Nervos: rede de discursos e pr?ticas de cuidado na aten??o b?sica no munic?pio de Natal/RN

• Main Author: Azevedo, Luciana Fernandes de Medeiros
• Other Authors: CPF:00870893432
• Format: Others
• Language: Portuguese
• Published: Universidade Federal do Rio Grande do Norte 2014
• Subjects: Sa?de mental; Aten??o b?sica; Etnografia Institucional; Nervos; Mental health; Primary health care; Institutional Ethnography; Nerves; CNPQ::CIENCIAS HUMANAS::PSICOLOGIA
• Online Access: http://repositorio.ufrn.br:8080/jspui/handle/123456789/17387

Made available in DSpace on 2014-12-17T15:38:32Z (GMT). No. of bitstreams: 1 LucianaFM_TESE.pdf: 854964 bytes, checksum: 132a69f66769754a3d044805d52a783c (MD5) Previous issue date: 2010-06-07 === The Primary Health Care and one of its main strategies, the Family Health Strategy (ESF), are framed as the gateway to the Public Health System (SUS). Thus, most of the incident and prevalent health problems in the population attended should be solved at this level of care, including psychological suffering, and the so-called complaint of nerves. Nerves and nervous denote a complexity that is not always well comprehended by health workers, in such a way that the care to this kind of problem is usually inadequate. In this line of thought, the general objective of this study is to analyze the network of discourses and the care to the psychological suffering, expressed as nerves, in SUS daily Primary Health Care. Besides and more specifically, it aims at identifying the principles and guidelines of the Primary Health Care in mental health; to investigate health workers positioning before psychological suffering and complaints of nerves, and also analyze different actions and practices of care carried out in different Health Units towards complaints like nerves. Institutional Ethnography was the theoreticalmethodological perspective adopted for the work. This approach seeks to understand and analyze the institutional relationships in a particular context considering sociostructural influences and power relations, as well as daily discourses and practices. Based on interviews with health professionals, informal conversations and observations in six Health Units with ESF teams from different sanitary districts in Natal/RN, it was possible to check that the index of complaint of nerves is high. The referral to psychologists and psychiatrists, as well as the prescription of psychotropic drugs appear as the most common intervention at this level of care. In general, the participants complain that they have poor specialized knowledge about the theme of mental health. They face the problem of bad work conditions and the lack of institutional support, which make actions of illnesses prevention and health promotion even more difficult. Besides, there are different ongoing practices such as meetings for hypertensive and aged people, walk, visit, round-table discussions and community therapy. However, not all of these actions are aimed at the care of psychological suffering. It is observed that the Matrix Support, which is a methodological strategy of supervision and follow up forcases of mental health, hasn t been totally implemented in the municipal system, although it is a tool that has been used by psychologists in some Health Units in the city. It was also verified that the health care practices to the problem of nerves strongly depend on the professional s commitment with the PSF guidelines and on mental health policies, in addition to continued support, when available, from other professional who works as matrix supporter === A aten??o b?sica e uma de suas principais estrat?gias, a Estrat?gia Sa?de da Fam?lia (ESF), se configuram como a porta de entrada para o Sistema ?nico de Sa?de (SUS). Dessa maneira, boa parte dos problemas de sa?de incidentes e prevalentes na popula??o dscrita deve ser resolvida nesse n?vel de aten??o, incluindo o sofrimento psicol?gico e a denominada queixa de nervoso. Nervos e nervoso denotam uma complexidade que nem sempre ? bem compreendida pelos trabalhadores de sa?de, de maneira que o cuidado a esse tipo de problema geralmente ? inadequado. O objetivo geral desse trabalho ? analisar a rede de discursos e de cuidados no atendimento ao sofrimento psicol?gico que se expressa como nervos, no cotidiano da aten??o b?sica do SUS. Mais especificamente, identificar os princ?pios e diretrizes da aten??o b?sica em sa?de mental; investigar o posicionamento dos trabalhadores de sa?de diante do sofrimento psicol?gico e das queixas de nervos, e analisar as diferentes a??es e pr?ticas de cuidado realizados nas diferentes Unidades de Sa?de diante de queixas como nervos. A perspectiva te?rico-metodol?gica adotada no trabalho foi a Etnografia Institucional. Essa abordagem busca compreender e analisar as rela??es institucionais em determinado contexto considerando as influ?ncias socioestruturais e as rela??es de poder, bem como as pr?ticas e os discursos cotidianos. Foram realizadas entrevistas com trabalhadores de sa?de, conversas informais e observa??es em seis Unidades de Sa?de com equipes da ESF de diferentes distritos sanit?rios do munic?pio de Natal/RN. Constatou-se o alto ?ndice de queixas de nervos, sendo que o encaminhamento a psic?logos e psiquiatras e a prescri??o de psicotr?picos s?o a forma mais comum de interven??o. Em geral, h? uma falta de conhecimento especializado sobre o tema da sa?de mental, bem como aus?ncia de discuss?es sobre as pol?ticas de sa?de mental. De um lado, as condi??es de trabalho e a falta de apoio institucional dificultam a realiza??o de a??es de preven??o de doen?as e promo??o ? sa?de. Por outro, h? diferentes pr?ticas em andamento tais como reuni?es de hipertensos e idosos, caminhadas, visitas, rodas de conversas e terapia comunit?ria embora nem todas visem o cuidado espec?fico ao sofrimento psicol?gico. O apoio matricial, estrat?gia metodol?gica de supervis?o e acompanhamento de casos de sa?de mental, vem sendo implantado por psic?logos em algumas Unidades de Sa?de do munic?pio, por?m ainda n?o est? totalmente implantado na rede. As pr?ticas de cuidado aos problemas de nervos dependem principalmente do envolvimento do trabalhador com as diretrizes da ESF e das pol?ticas de sa?de mental, al?m do apoio sistem?tico, quando dispon?vel, de outro profissional que funciona como apoiador matricial