O cotidiano das(os) enfermeiras(os) da estratégia de saúde da família frente as visitas domiciliares as residências terapêuticas

Abstract

The Psychiatric Reform in Brazil has redirected the mental health care model, providing a new political and social view of patients with mental disorders, and was strengthened by social movements such as the Mental Health Workers' Movement, the Second National Congress of Mental Health Workers, and the Anti-Asylum Movement, as well as the laws and ordinances that consolidated them. With the process of deinstitutionalizing people who had been treated for decades by an excruciating model, through the Psychiatric Reform, services have been set up that focus on care in freedom, with the aim of socially rehabilitating these people through reception, support for psychiatric care and recovery of citizenship. To this end, in addition to other services, Therapeutic Residential Services have been set up, which aim to be structured as communal housing, integrated into urban spaces, in which residents are able to take part in the community's social activities and receive comprehensive and humanized care through the social and health care network, as evidenced in the context of this study by the Family Health Strategy, which supports the social reintegration and rehabilitation of people who have been institutionalized. The publication of Law 8.080 of 1990 created the Unified Health System, which in 1994 established the Family Health Program to restructure services, guiding new professional practices with care based on disease prevention, promotion, and rehabilitation of the health of the population, the individual, the family and the community. In addition to these responsibilities, the Family Health Strategy is committed to carrying out home visits, which aims to guarantee more humanized care by building bonds of trust and empathy between users and professionals, a care process in which the participation of nurses is fundamental. In this context, this research aims to understand the daily routine of home visits by nurses in Therapeutic Residential Services located in their area of coverage, identifying the singularities of the participants in this work process. The study was based on a qualitative exploratory method of an observational and descriptive nature, interpreting the data after it had been found. A phenomenological approach was used, based on the perspective of Michel Maffesoli's Sociology of Everyday Life, with a view to understanding the look, desires, anxieties, and interests of nurses during home visits to Therapeutic Residential Services. Data collection tookin the Primary Health Care Units where the participants worked, and five nurses were interviewed, selected by purposive sampling. To collect the testimonies, semi-structured interviews and participant observation were carried out, which the researcher recorded in a field diary. This stage was based on "description", a methodological part of Michel Maffesoli's Comprehensive Sociology. The data was analyzed using the sociologist’s methodological framework, using the "intuition" and "metaphor" phases, as well as other theoretical frameworks. After transcribing the interviews, the content analysis technique was used, as it aims to understand the textual materials transcribed from the interviews and the perceptions obtained from the field diaries. Thematic analysis was used with floating reading, a technique for constituting the corpus, formulating, and reformulating the collected and transcribed speeches, searching for analytical categories. Through dialectic with various authors, analysis of the participants' reports and perceptions described in the field diary, the categories were studied respecting triangulation of analytical methods, which provided a cohesive and well-founded analysis, generating categories pertinent to the proposal ofthis study. The research met the legal ethical requirements for research involving human beings, in line with the provisions of Resolution 466/12 of the National Health Council. After going through all the stages, the following categories emerged: on the scene, the institutionalized Therapeutic Residential Service: a view from the nurses of the Family Health Strategy, in which it was identified that the professionals mistakenly see the purposes of the Therapeutic Residential Services, placing them as a new institutionalizing space. The second category is revealed by the following definition: biomedicine in evidence, as a motivation for carrying out home visits: the day-to-day visits unveiled by a perspective of "not being/not subjectivizing". This category identified that the visits made to the residents ofthe Therapeutic Residences were designed to reduce them to biological conditions, leaving behind the subject, their singularities, and their social demands. The last category pointed to the stigmatization of madness in the testimonies, in such a way that this worldview transposes the ideals of the Psychiatric Reform, since it corroborates the social exclusion of the residents of the Therapeutic Residences. This category was entitled: the little big thingsthat point to madness as a stigma that weakensthe social inclusion ofTRS´s residents.