Night Admission at a Psychosocial Care Center III

Abstract

Objective: to analyze night admission characteristics at a Psychosocial Care Center III (CAPS III - Centro de Atenção Psicossocial). Method: a qualitative research, whose data were collected with 15 nursing professionals from November to April 2016, through a semi-structured interview. Results: it was verified that night admission is provided by the nursing team in different dynamics from the day care. This team has strategies of care during crisis, avoiding search for other network services and maintaining the CAPS in its function within the psychosocial model. Final considerations: service operation depends on the nursing team for its permanence condition in all shifts, which leads to the need to think about the legislation reformulation that structures the CAPS III team, in order to guarantee the interdisciplinary care provided by the Brazilian Psychiatric Reform in this device, which should replace hospitalization in a specialized institution.

Homelessness, crack use, and length of stay as predictors of planned discharge from night care in a Psychosocial Care Center

“…Among the unplanned discharges, the departure without the team's knowledge stands out in 21.1% of the cases, which calls attention to the absence or difficulty of communication between users and professionals, difficulty in handling the user's motivation -who is faced with the lack of desire to continue in the night care embracement, and even the lack of appropriation of the psychosocial model, as already highlighted by other studies 7,9,19 .…”

“…As independent/explanatory variables, those recognized by clinical practice and scientific literature were used 1,3,4,7,9,11 as factors that may interfere with the type of discharge: homelessness (yes or no), the substance used (alcohol, crack, cocaine and marijuana), the pattern of use (none, occasional, weekly or daily), medical and nursing evaluation for admission (yes or no), going to bed for detoxification (yes or no), length of stay proposed by the team and length of stay (numerical), need for hospital support during the night care embracement (yes or no), and hospitalization previous psychiatric (yes or no). It is worth mentioning that all these terms and criteria were reproduced following the template from paper records and patient documentation used in the CAPS.…”

“…It is necessary to strengthen the relationships of trust between users and professionals, first align the function of night care embracement at a given moment and then, to ensure communication and the construction of community care with meaning for all involved 9 .…”

“…During the night shift and on holidays/weekends, they were monitored mainly by the nursing team and, in 87.7% of admissions, the nurse conducted the initial assessment. Nursing is powerful to play a therapeutic role and approach the subject in its entirety, as it has different strategies to deal with the crisis in the psychosocial model 9 .…”

“…Night care embracement at CAPS AD III is considered by professionals, family members, and users a resource essential in RAPS6. However, studies point to the need to rethink its dynamics, mainly by reproducing biomedical and asylum practices the teams face in crises, which contradict the principles of psychosocial care and reinforce-fragmented care and institutionalized [7][8][9] . A typical result reflecting these practices is the early abandonment of care at night care embracement, with difficulty planning discharge between staff and users.…”