O agir competente como estratégia de gestão do risco de violência no trabalho: o ponto de vista da atividade humana de trabalho dos técnicos de enfermagem de uma instituição pública psiquiátrica

Abstract

It has been observed on the hospital unit, psychiatry area, an increase in the potential risk of violence on the working populations involved. A question then arises: how the competent action, in this context, can arbitrate between hetero-determination and the mobilization of knowledge/values incorporated into practice? In search of answer to this question, the study aims to understand how the work activities of nurses technicians (NT) that work in a psychiatric emergency, can reveal the difficulties and strategies built to develop the actions of assistance, competence and construction of health of workers. The methodological approach used in this study was based on Ergonomic Work Analysis - EWA, through observations (general and systematic) and interviews (semi-structured and self-confrontation) and ergological, whose sample consisted of 17 professionals (NT) of the Care Center for Crisis (CCC). The results revealed that structural changes brought impacts in the assistance. A) Regarding the organization of psychiatric care network were identified two main factors: (1) the distance between the organization of psychiatric care recommended by the Psychiatric Reform and the actual structure and organization of the system, (2) social transformations conducted significant changes in the profile of patients, where drug addicts, today comprise 65% of the demand of the studied hospital. B) As for the conflict of rules originated in discussions among Psychiatry and Mental Health - distinct disciplines that underpin the practices of care and its instrumentality, it can highlight the following factors: (1) the instrumentality used in the dimensions of care in psychiatric area, especially in the CCC, to patient in crisis, discloses the use of hard technologies through the restraint. (2) the predominance of entry of patients with voluntary hospitalization momentary or involuntary reinforces the approach used before the potential risk. The nursing technician develops a fundamental role in assessing the evolution, of the possible side effects of medication and the risk of violent reactions by patients, and participates as a co-manager of the doctor/patient interfaces, structuring the collective settings required in everyday care.