A palavra cantada nos espaços intersubjetivos de um centro de atenção psisossocial do município do Natal/RN

The psychiatric care and mental health are undergoing constant change over the History. The Brazilian Psychiatric Reform, which brings up the deinstitutionalization as a structuring in the restorative care process. The Reform has as one of the mainly substitutive services the Centers for Psychosocial Care (CAPS), which work from the Singular Therapeutic Project (PTS) in order to restore the autonomy and restore the dignity of users. The therapeutic workshop is some of the resources used and work several kinds of activities as: writing, handcraft, music, poetry, and so forth. This study set up to apprehend the social representations of helping of the music workshop carried out in the CAPS II east of Natal/RN, from the reports given by the participants of the workshop, using the focal group as technique. This is a descriptive exploratory study with a qualitative approach. A total of 16 users participated in four musical therapeutic workshops from April to May 2010. The study was approved by the Ethics and Research Committee of UFRN. The discursive material from the workshop was submitted to the informational resource of Analyse Lexicale par Contexte d um Ensemble de Segments de Texte, ALCESTE, and analyzed based on the Theory of Representations and the Central Core Theory. The majority of subjects were men (62.5%), single (62.5%), aged 40-49 years (37.6%) and elementary school level (56.2 %). The reports were transcribed and submitted to the classification system of ALCESTE, which elected the following categories: Category 1 - Experience in the Word Family Sung, Category 2 - Musical Experiences and Approaches, and Category 3 - Feelings and emotions evoked by music. The representation of these individuals is anchored in the experience they have with the CAPS, lived and socialized by common sense, through this particular social group workshop objectified in music therapy as a therapeutic modality enjoyable. The central core revealed the intrinsic relationship between users and the music, establishing a relationship of openness to use the same while its therapeutic use in workshops of substitute services for mental health. Peripherals elements issues are related to listen, share and experience music in the family. Intermediary Elements relate to the feelings and emotions evoked by music, given her close relationship with it. It was found in the study that music can be construed as an artifact of good therapeutic responsiveness to users, configuring it as an invigorating and enjoyable therapy, confirming the need for continuity of this activity, as well as its expansion into the service

Nem tudo que reluz é ouro: oficinas terapêuticas no cenário da Reforma Psiquiátrica

The purpose of this study is to discuss the therapeutic workshops function, while questioning if they constitute a mechanism for change of the traditional asylum logic. The Psychiatric Reform was materialized with the financing and regulation of alternative services that substitute the psychiatric hospital. This change was promoted by the anti asylum debate and the deinstitutionalization besides psychosocial rehabilitation paradigms. Mental health care, therefore, acquired a new form and the Centers for Psychosocial Care (CAPS) are considered the main services of the health network presently under construction. They are services that offer a variety of therapeutics and amongst them is the workshop, considered essential for the advancement of the Reform ideas. The study was conducted in a CAPS II in Natal, RN. Systematic visits were made using the Institutional Analysis perspective, futhermore were made interviews with professionals who was related to workshops. In the end, data were then discussed according to Schizoanalysis. Results denot that workshops represents, in the same time, progress and regress of Psychiatric Reform. It was observed that workshops were oftentimes reduced to strategies for the occupation of time, and as a means for the transmission of social values considered correct. The relationship between professionals and the user of the service was hierarchical and both players was seeing the workshop as a task to be met. Although users expressed intreresting about wokshops, was reported that the work was boring. Besides, except for some cases, the therapeutic workshops wasn t helping clients to create other possibilites in theirs life and stops the job inside the mental care service

Oficina terapêutica e um caso de alcoolismo

Pós-graduação em Psicologia - FCLAS

Trupe Maluko Beleza: percursos e sentidos de uma oficina de teatro no campo da saúde mental

Pós-graduação em Psicologia - FCLAS

Discurso moderno e psiquiatria reformada: considerações sobre um Centro de Atenção Psicossocial (CAPS)

A presente dissertação tem o objetivo de discutir a relação entre um dos novos serviços de intervenção e cuidados sobre a loucura, o Centro de Atenção Psicossocial (CAPS), e o olhar psiquiátrico que se construiu ao longo do século XIX. O CAPS, amparado pelos preceitos da Reforma Psiquiátrica Brasileira, visa, tal como outros dispositivos, combater o modelo asilar de assistência à loucura que se deu ao longo dos séculos, sobretudo sustentado, a partir do período moderno, no discurso psiquiátrico que tomou a loucura como objeto de seu saber, transformando-a em doença mental. O método utilizado para investigação foi a observação participante que se deu através da presença direta da pesquisadora no campo de estudo, descrevendo os elementos que circunscreveram o objeto de pesquisa, tais como: oficinas terapêuticas, grupos de psicologia e de família, acolhimento, assembleias e demais atividades, coletivas ou individuais, que fazem parte da dinâmica própria do serviço investigado. Inicia com a descrição do objeto, CAPS II: Santa Izabel, desde sua implantação no município de Santa Izabel do Pará, em 2001, até suas configurações atuais. Em seguida fundamenta os preceitos da Reforma Psiquiátrica que regulamentam ideologicamente este serviço, situando as referências históricas que culminaram neste movimento reformista, a partir das contribuições teóricas foucaultianas sobre o poder psiquiátrico e transformação da loucura em doença, bem como referencia demais autores que se apropriaram desta temática no contexto europeu, brasileiro e paraense. A Psicanálise é tomada, nesta dissertação, como uma possibilidade de apostar no sujeito possível de advir e existir, destacando as contribuições de Freud e Lacan sobre a teoria psicanalítica da psicose. Finaliza com análise dos dados coletados, aproximados ao referencial bibliográfico, demonstrando que, apesar do CAPS propor a ruptura com o modelo asilar instituído pelo saber psiquiátrico, naquele século, várias ações que se sustentam nesse objetivo, atualizam práticas asilares que, ao invés de darem um novo lugar à loucura, reeditam o enclausuramento imposto aos sujeitos que vivenciavam tal experiência subjetiva. Conclui que o CAPS precisa problematizar e relativizar as exigências regulamentadas pela Reforma e por sua lei, para conseguir resistir ao saber medicalizante que se faz tanto presente quanto antes, e assim conseguir reinventar práticas, conceitos, e modos de existência à loucura.

O trabalho como dispositivo de atenção em saúde mental: trajetória histórica e reflexões sobre sua atual utilização

The partnership between Mental Health (MH) and work is present throughout the history of psychiatry. Capitalist society has used and uses the fitness or unfitness for work not only as one of the elements to the definition of "normality", but also as a treatment strategy. In this perspective, one can find a position healing and, more recently, a different proposal put forward by the psychiatric reform that considers also make / produce, the construction of meaning in the work as crucial for subjectivity. This sense is present in therapeutic workshops that seek to value the uniqueness, not to override the differences. The objective of this paper is to reflect on the relationship between Attention in SM / Work. Initially presents three theses, from which this relationship is built historically: 1 - Work as a means of avoiding idleness returning productively to society; 2 - Work as a healing practice, from the prescription, and 3 - Work as a strategy for care and social inclusion. Below, we discuss some questions about therapeutic workshops and income generation in the mental health care as a device for attention and social inclusion.

A configuração de forças na constituição histórica do trabalho como estratégia de cuidado em saúde mental: problematizações foucaultianas

Investigated in this paper, as contributions to Foucault's genealogy of knowledge, the historical constitution of the joint activities between Work and Care in Mental Health (called Therapeutic Workshops, among other names) in their different purposes and dimensions that contributed to the production care of patients with psychological distress at different times. History is here understood as a multiplicity (and nonlinearity) of time series and various blending and shuffleforming speeches as truths. In conjunction we have discussed, we conclude that the work as a therapeutic modality in nursing homes, there emerged in the world of psychiatry, but of capitalism. Associated with measures of occupation "empty minds" of misfits, later earned the position of an instrument of discipline and social regulation. With the Psychiatric Reform, activities Work in Mental Health have been re-invented as spaces enablers of access to citizenship and contractuality social network users.

Corpos em travessia: ensaio de uma clínica dos fluxos

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Avaliação de boas práticas em saúde mental na atenção psicossocial

A partir do redirecionamento do modelo assistencial no Brasil emerge a necessidade de discussão da reinvenção de práticas alinhadas com o cenário de transformações. As práticas agora devem se desenvolver no sentido de superar o isolamento das grades, dos muros e das chaves, do apagamento do sujeito, da supressão de sintomas e das personalidades dos sujeitos em sofrimento psíquico. Diante disso, é que este estudo tem como objetivos avaliar boas práticas em saúde mental na atenção psicossocial no contexto de um município da região Sul do Brasil. Para tanto, organizou-se como uma pesquisa avaliativa construtivista, com enfoque responsivo, a medida que desenvolve um consenso critico entre os grupos de interesse. Está baseada na Avaliação de Quarta Geração, proposta por Guba e Lincoln (2011), que emerge como opção metodológica e se articula com o referencial teórico das \"Boas Práticas em Saúde Mental Comunitária\", proposto por Thornicroft e Tansella (2010). Este é apresentado de modo a identificar boas práticas na saúde mental, com base na articulação de 3 eixos indispensáveis e indissociáveis: a ética, como princípio fundamental que deverá orientar o planejamento, a assistência e a avaliação dos serviços. A evidência deve embasar as intervenções e serviços. E a experiência como uma evidência do que vem sendo produzido nas experiências locais e regionais de organização da rede de serviços. Como resultado do processo as práticas de Acolhimento, Projeto Terapêutico Singular e Transferência de Cuidados emergiram para discussão. O Acolhimento torna-se concreto nas ações da Porta Aberta, e significa escuta qualificada no momento em que a necessidade emerge, além de representar a oferta de atenção de qualidade baseada no processo relacional que fortalece o estabelecimento de vínculos e a construção de projetos de vida. O Projeto Terapêutico Singular apresenta-se como uma boa prática, a medida que é capaz de dar resposta singularizada e individualizada às necessidades do sujeito, de modo a oportunizar como resultado uma pessoa capaz de andar na vida. É definido de forma compartilhada entre equipe, usuário e família, segundo os objetivos terapêuticos para cada sujeito, e utiliza o técnico de referência, as mini equipes, as oficinas terapêuticas, os grupos terapêuticos, as assembleias, enfim, ofertas e propostas que permitem ao sujeito retomar o envolvimento com os espaços da cidade, no caminho da produção de vida. Com relação à Transferência de Cuidados, esta possibilita ao sujeito que vive o processo não só circular em uma rede de serviços, mas, acima de tudo, buscar, com suporte dela, sua emancipação. Para tanto, investe em práticas que estimulem a autonomia dos sujeitos, por meio de instrumentos como o Acompanhamento Terapêutico, Grupo de Apoio à Alta, espaços de decisões e discussões, estímulo à busca e resolução de problemas, atividades de reconhecimento dos espaços da cidade, transporte, cultura e lazer. Além disso, investe nas ações com a Atenção Básica, a partir do Apoio Matricial com processos de formação continuada com as equipes, e mapeamento da situação da saúde mental nos territórios. Ao final deste estudo, é possível concluir que o modelo de atenção psicossocial demonstrou potencialidade de produzir boas práticas na atenção à saúde mental, e que estas tem transformado a vida dos sujeitos em sofrimento psíquico, bem como tem auxiliado no processo de reconquista de espaços sociais

Creating a therapeutic environment : a non-randomised controlled trial of a quiet time intervention for patients in acute care

Background: Noise is a significant barrier to sleep for acute care hospital patients, and sleep has been shown to be therapeutic for health, healing and recovery. Scheduled quiet time interventions to promote inpatient rest and sleep have been successfully trialled in critical care but not in acute care settings. Objectives: The study aim was to evaluate as cheduled quiet time intervention in an acute care setting. The study measured the effect of a scheduled quiet time on noise levels, inpatients’ rest and sleep behaviour, and wellbeing. The study also examined the impact of the intervention on patients’, visitors’ and health professionals’ satisfaction, and organisational functioning. Design: The study was a multi-centred non-randomised parallel group trial. Settings: The research was conducted in the acute orthopaedic wards of two major urban public hospitals in Brisbane, Australia. Participants: All patientsadmitted to the two wards in the5-month period of the study were invited to participate, withafinalsample of 299 participants recruited. This sample produced an effect size of 0.89 for an increase in the number of patients asleep during the quiet time. Methods: Demographic data were collected to enable comparison between groups. Data for noise level, sleep status, sleepiness and well being were collected using previously validated instruments: a Castle Model 824 digital sound level indicator; a three point sleep status scale; the Epworth Sleepiness Scale; and the SF12 V2 questionnaire. The staff, patient and visitor surveys on the experimental ward were adapted from published instruments. Results: Significant differences were found between the two groups in mean decibel level and numbers of patients awake and asleep. The difference in mean measured noise levels between the two environments corresponded to a ‘perceived’ difference of 2 to 1. There were significant correlations between average decibel level and number of patients awake and asleep in the experimental group, and between average decibel level and number of patients awake in the control group. Overall, patients, visitors and health professionals were satisfied with the quiet time intervention. Conclusions: The findings show that a quiet time intervention on an acute care hospital ward can affect noise level and patient sleep/wake patterns during the intervention period. The overall strongly positive response from surveys suggests that scheduled quiet time would be a positively perceived intervention with therapeutic benefit.

PEPA workshops for allied health professionals : outcomes and directions for the future

The Program of Experience in the Palliative Approach (PEPA) started in 2003 as an initiative of the Australian Government, Department of Health and Ageing. The overall aim of PEPA is to improve the quality, availability and access to palliative care for people who are dying, and their families, by providing high quality learning experiences for primary care providers, including allied health professionals. As part of the program, an allied health workshop program has been developed following an extensive review of the literature and in consultation with experts in the field. The PEPA allied health workshops are offered across all states/territories.

Therapeutic relationships in specialist palliative care nursing practice.

There has been limited research into the scope or standards of specialist palliative care nursing practice in an Australian context. This study sought to develop a competency framework that described the core domains of specialist palliative care nursing. This article explores one key domain of specialist palliative care nursing practice - therapeutic relationships - that was identified as underpinning other domains of practice. A mixed method was used, involving a literature review, a survey including practice exemplars and an interview of specialist palliative care nurses. Seventy-four registered nurses working in designated specialist palliative care nursing roles from each Australian state and mainland territory were involved. The nurses represented metropolitan, regional, rural and remote communities, various inpatient facilities and community practice settings. Five core domains of specialist palliative care nursing practice were identified: complex supportive care, collaborative practice, leadership, improving practice and therapeutic relationships. Therapeutic relationships were identified as the central domain of specialist palliative care nursing practice to which all other domains were inextricably linked.

A naturalistic inquiry of registered nurses' perspectives and expectations of psychodynamic therapeutic care in acute psychiatric inpatient facilities

Within contemporary inpatient mental health nursing practice, the psychodynamic model of care considered previously to be central to the nurse-patient relationship now seems a radical concept. It appears to exist only within primary care facilities and public health care practice settings. This naturalistic inquiry aimed to explicate mental health nurses' perspectives and expectations of providing psychodynamic therapeutic care in acute inpatient psychiatric facilities. Ten registered nurses working in acute inpatient mental health facilities were interviewed. Five themes emerged: a career for life, relating in a psychodynamic manner, swimming against the current, adopting a position of difference, and hopeful expectancy.