Literature Review
Brandi25
NURSINGCLINICALCAREINMENTALHEALTH.pdf
Silva PO, Silva DVA, Rodrigues CAO et al. Nursing clinical care in mental health.
English/Portuguese
J Nurs UFPE online., Recife, 12(11):3133-46, Nov., 2018 3133
ISSN: 1981-8963 ISSN: 1981-8963 https://doi.org/10.5205/1981-8963-v12i11a236214p3133-3146-2018
NURSING CLINICAL CARE IN MENTAL HEALTH CUIDADO CLÍNICO DE ENFERMAGEM EM SAÚDE MENTAL
CUIDADO CLÍNICO DE ENFERMERÍA EN SALUD MENTAL Patrícia Oliveira Silva1, Daniel Vinícius Alves Silva2, Carolina Amaral Oliveira Rodrigues3, Natália Hiany
Fonseca Santos4, Samara Frantheisca Almeida Barbosa5, Viviane Dias Souto6, Ricardo Otávio Maia Gusmão7
ABSTRACT
Objective: to identify the elements, that characterize clinical nursing care in mental health in the context of Psychiatric Reform and Humanization of Care. Method: this is a bibliographic, descriptive study, of integrative type, with search of articles in the VHL, between 1995 and 2017. The data was systematized using the Content Analysis technique. Results were presented in three categories: Humanization of Care and its implications on Nursing care in mental health; Care strategies in the field of mental health: incorporating new technologies; Humanized nursing care: rescuing subjectivity. Results: 16 studies were identified according to established criteria. The characteristics of the selected articles were presented, according to authors, year of publication; title of the periodical; QUALIS; impact factor and level of evidence; place of publication, methodological design adopted; objectives and main results. Conclusion: the precepts of the Brazilian Psychiatric Reform and the National Humanization Policy must be respected in nursing in mental health. In addition, interdisciplinarity is considered as a resource for the expansion of the clinic. Descriptors: Humanization of Assistance; Nursing; Psychiatric Nursing; Mental Health; Psychoanalysis; Mental Health Services.
RESUMO
Objetivo: identificar os elementos que caracterizam o cuidado clínico de Enfermagem em Saúde Mental no contexto da Reforma Psiquiátrica e da Humanização da Assistência. Método: trata-se de um estudo bibliográfico, descritivo, do tipo revisão integrativa, com busca de artigos na BVS, entre os anos de 1995 e 2017. Realizou-se a sistematização dos dados pela técnica de Análise de Conteúdo. Apresentaram-se os resultados em três categorias “Humanização da assistência e a sua relação com o cuidado de Enfermagem na Saúde Mental”; “Estratégias de cuidado no campo da Saúde Mental: incorporando as novas tecnologias” e “Cuidado clínico de Enfermagem humanizado: resgatando a subjetividade”. Resultados: identificaram-se 16 estudos de acordo com os critérios estabelecidos. Apresentaram-se as características dos artigos selecionados segundo os autores, o ano de publicação, o título do periódico, o Qualis, o fator de impacto e o nível de evidência, o local de publicação, o delineamento metodológico adotado, os objetivos e os principais resultados. Conclusão: constata-se que se devem respeitar, na Enfermagem aplicada à Saúde Mental, os preceitos da Reforma Psiquiátrica Brasileira e da Política Nacional de Humanização. Considera-se, além disso, a interdisciplinaridade como um recurso para a ampliação da clínica. Descritores: Humanização da assistência; Enfermagem; Enfermagem Psiquiátrica; Saúde Mental; Psicanálise; Serviços de Saúde Mental.
RESUMEN
Objetivo: identificar los elementos que caracterizan el cuidado clínico de Enfermería en Salud mental en el contexto de la Reforma Psiquiátrica y Humanización de la Asistencia. Método: se trata de un estudio bibliográfico, descriptivo, tipo revisión integrativa con búsqueda de artículos en la BVS, entre los años 1995 y 2017. Se realizó la sistematización de los datos por la técnica de Análisis de contenido. Se presentaron los resultados en tres categorías: Humanización de la Asistencia y sus imbricaciones sobre el cuidado de enfermería en la salud mental; Las estrategias de cuidado en el campo de la salud mental: incorporando nuevas tecnologías; Cuidado clínico de Enfermería humanizado: rescatándose la subjetividad. Resultados: se identificaron 16 estudios de acuerdo a los criterios establecidos. Se presentaron las características de los artículos seleccionados, según autores, año de publicación; título del periódico; QUALIS; factor de impacto y nivel de evidencia; lugar de publicación, delineamiento metodológico adoptado; objetivos y principales resultados. Conclusión: se debe respetar en la enfermería en la salud mental los preceptos de la Reforma Psiquiátrica Brasileña y de la Política Nacional de Humanización. Además, se considera la interdisciplinaridad como recurso a la ampliación de la clínicaDescriptores: Humanización de la Atención; Enfermería; Enfermería Psiquiátrica; Salud Mental; Psicoanálisis; Servicios de Salud Mental. 1,2,3,4,5,6 Nursing Students, State University of Montes Claros / Unimontes. Montes Claros (MG), Brazil. E-mail: [email protected] ORCID iD: https://orcid.org/0000-0002-1426-4029; E-mail: [email protected] ORCID iD: https://orcid.org/0000-0001-9280-9146; E-mail: [email protected] ORCID iD: https://orcid.org/0000-0003-1804-619X; E-mail: [email protected] ORCID iD: https://orcid.org/0000-0002-7922-7093; E-mail: [email protected] ORCID iD: https://orcid.org/0000-0002-1438-985X; E- mail: [email protected] ORCID iD: https://orcid.org/0000-0001-6228-8490; 7Master in Psychoanalytic Theory, State University of Montes Claros / Unimontes. Montes Claros (MG), Brazil. E-mail: [email protected] ORCID iD: https://orcid.org/0000-0001-9941-1114
INTEGRATIVE REVIEW ARTICLE
Silva PO, Silva DVA, Rodrigues CAO et al. Nursing clinical care in mental health.
English/Portuguese
J Nurs UFPE online., Recife, 12(11):3133-46, Nov., 2018 3134
ISSN: 1981-8963 ISSN: 1981-8963 https://doi.org/10.5205/1981-8963-v12i11a236214p3133-3146-2018
The discussion on the model of care for
mentally ill patients centered in psychiatric
hospitals began in Brazil at the end of the
1970s. Since then, the Brazilian Psychiatric
Reform (BPR) has been initiated,
characterized by the restructuring of the care
model with the implementation of the
Psychosocial Care Strategy (PSCS). The notion
of territory, interdisciplinary and intersectoral
practice, promotion of citizenship and
autonomy of users and their families,
psychosocial rehabilitation and
deinstitutionalization are pointed out as
principles.1
This process was carried out with the
approval of Law 10.216 of 2001.2-3 The
Psychosocial Care Centers (PSCC) 4 were
created and the substitutive devices were
expanded in 2011, with ordinance 3088, with
the creation of the Psychosocial Care Network
(PSCN) for people with mental suffering or
disorder and with needs arising from the use
of crack, alcohol and other drugs.5-6
The National Humanization Policy (NHP)
was implemented by the Ministry of Health
(MH) in 2003, which has, as guidelines, the
valuation of subjective, collective and social
dimensions in all health care and management
practices, the strengthening of
interdisciplinary work, support for the
construction of networks committed to the
production of health and subjects, the
construction of autonomy and collective
protagonist and the appreciation of the
environment, with the organization of healthy
and welcoming work spaces.7
The beginnings of Psychiatric Nursing are
characterized by a model of asylum
treatment, in which the constant vigilance of
mentally ill patients with a focus on disease
and medicalization was carried out.8-9 From
the BPR and NHP, need for health
professionals, especially nurses, to reflect on
their.10
● To identify the elements that
characterize clinical Nursing care in Mental
Health in the context of the Psychiatric
Reform and the Humanization of Care.
This is a bibliographic descriptive study of
the type integrative review, with search of
articles in the Virtual Health Library,
published between 1995 and 2017. The
following stages of the review are integrated:
elaboration of the guiding question;
establishment of criteria for inclusion and
exclusion of studies/sampling; definition of
the information to be extracted from the
selected studies; evaluation of the studies
included in the review; analysis of the
studies/interpretation of the results and
presentation of the integrative review.11
The guiding question was established: what
is the scientific production about the clinical
care of Mental Health Nursing in the context
of Psychiatric Reform and Humanization of
Care?
The health descriptors were then consulted
on the Health Sciences Descriptors (DeCS)
platform, with the search by the Boolean
operator "and": "Humanization of Care" and
"Mental Health" and "Nursing"; "Humanization
of Care" and "Psychiatric Nursing";
"Humanization of Care" and "Nursing" and
"Psychoanalysis". The data search was the
carried out in the Virtual Health Library
(VHL). The data collection and the
bibliographic survey were carried out in the
months of March and April of 2017.
The following were defined as inclusion
criteria for publications: complete articles,
electronically available, in the Portuguese
language and with the theme proposed in the
title, abstract or descriptor. The following
exclusion criteria were established: letters to
the editor, editorials, integrative reviews,
theses, dissertations and articles in duplicate.
Initially, 75 publications eligible for inclusion
in the review were identified. The texts were
selected based on the reading of the abstracts
and the full reading of the article, when the
information contained in the abstract was not
enough. Thus, 16 publications were chosen
because they met the inclusion criteria and
the objectives of this research.
The path was traced in the identification
and selection of component articles of the
study sample shown in Figures 1 and 2.
Descriptors AF SA S
“Humanization of Care “and” Mental Health
"and" Nursing”
24 10 9
INTRODUCTION
METHOD
OBJECTIVE
Silva PO, Silva DVA, Rodrigues CAO et al. Nursing clinical care in mental health.
English/Portuguese
J Nurs UFPE online., Recife, 12(11):3133-46, Nov., 2018 3135
ISSN: 1981-8963 ISSN: 1981-8963 https://doi.org/10.5205/1981-8963-v12i11a236214p3133-3146-2018
“Humanization of Care “and” Psychiatric
Nursing”
23 11 5
“Humanization of Care “and” Nursing "and"
psychoanalysis”
28 2 2
Total 75 23 16
AF - Articles Found; SA - Selected Articles; S - Sample.Figure 1. Search
systematization. Montes Claro (MG), Brazil, 2017.
Figure 2. Flowchart of study selection adapted from the Preferred
Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA
2009). Montes Claros (MG), Brazil, 2017.
After choosing the search strategies and
the inclusion and exclusion criteria, the
information to be extracted from the
publications was selected: title and
authorship; year of publication; title of the
journal/database; place of publication/type
of study; method/level of evidence; objective
and main results. For that, an instrument was
used to collect the variables of interest of the
research.
The qualifications of the journals of the
publications selected according to Qualis in
the interdisciplinary category were sought
out, classified by the Coordination of
Improvement of Higher Level Personnel
(CAPES) and established in eight strata - A1,
A2, B1, B2, B3, B4, B5 and C, whose highest
value (100) is attributed to journals rated A1
and lowest value (zero), for classification C.12
The Impact Factor (IF) of the journals, an
instrument for evaluating the quality of
publications used as a criterion for the
selection of journals to be indexed by the
Science Citation Index (SCI), was investigated.
The IF is calculated annually by the number of
citations included in its articles in another
journal, and its value can vary as follows: 0 =
FI ≥ 3,8. This calculation is done by the
Records identified through VHL surveys (n= 75)
Records after deleting duplicate studies
(n=23)
Excluded studies
(n=29)
Complete studies
and assessed for
eligibility (n= 23)
Full studies
excluded
(n= 7)
ID E N
T IF
IC A
T IO
N
Studies included
in qualitative
synthesis (n= 16)
E L IG
IB IL
IT Y
S E L E C
T IO
N
IN C
L U
S IO
N Studies included
in quantitative
synthesis (n= 16)
Selected studies
for reading the
abstract (n= 52)
Silva PO, Silva DVA, Rodrigues CAO et al. Nursing clinical care in mental health.
English/Portuguese
J Nurs UFPE online., Recife, 12(11):3133-46, Nov., 2018 3136
ISSN: 1981-8963 ISSN: 1981-8963 https://doi.org/10.5205/1981-8963-v12i11a236214p3133-3146-2018
Institute for Scientific Information/Thompson
Scientific Reuters for journals indexed in its
database and the result is published by
Journal Citations Reports (JCR).13-14 Another
resource was also used to perform the
classification, elaborated by the Scientific
Electronic Library Online (SciELO), for being
considered more viable in relation to the
Brazilian reality.
The articles were analyzed and classified
by level of evidence. The degree of evidence
was determined in a hierarchy system that
covers seven levels: level 1 - systematic
reviews or meta-analysis of relevant clinical
trials; level 2 - evidence derived from at least
one well-delineated randomized controlled
trial; level 3 - well-delineated clinical trials
without randomization; level 4 - well-
delineated cohort and case-control studies;
level 5 - systematic review of descriptive and
qualitative studies; level 6 - evidence derived
from a single descriptive or qualitative study
and level 7 - opinion of authorities or report
of expert committees. 15
The fourth, fifth and sixth stages of the
analysis, interpretation and synthesis of the
publications were carried out to present this
review. The presentation and discussion of the
results obtained were made in a descriptive
way, allowing the evaluation of the
applicability of the integrative review
elaborated, in order to reach the objective of
this study.
The studies were analyzed by two
independent researchers. The results obtained
were individually compared. The
disagreements were reviewed and the doubts
were exhausted. The results were then
presented and three categories were
discussed: Humanization of care and its
relation with Nursing care in Mental Health;
Care strategies in the field of Mental Health:
incorporating new technologies and
Humanized Nursing care: rescuing
subjectivity.
Sixteen articles on the subject were
identified (eight published in LILACS and eight
in BDNEF), according to the inclusion criteria.
The distribution of the articles selected
according to the authors, the year of
publication, the journal title, the Qualis, the
impact factor and the level of evidence are
presented in Figure 3.
RESULTS
Silva PO, Silva DVA, Rodrigues CAO et al. Nursing clinical care in mental health.
English/Portuguese
J Nurs UFPE online., Recife, 12(11):3133-46, Nov., 2018 3137
ISSN: 1981-8963 ISSN: 1981-8963 https://doi.org/10.5205/1981-8963-v12i11a236214p3133-3146-2018
Nº Author Year of
publkication Title of the journal QUALIS Impact factor Level of
evidence
01 Almeida ANS, Feitosa RMM, Boesmans EF,
Silveira LC2 2014 Research Journal: Care is Fundamental (Online). B2 Without evaluation 6
02 Nasi C, Cardoso ASF, Schneider JF, Olschowsky A, Wetzel C3
2009 Mineira Journal of Nursing (REME) - online. B2 Without evaluation 7
03 Chaves ECL, Furegato ARF, Scatena MCM, Carvalho EC4
2008 Science, Care and Health. B4 Without evaluation 6
04 Spadini LS, Bueno SMV6 2005 Health Sciences: ActaScientiarum. B3 Without evaluation 6
05 Oliveira, LC; Silva, RAR; Medeiros, MN;
Queiroz, JC; Guimarães, JG8 2015 Research Journal: Care is Fundamental (Online). B2 Without evaluation 6
06 Moretto CC, Conejo SP, Terzis A18 2008 Bond. B1* Without evaluation 6
07 Costa JRE20 2010 The World of Health. B2 Without evaluation 6
08 Macedo JQ, Silveira MFA, Eulálio MC, Fraga
MNO, Braga VAB21 2011 Online Brazilian Journal of Nursing. B2 Without evaluation 6
09 Oliveira FB, Silva AO22 2000 Brazilian Journal of Nursing. B1 Without evaluation 7
10 Rocha GDSC, Barcelos ICRR, Coloda RG23 2010 Research Journal: Care is Fundamental (Online). B2 Without evaluation 6
11 Costa E, Süsskind MB24 2004 Text Context Nursing. B1 Without evaluation 7
12 Zerbetto SR, Rodrigues ARF25 1997 Latin American Journal of Nursing. B1 0.634 6
13 Barreto MS, Büchele F, Coelho, EBS26 2008 Cogitare Nursing. B2 Without evaluation 7
14 Willrich JQ, Bielemann VL, Chiavagatti FG, Kantorski LP, Borges LR27
2013 Journal of Nursing of UFSM. B4 Without evaluation 6
15 Brischialiari A, Maftum MA, Waidmann MAP, Mazza VA28
2008 Electronic Journal of Nursing. B2 Without evaluation 6
16
Vieira AN, Silveira LC, Silva LMS, Rodrigues DP,
Martins IC29 2015 Journal of Nursing UFPE online.
B4 Without evaluation 7
*Nursing
Figure 3. Distribution of selected articles, according to authors, year of publication, journal title, QUALIS, impact factor and level of evidence. Montes Claros (MG), Brazil, 2017.
Silva PO, Silva DVA, Rodrigues CAO et al. Nursing clinical care in mental health.
English/Portuguese
J Nurs UFPE online., Recife, 12(11):3133-46, Nov., 2018 3138
ISSN: 1981-8963 ISSN: 1981-8963 https://doi.org/10.5205/1981-8963-v12i11a236214p3133-3146-2018
There were the highest number of
publications in the year 2008 - four (25%)
followed by two (12.5%) in 2010 and another
two in 2015. The largest number of
publications was found in the journal "
Research Journal: Care is Fundamental "(online),
with three (18.75%) articles. It was published,
in relation to the classification of Brazilian
journals, elaborated by CAPES, the majority of
studies in Qualis B2 journals - eight
publications (56.25%). It was recorded, as to
the Impact Factor, that only one journal was
classified: "Latin American Journal of Nursing "
(0.634). The result of the IF is considered low,
which is due to the fact that the publication is
little sought by the international researchers
to carry out their researches.16
The journals were found in the SciELO
electronic library: " Brazilian Journal of
Nursing" (0.2455); "Latin American Journal of
Nursing" (0,3856) and " Text Context Nursing "
(0,1948). It was identified that the low Impact
Factor of these journals can be justified,
mainly, due to the lack of articles written in
the English language, preventing a more
expressive repercussion of the publications.17
The level of evidence of these studies was
reported as 11 (68.75%) are level 6 and five
(31.25%) are level 7. This distribution is
explained by the subjective theme of the
studies - humanization.
It was observed that the Brazilian region
with the most publications was the Southeast,
with eight (50%) placements. It is observed
the predominance of qualitative studies, with
respect to the methodological design, with 11
(68.75%), according to figure 4.
Silva PO, Silva DVA, Rodrigues CAO et al. Nursing clinical care in mental health.
English/Portuguese
J Nurs UFPE online., Recife, 12(11):3133-46, Nov., 2018 3139
ISSN: 1981-8963 ISSN: 1981-8963 https://doi.org/10.5205/1981-8963-v12i11a236214p3133-3146-2018
Nº Place of publication /
Type of study Objectives Main results
01 Location: Rio de Janeiro-RJ Type: Qualitative
Understanding how clinical Nursing care can be developed from a perspective that considers the person in psychic suffering as the subject of this practice.
Subject and Listening and Listen to who cares. The workshop allowed nurses to approach other theoretical and methodological approaches that conceptualize the subject beyond the Cartesian, such as the referential of psychoanalysis, enabling the nurse to recognize that the process of caring is complex and demands actions based on the singularity of each subject.
02 Location: Belo Horizonte-MG Type: Reflexive
Reflect on the principle of integrality and its insertion in the area of Mental Health, addressing this principle in the network of substitutive services in Mental Health as an indicator device for a new way of thinking and attention in Mental Health
It is necessary that the professionals of the health services develop an integral service to their users, sharing experiences, with the participation of the family and the community.
03 Location: Maringá – PR Type: Descriptive, qualitative approach.
To report the experience of interpersonal communication between a nurse and a client with schizophrenia, based on the technical principles of non-directive relationship, centered on the person, seeking to analyze the relevant aspects of this process, of this interaction.
The nurse sought to clarify the ideas exposed and create favorable conditions for the client to reach the meaning of his illness for himself. The center of the interaction was the customer and everything he considered significant. The nurse was the vehicle of help. "Non-directivity" is a complex approach, being therapeutic whenever the client exposes their feelings and the nurse can understand it and help it according to their needs.
04 Location: Maringá-PR Type: descriptive exploratory qualitative
To identify the understanding that the students of the Specialization course in Psychiatric Nursing and Mental Health have on the position of the nurse of this area of action and its relation with the problematizing education.
The students punctuated, for problematizing conduct in assisting humanization: dialogue as the basis for transformation and construction in the nurse-patient relationship; respect for the citizenship of the patient and the commitment of the professional to the concrete application of truly humanized care, as a proposal to care for the mentally ill.
05 Location: Rio de Janeiro-RJ Type: exploratory research of a qualitative nature
To analyze nurses' perception about the humanized care in the routine of Nursing care in a Mental Health hospital unit, identifying their skills and abilities in the assistance to the client in this type of hospitalization unit.
Respondents understand that humanization means caring for people, collectively, with responsibility, commitment, and ethics, helping them overcome their limitations. They are based on the conception of the Psychiatric Reform as a movement, which has brought significant gains to the new Mental Health approach, in which the philosophy of humanization can contribute to effective and resolute Nursing care.
06 Location: São Paulo-SP Type: descriptive and exploratory, with qualitative analysis
Reflect on the experience of an Institution, which has as its guiding humanist character, besides the contributions and difficulties faced by the multidisciplinary team, highlighting the role of the psychologist in Mental Health and the subjectivity that it involves.
It presents the partnership with the Unified Health System (UHS), based on the National Humanization Policy (NHP). It ends with the reflections provided by the study showing that humanized work in health can be feasible and long-lasting.
07 Location: São Paulo-SP Type: Experience report
Address the issue of psychiatry and humanization - or dehumanization - when bioethics is not present in the psychiatric environment
We believe that we have a responsibility to change the state of Mental Health and psychiatry, and we should never accuse others of the fact that change is not possible. It is noticed that there is an urgency in humanizing the practice and the care in psychiatry, and to humanize is to understand the other in its totality. A patient is not limited to the disease, but is a human being worthy of attention and respect.
08 Location: Niterói-RJ To understand the social representations of Nursing Care in Mental Health Mental Health Nursing care is represented in the humanization of Mental Health
Silva PO, Silva DVA, Rodrigues CAO et al. Nursing clinical care in mental health.
English/Portuguese
J Nurs UFPE online., Recife, 12(11):3133-46, Nov., 2018 3140
ISSN: 1981-8963 ISSN: 1981-8963 https://doi.org/10.5205/1981-8963-v12i11a236214p3133-3146-2018
Type: Qualitative
elaborated by the graduates of undergraduate Nursing courses in Campina Grande, PB
care. This representation facilitates the change in the perception of the graduates from the theoretical-practical experiences and allows them to visualize a distinction between the professional practice of the nurse in the current context and the role attributed to it according to the precepts of the Psychiatric Reform.
09 Location: Brasília-DF Type: Essay
Reflect on the concepts of psychosocial rehabilitation and interdisciplinarity in the field of Mental Health. It is tried to show the importance and the actuality of these subjects in the construction of the knowledge and practices in the Nursing area in Mental Health or psychiatric.
Psychosocial rehabilitation is understood as a conception and not as a technique, a process that increases the user's ability to establish social and affective exchanges in the different settings: at home, at work and in the social fabric. Interdisciplinarity is the ability to converge expertise by orchestrating efforts in building a single text, written in multiple hands. The discussion of these themes enables the Nursing professional to constitute practices and knowledge anchored in a utopian, ethical and aesthetic dimension.
10 Location: Rio de Janeiro-RJ Type: Qualitative and descriptive study- Experience report
Identify the challenges of the field of practice in Mental Health in the production of knowledge about the impact of the change of the stigmatized to the humanized look on the psychiatric asylums.
We observed focus on the care of the body and the Nursing performance with relation to the characterization of the client; specificity and fear of treatment; the concern to know the environment; discipline activities before and during practical instruction. The perception of the academics occurred in a humanized way with respect to the Nursing care of the psychiatric asylums, not prejudiced concerning them and not stigmatized referring to the psychiatric world
11 Location: Florianópolis- SC Type: Experience Report
To develop with the Nursing team a reflective process about care in the perspective of reaching the humanization of care, exploring the work condition and education, based on the Freirean methodological theoretical framework.
They point out that the knowledge and understanding of the historical process make it possible to think and generate the necessary changes that constitute the beginning of the transformations that we intend, because we can perceive that it can do different. They emphasized the importance of listening, observing and respecting the client's subjectivities as a fundamental point for the humanization of care.
12 Location: Ribeirão Preto-SP Type: Qualitative
Establish and analyze the therapeutic relationship with the patient in the process of resocialization, according to the humanistic view of care. To evaluate the non-directive approach used in the interaction, from the theoretical foundation on therapeutic relationship, centered on the person in relation to help.
The nurse's anxiety identified mainly in the application of the technique, however, was attentive, without interfering in the patient's point of view. The patient's anxiety reflected the consequences of her adjustment outside the hospital setting.
13 Location: Curitiba-PR Type: Experience Report
Redeem daily life skills of institutionalized sufferers by promoting educational activities and personal skills, encouraging them to perform daily activities.
It was shown that the group of psychic sufferers, when accompanied, care with attention and adequate guidance, perform with greater dexterity the activities considered basic in daily life, those that have lost over the years that remain hospitalized. It also showed experiences full of meanings, suggesting a practice of psychiatric Nursing care focused on the process of humanization, seeking simple alternatives, but at the same time, full of practical subsidies for a group of people who lost autonomy in self-care by the institutional process.
14 Location: Santa Maria- RS Type: qualitative study in the form of a case study
To appreciate the importance of the environment of a Psychosocial Care Center and its relationship with the therapeutic process in Mental Health.
It is evidenced that the construction of a comfortable environment that invests in the production of subjectivities is a tool capable of enhancing the process of psychosocial rehabilitation. And it is in the encounter, among team users, that affective bonds are built and this is the primary component that qualifies the environment.
Silva PO, Silva DVA, Rodrigues CAO et al. Nursing clinical care in mental health.
English/Portuguese
J Nurs UFPE online., Recife, 12(11):3133-46, Nov., 2018 3141
ISSN: 1981-8963 ISSN: 1981-8963 https://doi.org/10.5205/1981-8963-v12i11a236214p3133-3146-2018
15 Location: Goiânia- GO
Type: exploratory and descriptive
It was to describe and evaluate the result of the implementation of workshops of sensitization of the Nursing team for a humanized care to the patient with mental disorder
Professionals perceive the mental disorder sufferer as a human being who needs to be cared for wholeness; on the other hand, the development of the workshops provided a reflection on the care developed and an awakening of the critical sense of the professional practice, allowing the resignification of care.
16 Location: Recife-PE Type: theoretical reflection
Reflect on the contributions of psychoanalysis to care and to the clinic in Nursing practice.
Nursing, seeking interdisciplinary practice, appropriated the psychoanalytic framework in its work processes to develop care actions in health care settings. This articulation has been effected in the assistance, mainly in the Mental Health services; but also in teaching and research.
Figure 4. Characteristics of studies according to place of publication, methodological design adopted, objectives and main results. Montes Claros (MG), Brazil, 2017.
Silva PO, Silva DVA, Rodrigues CAO et al. Nursing clinical care in mental health.
English/Portuguese
J Nurs UFPE online., Recife, 12(11):3133-46, Nov., 2018 3142
ISSN: 1981-8963 ISSN: 1981-8963 https://doi.org/10.5205/1981-8963-v12i11a236214p3133-3146-2018
● Humanization of care and its relation with
Nursing care in Mental Health
The public policies for humanized Nursing
care in the field of Mental Health are
corroborated.
From the BPR, through the
deinstitutionalization of those suffering from
mental illness, it was possible to replace
mental asylum by community-based Mental
Health services, prioritizing social
reintegration, autonomy and family life. In
this sense, the reform seeks to improve care
and protect the rights of people with mental
disorders.18-19
The need to reorient Nursing care through
an ethical stance was respected, respecting
patients' rights, including freedom. The
ethical precepts and the principles of BPR are
taken as important references to be followed
by the nurse in his / her care practices.20
With the process of humanization of care in
the field of Mental Health and the process of
deinstitutionalization, psychosocial
rehabilitation is sought.18-21 The emergence of
Nursing care outside hospital institutions and
towards territory. It is necessary that the
nurses take responsibility for the care in
Mental Health, in its diverse scenarios of
action, emphasizing the primary health care.
Criticism of maltreatment and the lack of
adequate care in the health services by the
users are verified. It is therefore advocated
during the academic training of nurses that
there should be a rupture of the thoughts left
by the history of psychiatry and centered on
the ideas of exclusion and danger. It is
possible, with the breakdown of prejudice, a
new look at these subjects, favoring the
practice of a humanized Nursing care.22-24
It is established with the NHP that
humanization should have as its guiding
principles the valorization of the subjective
dimension, the strengthening of teamwork,
promotion of cross-sectionalism, support to
the construction of assistance networks and
the protagonist of the individuals and groups.8-
9
Through the theoretical discussions in the
field of Mental Health, the need to reflect on
professional relations in health services was
highlighted, with emphasis on the subjects'
subjectivity. It is sought, therefore, that
humanized practices can be constructed from
the expansion of the health-disease process of
the users.21 It is emphasized that nurses must
have a holistic view of the process of
attention with sensitivity to the listening of
the users.18,21
Ethical and aesthetic proposals are pointed
out with humanization: in relation to ethical
proposals, all those involved are classified as
co-responsible for health actions. People are
considered subjectively as autonomous and
protagonists of the health-disease process and
mental illness, according to the aesthetic
proposition of health production systems. In
this way, Nursing care is reconstructed with
practices focused on the real needs of the
users.18-19,22
● Care strategies in the field of Mental
Health: incorporating new technologies
A humanized Nursing practice is obtained
through several strategies and new care
technologies constructed in articulation with
public policies in the field of Mental Health.
Emphasis is given to the need for an
integral approach due to the complexity of
the object in Mental Health, with the
emergence of the urgency of a care that does
not reduce the subject to the disease. With
the integrality, the objective is to allow the
expansion of the clinic through the contact
and reception of psychic suffering, breaking
down barriers and dismantling the ideal of
hospitalization and isolation as the best form
of intervention.3,18,25-26
PSCN was instituted by the 3088 ordinance
in Brazil in 2011.5 It is necessary to ensure the
articulation and integration between the
network's attention points in order to ensure
the effectiveness of the integrality and
humanization of Mental Health care. As
attention strategies, network work,
intersectoriality and interdisciplinarity, as
Nursing tools, are highlighted.
Integrality and networking are fostered
through interdisciplinarity, promoting the
autonomy and social insertion of the subject
in his community. It is necessary to expand
the services of territorial base, its articulation
with the other points of the network and the
involvement of professionals, users, family
and community.3,25
Contact and welcome are understood as
important care strategies in situations of
psychological distress and responses are
produced different from those guided by the
biomedical model. It is pointed out the
knowledge of therapeutic listening, which
reorients the practice of professionals and
favors the autonomy of users, to organize the
work process with a view to access and
monitoring of each subject in their care
project, which should be unique.26
DISCUSSION
Silva PO, Silva DVA, Rodrigues CAO et al. Nursing clinical care in mental health.
English/Portuguese
J Nurs UFPE online., Recife, 12(11):3133-46, Nov., 2018 3143
ISSN: 1981-8963 ISSN: 1981-8963 https://doi.org/10.5205/1981-8963-v12i11a236214p3133-3146-2018
New clinical devices to be developed by
Nursing in Mental Health, such as therapeutic
workshops, are constituted. It seeks to rescue
the subjectivity and autonomy of the users
and to develop skills that were lost in the
hospitalizations. Socialization, expression,
income generators, social insertion, literacy,
among others.18-19,25-26
It is important to emphasize the ambience,
a strategy advocated by the NHP, as a
significant and structuring factor of the
therapeutic process, besides being a concrete
structural aspect, since it directs the
promotion of interaction and the creation of
bonds with the users, promoting the
development of emotional stability throughout
the treatment. It is necessary a place with
adequate physical structure and availability of
human and material resources that allow the
reception of the user and family, privileging
comfort and subjectivity in the therapeutic
process.27-28
For the development of a humanized
Nursing care in Mental Health, these
strategies are indicated as tools of care.
• Nursing clinical care: rescuing
subjectivity
Collaborating for the practice of care in
Nursing in Mental Health, through
psychoanalysis and interdisciplinarity, making
the expansion of the clinic and the
humanization of care possible.
The scope of technologies in Nursing has
been expanded to produce care in Mental
Health. It is verified the guarantee of integral
care when the nurse appropriates knowledge
from other areas, especially psychoanalysis,
an important reference for rescuing aspects of
subjectivity.8-9,22,29-30
As a result, the notion that attending a
client with psychic suffering is not only
limited to the identification of their basic
human needs.2,25,29-30
It creates a new perspective of care in
these movements, differing from the practice
traditionally exercised in hospital units, as
exemplified by group actions and
interventions in communities. It is considered
that the subjectivity approach raises issues in
group management, body care, drug use and
adherence, producing effects in several
situations inherent in the Nursing work
processes.29-30
It is evaluated that some psychoanalytic
concepts and tools stand out in Nursing care,
such as listening, the category of subject and
the construction of the clinical case.28 It is
observed that, as a principle, listening has the
creation of a space for the word is said,
explaining the psychic mechanisms involved in
the process of illness; on the other hand, the
act of telling alleviates the patient's anguish,
simply by talking about what makes him
suffer, allowing an articulation of suffering
with the subject's life history.8-9
The possibility of bringing to the scene the
unconscious subject who, through speech, can
express a wisdom unknown even by himself,
placing the subject with psychic suffering in
the active position.2
It is possible to move care, in its
prescriptive format, into the subject
category, a patient approach that can
participate in the process of elaborating their
care needs. It is verified that the construction
of the clinical case, in turn, became an
instrument for the Nursing clinic. It is
understood, in this construction, that the
subject who demands care participates in the
elaboration of his experience of suffering and
his care needs. Opportunities are provided in
which the patient's speech is produced in a
free way, without being tied to the programs
and institutional protocols.2,6,27
It is considered essential the process of
incorporating the subjective dimension in the
clinical care of nurses to promote the
humanization of care. It is required, in order
to define the way of expressing the
relationship with the other, the process or the
therapeutic relationship, the availability of
the professionals to interact with the client. It
is defended, therefore, a humanized care of
Nursing focused on the act of listening and
made possible by the transference and the
construction of a therapeutic relationship.4,8-
9,28
It is concluded that the clinical care of
Nursing in Mental Health must consider the
precepts of BPR and NHP to be provided with
quality and incorporating the humanization of
care.
Key strategies for holistic Nursing care are
listed: the integrality articulated from a
network work with the articulation between
its devices; interdisciplinarity;
intersectoriality; the contact and the
welcoming; therapeutic listening; the notion
of territory; psychosocial rehabilitation; the
resources of therapeutic and educational
workshops; the ambience and the
incorporation of the subjective component
with the clinical extension.
It is also considered the interdisciplinarity
in Nursing in Mental Health as a resource of
clinical expansion through psychoanalysis
that, based on its concepts and tools, with
CONCLUSION
Silva PO, Silva DVA, Rodrigues CAO et al. Nursing clinical care in mental health.
English/Portuguese
J Nurs UFPE online., Recife, 12(11):3133-46, Nov., 2018 3144
ISSN: 1981-8963 ISSN: 1981-8963 https://doi.org/10.5205/1981-8963-v12i11a236214p3133-3146-2018
emphasis on listening, the category of subject
and the construction of the clinical case ,
allows the construction of therapeutic
relationships. It is suggested the incorporation
of these theoretical references by the nurses
in their care practices.
1. Gonçalves AM, Sena RR. A reforma
psiquiátrica no Brasil: contextualização e
reflexos sobre o cuidado com o doente mental
na família. Rev Latino-am Enfermagem
[Internet]. 2001 [cited 2017 Mar 09];9(2):48-
55. Available from:
https://www.revistas.usp.br/rlae/article/vie
wFile/1551/1596
2. Almeida ANS, Feitosa RMM, Boesmans EF,
Silveira LC. Cuidado clínico de enfermagem
em saúde mental: reflexões sobre a prática do
enfermeiro. Rev pesqui cuid fundam Online
[Internet]. 2014 [cited 2017 Mar 07];6(1):213-
31. Available from:
http://www.seer.unirio.br/index.php/cuidad
ofundamental/article/view/2819
3. Nasi C, Cardoso ASF, Schneider JF,
Olschowsky A, Wetzel C. Conceito de
integralidade na atenção em saúde mental no
contexto da reforma psiquiátrica. REME rev
min enferm. [Internet]. 2009 [cited 2017 Apr
09];13(1):139-46. Available from:
http://www.reme.org.br/artigo/detalhes/174
4. Chaves ECL, Furegato ARF, Scatena MCM,
Carvalho EC. Uma interação enfermeiro-
cliente aplicando princípios do
relacionamento não diretivo. Ciênc Cuid
Saúde. [Internet]. 2008 [cited 2017 Mar
17];7(2):248-55. Available from:
http://www.periodicos.uem.br/ojs/index.php
/CiencCuidSaude/article/view/5013
5. Ministério da Saúde (Brasil). Portaria nº
3088, de 23 de dezembro de 2011. Institui a
Rede de Atenção Psicossocial. Brasília (DF);
Ministério da Saúde: 2011 [cited 2017 Mar 21].
Available from:
http://bvsms.saude.gov.br/bvs/saudelegis/g
m/2011/prt3088_23_12_2011_rep.html
6. Spadini LS, Bueno SMV. Análise da
conduta educativa do enfermeiro psiquiátrico
e saúde mental e a educação
problematizadora. Acta scihealthsci.
[Internet].2005 [cited 2017 Mar 25];27(1):1-7.
Available from:
http://periodicos.uem.br/ojs/index.php/Acta
SciHealthSci/article/view/1429/799
7. Ministério da Saúde (Brasil). Núcleo
técnico da Política Nacional de Humanização.
Humaniza SUS: política nacional de
humanização. Brasília (DF); Ministério da
Saúde: 2004 [cited 2017 Mar 17]. Available
from:
http://bvsms.saude.gov.br/bvs/publicacoes/h
umanizasus_2004.pdf
8. Oliveira LC, Silva AR, Medeiros MN,
Queiroz JC, Guimarães J. Cuidar humanizado:
descobrindo as possibilidades na prática da
enfermagem em saúde mental. Rev pesqui
cuid fundam Online [Internet]. 2015 [cited
2017 Mar 21];7(1):1174-82. Available from:
http://saudepublica.bvs.br/pesquisa/resource
/pt/bde-26691
9. Delaney KR. Upcoming Health Care
Reforms: Stepping Up to the challenges.
Psychiatric Nursing [Internet]. 2010 [cited
2018 Sept 06];24(4):287-289. Available from:
https://www.psychiatricnursing.org/article/S
0883-9417(10)00044-0/fulltext doi
https://doi.org/10.1016/j.apnu.2010.04.005
10. Lacchini AJB, Ribeiro DB, Soccol KLS,
Terra MG, Silva RM. A enfermagem e a saúde
mental após a reforma psiquiátrica. Rev
Contexto Saúde. [Internet]. 2013 [cited 2017
Mar 20];11(20):565-568. Available from:
https://www.revistas.unijui.edu.br/index.php
/contextoesaude/article/view/1579
11. Mendes KDS, Silveira RCCP, Galvão CM.
Revisão integrativa: método de pesquisa para
a incorporação de evidências na saúde e na
enfermagem. Texto & contexto enferm.
[Internet]. 2008 [cited 2017 Mar
17];17(4):758-64. Available from:
http://www.scielo.br/pdf/tce/v17n4/18.pdf
12. Erdmann AL, Marziale MHP, Pedreira MLG,
Lana FCF, Pagliuca LMF, Padilha MI et al.
Evaluation of scientific periodicals and the
brazilian production of nursing articles. Rev
Latino-am Enferm. [Internet] 2009 [cited 2017
Apr 17];17(3):403-409. Available from:
http://www.scielo.br/pdf/rlae/v17n3/19.pdf
13. Pinto AC, Andrade JB. Fator de impacto
de revistas científicas: qual o significado deste
parâmetro?. Qim nova. [Internet] 1999 [cited
2017 Mar 18];22(3):448-453. Available from:
http://www.scielo.br/pdf/qn/v22n3/1101.pdf
14. Thomaz PG, Assad RS, Moreira LFP. Using
the Impact Factor and H Index to Assess
Researchers and Publications. Arq Bras
Cardiol. [Internet] 2011 Feb [cited 2017 Mar
11];96(2):90-93. Available from:
http://www.scielo.br/pdf/abc/v96n2/en_v96
n2a01.pdf
15. Melnyk BM, Fineout-Overholt E. Evidence-
based practice in nursing and healthcare: A
guide to best practice. Philadelphia:
Lippincott, Williams & Wilkins. [Internet] 2011
[cited 2017 Apr 17]. Available from:
http://file.zums.ac.ir/ebook/208-Evidence-
Based%20Practice%20in%20Nursing%20&%20He
althcare%20-
REFERENCES
Silva PO, Silva DVA, Rodrigues CAO et al. Nursing clinical care in mental health.
English/Portuguese
J Nurs UFPE online., Recife, 12(11):3133-46, Nov., 2018 3145
ISSN: 1981-8963 ISSN: 1981-8963 https://doi.org/10.5205/1981-8963-v12i11a236214p3133-3146-2018
%20A%20Guide%20to%20Best%20Practice,%20Se
cond%20Edition-Be.pdf
16. Marziale MHP, Mendes IAC. O fator de
impacto das publicações científicas. Rev
Latino-am Enferm. [Internet] 2002 [cited 2017
Mar 21]; 10(4): 466-467. Available from:
http://www.scielo.br/pdf/rlae/v10n4/13356.
17. Marques F. Para ampliar o impacto. Rev
Pesquisa Fapesp. [Internet] 2015 Jan [cited
2017 Mar 17]; 227: 32-35. Available from:
http://revistapesquisa.fapesp.br/wp-
content/uploads/2015/01/032-
035_Scielo_227.pdf
18. Moretto CC, Conejo SP, Terzis A. O
atendimento em uma instituição de saúde
mental infantil. Vínculo. [Internet] 2008 [cited
2017 Mar 17];5(1):55-67. Available from:
http://pepsic.bvsalud.org/pdf/vinculo/v5n1/v
5n1a07.pdf
19. Fitzpatrick JJ. Perspectives in Psychiatric
Nursing: Thoughts From Our Early Leaders.
Psychiatric Nursing [Internet] 2016 [cited 2018
Sept 06];30(5):497. Available from:
https://www.psychiatricnursing.org/article/S
0883-9417(16)30169-8/pdf DOI
https://doi.org/10.1016/j.apnu.2016.08.007
20. Costa JRE. Psiquiatria: bioética-
insanidade e (des) humanização. Rev Mundo
Saúde. [Internet] 2010 [cited 2017 Mar
17];34(4):531-34.17. Available from:
https://www.saocamilo-
sp.br/pdf/mundo_saude/79/531a534.pdf
21. Macedo JQ, Silveira MFA, Eulálio MC,
Fraga MNO, Braga VAB. Social Representation
of Nursing Care in Mental Health: qualitative
study. J Nurs UFPE on line. [Internet] 2010
[cited 2017 Mar 21];9(3):1-8. Available from:
https://www.objnursing.uff.br/index.php/nur
sing/article/view/3139/717
22. Oliveira FB, Silva OA. Enfermagem em
saúde mental no contexto da reabilitação
psicossocial e da interdisciplinaridade. Rev
Bras Enferm. [Internet] 2000 [cited 2017 Mar
25];53(4):584-92. Available from:
http://www.scielo.br/pdf/reben/v53n4/v53n
4a13.pdf
23. Rocha GDSC, Barcelos ICRR, Coloda RG. A
distância da proximidade entre o asilo
psiquiátrico e a produção de sentidos: o
aprendizado de enfermagem psiquiátrica nos
dias atuais. Rev pesqui cuid fundam Online.
[Internet] 2010 [cited 2017 Mar 17];2(4):1313-
25. Available from:
http://www.seer.unirio.br/index.php/cuidad
ofundamental/article/view/580/pdf_142
24. Costa E, Süsskind MB. Problematizando
para humanizar: uma proposta de
transformação do cuidado em uma enfermaria
psiquiátrica. Texto contexto & enferm.
[Internet] 2004 [cited 2017 Apr 20];13(1):163-
70. Available from:
http://www.redalyc.org/pdf/714/71413122.p
df
25. Zerbetto SR, Rodrigues AR.
Relacionamento não diretivo do enfermeiro
com paciente em processo de ressocialização.
Rev latino-am enferm. [Internet] 1997 [cited
2017 Mar 17];5:77-83. Available from:
http://www.scielo.br/pdf/rlae/v5nspe/v5nsp
ea10.pdf
26. Barreto MS, Büchele F, Coelho, EBS. O
cuidado com o sofredor psíquico
institucionalizado. Cogitare Enferm. [Internet]
2008 [cited 2017 Mar 17]; 13(4): 607-611.
Available from:
https://revistas.ufpr.br/cogitare/article/view
/13125
27. Willrich JQ, Bielemann VL, Chiavagatti
FG, Kantorski LP, Borges LR. Ambiência de um
centro de atenção psicossocial: fator
estruturante do processo terapêutico. Rev
Enferm UFSM. [Internet] 2013 [cited 2017 Mar
20];3(2):248-58. Available from:
http://dx.doi.org/10.5902/217976927977
28. Brischialiari A, Maftum MA, Waidmann
MAP, Mazza VA. Sensibilizando a equipe de
enfermagem ao cuidado humanizado em saúde
mental mediante oficinas educativas. Rev
Eletr Enf. [Internet] 2008 [cited 2017 Mar
17];10(4):1080-90. Available from:
https://www.fen.ufg.br/fen_revista/v10/n4/
pdf/v10n4a21.pdf
29. Vieira AN, Silveira LC, Silva LMS,
Rodrigues DP, Martins IC. Reflection about the
contributions of psychoanalysis for the care
and nursing clinic. J Nurs UFPE on line.
[Internet] 2014 [cited 2017 Mar 17];8(2):450-
6. Available from:
https://periodicos.ufpe.br/revistas/revistaenf
ermagem/article/view/9693/9750
30. Kellehear KJ. The theory-practice gap:
Well and truly alive in mental health nursing.
Nursing e Health Sciences [Internet]. 2014
[cited 2018 Sept 06];6(2) Available from:
https://onlinelibrary.wiley.com/doi/abs/10.1
111/nhs.12156 doi:
https://doi.org/10.1111/nhs.12156
Silva PO, Silva DVA, Rodrigues CAO et al. Nursing clinical care in mental health.
English/Portuguese
J Nurs UFPE online., Recife, 12(11):3133-46, Nov., 2018 3146
ISSN: 1981-8963 ISSN: 1981-8963 https://doi.org/10.5205/1981-8963-v12i11a236214p3133-3146-2018
Submission: 2018/04/22 Accepted: 2018/08/16 Publishing: 2018/11/01
Corresponding Address
Patrícia Oliveira Silva Rua Topázio, 1073 Monte Carmelo CEP: 39402-015 ― Montes Claros (MG), Brazil
Copyright of Journal of Nursing UFPE / Revista de Enfermagem UFPE is the property of Revista de Enfermagem UFPE and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
