Assistência às famílias de crianças com Transtornos do Espectro Autista: percepções da equipe multiprofissional

Resumo Objetivo: sintetizar o cuidado prestado por profissionais de saúde, nos diferentes níveis de atenção, às famílias de crianças com Transtornos do Espectro Autista. Método: estudo qualitativo, baseado no referencial teórico filosófico do Cuidado Centrado na Família, desenvolvido com 22 profissionais de três equipes multidisciplinares de serviços da Rede de Atenção à Saúde de um município do estado de Mato Grosso do Sul, Brasil. Os dados foram coletados por meio de dois grupos focais com cada equipe, organizados com apoio do software Atlas.ti 8 Qualitative Data Analysis e submetidos à Análise Temática de Conteúdo. Resultados: as descobertas mostram ações centradas em situações pontuais, principalmente nas demandas e necessidades advindas do cuidado da criança e de seu comportamento atípico. Fatores influenciadores para o cuidado à família, como a sobrecarga de trabalho e a pouca experiência profissional, evidenciam a fragilidade da assistência multiprofissional e a invisibilidade da família enquanto unidade de cuidado. Conclusão: destaca-se a necessidade de rever o funcionamento e modo como a rede para o cuidado multiprofissional da criança e sua família está organizada. Recomenda-se a oferta de ações de educação permanente que contribuam com a qualificação das equipes multiprofissionais no cuidado às famílias de crianças no espectro do autismo.

Asistencia a familias de niños con Trastornos del Espectro Autista: percepciones del equipo multidisciplinario

Resumen Objetivo: resumir la atención que brindan los profesionales de la salud, en los diferentes niveles de atención, a las familias de niños con Trastornos del Espectro Autista. Método: estudio cualitativo, basado en el marco teórico filosófico de la Atención Centrada en la Familia, desarrollado con 22 profesionales de tres equipos multidisciplinarios de servicios de la Red de Atención de la Salud en un municipio del estado de Mato Grosso do Sul, Brasil. Los datos fueron recolectados a través de dos grupos focales con cada equipo y organizados con la ayuda del software Atlas.ti 8 Qualitative Data Analysis ® y sometidos al Análisis de Contenido Temático. Resultados: los hallazgos muestran acciones enfocadas en situaciones específicas, principalmente en las demandas y necesidades que genera el cuidado del niño y su comportamiento atípico. Factores que influyen en la atención a la familia, como la sobrecarga de trabajo y la poca experiencia profesional, revelan las falencias que tiene la asistencia multidisciplinaria y la invisibilidad de la familia como unidad de atención. Conclusión: es necesario examinar el funcionamiento y la forma en que está organizada la red para la atención multidisciplinaria de los niños y sus familias. Se recomienda implementar acciones de educación continua que contribuyan a la capacitación de los equipos multidisciplinarios para la atención a las familias de niños con espectro autista.

Assistance to families of children with Autism Spectrum Disorders: Perceptions of the multiprofessional team

OBJECTIVE

to synthesize the care provided by health professionals, at different care levels, to the families of children with Autism Spectrum Disorders.

METHOD

a qualitative study, based on the Family-Centered Care philosophical theoretical framework and developed with 22 professionals from three multidisciplinary teams from the Health Care Network of a municipality in the state of Mato Grosso do Sul, Brazil. The data were collected through two focus groups with each team, organized with the support of the Atlas.ti 8 Qualitative Data Analysis® software and submitted to Thematic Content Analysis.

RESULTS

the findings show actions centered on specific situations, especially on the demands and needs arising from the child's care and atypical behavior. Influencing factors for family care, such as work overload and little professional experience, show the weakness of multiprofessional care and the invisibility of the family as a care unit.

CONCLUSION

the need is highlighted to review functioning of the network for the multiprofessional care of children and their families and how such network is organized. It is recommended to offer permanent education actions that contribute to the qualification of multiprofessional teams in the care of families of children in the autism spectrum.

Family Nursing Practice Scale: Portuguese Language Translation, Cross-Cultural Adaptation, and Validation

Studies of family nursing interventions have shown positive results for the health of individuals and families. To increase the availability of instruments that evaluate the practice of family nursing, this research adapted and validated the Family Nursing Practice Scale (FNPS) for use in Brazil with a sample of 144 hospital nurses using a cross-sectional design. The adaptation process involved back-translation, validation by a committee of experts, and semantic analysis. Content validity was analyzed through the content validity coefficient (CVC); construct validity was analyzed by exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and convergent and discriminant validation through average variance extracted (AVE). The reliability of the measure was evaluated using Cronbach's alpha index and composite reliability (CR). The results indicate that the adapted version of FNPS is recommended for family nursing research, education, or clinical practice with Brazilian nurses.

Meaning of aging for caregivers of senile elderly people

OBJECTIVES

to understand the meaning of aging for caregivers of senile elderly people.

METHODS

qualitative study carried out with 12 caregivers of elderly people registered in the Home Care Service, adopting the Explanatory Model of Kleinman's Disease as a theoretical framework. Data were collected from April to June 2019, through semi-structured, audio-recorded interviews, carried out at home and submitted to content analysis.

RESULTS

taking care of senile elderly people triggers reflections on aging that sometimes lead to a new meaning of this process, besides stimulating the recognition of the factors that influence it, with emphasis on the life history, occupation and deleterious behaviors adopted throughout life.

FINAL CONSIDERATIONS

the care experience influences the meaning attributed to aging, favoring: the identification of modifiable and non-modifiable aspects and behaviors that make it healthy; reflection on aging itself, with a new meaning of habits and behaviors to be adopted.

Family resilience: perception of family members of psychoactive substance dependents

Objective:

to understand the perception of family members of psychoactive substance dependents on the elements of the functioning of their family in family resilience.

Method:

a qualitative approach study, based on the theoretical interpretive framework of family resilience from a systemic perspective. The participants were eleven family members of psychoactive substance dependents from a Psychosocial Care Center - Alcohol and Drugs, from a city in the state of São Paulo. For data collection, semi-structured interview, genogram and ecomap were used. Data analysis was based on the Content Analysis technique, thematic category.

Results:

from the interviews, three thematic categories were formulated: mobilization in search of support and social support; positive perspectives that would strengthen the family, and assertive communication. These categories point to references to the mobilization and unity of the family in search of social support in the intra-family, extended family and extra-family contexts and positive perspectives, such as persistence, perseverance, hope, faith and religiousness.

Conclusion:

the situation of having a psychoactive substance dependent in the family seemed to mobilize coping devices and attempts to overcome them through the resilience forces. The results may favor the daily clinical reasoning of the health professionals, helping them to recognize and value the identified resilience attributes.

Crenças de enfermeiros do contexto hospitalar sobre a inclusão da família no cuidado de enfermagem

A família foi sendo modificada conforme a sociedade foi se desenvolvendo, a enfermagem é conhecida como a profissão que atua diretamente com as famílias em seu cotidiano de trabalho. Objetivo: Descrever como os enfermeiros percebem a inclusão da família no planejamento do cuidado de enfermagem no seu trabalho. Métodos: Estudo qualitativo realizado com 10 enfermeiros hospitalares por meio de entrevista áudio gravada, todos os preceitos éticos foram resguardados. Resultados: Três categorias emergiram da análise dos dados foram elas: A inclusão da família no cuidado ao paciente hospitalizado promove a melhora do paciente e fortalece o vínculo familiar; A presença da família no serviço é uma oportunidade para o enfermeiro ensinar a família sobre os cuidados; algumas famílias têm dificuldades para se envolver no cuidado do paciente. Conclusões: Esse estudo possibilitou compreender como os enfermeiros perceberam os familiares em seus ambientes de trabalho, devido a amostra pequena esse estudo não pode ser generalizado, assim é necessário as realizações de mais estudos são necessárias para confirmar os achados nesse estudo.

Family experiences in discovering Autism Spectrum Disorder: implications for family nursing

OBJECTIVES

to describe the family's experience in the process of discovering the diagnosis and initiation of treatment of children with Autism Spectrum Disorder.

METHODS

this qualitative and descriptive study interviewed nine relatives of eight children on autism spectrum. They were inserted in health services, public education, and Association of Parents and Friends of The Exceptional of cities in the countryside of the Center-West. Data were collected through open interviews from July to September 2017. Data was submitted to thematic analysis.

RESULTS

at the beginning, the family was difficult to perceive the first atypical signs presented by the children. Families experience situations of vulnerability, since support networks are insufficient. The school played a significant role in recognizing unexpected behaviors.

FINAL CONSIDERATIONS

support, offered by nurses, health professionals, school and social support devices, is important to family and children in this trajectory.

Brazilian transgender children and adolescents: Attributes associated with quality of life

Objective:

to describe attributes associated with the Quality of Life of Brazilian transgender children and adolescents according to their own perception.

Method:

descriptive study conducted with 32 participants between eight and 18 years old, who were either interviewed or participated in focus groups. The statements were transcribed, grouped with the aid of the Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires software, version 0.7 alpha 2 and described according to the definition of Quality of Life by the World Health Organization concerning to the mental, physical, and social dimensions.

Results:

it was possible to identify the family nucleus as the main social support for transgender children and adolescents. However, the experience of prejudice and discrimination were negative attributes associated with Quality of Life.

Conclusion:

the statements indicate that lives of transgender children and adolescents are impacted by social, physical, and mental factors due to the stigma and discrimination experienced. It is expected to contribute to the formulation of public policies related to transgender children and adolescents and expand the discussion on the citizens’ duties and rights in relation to transsexuality.

Predictors of Expressed Emotion in First Episode Psychosis

This article evaluated the predictors of EE and its components, EOI and CC, in relatives of first episode psychosis patients (FEP) in Brazil. Cross-sectional observational study conducted with 82 dyads of FEP patients and their relatives. Data collection instruments: sociodemographic and clinical data questionnaire, Family Questionnaire, Zarit Burden Interview and Morisky Medication Adherence Scale. Logistic and linear regression models were used. Our results indicate that patient's age, relative's sex, daily time spent together, and family burden were predictors of EE and its components. Our findings may be helpful in planning nursing interventions to reduce EE and prevent psychotic relapses.

Contexts of vulnerabilities experienced by adolescents: challenges to public policies

OBJECTIVES

to understand the context of vulnerability experienced by adolescents from the perspective of health professionals from the Family Health Strategy.

METHODS

a descriptive-exploratory qualitative study developed with 80 Family Health Strategy professionals in the Midwest region of Brazil. Data collection was developed from July to September 2018 through a focus group, and submitted to Thematic Analysis.

RESULTS

it was understood that the vulnerability experienced by adolescents is not an exposure to something isolated, but is linked to risk and protection factors, socioeconomic and cultural contexts, public and health policies.

FINAL CONSIDERATIONS

there are still gaps in public policies for this population, which impacts on the access and development of promotion actions by health professionals.

Caregiver burden and stress in psychiatric hospital admission

OBJECTIVE

to evaluate the relation between sociodemographics factors, stress and burden of care of family caregivers of patients at a psychiatric hospital admission.

METHOD

quantitative study, with a cross-sectional correlation design. A total of 112 family caregivers participated, older than 18, in a Brazilian psychiatric hospital. A sociodemographic questionnaire was used to collect data, the Zarit Burden Interview and LIPP Adult Stress Symptom Inventory.

RESULTS

burden of care in family caregivers at a psychiatric hospital admission was significantly associated with stress (p=0.000). The psychological symptoms of stress predicted severe burden. Most caregivers presented a moderate or severe burden, with 52.7% in the resistance phase of stress; 66.1% presented psychological symptoms.

CONCLUSION

results show the alarming situation of caregivers of patients from a psychiatric hospital, evidencing their own vulnerability to illness. Indeed, the during admission in a psychiatric hospital, not only patients need care, but also their caregivers.

Family experiences in the identification of the first-episode psychosis in young patients

The study aimed to understand the family experience in the identification of the first-episode psychosis in young family members. Qualitative research using symbolic interactionism and narrative. Data were collected through depth interview with 13 relatives of 11 young patients treated for the first-episode psychosis. The families showed behavior consistent with the meanings they gave to the disease process of the young relatives, represented by categories: "waiting move: trying to justify the behavior of the adolescent", "not understanding the psychosis", and "seeking help". This research fostered the understanding of how families decided to seek help in the healthcare system. The nursing interventions with these families could contribute to early detection and beginning of treatment.

The trajectory of crack users to the street situation in the perspective of family members

OBJECTIVES

To understand the family experience regarding the trajectory of crack users for the street situation.

METHODS

Qualitative study using the systemic approach as the theoretical referential and the narrative as methodological referential. We conducted interviews with eleven family members of crack users with street situation experience cared for at a community mental health service. We analyzed the interviews using the inductive content analysis technique.

RESULTS

The family members understood the trajectory of the crack users for the street situation from two perspectives. One before the street situation process, for which they described a problematic childhood, the presence of stressor traumas/events, vulnerabilities in the family environment, and their family members' encounter with the drug world. Moreover, another posterior to the street situation, for which they narrated the perception of alterations in the users, the discovery of crack use, the deepening of the individuals' relationship with the streets, and the adoption of coping strategies.

CONCLUSIONS

It was made evident that the family adopts an explicative model for the behavior of drug use and contact with the streets based on the life history of the crack user family member.

Expressed emotion and socio-demographic and clinical factors in families of Brazilian patients with schizophrenia

BACKGROUND

Families are the main caregivers of people with schizophrenia. Family dynamic and expressed emotion (EE) of relatives are fundamental determinants on the course of schizophrenia.

METHOD

This study analyzed socio-demographic and clinical factors related to EE components. A total of 94 dyads (patients with schizophrenia and their relatives) were recruited from three mental health clinics. A form containing socio-demographic and clinical variables and the Brazilian version of Family Questionnaire were used and the data were analyzed through regression model.

RESULTS

Results showed that factors such as patients' occupation status and patients' age, as well as relatives' gender and the degree of relatedness, were related to emotional overinvolvement and critical comments levels.

CONCLUSION

This is the first study in the Brazilian cultural context that evaluates EE components and related factors on families of patients with schizophrenia. Other studies concerning EE on different cultural contexts and possible interventions must be carried out to help health professionals to improve patient and family care.

The experience of grandmothers in the care of the adolescent who consumes psychoactive substances

Abstract Objective: To apprehend the experience of grandmothers who take care of their grandchildren who consume psychoactive substances. Methods: A descriptive study with a qualitative approach conducted with five grandmothers of two health services in a city in the interior of São Paulo. Data have collected from July 2015 to May 2016, through semi-structured interviews and analyzed using the technique of thematic content analysis. Results: The grandmothers recognized that their grandchildren used drugs when they changed their behavior, which required them to take on the role of counselor and educator. The aging process and financial difficulty consisted in limits to care. Conclusion and implications for practice: The grandmothers suffered psychosocial, structural, and organizational impacts, requiring nurses to enhance their facilitator skills in relational processes between two distinct generations of age and values.

As relações familiares com adolescentes usuários de substâncias psicoativas: percepção dos pais

O objetivo deste estudo consiste em discutir a experiência das famílias que cuidam de adolescentes consumidores de substâncias psicoativas, no âmbito de seu funcionamento. Estudo qualitativo, descritivo, tendo como participantes da pesquisa os genitores de adolescentes consumidores de drogas, de um Centro de Atenção Psicossocial-Álcool e Drogas do interior paulista. Foram realizadas entrevistas semiestruturadas e os dados foram analisados pela técnica de análise de conteúdo, categorial temática. Os resultados apontam que estes genitores apresentam dificuldade de estabelecer diálogo assertivo com seus filhos e filhas, em desenvolver seu papel hierárquico e de estabelecer limites ao adolescente. Tais situações geram sentimentos ambivalentes e emoções negativas que os mobilizam a buscar apoio no âmbito familiar, informacional, religioso e instrumental. Conclui-se que o cuidado deve envolver o adolescente que consome drogas e sua família, considerando os aspectos interacionais, organizacionais e comunicacional do coletivo familiar.

Where to seek help? Barriers to beginning treatment during the first-episode psychosis

Objective

As decreasing the duration of untreated psychosis has been highlighted as key indicator in relation to improved prognosis, this study aims to identify the access barriers to beginning early treatment of young people in first-episode psychosis (FEP), based on family reports on the experience of perceiving illness and help-seeking.

Method

A qualitative research was carried out with 12 relatives of 12 young people passing through their first psychiatric hospital admission as a result of their FEP. Depth interviews were used for data collection and thematic content method for data analysis.

Results

Barriers to beginning treatment were lack of knowledge and difficulty in recognizing mental illness, lack of knowledge on where to seek specialized treatment, and stigma and resistance to psychiatric treatment.

Conclusion

It was demonstrated that the family members are protagonists in the search for treatment of young people in their FPE, given that the initiative for seeking treatment came from them.

Emoção expressa de familiares e recaídas psiquiátricas de pacientes com diagnóstico de esquizofrenia

RESUMO Objetivo: Avaliar a relação entre recaídas psiquiátricas de pacientes com diagnóstico de esquizofrenia, níveis de emoção expressa de seus familiares e fatores relacionados. Método: Estudo prospectivo, realizado em um serviço ambulatorial de saúde mental e em dois Centros de Atenção Psicossocial, com pacientes e familiares que responderam ao Family Questionnaire − Versão Português do Brasil, um formulário contendo as variáveis sociodemográficas e clínicas e um roteiro estruturado para avaliação de recaídas. Para a análise, utilizou-se do modelo de regressão logística. Resultados: Participaram do estudo 89 díades. Dos pacientes investigados, 31% apresentaram recaídas, e 68% dos familiares, elevada emoção expressa. A relação entre a emoção expressa e as recaídas não foi significativa. A análise de regressão logística mostrou que quanto maior o número de internação nos 2 anos precedentes ao estudo, a chance de o paciente apresentar recaídas no período de 24 meses é de 1,34. Conclusão: A emoção expressa foi insuficiente para predizer recaídas. Assim, as recaídas devem ser compreendidas como um fenômeno multifatorial. Esses resultados fornecem subsídios para intervenções e investigações sobre os múltiplos fatores envolvidos na evolução do paciente com esquizofrenia, acompanhado em serviços de saúde mental de base comunitária.

Family resilience and chemical dependency: perception of mental health professionals

ABSTRACT Objective: To learn the perception of health professionals from the Psychosocial Attention Center for Alcohol and Other Drugs regarding the resilience attributes that are critical to family members of psychoactive substance dependents. Method: A qualitative descriptive study conducted from February to May 2016, using a focus group technique for data collection. In total, 15 professionals participated in the study: 13 health professionals and two administrative professionals. The statements were recorded and transcribed, and these data were analyzed using the technique of thematic content analysis. Results: Health professionals recognize the family resilience attributes needed for efficient and assertive communication, as well as organizational patterns and facilitating family strengths, factors that contribute to improved family relationship and family functionality. Final considerations: This study contributed to a perspective of clinical intervention with family members that is not limited to the negative aspects of family relationship and life, such as fragility and family dysfunction.

Predictive Validity of the Brazilian Portuguese Version of the Family Questionnaire for Relapse in Patients With Schizophrenia

Background and Purpose: The Family Questionnaire-Brazilian Portuguese Version (FQ-BPV) has been preliminarily validated in the Brazilian population. This study assessed the predictive validity of the FQ-BPV for relapse in patients with schizophrenia. Methods: Ninety-four dyads (patients with schizophrenia and their relatives) were recruited from three mental health clinics. Expressed emotion was assessed using the FQ-BPV. Presence of relapse was assessed at 6-, 9-, 12-, and 18-month follow-ups and analyzed through logistic regressions. Results: The critical comments (CC) domain of the FQ-BPV was statistically significant at 18 months. However, the model was not sufficiently robust to classify individuals correctly into relapse or no relapse categories. Conclusion: The FQ-BPV did not predict relapse well and we cannot recommend it for that purpose in Brazil without further studies.

Strategies for coping with family members of patients with mental disorders

Objective:

to identify the coping strategies of family members of patients with mental disorders and relate them to family member sociodemographic variables and to the patient's clinical variables.

Method:

this was a descriptive study conducted at a psychiatric hospital in the interior of the state of São Paulo, with 40 family members of hospitalized patients over the age of 18, and who followed the patient before and during hospitalization. We used tools to characterize the subjects and the Folkman and Lazarus Inventory of Coping Strategies.

Results:

the coping strategies most often used by family members were social support and problem solving. Mothers and fathers used more functional strategies (self-control p=0.037, positive reappraisal p=0.037, and social support p=0,021). We found no significant differences between the strategies and other variables examined.

Conclusion:

despite the suffering resulting from the illness of a dear one, family members make more use of functional strategies, allowing them to cope with adversities in a more well-adjusted way.

PERFIL DAS EQUIPES DOS CENTROS DE ATENÇÃO PSICOSOCIAL DE UMA REGIÃO DO ESTADO DE MINAS GERAIS

Introdução: O Centro de Atenção Psicossocial é um serviço de saúde mental centrado na comunidade e destinado a substituir o hospital psiquiátrico como centro da assistência ao portador de transtorno mental. Objetivo: Identificar o número, o perfil e a prática dos profissionais de nível superior que compõem as equipes de Centros de Atenção Psicossocial credenciados ao Sistema Único de Saúde na região Macrorregional Noroeste Sanitária de Saúde de Minas Gerais. Casuística e Métodos: Os dados foram coletados por meio de questionários aplicados a todos os profissionais dos serviços investigados. Resultados: O perfil dos 31 profissionais é de jovens, com ausência de especialização e pouca experiência na área de saúde mental, mas em número suficiente conforme preconiza o Ministério da Saúde. Em relação às práticas, observou-se que o atendimento individual, os grupos e as ações básicas de enfermagem são as práticas de cuidado mais comuns, realizadas pela maioria da equipe multiprofissional. O modelo de atenção à saúde ainda é biomédico e a teoria de enfermagem é de cuidados à saúde centrados também no atendimento familiar. As dificuldades encontradas para aplicar a política de saúde mental vigente no país são de ordem financeira, política e de recursos humanos. Conclusão: Esta pesquisa descreveu equipes com pouca especialização em saúde mental e com alta rotatividade. O atendimento individual foi a prática mais citada entre os profissionais, mas também existem práticas de cuidados e de grupos indicando que os profissionais estão se esforçando para fortalecer a proposta de atendimento na comunidade. Porém, é preciso manter os profissionais nas equipes e investir na sua formação no sentido de transformar a assistência e o cuidado em saúde mental.

Ajustamento familiar após o surgimento da esquizofrenia

Considera-se que, quando ocorre o primeiro episódio da esquizofrenia, a vida familiar é interrompida e a sua trajetória de vida pode ser modificada. Em vista disso, o objetivo deste trabalho foi conhecer a trajetória de famílias nos primeiros cinco anos de convivência com a doença mental, identificando o seu processo de ajustamento. A pesquisa está fundamentada no Interacionismo Simbólico. Foram realizadas entrevistas com 23 familiares de 21 portadores de esquizofrenia. A análise foi realizada visando à determinação de uma linha do tempo, que permitiu descrever o processo de ajustamento familiar através de três momentos: Percebendo a Mudança, Diagnóstico e Início do Tratamento, e Seguindo em Frente. Conclui-se que todas as fases apresentadas neste projeto são ricas e podem ser mais exploradas.

[Research with families of people with mental disorder]

The purpose of this paper is to present a critical reflection on the knowledge produced on the topics: the impact of the mental illness in the family, the impact of the family environment in the evolution of the eating and the experience family with the mental illness. The measures of overload and express emotion are useful to guide public politics and the practice professional, however in they do not give a multidimensional picture to them of the experience of the care. Research on the familiar experience contribute to the understanding of the present suffering in this experience and of the forms of confrontation adopted by the families, also contributing to perceive the differences of the cultural contexts in the confrontation of the families.

O cuidador e a sobrecarga do cuidado à saúde de pacientes egressos de internação psiquiátrica

OBJETIVO: Identificar as características sóciodemográficas e o grau de sobrecarga dos familiares cuidadores de pacientes egressos de internação psiquiátrica. MÉTODOS: Estudo quantitativo exploratório realizado em um ambulatório de saúde mental utilizando um questionário e a Escala de Avaliação da Sobrecarga dos Familiares. A amostra compôs se de 21 cuidadores de pacientes egressos de internação psiquiátrica. RESULTADOS: Todos os cuidadores tinham vínculo familiar, média de idade de 46 anos, sendo a maioria mulheres. As mães foram as principais cuidadoras em 38% dos casos. Todos apresentaram grau de sobrecarga, sendo a objetiva predominantemente maior. Os maiores escores médios relacionaram se às preocupações com a segurança física e futuro do paciente. CONCLUSÃO: foi identificada considerável sobrecarga familiar entre os cuidadores o que evidencia a importância de uma relação colaborativa entre os serviços de saúde mental, pacientes, seus cuidadores e suas famílias para melhor manutenção dos tratamentos psiquiátricos.

Expressões utilizadas por familiares ao relatarem experiências de conviver com o adoecimento mental

OBJETIVO: Identificar as expressões usadas por familiares para descrever a experiência de conviver com o adoecimento mental. MÉTODOS: Tratase de pesquisa que realizou análise dos relatos de familiares por meio do software Analyse Lexicale par Contexte d'um Ensemble de Segments de Texte (ALCESTE), contendo metodologia de análise de dados qualitativos que se adapta a qualquer domínio de investigação, em que se pretenda tratar material textual. RESULTADOS: A análise realizada pelo ALCESTE forneceu quatro classes agrupadas duas a duas: Classe 2 -- início da doença e Classe 4 -- início do tratamento; Classe 1 -- convivência e Classe 3 - cotidiano. CONCLUSÃO: Os momentos descritos pelos familiares foram identificados por expressões, palavras e termos usados pelos mesmos em suas narrações. A principal contribuição deste estudo foi trazer a linguagem dos familiares para descrever os momentos do adoecimento por meio de uma metodologia de análise mais distante do pesquisador.

Adherence level and knowledge about psychopharmacological treatment among patients discharged from psychiatric internment

This exploratory, descriptive and prospective study aimed to identify the degree of adherence to psychopharmacological treatment of patients who were discharged from psychiatric hospitalization and their knowledge about their prescription and diagnosis. The study was carried out at a Mental Health Service. The sample consisted of all service clients who were discharged from psychiatric hospitalization in the data collection period. A Sociodemographic Questionnaire and the Morisky-Green Test were the instruments used. Data were analyzed through central trend measures. In total, 48 patients participated in the study. Regarding adherence, 70.8% of them showed a low adherence level to psychopharmacological treatment. Moreover, only twenty-one patients knew what their diagnosis was and most did not know or partially knew the name and dose of all prescribed medications.

[Schizophrenia: adherence to treatment and beliefs about the disorder and the drug treatment]

This study verified the adherence of people with schizophrenia to the medication, identified and compared their beliefs about the disorder and the drug among patients who adhered and those who did not. Participants were 14 patients of a psychiatric outpatient clinic. Semi-structured interviews and the Morisky-Green test were performed. The data was analyzed using a quali-quantitative approach. Results showed that 64.3% of patients do not adhere to treatment. Most participants considered the drug capable of reducing the seriousness and severity of the disorder. However, the drawbacks for patients that did not adhere to the treatment were more expressive. Side effects were the cause for interrupting the treatment for 80% of patients who intentionally did not adhere to treatment. It was observed there is insufficient knowledge about schizophrenia and the drug treatment. Patients referred to faith as a strategy to cope with the process they were experiencing. This study points at the need for strategies directed towards the promotion of drug treatment adherence among people with schizophrenia.

O cuidado em saúde mental na atualidade

O objetivo desse trabalho foi identificar as características sócio-demográficas dos cuidadores de pessoas que tiveram alta hospitalar de internação psiquiátrica. Foi realizado um estudo quantitativo exploratório em um serviço ambulatorial de saúde mental. A amostra foi composta por pacientes egressos de internação e seus cuidadores. Foi utilizado um questionário e a pesquisa foi aprovada pelo CEP. De 48 pacientes egressos 21 possuíam um cuidador. Todos os cuidadores identificados eram familiares dos pacientes e a idade média foi de 46,6 anos. As mães eram as principais cuidadoras em 38% dos casos. Casados ou amasiados representaram 61,9% dos cuidadores e apenas um cuidador não tinha filhos. A principal fonte de renda foi trabalho eventual para 28,6%. Conhecer quem são os cuidadores dos pacientes egressos de internação psiquiátrica, hoje, possibilita identificar características que podem fomentar a determinação do melhor tratamento e suporte profissional ao cuidado dessa clientela.

[Psychiatric hospitalization and maintaining the treatment outside the hospital]

The objective of this study was to identify common features between people that have been recently discharged from psychiatric hospitalization. A quantitative exploratory study was performed at an outpatient mental health service center. The sample was comprised by patients who had recently been discharged. A questionnaire was used and the study was approved by the Review Board. Interviews were performed with 48 patients who were in average 39 years old. Diagnosis for Schizophrenia and Schyzotypal Disorders were prevalent for 33.3% of the sample. An average 13 patients were discharged from psychiatric hospitalization every month, 62.5% of which had been previously hospitalized. In the studied period, 12.5% of the sample required rehospitalization. Psychiatric hospitalization proved to be a necessary resource in crisis episodes and as part of the psychiatric treatment, especially of severe mental disorders. It is evinced that there is a need for adequate treatment maintenance in community health care services to avoid the need of rehospitalizations.

[Assessment of alcohol use in families of the suburbs of Guayaquil City, Ecuador, by nursing students]

The aim of this study was to present the demographic and alcohol use profiles of families assessed by nursing students during the Community and Family Nursing Program. This is a case study using The family assessment questionnaire as its data source, which was applied by nursing students to assess family health conditions, during their practical training. Family selection was by convenience according to risk indicators and poverty, assessed from the outside condition of the dwelling or from public health services records of the area. A questionnaire correlated with the one that students applied was prepared to obtain data. This instrument obtained information about the socioeconomic profile, family environment and alcohol consumption. The Alcohol Use Disorder Identification Test (AUDIT) was applied to families that reported alcohol use. Of the 128 families evaluated by students we found 47 families who reported alcohol consumption, these families answered AUDIT, the average total score was 10.66 which equates to risk level 2. The suggested intervention for this level of risk is simple counseling that can be offered by nurses in the primary health care.

Assistência ao familiar cuidador em convívio com o alcoolista, por meio da técnica de solução de problemas

Esta pesquisa teve como objetivo oferecer treinamento aos familiares cuidadores de pacientes alcoolistas, por meio da técnica de solução de problemas. Trata-se de estudo descritivo, do qual participaram 8 familiares cuidadores. Realizaram-se três reuniões nas quais foram trabalhados temas como alterações do comportamento e esgotamento de quem cuida. Desses encontros, emergiram sentimentos que a situação alterações do comportamento mobiliza, autocuidado do cuidador através do compartilhamento das responsabilidades com familiares e outros e busca por atendimento especializado. Os participantes do estudo consideraram positiva a intervenção proposta, pois possibilitou a reflexão acerca de suas vivências e o seu potencial para manejar dificuldades. Acredita-se, aqui, que esse seja um horizonte a ser trilhado pelo enfermeiro, munido de capacitação para prestar assistência ao familiar cuidador.

[The use of the Calgary Model for assessment of families of the aged in clinical practice]

This qualitative study has as objective to present the experience to assessment of the families of dependent aged under the systemic approach. The Calgary Model was used as theoretical framework and as methodological strategy the case study. The data had been collected with five families of dependent older person, from September of December of 2005, by means of the instrument elaborated previously. The application of this model allowed doing the familiar analysis raising the main aspects of its structure, development and functioning. We believe that the nurse must search endorsement in the scientific literature and adopts pertinent instruments to contribute for the development of its abilities to do the familiar approach.

Quem são os egressos de internação psiquiátrica?

Objetivo: Conhecer quem são, hoje, as pessoas com transtornos mentais que tiveram alta hospitalar de internação psiquiátrica recente, e quais suas características comuns. Método: Pesquisa quantitativa descritiva realizada no período: 17/12/2007 a 17/04/08, através de questionário acerca das variáveis sociodemográficas, internações anteriores e conhecimento de 48 pacientes quanto ao diagnóstico e tratamento psicofarmacológico. Resultados: A média de idade foi 39 anos e 30 pacientes eram mulheres. Diagnósticos de Esquizofrenia e Transtornos Esquizotípicos foram prevalentes em 33,3% da amostra. Não souberam dizer qual era seu diagnóstico 56% da amostra, e apenas 43,8% souberam dizer corretamente nomes e dosagens dos medicamentos. Tinham pelo menos uma internação psiquiátrica anterior 62,5% deles. Conclusões: Conhecer quem são esses pacientes possibilita identificar características que podem fomentar a determinação do melhor tratamento, suporte profissional e elaboração de intervenções psicoeducativas que demonstraram ser necessárias a essa população.

A convivência em família com o portador de transtorno psíquico

Este estudo teve como objetivo conhecer as experiências da família no convívio com o portador de transtorno psíquico, utilizando-se da avaliação estrutural deste grupo familiar. Consiste num estudo descritivo de abordagem qualitativo. Os dados foram coletados, em 2004, a partir de uma família que possui um de seus membros portador de transtorno psíquico e vem sendo acompanhada num Centro de Atenção Psicossocial. Tais dados foram obtidos por meio de três entrevistas realizadas no domicílio, seguindo-se a orientação teórico-metodológica do Modelo Calgary de Avaliação de Família, num recorte centrado na avaliação estrutural. Os resultados foram apresentados enfatizando-se os seguintes aspectos: estrutura interna (composição familiar, gênero, orientação sexual, ordem de nascimento, subsistemas, limites), estrutura externa (família extensa e sistemas mais amplos), o contexto (etnia, raça, classe social, religião e espiritualidade, ambiente). Consideramos que o modelo utilizado consiste num aporte relevante para avaliação de famílias com portadores de transtorno psíquico, apontando para aspectos centrais do cuidado de enfermagem a estas famílias.

Doentes mentais e seu perfil de adesão ao tratamento psicofarmacológico

A não adesão ao tratamento medicamentoso é um fenômeno complexo e universal que se desenvolve gradualmente no curso dos tratamentos psiquiátricos e está relacionado ao agravamento das doenças. O objetivo deste estudo foi descrever o perfil de utilização de um psicofármaco na clientela de um serviço de saúde mental comunitário e suas características. Realizamos um estudo retrospectivo, nos prontuários de pacientes que fizeram uso de Decanoato de Haloperidol, num período de 1 ano e 8 meses. Analisamos 167 prontuários. O uso irregular da medicação esteve presente em 60% dos pacientes e reflete um grande risco para ocorrência de recaídas e reinternações. Este perfil configura uma baixa adesão ao tratamento medicamentoso prescrito, o que remete a reflexão sobre quais fatores estão influenciando este comportamento e quais medidas podem ser implementadas na manutenção do tratamento extra-hospitalar destas pessoas.

Encontrando-se em casa: uma proposta de atendimento domiciliar para famílias de idosos dependentes

OBJETIVO: Este estudo qualitativo teve por objetivo descrever como um sistema familiar reage perante a situação de dependência em um membro idoso, quais recursos utiliza para manter sua estabilidade e a assistência de enfermagem disponibilizada neste contexto. MÉTODOS: Utilizou-se como referencial teórico a abordagem dos sistemas familiares e como método a pesquisa-ação. Os dados foram colhidos de novembro de 2004 a janeiro de 2005, utilizando-se o genograma, o ecomapa e o levantamento de problemas. RESULTADOS: Principais demandas familiares: luto antecipado, sobrecarga do papel de cuidador, falta de conhecimento sobre a doença e desajustamento familiar perante a crise. Principais intervenções: incentivar a narrativa da enfermidade, oferecer sugestões e informações, elogiar as forças familiares e assegurar pronto atendimento. CONCLUSÕES: Com o atendimento à família sob o enfoque sistêmico foi possível propor as intervenções de ajuda para a melhoria da qualidade de vida familiar, de maneira que ela também vislumbrasse suas próprias soluções para o enfrentamento das adversidades.

[The impact of schizophrenia on the family]

The impact of schizophrenia on the family has been compared to the trauma experienced by victims of catastrophes. Considering the social repercussion on the health system and the emotional repercussion on the schizophrenic individual, with consequences to the family group, an ethnographic case study was developed aimed at describing the impact of schizophrenia on the family. One family consisted offaither, mother, and five children, four of whom are schizophrenic, participated in the study, and have had a follow-up in a public psychiatric service. Schizophrenia impacts family members through their suffering, isolation, and overload.

[First episode of schizophrenia and nursing care]

Schizophrenia is one of the main health problems in current days, requiring considerable investment from the health system. Intervening in the first episode offers a unique opportunity in the treatment of schizophrenia and influences the course of the illness. This article consists of a critical literature review aimed at examining knowledge on first episode schizophrenia and discussing the contribution of nursing care. A research was carried out in bibliographical databases. The data collected made possible the organization of information on the general concept of schizophrenia, its first episode, types of intervention and nursing performance. We found out that in Brazil there are few studies related to first episode schizophrenia in Nursing, few available specialized services, and few social resources. This situation reveals the need for more studies on first episode schizophrenia.

Adesão ao tratamento psicofarmacológico

Nesta revisão de literatura procuramos identificar os principais conteúdos relacionados à adesão do doente mental ao tratamento psicofarmacológico: definições, implicações, resultados. Realizamos a revisão bibliográfica nas bases Medline e Pubmed com as palavras chave adesão, medicação antipsicótica e doença mental. Foram selecionados 52 trabalhos. A maioria deles (73 %) buscou identificar fatores que podem influenciar adesão aos tratamentos. Os 27% restantes buscaram avaliar a influência de intervenções profissionais na adesão. Os principais fatores relatados relacionaram-se ao paciente, tipo de medicamento, fatores sociais. Com respeito às intervenções, aquelas que combinaram estratégias educacionais e comportamentais foram mais eficientes.

Caracterização da produção do conhecimento sobre sistematização da assistência de enfermagem no Brasil

Trata-se de um estudo bibliográfico que teve como objetivo caracterizar a produção científica nacional sobre o tema "Sistematização da Assistência de Enfermagem" e visualizar tendências da mesma. Foi realizado levantamento bibliográfico retrospectivo (2002-1990) das publicações, considerando os critérios: data, título do periódico, tipo de pesquisa e enfoque da publicação. A média da produção foi de 13,4 publicações/ano e os artigos distribuídos em 23 periódicos com predomínio de estudos realizados na área hospitalar (63,2%). O tema cardiologia ocorreu em 17,6% das publicações e o foco da atenção na implementação, desenvolvimento e avaliação de modelos de SAE em 78,6%. A taxonomia NANDA foi citada em 40,2% da produção e Wanda Horta em 40,5%. Considera-se que existem ainda lacunas nessa área do conhecimento, mas a crescente divulgação da produção científica sobre o tema poderá auxiliar os profissionais na implementação da Sistematização da Assistência de Enfermagem.

[Assessment and intervention in families assisted by the family health team]

This study aims at demonstrating the importance of using the Calgary Family Assessment and Intervention Model in the care practice of Family Health teams. It was carried out in a Family Health team, involving one family with a serious psychiatric disorder patient. The construction and application of instruments allowed establishing an intervention plan that led to behavioral changes. The conclusion is that this model can be used in family care. By using this model, families come closer to the health service and it becomes possible to plan the rendered care better.

Perception of the mothering role of women who live in a context of drugs and violence

The number of women involved with drugs is increasing, and the same is true for violence against them. Many of these women are mothers. This study aimed to investigate how mothers of children between one month and six years old who are living in a context of drugs and violence and are receiving treatment for drug addiction interpret their experience as mothers. This article is part of a multicenter study in Colombia and Brazil and discusses the results of interviews with 6 Colombian mothers. Focused ethnography was used and the interviews were submitted to latent content analysis. Violence was present in the participants' socio-cultural context and drugs consumption in their family of origin. These aspects possibly induced them to become addicted to drugs and influenced their mothering role. Overall, the mothers expressed ambivalence about their role in that they idealized being mothers but were aware that they were addicted mothers.

International nursing leadership related to the drugs phenomenon: a case study of the partnership experience between the Inter-American Drug Abuse Control Commission (CICAD) and the University of Alberta - Faculty of Nursing

In this article, the authors discuss the value of international health in advancing the nursing profession through the development of strong leadership in the area of drug demand reduction. Paradigms for nursing leadership are briefly reviewed and linked to the development of the "International Nursing Leadership Institutes" organized by the Inter-American Commission for the Control of Drug Abuse (CICAD). The "International Nursing Leadership Institutes" have facilitated the implementation of Phase III of the CICAD Schools of Nursing Project: a) planning and implementing the first "International Research Capacity-Building Program for Nurses to Study the Drug Phenomenon in Latin America", b) development of Regional and National Strategic Plans for Nursing Professionals in the Area of Demand Reduction in Latin America, and c) preparation of a document that provides guidelines on how to include drug content into undergraduate and graduate nursing curricula. The article also brings reflections directly from several of the participants in the first International Research Capacity-Building Program for Nurses to Study the Drug Phenomenon in the Americas, offered in collaboration with the Faculty of Nursing at the University of Alberta in Edmonton, Canada. These reflections demonstrate the multiplicity of ways in which this capacity-building program has made it easier for these members of Latin American Schools of Nursing to show leadership in the area of drug demand reduction.