A equipe de enfermagem e a emergência psiquiátrica: vozes de profissionais numa unidade de pronto atendimento.

Abstract

This is a qualitative, descriptive study, according to the principles of Grounded Theory, based in an emergency care unit (PSU) in the municipality of Rio Verde in the central Brazilian state of Goiás. The aim of the study was to understand how the nursing staff at a general Emergency Unit perceives psychiatric emergencies. The study is justified because of the ongoing changes triggered by the psychiatric reform process. According to the new policies, emergency care units, both within general hospitals and in community health facilities, are designed to be important points of the public mental health network. Data were collected through semi-structured interviews with 14 nurses participating in the study. Participants were asked about their approach to psychiatric crisis in the emergency room. A grounded theory analysis of the data was undertaken. Three categories emerged: The lens through which the team sees the patient (difference and challenge); The team s feelings (helplessness and acceptance); and Action strategies (technical; rapid and involved). From the analysis we understand that the service has not developed a steady way of attending to patients with mental health problems. The admission of psychiatric problems in the emergency units has still not been integrated in the team s routine. Mostly, the professionals feel distressed, as they do not feel competent to face psychiatric emergency. The team s model is highly physician-centered, with the remaining team members almost always being limited to attend to the physician s orders, for example, providing medication or restraining the patient. The difficulties encountered, with regard to the care of patients with mental disorder, seem to be mainly derived from gaps in training and in the way the team s routines are designed. This makes investment in improved training concerning psychiatric emergencies necessary. Even with the difficulties encountered in the service studied, we believe that continuing education efforts may produce new possibilities in emergency mental health care and thus a strengthening of local health network.