Imaginário coletivo de enfermeiros em relação ao paciente com diagnóstico de esquizofrenia na Atenção Primária à Saúde

Abstract

The nurse’s work can be considered essential for the consolidation of the principles of the Brazilian Psychiatric Reform based on the articulation between mental health and Primary Health Care. There are challenges to be overcome though for its potential will be maximized in this regard. One challenge is the deconstruction of ancient prejudices about “madness” that are still present in various segments of society, including the professional category in question. Paradoxically, it is also up to the nurse to fight these prejudices. This study assumes that the concept of collective imaginary, in its psychoanalytic sense, is capable of helping to circumscribe prejudices in general, especially through the identification of nonconscious beliefs, images and emotions. Thus, the objective was to understand the collective imaginary about the patient diagnosed with schizophrenia by a group of nurses who work in Primary Health Care. This research can be classified as qualitative using the psychoanalytic method. The participants were 15 nurses who work in Primary Health Care in a city in the interior of the State of Minas Gerais. The instrument used was the Thematic Drawing-and-Story Telling Procedure. The data collection took place collectively. The participants were asked to draw a patient with a diagnosis of schizophrenia being attended by a nurse in Primary Health Care and to write a story about their drawing, giving a title. The collected data were submitted to psychoanalytic interpretation, aiming to capture the fields of meaning that support the participants’ collective imaginary. Three fields of meaning were delimited. The first field, titled “I assist, I do not deny care, I forward when I can”, reveals that, in most participants’ collective imaginary, the belief that the diagnosis of schizophrenia in Primary Health Care seems to be the sole responsibility of the professionals and/or health services purportedly specialized in mental health has a central role. The second field of meaning, called The “super-healthcare team”, was organized based on the belief that the health team – in which most participants did not include themselves in their stories – represents a kind of powerful entity capable of undertaking the appropriate management of patients diagnosed with schizophrenia. “The problem patient”, the third and final field of meaning, organized around the negative image on the basis of which the patient diagnosed with schizophrenia is preponderantly represented in the participants' collective imaginary. That patient is seen as someone who creates problems due to agitation, aggressiveness and unpredictability. Therefore, this study supports, specifically with respect to the participants, the outlines of the conceptual-emotional substrate of the behaviors concerning patients diagnosed with schizophrenia and the mental health care they are offered in Primary Health Care.