Os sentidos atribuidos a atencão a crise nas praticas discursivas dos profissionais de Centros de Atenção Psicossocial: contribuições para a enfermagem psiquiátrica

Abstract

Crisis, thought to be an expression of illness, refers to the time in one’s life when suffering is so intense that it can generate a loss of psychic, family and social structure. These situations lead to conflicting experiences that cause a breakup both from the socially acceptable reality and from affection bonds that support the individual. In the Psychiatric Reformation context, crisis reflects breakups as well as family and social conflicts. In this sense, this research aims to get to know the professional discourse practice awareness in dealing with crisis in Psychosocial Care Centers. Finding the meaning of a phenomenon is both an intersubjective interaction and a social structural process in which the subjects, from their own discourse practices, take stands, get to know one another and set up the ways for daily event comprehension. This study is characterized by a qualitative approach that makes use of a Social Constructivism theoretical basis. The data used were obtained from the Southern Brazil Psychological Care Center Evaluation (CAPSUL) research database. The research is divided into a quantitative and a qualitative study. The qualitative evaluation focused on Psychosocial Care Centers I and II from five counties in southern Brazil: Alegrete, Joinville, São Lourenço do Sul, Porto Alegre and Foz do Iguaçu. Developed from a case study perspective, it involved users, their relatives and professionals. In the present study, 27 interviews with Psychosocial Care Center professionals in Alegrete and three field diaries that describe a 390 h. observation period at Psychosocial Care Centers and the health network were analyzed. Data analysis was performed by connecting four aspects: the use of interpretation repertoires and idea association maps, the literature examined during the research, the theoretical-methodological basis and the researcher interpretation, creating discourse practices and awareness related to two categories. The first, called Perilousness and Citizenship: meanings connected to crisis refers to meanings involved with crisis which are built up as truths created by the knowledge/power games that are expressed from the moment people interact with each other and who, upon expressing themselves in discourse, take stands for or against hegemonic power. Thus, the identified meanings - perilousness and citizenship – have been discussed for the purpose of understanding their influence upon building crisis awareness practices. In the second category, so-called From violence to bonding: building new meanings to crisis territorial care, crisis awareness territorial care practices and the meanings conveyed are discussed. The practices that have been identified are: welcoming, user accompaniment during in the various mental health network practices (general hospital, emergency, therapeutic home care, in addition to Psychosocial Care Centers), mechanical restraint and Military Police contact. One of the contributions of this study is the clear need to discuss crisis awareness practices and their construction in a collective way from bonding relationships. Another contribution is in the discussion about the work of mental health nursing, especially at the moment of transition from the nursing activity that seeks to adapt to an appropriate interdisciplinary practice