mutual help or support among users, something that can probably be explained by the service work dynamics, as well as the relationship between technicians and users, which has a tendency to create hurdles for meetings among users, as well as being non-conducive to theirempowerment

Agente penitenciário: trabalho no cárcere

Behind the high walls of a prison, there is suffering! Suffering from those who atone to their punishment, from those who work on behalf of an alleged regeneration, suffering that has remained for over two centuries. For those who had their conducts characterized as a crime, many studies have been developed. On the other hand, little is known about the prison servants. This research focused mainly on the identification, from the perspective of the correctional officers from two prisons in different states of Brazil, of the negative influence that their jobs have on them, on the factors that serve as protection, as well as the ones that offer them risk. It was observed that hygiene and security conditions are precarious in both prisons. From the reports, scabies, tuberculosis, hepatitis, H1N1, constant violence, politicization of the working environment, doubled working hours, lack of career planning and salaries emerge as evidence of the place where the bodies who work there are subdued, not taking the differences into account. From the above, and as of the many things that still need to be said about this category, it is reiterated the importance in developing studies about the conditions and the work organization and its implications on the mental health of those workers, who lack of public policies committed to their working realities