Cuidado de enfermagem sistematizado à família da pessoa com transtorno mental no paradigma da desinstitucionalização

Abstract

The current model of mental health care in Brazil is grounded in the paradigm of deinstitutionalization, thus there is a shift from traditional practices to psychiatric care practices carried out in the community, and more specifically with the family. Concomitantly, the family that once was excluded from accompanying a relative during psychiatric hospitalization starts to participate actively in a new way of conceiving and treating the person with a mental disorder. Therefore, the changes taking place in health policies have included people with mental disorders and their families as protagonists of a process that looks for renewing the forms of assistance, with the partnership of professionals, which implies the need for changing workers regarding mental health care, given the difficulties of the family. In this context, the systematization of nursing care can be a work process that fits the changes required by the present health care model. Thus, the nurse taking activities on a scheduled basis can contribute to more effective care, since many activities provided in a non-systematic way can leave gaps in a holistic care. This study aimed at: 1-understanding the needs of families caring for a person with mental disorder in the current model of mental health care, 2-talking about the daily lives of families who have a relative with mental disorder from the diagnosis to the present days (deinstitutionalization movement), and 3-presenting a proposal of nursing care and family caregivers for persons with mental disorder based on the Travelbee's theory. It is a qualitative study, carried out in three regional health municipalities of Paraná State (11 th 13 th and 15 th), using the technique of data collection of oral history, with thirty-two families of persons admitted to the Emergency Psychiatric of the Municipal Hospital of Maringá (Hospital Municipal de Maringá) in 2008. Data collection was carried out from May 2009 to March 2011. The data were analyzed according to Rey's theoretical framework, leading to: the understanding of the needs in the context of deinstitutionalized family assistance; the knowledge about family life concerning the experience with the person with mental disorder at home, and the preparation of a systematized proposal on nursing care based on family needs and the Travelbee's theory. It is verified that the family needs much support concerning the network of mental health care, such as: family counseling; agreement with the treatment; hospital admissions; financial resources - Aid; travel assistance - Transportation; and reintegration into social life; including outpatient services and links between professionals and people receiving care. Moreover, it is observed the blaming for the disease, ignorance about mental disorder and its symptoms, social isolation, conflict situations in mental crises, as well as financial, physical and psychological burden. It was concluded that the families experience everyday situations that provide a unique environment not favorable to physical and mental health of their members and there is lack of preparation in caring for the ill person. However, if the needs are attended and fulfilled by the professionals in a systematic way, it is possible for people with mental illness to live in the home environment, and not to cause overload and conflicts to those who surround them.