Saúde mental na unidade de pronto atendimento: conhecimentos e práticas de enfermeiros

Abstract

The Brazilian Psychiatric Reform promoted historical changes in the health care model for people with mental disorders, having as an important milestone the creation of the Psychosocial Care Network, which diversified the points of care for this public. In the context of urgency and emergency, such care must be performed by all health equipment that make up the Urgency and Emergency Network, including the Emergency Care Unit, which is the scenario of this study. Among the multiprofessional team working in this space, nurses stand out for their fundamental role and specific attributions in this type of care. In this work, it was intended to understand the knowledge (knowing) and the practices (doing) of nurses about mental health care in the context of the Emergency Care Unit. This is a research that involved the construction of an integrative literature review manuscript about the state of the art of the object of study and another with a qualitative approach with an exploratory approach, in which the case study was used as a methodological reference and, as a theoretical framework, the Theory of Social Representations. In the integrative review study, 56 references were selected and in the field research there was the participation of 22 nurses who are part of the staff of the Emergency Care Unit in the municipality of Três Lagoas, state of Mato Grosso do Sul. Data collection was carried out through interviews using a semi-structured data collection instrument. Data from the integrative review enabled the construction of six categories: 1- Characteristics of mental health conceptions; 2- Characteristics of communication; 3- Characteristics of interventions; 4- Characteristics of network service; 5- Characteristics of competence in mental health care and; 6- Characteristics of barriers during consultations . The data from the fieldwork were analyzed in the light of the Theory of Social Representations with the aid of the software IRaMuTeQ (Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires) version 0.7 alpha 2, enabling the following categories: a) “The tortuosity of the Psychosocial Care Network: in search of a path”; b) “The abyss between the health professional and the person with mental disorder” and; c) “Unveiling the care of nurses at the Emergency Care Unit in mental health”. There was an important lack of knowledge about the Psychosocial Care Network, lack of approximation with aspects of the field of mental health in their work processes, the triggering of negative feelings, fragility in training processes and the use of physical, chemical and physical restraint. mechanics as possibilities of attention to the person with mental disorder. In addition, potentialities were perceived for the production of mental health care from attempts to achieve the best possible care within the existing conditions in the scenario of action and the establishment of effective communication with the user and their families. In this way, it was possible to know the cognitive elements present in the nurses' social representations about the possibilities and everyday concreteities related to mental health care in the Emergency Care Unit, which brings possibilities to (re)think the mental health practices that they have. been produced and the improvement of strategies in the ways of work of the nurses participating in the research.