Gerência do cuidado do enfermeiro em saúde mental na atenção primária à saúde: possibilidades e desafios

Abstract

Introduction: the redirection of mental health care towards care based on freedom and guarantee of rights was marked by the replacement of psychiatric hospitals with a network of services with non-asylum characteristics and with a territorial base. The Psychosocial Care Network (RAPS) is composed of health devices in the most diverse modalities, distributed in the three levels of care - primary, secondary, tertiary -, in addition to deinstitutionalization strategies, in the conception of guaranteeing rights through improvement in the process. of autonomy and the exercise of citizenship of the person affected by mental disorders. Primary Health Care (PHC) stands out as a strategic point of the RAPS. In this sense, the process of consolidation and strengthening of the Brazilian Psychiatric Reform is intrinsically linked to the articulation of Primary Health Care and the substitutive network of mental health care, in an attempt to overcome the hegemony of hospital-centered care. Active agent of the health team in the most diverse levels of care, the nurse must carry out the management of nursing care, carrying out direct and indirect interventions, reflecting on the best practices in the flow of patient care, through the construction of bonds with the family, team and community, in addition to knowledge of the care tools available in the field of practice and in the care network for users, in order to guarantee quality care. Objective: to understand the management of mental health care performed by nurses in Primary Health Care. Methodology: qualitative, descriptive research. Data were collected through semi-structured interviews with 16 nurses working in 14 Basic Health Units (UBS), between October and November 2020. The Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires software was used. 0.7 alpha 2 for the treatment of interview data, analyzed using Bardin's Content Analysis. Results and Discussion: after analyzing the Iramuteq software, seven classes emerged that constituted three categories of meaning: knowledge and practices in the nurses' perception of RAPS and mental health care in PHC; the psychosocial care network and the management of mental health nursing care in PHC and potentialities and challenges in network mental health care management by PHC nurses. Final Considerations: nurses consider the relevance of mental health care management, however, they still move between the psychosocial care mode and the biomedical model, reinforced at this time of pandemic. Furthermore, they presented an understanding of aspects of psychosocial care, such as active listening and comprehensive care, but the challenges related to the daily work process made it difficult to qualify the management of nursing care in mental health. It is hoped that this research can contribute to the understanding of mental health nursing care management in Primary Health Care, favoring the organization of the care network at this level of health care.