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KNOW LEDGE OF NURSES AT A PSYCHI ATRI C HOSPI TALI ZATI ON UNI T OF A TEACHI NG
HOSPI TAL
1Agn es Olsch ow sk y2 Mar ia de Lour des Cust ódio Duar t e3
Olschowsky A, Duart e MLC. Knowledge of nurses at a psychiat ric hospit alizat ion unit of a t eaching hospit al. Rev Lat ino- am Enfer m agem 2007 j ulho- agost o; 15( 4) : 689- 91.
This st udy aim s t o ident ify t he knowledge of t he nurses in a psychiat ric hospit alizat ion unit at a universit y hospit al. I t is an explorat ory, descript ive research wit h a qualit at ive approach, ut ilizing sem ist ruct ured int erviews. Th e n u r ses r efer t o a ch an ge in t h e assist in g car e, st ar t in g fr om t h eir ex per ien ce in t h e asy lu m m ode an d
m ak in g r ef er en ces t o t h e con cept s of t h e psy ch osocial m ode: in t egr alit y , w elcom in g, in t er disciplin ar it y an d in t er p er son al r elat ion sh ip . I n t eg r al an d in d iv id u al car e, k n ow led g e of t h e p sy ch iat r ic sy n d r om es an d t h eir
t reat m ent as w ell as t he considerat ion of t he subj ect ivit y of t he subj ect under psychiat ric suffering are part of t he know ledge t hat guides nur sing act ions in m ent al healt h.
DESCRI PTORS: m ent al healt h; psy chiat r ic nur sing; hospit als, univ er sit y
SABERES DE LOS ENFERMEROS EN UNA UNI DAD DE I NTERNACI ÓN PSI QUI ÁTRI CA EN UN
HOSPI TAL UNI VERSI TARI O
Est e est udio t iene por obj et ivo ident ificar los saber es de los enfer m er os en una unidad de int er nación
psiquiát rica en un hospit al universit ario. Se t rat a de una invest igación explorat oria, descript iva, con aproxim ación cualit at iva, ut ilizando la ent revist a sem i- est ruct urada. Los enferm eros refieren una t ransform ación en el cuidado
asist en cial a par t ir de su ex per ien cia en el m odo asilar , h acien do r ef er en cias a las con cepcion es del m odo psicosocial: int egralidad, acogida, int erdisciplinaridad y relación int erpersonal. El cuidado int egral e individual, el
conocim ient o de los síndrom es psiquiát ricos y su t rat am ient o y la consideración de la subj et ividad del individuo baj o sufrim ient o psíquico son form as del saber que orient an las acciones de la enferm ería en salud m ent al.
DESCRI PTORES: salud m ent al; enfer m er ía psiquiát r ica; hospit ales univ er sit ar ios
SABERES DOS ENFERMEI ROS EM UMA UNI DADE DE I NTERNAÇÃO PSI QUI ÁTRI CA DE UM
HOSPI TAL UNI VERSI TÁRI O
Est e est udo t em o obj et iv o de ident ificar os saber es dos enfer m eir os em um a unidade de int er nação
p si q u i át r i ca em u m h osp i t al u n i v er si t ár i o. Tr at a- se d e p esq u i sa ex p l or at ór i o- d escr i t i v a, com ab or d ag em q u al i t at i v a, u t i l i zan d o a en t r ev i st a sem i - est r u t u r ad a. Os en f er m ei r os r el at am t r an sf or m ação n o cu i d ad o assist encial a part ir de sua experiência no m odo asilar, fazendo referências às concepções do m odo psicossocial:
int egr alidade, acolhim ent o, int er disciplinar idade e r elacionam ent o int er pessoal. O cuidado int egr al e indiv idual, o con h ecim en t o sob r e as sín d r om es p siq u iát r icas e seu t r at am en t o e a con sid er ação d a su b j et iv id ad e d o
indiv íduo, em sofr im ent o psíquico, são saber es que nor t eiam as ações de enfer m agem em saúde m ent al.
DESCRI TORES: saúde m ent al; enfer m agem psiquiát r ica; hospit ais univ er sit ár ios
Disponible en castellano/ Disponível em língua portuguesa SciELO Brasil w w w .scielo.br/ rlae
1
Paper ext ract ed from Course Conclusion Monograph; 2 PhD, Professor, Rio Grande do Sul Federal Universit y School of Nursing, Brazil, e- m ail: agnes@enf.ufrgs.br;
3
Mast er’s st udent , Universit y of São Paulo at Ribeirão Pret o College of Nursing, WHO Collaborat ing Cent re for Nursing Research Developm ent , Brazil, e- m ail: m alulcd@yahoo.com .br
Rev Lat ino- am Enferm agem 2007 j ulho- agost o; 15( 4) : 689- 91
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I NTRODUCTI ON
M
ent al healt h nur sing car e has been going t h r ou gh a ch allen gin g pr ocess: t h e ex per ien ce of a c h a n g e i n p a r a d i g m f r o m t h e a s y l u m t o t h e p sy ch osocial m od el. Th is t r an sf or m at ion st ar t ed in Brazil in t he 1970s, am id a polit ical m ovem ent called Psy chiat r ic Refor m , w hich aim s t o im plem ent ex t r a-h osp it al ser v ices, f ocu sin g on car e d eliv er y t o t a-h e su b j e ct i n t h e t e r r i t o r y, a i m i n g t o o v e r co m e t h e concept ion of t he asy lum as a space of segr egat ion, r est r aint and isolat ion.I n t his new cont ext , t he psychosocial m odel, r ecom m ended by t he Psy chiat r ic Refor m , focuses on t h e su bj ect as a bein g f u ll of su bj ect iv it ies, an d is concerned wit h t his person’s daily life, fam ily, school, ch u r ch , clu b an d ot h er s. Con sequ en t ly, t h e n u r ses’ act ion s m u st aim t o deliv er car e t h at con sider s t h e individual’s t ot alit y: consider him ( er) as a person full o f f e e l i n g s, b e l o n g i n g t o ( a n d h av i n g ) a f a m i l y, insert ed in a social cont ext t hat cannot be discarded, but r at her used in favor of his( er ) t r eat m ent .
I n v iew of t his new , am plified concept ion of car e, w e aim t o discov er psy chiat r ic nur ses’ body of k n o w l e d g e , u n d e r s t o o d a s t h e s e p r o f e s s i o n a l s ’ k n o w l e d g e a n d c o n c e p t i o n s a b o u t t h e i r w o r k . Kn ow ledge is def in ed as k n ow in g, bein g in st r u ct ed, hav ing infor m at ion and possessing k now ledge( 1 ).
I n t he asylum cont ext , t he nur se’s role w as, i n m o st ca se s, t h a t o f a ssi st a n t , o b se r v i n g a n d r ecor din g t h e pat ien t s’ beh av ior, t h at is, t h ey w er e r esp on sib le f or w at ch in g t h e “ cr azy p eop le”, w at ch and r epr ehending t he m ent ally ill( 2). They w er e also in ch ar g e of d ir ect car e: m ain t ain in g h y g ien e an d co m f o r t , a d m i n i st er i n g m ed i ca t i o n , r est r a i n t , a n d t aking car e of t he pat ient ’s clot hing and feeding.
Cur r ent ly, t he nur se uses t he for m at ion of a t herapeut ic bond as one of t he m ain work t ools. This p r o cess o f h el p t o t h e p sy ch i at r i c su b j ect i m p l i es t h e o r e t i ca l k n o w l e d g e a sso ci a t e d t o t h e n u r se ’ s capacit y of com m unicat ion and self knowledge, which dem ands som e basic r equir em ent s: capacit y t o lov e, em p at h y, t ech n i cal , sci en t i f i c cap aci t y an d cr i t i cal aw ar en ess( 2 ).
Concom it ant ly t o t he change of t he psychiat ric n u r se’ s f u n ct i o n s, t h e p o p u l a t i o n ’ s d em a n d s a l so changed, w hich m ade nur ses assum e new r oles and i m p o se t h e m se l v e s a s q u a l i f i e d p r o f e ssi o n a l s t o per for m fu n ct ion s of t h e h igh est car e an d scien t ific lev el( 3 ).
Thus t he obj ect ive of t his st udy is t o ident ify t he nurses’ know ledge at a psychiat ric hospit alizat ion unit of a t eaching hospit al.
METHODOLOGY
This is an ex plor at or y - descr ipt iv e st udy w it h a qualit at iv e appr oach. The r esear ch w as per for m ed at a universit y hospit al wit h eight nurses who work at t he psychiat ric hospit alizat ion unit . I t is an int ent ional sam ple, com posed by invit ing subj ect s. The inst rum ent u se d f o r d a t a co l l e ct i o n w a s t h e se m i st r u ct u r e d int er v iew . Dat a analy sis w as div ided in t hr ee st ages a c c o r d i n g t o M i n a y o( 4 ): d a t a o r d i n a t i o n , d a t a cl a ssi f i ca t i o n a n d f i n a l a n a l y si s. Th i s st u d y w a s appr ov ed by t he I nst it ut ional Rev iew Boar d, pr oj ect 05- 331, on August 25t h 2005.
NURSES’ KNOW LEDGE
Th e i n t e r v i e w e e s ’ k n o w l e d g e a p p o i n t s k now ledge of t he psy chosocial m odel as opposed t o t he asy lum m odel( 5). The lat t er r educes clinical car e t o a classificat ion of insanit y as a disease t hat m ust be t r eat ed, cur ed and cont r olled. I n t his sense, t he p sy ch osocial m od el p r op oses t h e ex p an sion of t h e insanit y concept ion, per ceiv ing t he subj ect in his( er ) in div idu alit y an d su bj ect iv it y, in ser t ed in t h e social con t ex t , b ein g v alu ed as a cit izen w it h r ig h t s an d o b l i g a t i o n s i n so ci e t y( 5 ). Re g a r d i n g t h e p a r a d i g m change, t he int er v iew ees v isualize k now ledge of t his t r an sf or m at ion .
I had previous experiences in which t he pat ient ’s right s
were not m et . He was seen as t hat old t hing of a m ent ally ill
person, t he crazy pat ient . And t hat here, t he psychiat ric pat ient
is a pat ient who is in m ent al pain and needs care and help [ …] So,
we have t o welcom e him ( N1) .
The t ransform at ion of t he focus on t he m ent al d i sease i s o b ser v ed , co n si d er i n g t h e ex i st en ce o f s u f f e r i n g . Th i s r e p o r t r e v e a l s k n o w l e d g e a b o u t w elcom ing, bonding, r esponsibilit y and car e cont r act , which are direct ives of int egral care in Ment al Healt h. Thus, at t em pt s are m ade t o consider healt h as a global con dit ion , r esu lt in g f r om in div idu al f u n ct ion in g an d social r elat ionships( 6 ).
Th e n u r se - p a t i e n t r e l a t i o n sh i p m u st b e characterized as a partnership that requires com petence, social responsibilit y, int erdisciplinary collaborat ion from t he nurse and et hical- legal param et ers( 7).
Rev Lat ino- am Enferm agem 2007 j ulho- agost o; 15( 4) : 689- 91 w w w .eer p.usp.br / r lae Knowledge of nurses at a psychiat ric...
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Her e w e ar e m or e n u r ses, m or e car eg iv er s. We
part icipat e m ore in t he pat ient ’s t reat m ent in all senses. We t alk
t o t he fam ily, exchange inform at ion, discuss wit h t he m edical
t eam , m eet ings [ …] The m ain psychiat ric nursing t ools, I t hink
t hat is com m unicat ion, em pat hy , and t he pr ofessional’s self
knowledge ( N2) .
This report show s know ledge t hat recognizes t he need for act ions t hat r equir e av ailabilit y for car e and list ening. The car e in healt h m ust be guided by n ew con cep t ion s an d , t h u s, t h e p r of ession als h av e t h eir act ion s or ien t ed by an ideology of cit izen sh ip, e t h i c s , h u m a n i z a t i o n a n d i n t e g r a l c a r e( 8 ). Th e int er v iew ees ar e concer ned w it h t heir self as a w or k t ool. Based on t his k now ledge, t he pr ofessional w ill k now his( er ) possibilit ies and lim it s. Self k now ledge is t he first st ep for a bet t er underst anding of t he ot her. Pe r c e i v i n g o n e ’ s o w n f e e l i n g s , s e n s a t i o n s a n d em ot ions im plies r ealizing t hat t he ot her ’s afflict ions can also be on e’s ow n . Discov er in g t h e self can be used as an ext ra resource t o t reat t he ot her( 9).
Anot her issue pr esent ed by t he int er v iew ees refers to the knowledge of psychiatric syndrom es, their care and treatm ent, em phasizing the psychopathological condit ions t hat enabled t he nurse for qualit y care.
Th e k n o w l e d g e o f p a t h o l o g y , sy m p t o m a t o l o g y ,
t reat m ent , m edicat ion, adverse effect s. I t hink t hat t he knowledge
of sym pt om s, which serves as a good guide for care ( E6) .
This report is cent ered on t he idea of what is norm al and pat hologic, focusing on t he sym pt om , which explains t he im port ance of t his knowledge as necessary and valued. I t is im port ant for t his professional t o be ab le t o lin k k n ow led g e an d t h e im p or t an ce of t h e pat hology t hat affect s t he subj ect( 10).
Th e i n t e r v i e w e d n u r s e s p o i n t t o t h e im por t ance of k now ing, in w hich k now ledge, due t o it s dy nam ic nat ur e, t r ansfor m s it self in t he r ealit y of car e pr act ice.
I t ry t o keep m yself updat ed, st udying [ ...] We have t o
t ry t o keep ourselves updat ed about t heory, wit h new knowledge,
a lot of reading. Be inform ed of t he novelt ies so t hat we can help
t he pat ient ( E3) .
Th e s e p r o f e s s i o n a l s a p p o i n t s e e k i n g t heor et ical k now ledge t hr ough st udy and r eading, as a f ou n dat ion f or pr act ical k n ow ledge, as ex t r em ely i m p o r t a n t f o r t h e i r k n o w l e d g e , g u i d i n g t h e i r pr of ession al pr act ice.
FI NAL CONSI DERATI ONS
The int er v iew ees r epor t on a t r ansfor m at ion in assist ent ial car e, based on t heir ex per ience in t he a sy l u m m e t h o d , r e f e r r i n g t o co n ce p t i o n s o f t h e p s y c h o s o c i a l m e t h o d : i n t e g r a l i t y, w e l c o m i n g , in t er d iscip lin ar y, in t er locu t ion , self k n ow led g e an d suffering of t he singular subj ect . Ot her knowledge t hey value relat es t o psychiat ric syndrom es, t heir care and t r eat m en t .
This knowledge indicat es t he nurses’ t echnical a n d sci en t i f i c k n o w l ed g e. Ho w ev er, t h ei r p o l i t i ca l c a p a c i t y m u s t b e i m p r o v e d , a s a s p a c e f o r par t icipat ion. Nur sing m ust seek a bet t er ar t iculat ion b e t w e e n t h e m o v e m e n t s a n d t r a n sf o r m a t i o n s i n p sy ch iat r ic car e. Cr it icizin g an d d eb at in g allow f or t hink ing and r et hink ing psy chiat r ic nur sing.
REFERENCES
1 . Fer r eir a ABH. Dicion ár io Au r élio Elet r ôn ico: sécu lo XXI [ CD- ROM] . Ver são 3.0. Rio de Janeir o ( RJ) : Nov a Fr ont eir a; 1 9 9 9 . Sab er.
2. Rocha RM. Enferm agem psiquiát rica: que papel é est e? Rio de Janeir o ( RJ) : I nst it ut o Fr anco Basaglia; 1992.
3. Rodr igues ARF. Enfer m agem psiquiát r ica e saúde m ent al: pr ev enção e int er v enção. São Paulo: EPU; 1 9 9 6 .
4 . Mi n a y o MCS. O d e s a f i o d o c o n h e c i m e n t o : p e s q u i s a qualit at iva em saúde. Rio de Janeir o ( RJ) ; 1994.
5 . Cost a- Rosa A. O m odo psicossocial: u m par adigm a das p r á t i ca s su b st i t u t i v a s a o m o d o a si l a r. I n : Am a r a n t e P, organizador. Ensaios: subj et ividade, saúde m ent al, sociedade. Rio Janeir o ( RJ) : Fiocr uz, 2000.
6 . Olsch ow sk y A. O en sin o d e en f er m ag em p siq u iát r ica e saúde m ent al: análise da pós- graduação “ Lat u Sensu”. [ t ese] . Ribeir ão Pr et o ( SP) : Escola de En fer m agem / USP; 2 0 0 1
7. Laraia MT, St uart GW. Enferm agem psiquiát rica: princípios e pr át ica. Por t o Alegr e ( RS) : ARTMED; 2 0 0 1 .
8 . Vilela SC, Sacar t ena MCM. A enfer m agem e o cuidar na área de saúde m ent al. Rev Bras Enferm agem 2004 novem bro/ d ezem b r o; 5 7 ( 6 ) : 7 3 8 - 4 1 .
9 . Rocha RM, Kest enber g CCF, Oliveira EB, Silva AV, Nunes MBG. Co n st r u i n d o u m co n h e ci m e n t o se n sív e l e m Sa ú d e Ment al. Rev Bras Enferm agem 2003 j ulho/ agost o; 56( 4) : 378-8 0 .
1 0 . Rodr igu es RM, Zan et t ML. Teor ia e pr át ica assist en cial na enferm agem : o ensino e o m ercado de t rabalho. Rev Lat ino-am . Enfer m agem 2 0 0 0 dezem br o; 8 ( 6 ) : 1 0 2 - 9 .
Recebido em : 27.4.2006 Aprovado em : 4.6.2007
Rev Lat ino- am Enferm agem 2007 j ulho- agost o; 15( 4) : 689- 91 w w w .eer p.usp.br / r lae
Know ledge of nurses at a psychiat ric...
