Percepção dos cuidadores sobre o cuidado e os serviços residenciais terapêuticos de Alfenas/ MG
Data
2014
Autores
Bressan, Vania Regina 
Orientadores
Marcolan, Joao Fernando
Tipo
Tese de doutorado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
Compreender a percepção dos cuidadores sobre o cuidado prestado aos moradores e sobre os Serviços Residenciais Terapêuticos de Alfenas/MG. Método: Estudo qualitativo para o qual foram entrevistados 15 cuidadores. As entrevistas foram gravadas, transcritas e categorizadas em temas em acordo com a análise de conteúdo de Bardin. Para a análise dos dados utilizou-se referenciais teóricos da reforma psiquiátrica e da Política Nacional de Saúde Mental, autores que discutem a assistência em Saúde Mental e a reforma psiquiátrica brasileira. Resultados: Os resultados obtidos foram agrupados em dois eixos temáticos: o cuidado no Serviço Residencial Terapêutico e o Serviço Residencial Terapêutico no contexto da reforma psiquiátrica. No primeiro eixo temático verificou-se que as práticas de cuidado nos serviços eram ambíguas, com ações voltadas para o bem-estar dos moradores, mas também práticas manicomiais com relações de poder verticalizadas, violência, ociosidade, prisão, negligências, controlar, vigiar e punir e observação pouco utilizada como recurso terapêutico. Verificou-se a ocorrência de mortes, que causaram sofrimento para alguns cuidadores e desconfiança a outros. Mesmo com o cuidar revelado como difícil e com riscos de agressão física e verbal, o cuidador sentia-se orgulhoso, gratificado e satisfeito pessoalmente com o trabalho. Atributos pessoais que contribuíam para produzir o cuidar de qualidade foram descritos. A concepção de cuidado foi ambígua entre os cuidadores, ora estruturada sobre proximidade, sentimentos, significados e construção de vínculo, que por vezes adquiria aspecto negativo quando o cuidador confundia o papel de profissional com assistencialismo, protecionismo, maternalismo, a impedir que o morador atingisse sua autonomia para poder gerir a própria vida e de fato assumisse seu papel de cidadão, como preconiza a reabilitação psicossocial, pressuposto da reforma psiquiátrica. Ora a concepção de cuidado era influenciada pela concepção social da loucura ou do transtorno mental enquanto incapacitante e excludente. Em relação ao Serviço Residencial Terapêutico no contexto da reforma psiquiátrica, verificamos x que há muito que se progredir, como melhorar a qualificação e capacitação dos funcionários. A demora em tomar atitudes por responsáveis técnicos e a falta de capacitação e supervisão dos cuidadores os levaram às práticas pautadas sobre a experiência, aprendidas pelo fazer ou por imitação do comportamento de outros cuidadores. Cada cuidador fazia o que achava que era o mais correto segundo seu julgamento e parâmetros, por isso incorreram em erros que poderiam levar a fatalidades. Havia falta de coesão entre a equipe, não havia continuidade das ações por serem individualizadas entre os cuidadores. Não havia reuniões de equipe para se discutir problemas organizacionais relacionados ao trabalho e o Projeto Terapêutico Singular dos moradores era inexistente para nortear as intervenções da equipe. Conclusões: Concluímos que os Serviços Residenciais Terapêuticos, propostos para substituir os hospitais psiquiátricos e suas práticas asilares, mantinham práticas manicomiais e características de instituição total e não estavam desempenhando seu papel segundo as propostas e pressupostos teóricos da reforma psiquiátrica e da Política Nacional de Saúde Mental.
To understand the perceptions of caregivers regarding the care given to residents and the Assisted Living Facilities of Alfenas/Minas Gerais. Method:Fifteen caregivers were interviewed for this qualitative study. The interviews were recorded, transcribed and categorized into themes according to Bardin’s content analysis. For data analysis we used the theoretical frameworks of psychiatric reform and the National Mental Health Policy, authors who discuss assistance in Mental Health and the Brazilian psychiatric reform. Results: The results were grouped into two main themes: care in Assisted Living Facilities and the Assisted Living Facilities in the context of psychiatric reform. In the first thematic area we found that the care practices in services were ambiguous, with actions for the welfare of the residents, but also madhouse practices with vertically integrated power relations, violence, truancy, imprisonment, negligence, control, monitor and punish, and underused observation as a therapeutic resource. The occurrence of deaths was verified, which caused suffering to some caregivers and distrust to others. Even though giving care revealed itself to be difficult and with risks of physical and verbal aggression, the caregiver felt proud, personally gratified and satisfied with the work. Personal attributes that contributed to produce the quality of care were described. The concept of care among caregivers was ambiguous, sometimes structured on proximity, feelings, meanings and bond building, sometimes acquiring negative aspects when the caregiver confused the professional role with paternalism, protectionism and maternalism, preventing the residents from reaching autonomy in order to manage their own lives and in fact assume their role as a citizens, as recommended by psychosocial rehabilitation, an assumption of psychiatric reform. Care conception was influenced by social ideas of insanity or mental disordersas disabling and exclusionary. Regarding the Assisted Living Facilities in the context of psychiatric reform, we find that there is much progress yet to be achieved, such as improving xii employees’qualification and training. Delay in taking action by those responsible and the lack of training and supervision of caregivers led to practices based on experience, learned by doing or by imitating the behavior of other caregivers. Each caregiver employed what he thought were the most correct parameters according to his judgment and therefore incurred in errors that could lead to fatalities. There was a lack of cohesion among the team; there was no continuity of actions to be individualized among caregivers. There were no staff meetings to discuss organizational issues related to work and the Singular Therapeutic Project of the residents, to guide the team’s interventions, was lacking. Conclusions: We concluded that the Assisted Living Facilities, proposed to replace psychiatric hospitals and their asylum practices, kept madhouse practices and characteristics of a total institution and were not performing their role according to the proposals and theoretical assumptions of the psychiatric reform and the National Mental Health Policy.
To understand the perceptions of caregivers regarding the care given to residents and the Assisted Living Facilities of Alfenas/Minas Gerais. Method:Fifteen caregivers were interviewed for this qualitative study. The interviews were recorded, transcribed and categorized into themes according to Bardin’s content analysis. For data analysis we used the theoretical frameworks of psychiatric reform and the National Mental Health Policy, authors who discuss assistance in Mental Health and the Brazilian psychiatric reform. Results: The results were grouped into two main themes: care in Assisted Living Facilities and the Assisted Living Facilities in the context of psychiatric reform. In the first thematic area we found that the care practices in services were ambiguous, with actions for the welfare of the residents, but also madhouse practices with vertically integrated power relations, violence, truancy, imprisonment, negligence, control, monitor and punish, and underused observation as a therapeutic resource. The occurrence of deaths was verified, which caused suffering to some caregivers and distrust to others. Even though giving care revealed itself to be difficult and with risks of physical and verbal aggression, the caregiver felt proud, personally gratified and satisfied with the work. Personal attributes that contributed to produce the quality of care were described. The concept of care among caregivers was ambiguous, sometimes structured on proximity, feelings, meanings and bond building, sometimes acquiring negative aspects when the caregiver confused the professional role with paternalism, protectionism and maternalism, preventing the residents from reaching autonomy in order to manage their own lives and in fact assume their role as a citizens, as recommended by psychosocial rehabilitation, an assumption of psychiatric reform. Care conception was influenced by social ideas of insanity or mental disordersas disabling and exclusionary. Regarding the Assisted Living Facilities in the context of psychiatric reform, we find that there is much progress yet to be achieved, such as improving xii employees’qualification and training. Delay in taking action by those responsible and the lack of training and supervision of caregivers led to practices based on experience, learned by doing or by imitating the behavior of other caregivers. Each caregiver employed what he thought were the most correct parameters according to his judgment and therefore incurred in errors that could lead to fatalities. There was a lack of cohesion among the team; there was no continuity of actions to be individualized among caregivers. There were no staff meetings to discuss organizational issues related to work and the Singular Therapeutic Project of the residents, to guide the team’s interventions, was lacking. Conclusions: We concluded that the Assisted Living Facilities, proposed to replace psychiatric hospitals and their asylum practices, kept madhouse practices and characteristics of a total institution and were not performing their role according to the proposals and theoretical assumptions of the psychiatric reform and the National Mental Health Policy.
Descrição
Citação
BRESSAN, Vania Regina. Percepção dos cuidadores sobre o cuidado e os serviços residenciais terapêuticos de alfenas/ mg. 2014. 343 f. Tese (Doutorado) - Escola Paulista de Enfermagem, Universidade Federal de São Paulo , São Paulo, 2014.