Social representations of nurses of the Emergency Care Unit towards people with mental disorder

Abstract

Objective: To understand the Social Representations of nurses from an Emergency Care Unit about the care provided to people with mental disorders. Method: Qualitative exploratory study, supported by the theoretical and methodological framework of the Theory of Social Representations. Interviews were conducted from July to August 2021. The data were processed using the IRaMuTeQ software. Results: 22 nurses were interviewed. From the processed data, three discursive categories were constructed: the tortuousness of the Psycho-Social Care Network (RAPs): in search of a path; the abyss between the health professional and the person with mental disorder; and unveiling the care of nurses in the Mental Health Emergency Care Unit. Conclusion: We identified a lack of knowledge about the Psychosocial Care Network, anchoring elements associated with previous negative experiences that influence the professional-patient relationship, and nursing care permeated by cognitive barriers. Such findings are unprecedented in the locality studied and relevant to promote the qualification of the work of nurses in mental health in the Emergency Care Unit.

Intensity and frequency of moral distress in mental health nurses in Brazil

“…In the present study, the factor aforementioned had the lower median values for intensity and frequency of moral distress, the same result presented by a Brazilian study on moral distress in nurses from other work settings (2) . It is believed that these values are related to the expansion of discussions on ethical and technical competences in mental health, with emphasis on communication skills, respect for people with mental disorders and their families, guarantee of rights, autonomy of users in their treatment, and effectiveness of community-based services in this process (7)(8)(9) .…”

“…The factor "Social conflicts" is particularly linked to the context of mental health services in Brazil and presented the second highest median for the intensity and frequency of moral distress, with the highest predictor of the instrument "Recognizing that situations of family abandonment negatively interfere with the adherence and resolution of the user's treatment" (approximately 25% of the sample assigned the maximum score for the intensity and frequency of the item). It is believed that the highlight of the predictor and the factor in general in the study is related to a complex Brazilian historical-social paradigm of inequality, which gives way to a significant number of people with low family income and limited access to health, education, and culture services, thus perpetuating a community that insufficiently values the reality of mental disorders (6)(7)(8) .…”

“…For this context, it is recommended that nurses develop ethical and technical skills for a humanized, comprehensive, and community-based work, based on the users’ needs ( 6 ) . However, contrary to this perspective, problems are found related to professional training, lack of understanding of the policies and care model in force in mental health care and, above all, to the very disarticulation of RAPS , which contributes to the discontinuity of care ( 7 ) .…”

Intensidade e frequência de distresse moral em enfermeiros de saúde mental no Brasil

“…No presente estudo, o fator supramencionado teve os valores mais baixos de mediana para intensidade e frequência de distresse moral, mesmo resultado apresentado por um estudo brasileiro de distresse moral em enfermeiros de outros contextos de trabalho (2) . Acredita-se que estes valores estejam relacionados à ampliação de discussões sobre as competências éticas e técnicas em saúde mental, com destaque para as habilidades de comunicação, respeito às pessoas com transtornos mentais e seus familiares, garantia de direitos, autonomia dos usuários em seu tratamento e efetivação dos serviços de base comunitária neste processo (7)(8)(9) .…”

“…O fator "Conflitos sociais" está particularmente concatenado com o contexto dos serviços de saúde mental no Brasil e apresentou a segunda maior mediana para intensidade e frequência de distresse moral, com o preditor mais elevado do instrumento "Reconhecer que situações de abandono familiar interferem negativamente na adesão e resolutividade do tratamento do usuário" (aproximadamente 25% da amostra atribuiu pontuação máxima para intensidade e frequência do item). Acredita-se que o destaque do preditor e do fator em geral no estudo esteja relacionado a um complexo paradigma histórico-social brasileiro de desigualdade, que dá espaço a um número expressivo de pessoas com baixa renda familiar e limitação aos serviços de saúde, educação e cultura, perpetuando, assim, uma coletividade que valoriza insuficientemente a realidade dos transtornos mentais (6)(7)(8) .…”