Occupational Therapy in Psychiatric Short-Term Hospitalization Units: Scoping Review.

Given the context, the overarching aim is to identify scientific publications on occupational therapy in Psychiatric-Short-Term-Hospitalization-Units. Specific objectives include: (a) Analyzing the historical development of this research area; (b) Synthesizing existing evidence on the nature of documentary sources on occupational therapy in in Psychiatric-Short-Term-Hospitalization-Units; (c) Detailing the volume of scientific literature on occupational therapy in these units; (e) Evaluating available evidence on occupational therapy interventions to improve functionality, quality of life, and recovery in individuals admitted to in Psychiatric-Short-Term-Hospitalization-Units. A scoping review method was employed to conduct a historical mapping of research on in Psychiatric-Short-Term-Hospitalization-Units. The review proceeded in five stages following PRISMA guidelines. After applying selection criteria, the search identified 446 references. Findings are presented under three headings: (a) Historical trends in the scientific literature on occupational therapy and in Psychiatric-Short-Term-Hospitalization-Units; (b) Nature and volume of articles included in the occupational therapy synthesis in Psychiatric Short-Term Hospitalization Units; (c) Data extraction on methodological variables in the research of occupational therapy articles in in Psychiatric-Short-Term-Hospitalization-Units; and (d) Data extraction on research outcome variables of occupational therapy articles in Psychiatric Short-Term Hospitalization Units. The growth of occupational therapy in in Psychiatric-Short-Term-Hospitalization-Units is emphasized, with an increase in qualitative studies. Occupational therapy is underscored as an integral part of care, supporting the diversity and effectiveness of interventions. Common diagnoses include schizophrenia and depressive disorders. Group interventions and the spiritual dimension positively influence the quality of care and meaningful routines for recovery in in Psychiatric-Short-Term-Hospitalization-Units.

Work-schedule management in psychiatric hospitals and its associations with nurses' emotional exhaustion and intention to leave: A cross-sectional multicenter study.

BACKGROUND: Managing nurses' work schedules in hospitals is challenging because employer needs, like shift changes at short notice and overtime, may conflict with nurses' desires for a predictable and stable schedule. Nurses should have a certain degree of control over their work schedules, and their supervisors should support their needs in scheduling. How perceived control over work schedules, perceived support from supervisors in scheduling, shift changes at short notice, and overtime affect nurses' emotional exhaustion and intentions to leave has not been studied. OBJECTIVES: The aims are (1) to describe perceived control, perceived supervisor support, shift changes at short notice, and overtime among nurses in psychiatric hospitals; (2) to assess the variation of these four factors between units at psychiatric hospitals; and (3) to investigate the association between these factors with nurses' emotional exhaustion and intentions to leave. DESIGN: Cross-sectional survey study. SETTING(S): Swiss psychiatric hospitals with 24-hour services. PARTICIPANTS: Registered nurses (N = 994) from 114 adult-inpatient units. METHODS: To describe perceived control, perceived supervisor support, shift changes at short notice, and overtime among nurses, we calculated frequencies, percentages, means, and standard deviations of their responses to the survey. To assess the variation between units, we computed intraclass correlations for the four factors. We constructed random-effects models accounting for the clustering of nurses in units for emotional exhaustion and intentions to leave separately. RESULTS: Perception of work-schedule control was 3.32 (SD 1.39, range 0-5); perception of supervisor work-schedule support was 3.28 (SD 1.14, range 0-4). On average, 9 % of the nurses had to take over a shift at short notice at least three times per month, and 40 % worked at least 15 minute overtime on their most recent shift. Intraclass correlation for all four factors was higher than 0.05. Emotional exhaustion was significantly associated with supervisor support and overtime, and leaving intentions were significantly associated with perceived control, supervisor support and overtime. CONCLUSION: Perceived control, perceived supervisor support, shift changes at short notice, and overtime are promising factors for interventions to prevent nurses' emotional exhaustion and allay their intentions to leave. Unit managers should provide nurses with increased predictability and influence on their work schedules. This could reduce early career endings and early retirement and counteract nurse shortages.

Effectiveness of crisis resolution and home treatment teams in mental health crisis: a systematic review protocol / A efetividade das equipas de hospitalização domiciliária psiquiátrica: um protocolo de revisão sistemática / La efectividad de los equipos de hospitalización domiciliaria de atención psiquiátrica: un protocolo de revisión sistemática

Abstract Background: People with mental health crises may need intensive care support that, in many countries, implies a psychiatric hospitalization that may negatively affect the individual. Furthermore, it involves the individuals' removal from their daily spaces, which implies an adaptive effort when returning to the community. In order to reduce the treatment's impact of a mental health crisis, Crisis Resolution or Home Treatment (CRHT) Teams have been providing an alternative to inpatient treatment. Aim: To analyze and highlight CRHT teams' effectiveness in reducing days of treatment, relapse, and rehospitalization of adults (18-65 years) compared to treatment as usual defined as inpatient treatment. Methods: We will develop a systematic review of the current literature by the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2019 Statement. Two authors will independently conduct study inclusion, data extraction, quality, and bias risk assessments. We will include experimental study designs like randomized clinical trials, non-randomized, quasi-experimental, before and after studies, prospective and retrospective cohort studies, and case-control studies involving working-age adults (18-65 years) irrespective of culture, ethnicity, or mental health diagnosis. Results: We will include primary outcomes like days of treatment, relapse (as defined by each study), and rehospitalization. Secondary outcomes will be service user satisfaction, dropout rate, and the proportion of patients with adverse events (suicide, self-harm, or aggression/violence). Conclusions: This study will allow evidence to determine the need to create and encourage the implementation of CRHT teams to provide an effective alternative response to psychiatric hospitalization.

Resumo Contexto: A pessoa em crise de saúde mental pode precisar de tratamento intensivo que, em muitos países, implica um internamento psiquiátrico que pode afetar negativamente o indivíduo. Além disso, envolve o seu afastamento dos espaços quotidianos, o que implica um esforço adaptativo ao retornar à comunidade. A fim de reduzir o impacto do tratamento de uma crise de saúde mental, as Equipes de Hospitalização Domiciliária Psiquiátrica (EHDP) constituem-se como alternativa ao internamento hospitalar. Objetivo: Analisar e evidenciar a eficácia das EHDP na redução de dias de tratamento, recaídas e reinternamento de adultos (18-65 anos) em comparação com o tratamento usual definido como internamento hospitalar. Métodos: Desenvolveremos uma revisão sistemática da literatura de acordo com o Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2019 Statement. Dois autores conduzirão independentemente a inclusão de estudos, a extração de dados, a avaliação da qualidade e do risco de viés. Incluiremos estudos experimentais como ensaios clínicos randomizados, não randomizados, quase-experimentais, estudos pré e pós-teste, estudos de coorte prospetivos e retrospetivos e estudos de caso-controle envolvendo adultos em idade ativa (18-65 anos), independentemente da cultura, etnia ou diagnóstico de saúde mental. Resultados: Incluiremos outcomes primários como dias de tratamento, recaída (conforme definido por cada estudo) e reinternamento. Os outcomes secundários incluem a satisfação do cliente com o serviço, taxa de abandono e proporção de pacientes com eventos adversos (suicídio, automutilação ou agressão/violência). Conclusões: Este estudo trará evidências para determinar a necessidade de criar e incentivar a implementação de EHDP como uma resposta alternativa eficaz ao internamento psiquiátrico.

Resumen Contexto: Las personas con crisis de salud mental pueden necesitar apoyo en cuidados intensivos que, en muchos países, implica una hospitalización psiquiátrica que puede afectar negativamente al individuo. Además, implica la salida de los individuos de sus espacios cotidianos, lo que implica un esfuerzo adaptativo al regresar a la comunidad. Para reducir el impacto del tratamiento de una crisis de salud mental, los equipos de resolución de crisis o de tratamiento en el hogar (ERCTH) han estado brindando una alternativa al tratamiento hospitalario. Objetivo: Analizar y destacar la efectividad de los ERCTH en la reducción de días de tratamiento, recaída y rehospitalización de adultos (18-65 años) en comparación con el tratamiento habitual definido como tratamiento hospitalario. Metodología: Desarrollaremos una revisión sistemática de la literatura actual mediante la Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) 2019 Statement. Dos autores realizarán de forma independiente la inclusión de los estudios, la extracción de datos, las evaluaciones de la calidad y riesgo de sesgo. Incluiremos diseños de estudios experimentales como ensayos clínicos aleatorizados, no aleatorizados, cuasiexperimentales, estudios de antes y después, estudios de cohortes prospectivos y retrospectivos, y estudios de casos y controles con adultos en edad laboral (18-65 años) independientemente de la cultura, origen étnico o diagnóstico de salud mental. Resultados: Incluiremos resultados primarios como días de tratamiento, recaída (según la definición de cada estudio) y rehospitalización. Los resultados secundarios será la satisfacción del cliente del servicio, la tasa de abandono y la proporción de pacientes con eventos adversos (suicidio, autolesiones o agresión/violencia). Conclusiones: Este estudio aportará evidencias para determinar la necesidad de crear y fomentar la implementación de ERCTH para ofrecer una respuesta alternativa efectiva a la hospitalización psiquiátrica.

Humanization of care in acute psychiatric hospitalization units: A scoping review.

WHAT IS KNOWN ON THE SUBJECT?: Humanizing the world of health is a complex process that includes all the dimensions of the person. When a person has from a mental illness, the humanization of care becomes more important, as the disorder itself prevents the person to participate in their health process, even when showing self-harm or aggressive behaviours. These situations jointly with other factors related with professionals (insufficient ratio, inadequate treatment or lack of training) may cause the patient admitted to the acute psychiatric hospitalization unit to require the use of restrictive measures (involuntary admissions, mechanical restraints or forced administration of medication). WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: We identify the relevance of the perception the patient and family have regarding the care received, as well as the relevance of factors related to the professionals, among which the attitude, the staff ratio, the nursing time of direct dedication, and the therapeutic environment and safety of the patient and the professionals. All patients must be treated with dignity, respect, regardless of the aggressive manifestations caused by their pathology. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: A greater understanding of the care offered to admitted people affected by a mental disorder, their families and professionals who care for them in acute mental health units, giving greater importance to "caring" and not exclusively to "curing." ABSTRACT: INTRODUCTION: Humanization in Mental Health refers to give the same relevance to the clinical needs and to the social, emotional and psychological needs. AIM: To identify the published knowledge on current care models related to the humanization of care in acute psychiatric units. METHOD: Scoping review based on the methodological model of Arksey and O'Malley, and PRISMA methodology. Database searches (Pubmed, Cinahl, Virtual Library, Cuiden, Academic Google and PsycInfo) with the terms: "Humanization," "Hospitals Psychiatric," "Emergency Psychiatric," "Psychiatric Service" and "Psychiatric intensive care units." RESULTS: Twenty-two articles met the inclusion criteria. Four thematic units were identified: aspects related to (i) patient perceptions; (ii) Government policies and hospitality organizational culture; (iii) external factors such as the environment, family or associations; and (iv) safety and security. DISCUSSION: Only one of the articles mentions the concept analysed, although all of them contribute with key aspects of healthcare humanization, such as the empowerment of the patient, the care model, the staff ratio, the therapeutic relationship, the nursing time of direct dedication to the patient, the therapeutic environment, safety and patient and staff perception of feeling safe. IMPLICATIONS FOR PRACTICE: The present study can help to improve the care offered in acute mental health units.

Criterios diagnósticos de los pacientes con demencia en el Hospital Psiquiátrico Universitario René Vallejo Ortiz

Introducción: La Organización Mundial de la Salud reconoce la demencia como una prioridad de salud pública. Afecta a 50 millones de personas en todo el mundo y se registran alrededor de 10 millones de nuevos casos cada año. Objetivo: Aplicar los criterios diagnósticos a los pacientes con demencia de acuerdo al Manual Diagnóstico y Estadístico de los Trastornos Mentales-V y la Clasificación Internacional de Enfermedades-10, en el Hospital Psiquiátrico Universitario René Vallejo Ortiz entre junio de 2016 y diciembre de 2022. Métodos: Se realizó un estudio observacional, descriptivo de corte transversal. El universo estuvo compuesto por todos los pacientes ingresados en la mencionada institución. La muestra no probabilística y a criterio de los autores la integraron 66 pacientes adultos, con el diagnóstico en el periodo de estudio señalado. Se utilizó estadística descriptiva e inferencial. Los datos se presentaron en tablas y gráficos. Resultados: De los 66 pacientes investigados el 33,3 % presentaban entre 60 y 69. El sexo femenino representó el 57,6 %. De acuerdo al Manual Diagnóstico y Estadístico de los Trastornos Mentales- V, 24 pacientes para un 36,4 % se encontraban dentro de los A9, mientras que 12 (18,2 %) en los A10. Sin embargo, según la Clasificación Internacional de Enfermedades-10 el 93,9 % cumplen los criterios de demencia. Conclusiones: Las principales manifestaciones clínicas fueron la desorientación y la hipomnesia con asociación al deterioro cognitivo leve. En la asociación de las clasificaciones se constató que solo la mitad de los estudiados cumplían los criterios diagnósticos de forma unánime.

Introduction: The World Health Organization recognizes dementia as a public health priority. It affects 50 million people worldwide, with around 10 million new cases reported each year. Objective: To apply the diagnostic criteria to patients with dementia according to the Diagnostic and Statistical Manual of Mental Disorders-V and the International Classification of Diseases-10 at the René Vallejo Ortiz University Psychiatric Hospital between June of 2016 and December 2022. Methods: An observational, descriptive, cross-sectional study was carried out. The universe was made up of all patients admitted to the aforementioned institution. The non-probabilistic sample and at the discretion of the authors was made up of 66 adult patients with the diagnosis in the indicated study period. Descriptive and inferential statistics were used. The data was presented in tables and graphs. Results: Of the 66 patients investigated, 33.3% were between 60 and 69. The female sex represented 57.6%. According to the DSM-V, 24 patients, 36.4%, were within A9, while 12 (18.2%) were within A10. However, according to ICD -10, 93.9% meet the criteria for dementia. Conclusions: The main clinical manifestations were disorientation and hypomnesia associated with mild cognitive impairment. In the association of the classifications, it was found that only half of those studied unanimously met the diagnostic criteria.

Caracterización de pacientes con esquizofrenia en el Hospital Psiquiátrico Provincial de Sancti Spíritus

Introducción: Existe falta de consenso entre los expertos sobre la clínica y conceptualización de la esquizofrenia. La esquizofrenia es un trastorno mental severo que afecta al pensamiento, las emociones y el comportamiento. La causa de la enfermedad no está bien definida. Objetivo: Caracterizar los pacientes adultos esquizofrénicos internados en la institución. Métodos: Se realizó un estudio descriptivo para la caracterización del adulto con esquizofrenia hospitalizado se tuvo en cuenta, edad y sexo, independencia física, conducta, cognición, afectividad, síntomas positivos, negativos y nivel de rehabilitación. Se trabajó con una muestra intencional constituida por los adultos con diagnóstico de esquizofrenia ingresados en el hospital, en el periodo de 2018 al 2022, con un mínimo de seis meses de estadía hospitalaria, n=64. Resultados: El sexo predominante resultó el masculino 62,5 %, independencia física mínimo dependiente con un 51,57 %, la cognición estaba afectada en el 100 % de los estudiados, se destaca la desorganización del pensamiento y el embotamiento afectivo con el 100 y el 87,69 % respectivamente, con nivel de rehabilitación más preponderante el nivel cuatro para un 29,23 %. Conclusiones: La adecuada caracterización de los pacientes con esquizofrenia hospitalizados en el Hospital Psiquiátrico Docente Provincial de Sancti Spíritus, facilita el trabajo encaminado al fomento de las relaciones sociales a través de acciones que mejoran su estado de salud. Uno de cada siete pacientes con esquizofrenia puede alcanzar la recuperación funcional si dispone de una adecuada rehabilitación integral.

Introduction: There is a lack of consensus among experts on the clinical symptoms and conceptualization of schizophrenia. Schizophrenia is a severe mental disorder that affects thinking, emotions, and behavior. The etiology of the disease is not well defined. Objective: To characterize adult schizophrenic patients admitted to the institution. Methods: Descriptive study was carried out for characterization of the hospitalized adult with schizophrenia taking into account age and sex, physical independence, behavior, cognition, affectivity, positive and negative symptoms and level of rehabilitation. It was worked with an intentional sample consisting of adults diagnosed with schizophrenia admitted to the hospital, in the period from 2018 to 2022, with a minimum of six months of hospital stay, n = 64. Results: The predominant sex was male 62.5%, minimum dependent physical independence with 51.57%, affected exponent with greater representativeness was cognition in 100%, disorganization of thought and affective blunting stand out with 100 and 87.69% respectively, with the most preponderant rehabilitation level being level 4 for 29.23%. Conclusions: The proper characterization of patients with schizophrenia hospitalized in the Provincial Teaching Psychiatric Hospital of Sancti Spíritus, facilitates the work aimed at promoting social relationships through actions that improve their health status. One in seven patients with schizophrenia can achieve functional recovery if adequate comprehensive rehabilitation is available.

Cuidados de enfermería del plan de transición de la unidad de salud mental al hogar: Scoping Review (Revisión de alcance) / Mental Health Unit to Home Transition Plan´s Nursing Care: Scoping Review / Cuidados de enfermagem do plano de transição da unidade de saúde mental para o Lar: Scoping Review (Revisão do âmbito de aplicação)

Introducción. El reingreso hospitalario de los pacientes con enfermedad mental es causado principalmente por descompensación del trastorno de base; por esto, se deben considerar intervenciones centradas en la rehabilitación y reinserción social, siendo la transición a la atención domiciliaria una estrategia que aporta a la disminución de brechas, al acceso a los servicios y a las rehospitalizaciones. El presente estudio busca identificar y exponer, desde los cuidados de enfermería, cuáles son las características del plan de transición del paciente hospitalizado en la unidad de salud mental reportados en la literatura sintetizando los hallazgos. Metodología. Revisión de alcance según los lineamientos del JBI Manual for Evidence Synthesis y el informe PRISMA. Se consultaron las bases de datos PubMed, Biblioteca Virtual en Salud, Nursingovid y ScienceDirect, se incluyeron publicaciones en español, inglés y portugués en el período comprendido entre 2015-2021. Resultados. Se seleccionaron 14 artículos, identificando las siguientes temáticas: Planes y preparativos para el alta; Continuidad de la atención en salud; Apoyo social y familiar para el alta; y Adherencia terapéutica e Implicaciones para la práctica de enfermería. Discusión. En concordancia con otros estudios, se destacan las intervenciones que trabajan las buenas relaciones interpersonales, el apoyo social y la generación del vínculo entre el hospital y la comunidad. Conclusiones. La literatura encontrada reporta cinco características del plan de transición con intervenciones de enfermería que representan el éxito del proceso de transición para el paciente.

Introduction. Hospital readmission of patients with mental illness is mainly caused by worsening of the underlying disorder; therefore, interventions focused on rehabilitation and social reintegration should be considered, being the transition to home care a strategy that contributes to the reduction of gaps, and an improved access to services and rehospitalizations. The present study seeks to identify and expose, from nursing care, which are the characteristics of the transition plan of the hospitalized patient in the mental health unit reported in the literature synthesizing the findings. Methodology. Scoping review according to the guidelines of the JBI Manual for Evidence Synthesis and the PRISMA report. The databases PubMed, Biblioteca Virtual en Salud, Nursingovid and ScienceDirect were consulted, including publications in Spanish, English and Portuguese in the period 2015-2021. Results. Fourteen articles were selected, identifying the following topics: Discharge Planning and Preparations; Continuity of Health Care; Social and Family Support for Discharge; and Therapeutic Adherence and Implications for Nursing Practice. Discussion. In line with other studies, the interventions that deal with good interpersonal relationships, social support and the generation of the link between the hospital and the community stand out. Conclusions. The retrieved literature reports five characteristics of the transition plan with nursing interventions that represent the success of the transition process for the patient.

Introdução. A readmissão hospitalar de pacientes com doença mental é causada principalmente pela descompensação do transtorno subjacente. Por isso, intervenções voltadas para a reabilitação e reinserção social devem ser consideradas, sendo a transição para o cuidado domiciliar uma estratégia que contribui para a redução de lacunas, acesso aos serviços e reinternações. O presente estudo busca identificar e expor, de uma perspectiva de cuidados de enfermagem, quais são as características do plano de transição do paciente internado na unidade de saúde mental relatadas na literatura, sintetizando os resultados. Metodologia. Revisão do âmbito de acordo com as diretrizes do JBI Manual for Evidence Synthesis e do relatório PRISMA. Foram consultadas as bases de dados PubMed, Biblioteca Virtual em Saúde, Nursingovid e ScienceDirect, incluindo publicações em espanhol, inglês e português no período de 2015-2021. Resultados. Foram selecionados 14 artigos, identificando os seguintes temas: Planos e preparativos para a alta; Continuidade dos cuidados de saúde; Apoio social e familiar para alta; e Adesão terapêutica e implicações para a prática de enfermagem. Discussão. Em concordância com outros estudos, destacam-se as intervenções que trabalham o bom relacionamento interpessoal, o apoio social e a geração de vínculo entre o hospital e a comunidade. Conclusões. A literatura encontrada relata cinco características do plano de transição com intervenções de enfermagem que representam o sucesso do processo de transição para o paciente.

Upper Respiratory Tract Infection Trends in a Psychiatric Institute in Singapore.

OBJECTIVES: To compare the incidence of upper respiratory tract infection (URTI) between inpatients at the Institute of Mental Health in Singapore and the general population over 8 years to determine the effectiveness of our infection control strategies. METHODS: Data for cases of influenza and URTI at our institute between January 2012 and December 2019 were collected. National data were derived from weekly infectious disease bulletins that report daily averages of people attending polyclinics/surgeries with influenza and URTI. Interrupted time series analyses were used to determine the impact of infection prevention and control strategies on incidence. RESULTS: Over the 8 years, there were 1607 cases of URTI involving 182 clusters, equal to 3.16 cases per 10 000 patient-bed-days. 965 (60%) cases and 95 (52%) clusters occurred in long-stay wards, whereas 642 (40%) cases and 87 (48%) clusters occurred in acute wards. The median cluster size was 12 in the long-stay wards and 7 in the acute wards (p < 0.0001). The spikes in cases in June and December may be attributed to the increased staff and visitor mobility during school vacations in June and December. Strategies implemented during the study period did not significantly reduce the incidence of URTI. Previous strategies implemented in 2005 to meet accreditation standards are more likely to be contributors. CONCLUSION: Infection control strategies of our institute appear to be effective, because the incidence of URTI was lower in our institute than in the community. The similar incidence of URTI in acute and long-stay wards indicates that service-user turnover is not a contributor. Rather, staff and visitors are more likely to be the vector. The larger clusters in long-stay wards indicates a greater risk of transmission in such settings. Increased activity in our institute during school vacations may be associated with an increase in cases in June and December. It is difficult to determine if strategies implemented during the study period successfully reduce the incidence of URTI.

Os primeiros passos para a institucionalização da loucura em Alagoas na segunda meta de do século XIX ao estabelecimento do Asylo Santa Leopoldina: inserção de enfermeiros e tratamento / Los primeros pasos hacia la institucionalización de la locura en Alagoas en la segunda mitad del siglo XIX hasta la instauración del Asilo Santa Leopoldina: inserción de enfermeras y tratamiento / The first steps towards the institutionalization of madness in Alagoas in the second half of the 19th century to the establishment of Asylo Santa Leopoldina: insertion of nurses and treatment

A partir de 1850 Alagoas começou a discutir sobre as primeiras medidas sanitárias para conter as epidemias no estado. Foi nesse contexto que a comissão de higiene pública passou a propor medidas sanitárias coletivas e/ou individuais, como a limpeza das ruas e pântanos, orientações à população, controle na criação de porcos, construção do hospital de caridade, cemitério público de Maceió, lazareto do porto do Francês, abertura de enfermarias provisórias e adaptações à cadeia pública, este último abrigando o primeiro local para os alienados no Estado [Fragmento de texto] (AU)

Indicadores hospitalares e comportamento de pacientes internados em hospital psiquiátrico adepto à proibição do fumo / Hospital indicators and inpatient behavior in a psychiatric hospital that implemented the smoking ban / Indicadores hospitalarios y comportamiento de pacientes internados en hospital psiquiátrico que adoptó la prohibición de fumar

Resumo Objetivo: comparar indicadores de internação e de alta, custo com medicamentos e comportamentos dos pacientes antes e após a proibição do tabagismo em um hospital psiquiátrico. Método: estudo ecológico, longitudinal e retrospectivo realizado em um hospital psiquiátrico. Foram obtidos dados secundários por meio de consulta aos prontuários, referentes a 2142 internações. Aplicado teste de medianas para comparação das variáveis antes e após a proibição. Resultados: com a implementação da proibição, o percentual de ocupação dos leitos foi reduzido nas unidades masculinas de transtornos mentais (de 88,8% para 48,4%) e de dependência química (94,4% para 42,8%). A média de dias de internação foi reduzida na unidade masculina de dependência química (13,5 para 12,6) em comparação à unidade feminina (14,7 para 19,5). Os custos com psicofármacos e expectorantes, as agressões verbais/físicas e as contenções físicas/químicas foram reduzidos. Conclusão: a proibição do fumo alterou indicadores hospitalares, reduziu custos e melhorou o comportamento dos pacientes, contrariando o mito de que ela resulta em hostilidade. Espera-se que este estudo contribua para que os enfermeiros revejam suas crenças relacionadas à proibição do tabagismo com resultados positivos para as relações interpessoais e para a gestão dos serviços de saúde mental.

Abstract Objective: to compare hospitalization and discharge indicators, medication costs and patient behavior before and after the implementation of the smoking ban in a psychiatric hospital. Method: ecological, longitudinal and retrospective study carried out in a psychiatric hospital. Secondary data referring to 2142 hospitalizations were collected from medical records. The median test was used to compare the variables before and after the ban. Results: after the implementation of the ban, there was a reduction in bed occupancy rate in male units for mental disorders (from 88.8% to 48.4%) and substance dependence (from 94.4% to 42.8%). There was a reduction in the mean length of hospital stay in the male chemical dependency unit (from 13.5 to 12.6) compared to the female unit (from 14.7 to 19.5). There was a reduction in costs of psychotropic drugs and expectorants, episodes of verbal/physical aggressions and physical/chemical restraints. Conclusion: the smoking ban changed hospital indicators, reduced costs and improved patient behavior, contradicting the myth that it results in hostility. It is hoped that this study will help nurses to review their beliefs related to smoking cessation, as there were positive results for interpersonal relationships and for the management of mental health services.

Resumen Objetivo: comparar indicadores de internación, alta, costo con medicamentos y comportamientos de los pacientes antes y después de la prohibición del tabaquismo en un hospital psiquiátrico. Método: estudio ecológico, longitudinal y retrospectivo realizado en un hospital psiquiátrico. Fueron obtenidos datos secundarios, a partir de consulta a las fichas médicas, referentes a 2.142 internaciones. Fue aplicado el test de medianas para comparación de las variables antes y después de la prohibición. Resultados: con la implementación de la prohibición el porcentaje de ocupación de las camas fue reducido en las unidades masculinas de trastornos mentales (88,8% para 48,4%) y de dependencia química (94,4% para 42,8%). La media de días de internación fue reducida en la unidad masculina de dependencia química (13,5 para 12,6) en comparación con la unidad femenina (14,7 para 19,5). Los costos con psicofármacos y expectorantes, las agresiones verbales/físicas y las contenciones físicas/químicas fueron reducidas. Conclusión: la prohibición de fumar alteró los indicadores hospitalarios, redujo costos y mejoró el comportamiento de los pacientes, contrariando el mito de que esta resulta en hostilidad. Se espera que este estudio contribuya para que los enfermeros revisen sus creencias relacionadas con la prohibición del tabaquismo, considerando los resultados positivos para las relaciones interpersonales y para la administración de los servicios de salud mental, que fueron obtenidos.

Percepções e vivências da Enfermagem quanto à proibição do tabagismo em um hospital psiquiátrico / Nursing perceptions and experiences regarding smoking bans in a psychiatric hospital / Percepciones y experiencias de Enfermería sobre la prohibición de fumar en un hospital psiquiátrico

OBJETIVO: conhecer a experiência dos profissionais de Enfermagem diante da implementação da proibição do tabagismo em um hospital psiquiátrico. MÉTODO: realizou-se um estudo qualitativo com 73 profissionais de Enfermagem de um hospital psiquiátrico, do interior paulista, utilizando a Teoria Fundamentada nos Dados como referencial metodológico e o Interacionismo Simbólico como referencial teórico. Realizaram-se 1260 horas de observação participante com registros em diário de campo. Os dados foram analisados a partir das codificações aberta, axial e seletiva. RESULTADOS: observaram-se diferentes facetas da proibição do fumo, tais como insegurança, pessimismo, resistência e boicote, especialmente na unidade de internação privada. Entretanto, muitos profissionais da Enfermagem apoiaram a proibição quando constataram os benefícios para os pacientes. CONSIDERAÇÕES FINAIS: o processo de implementação da proibição do tabagismo foi acompanhado por dificuldades, porém, mostrou-se uma intervenção viável. Profissionais que inicialmente eram contra a proibição passaram a apoiá-la.

OBJECTIVE: to learn about the experience of nursing professionals in the implementation of the smoking ban in a psychiatric hospital. METHOD: a qualitative study was carried out with 73 nursing professionals from a psychiatric hospital in São Paulo's countryside, using Grounded Theory as a methodological reference and Symbolic Interactionism as a theoretical reference. There were 1260 hours of participant observation with field diary records. The data were analyzed from the open, axial and selective coding. RESULTS: different facets of the smoking ban were observed, such as insecurity, pessimism, resistance and boycott, especially in the private internment unit. However, many nursing professionals supported the ban when they saw the benefits to patients. FINAL CONSIDERATIONS: the process of implementing the smoking ban was accompanied by difficulties, but it proved to be a viable intervention. Professionals who were initially against the ban began to support it.

OBJETIVO: conocer la experiencia de los profesionales de enfermería en la implementación de la prohibición del tabaquismo en un hospital psiquiátrico. MÉTODO: realizamos un estudio cualitativo con 73 profesionales de enfermería de un hospital psiquiátrico del interior de São Paulo utilizando la teoría basada en los datos como marco metodológico y el Interaccionismo Simbólico como marco teórico. Foram 1260 horas de observación participante con registros de diario de campo. Los datos se analizaron mediante codificación abierta, axial y selectiva. RESULTADOS: observamos diferentes aspectos de la prohibición de fumar, como inseguridad, pesimismo, resistencia y boicot, especialmente en la unidad de internación privada. Sin embargo, muchos profesionales de enfermería apoyaron la prohibición cuando vieron beneficios para los pacientes. CONSIDERACIONES FINALES: el proceso de implementación de la prohibición de fumar estuvo acompañado de dificultades, pero resultó ser una intervención viable. Los profesionales que, inicialmente estaban en contra de la prohibición, vinieron a apoyarla.

Analysis on mental-insanity and cessation-of-dangerousness examinations in three Brazilian custodial institutions: a retrospective cross-sectional study

ABSTRACT BACKGROUND: In Brazil, the right to healthcare and the incorporation of best scientific evidence in public health are universally guaranteed by law. However, the treatment offered to patients with mental disorders in custodial hospitals in this country has not been rigorously evaluated. OBJECTIVES: To analyze the psychiatric diagnoses and treatments implemented in three Brazilian custodial institutions. DESIGN AND SETTING: This was a retrospective, cross-sectional and descriptive study on patients held in custody in three Brazilian institutions, as judicially-determined safety measures due to their mental disorders, and the tools used in diagnoses and treatments. These institutions are in Rio de Janeiro and the Federal District. METHODS: The data from medical and judicial records that were made available were assessed regarding the diagnoses that were made and the instruments that were used. RESULTS: None of these inpatients were evaluated using validated tools, and only a few medical records presented clear descriptions of the cases. No patient with substance involvement had undergone laboratory toxicological assays. It was not possible to verify the adequacy of treatments because the procedures were inadequately described in the records. CONCLUSIONS: No standardized protocols or instruments for diagnosing mental health disorders or assessing use of psychoactive substances had been applied among the inpatients at these custodial institutions in Rio de Janeiro and the Federal District. The treatments that were prescribed to these inpatients consisted mainly of drugs.

Loucura e direito penal: pistas para a extinção dos manicômios judiciários / Madness and criminal law: clues to the extinction of judicial asylums

RESUMO As interfaces entre a loucura e o direito penal, com a análise das medidas de segurança diante da Lei Antimanicomial e das políticas de atenção à saúde mental no Brasil, assim como a experiência do Programa de Atenção Integral ao Louco Infrator (Paili), integram os planos de desenvolvimento deste artigo. Discutem-se aqui o tratamento penal da loucura, a natureza jurídica e os fundamentos teóricos das medidas de segurança, bases a partir das quais são formuladas pistas que se voltam para o fechamento dos manicômios judiciários.

ABSTRACT The interfaces between madness and criminal law, with the analysis of security measures under the Antimanicomial Law and the mental health care policies in Brazil, as well as the experience of the Crazy Infractor Integral Care Program (Paili), make up the development plans of this work. This article discusses the criminal treatment of madness, the legal nature and the theoretical foundations of security measures, the basis on which clues are formulated that focus on the closing of judicial asylums.

Patient safety in a general hospital's psychiatric hospitalization unit: a phenomenological study / Seguridad del paciente en una unidad de internación psiquiátrica de un hospital general: estudio fenomenológico / Segurança do paciente em uma unidade de internação psiquiátrica em hospital geral: estudo fenomenológico*

ABSTRACT Objective: To understand the meaning of patient safety for a multiprofessional team in a psychiatric unit of a general hospital. Method: Qualitative study adopting the social phenomenological framework, employing open-ended interviews whose content was analyzed and discussed based on the literature through the elaboration of categories of analysis. Results: Eleven open-ended interviews were conducted. The meaning of psychiatric patient safety was understood to encompass team management experiences that emphasize physical coercion and control of symptomatology while indicating the expectation of elaborating new procedures that account for humanization. It also includes issues regarding organizational composition and experienced difficulties concerning physical structure, its interference in the process of providing safe care and expectations of improvement. Conclusion: This study analyzed the conception of patient safety in the multiprofessional team viewpoint, considering socio-historical and cultural contexts and the mutual relations that are part of meaning construction in the study setting.

RESUMEN Objetivo: Comprender el significado de la seguridad del paciente para un equipo multiprofesional de una unidad de internación psiquiátrica de un hospital general. Método: Estudio cualitativo guiado por la vertiente fenomenológica social, con entrevistas abiertas cuyo contenido fue analizado y discutido en base a la literatura, a través de la composición de categorías de análisis. Resultados: Se realizaron 11 entrevistas abiertas. Se pudo entender que el significado de la seguridad del paciente psiquiátrico implica las experiencias en la gestión del equipo, con énfasis en la contención física y el control de los síntomas, pero también se apuntó a la expectativa de construir un nuevo procedimiento que tenga en cuenta la humanización. También incluye cuestiones relativas a la composición de la organización y las dificultades experimentadas en relación con la estructura física, su interferencia en el proceso de cuidado seguro y las expectativas de mejora. Conclusión: Con esta investigación se pudo analizar el concepto de seguridad del paciente desde la perspectiva del equipo multiprofesional, considerando el contexto sociohistórico y cultural y las relaciones mutuas que forman parte de la construcción de este significado en el escenario de estudio.

RESUMO Objetivo: Compreender o significado da segurança do paciente para a equipe multiprofissional de uma unidade de internação psiquiátrica de um hospital geral. Método: Estudo qualitativo orientado pela vertente fenomenológica social, com entrevistas abertas cujo conteúdo foi analisado e discutido baseando-se na literatura, por meio da composição de categorias de análise. Resultados: Realizaram-se 11 entrevistas abertas. Foi possível compreender que o significado da segurança do paciente psiquiátrico envolve as experiências no manejo da equipe, com ênfase na contenção física e no controle de sintomatologia, mas também aponta para a expectativa de construção de um novo fazer que leve em conta a humanização. Inclui ainda questões referentes à composição organizacional e dificuldades vivenciadas quanto à estrutura física, sua interferência no processo de cuidar de forma segura e as expectativas de melhoria. Conclusão: Com esta pesquisa, pôde-se analisar a concepção de segurança do paciente pela ótica da equipe multiprofissional, considerando o contexto sócio-histórico e cultural e as relações mútuas que fazem parte da construção desse significado no cenário de estudo.

Violência institucional e enfermidade mental: narrativas de egressos de um manicômio da Bahia / Institutional violence and mental illness: narratives on people who left a Brazilian psychiatric hospital

RESUMO Sob a perspectiva da Reforma Psiquiátrica, a presente pesquisa objetivou apresentar relatos de violência institucional em internações de longa duração em um manicômio a partir de itinerários de vida de pessoas em processo de desinstitucionalização. Foi realizada observação participante de nove beneficiários do Programa De Volta para Casa desospitalizados há 13 anos em município de grande porte da Bahia. Os diários de campo, assim como transcrições de entrevistas semiestruturadas com três profissionais de saúde, foram transformados em nove narrativas, que, analisadas qualitativamente, permitiram identificar violências sofridas no período anterior à admissão no hospital e da internação. As razões de internação diferiram por gênero: homens foram internados por crimes contra a pessoa; mulheres, por 'quebra de resguardo', frustrações amorosas e violência física e sexual. Durante a internação, emergiram o cotidiano administrado e a exposição à violência institucional (ausência de atividades socioterapêuticas, medicação em doses punitivas com efeito sedativo, negligência à saúde física, agressão física, confinamento, 'injeção' e 'choque elétrico', preconceito, estigma), em que os sujeitos tiveram neutralizadas suas possibilidades de reação à dominação. Os resultados proporcionaram reflexão sobre a violência do Estado, crucial no atual contexto de desconstrução da Política Nacional de Saúde Mental.

ABSTRACT Under the perspective of the Psychiatric Reform, the aim of this article is .to present reports of institutional violence in long-term psychiatric hospitalizations, based on the life itineraries of people in the process of deinstitutionalization in a large municipality in the state of Bahia, Brazil. We carried out participating observation including nine beneficiaries of the 'De Volta para Casa' ('Back Home') Program, who left the hospital thirteen years ago; and three semi-structured interviews with workers who assisted them. The researchers' field diaries and the interviews transcripts were transformed into narratives, which were analyzed qualitatively, in order to identify violence suffered before admission or during hospitalization. Reasons for hospitalization differed by gender: men were hospitalized for crimes against people; women, for 'breaking seclusion', love frustrations, physical and sexual violence. Contents about the administered daily life, and exposure to institutional violence (absence of socio-therapeutic activities, medication in punitive doses with sedative effect, neglect concerning physical health, physical aggression, confinement, 'injection', 'electric shock', prejudice, stigma), emerged from the reports about the hospitalization period, showing that the subjects had their possibilities of reacting against domination neutralized. The results provided reflection on State violence, crucial in the current context of deconstruction of the Brazilian Mental Health Policy.

Factors related to the risk of illness of nursing staff at work in a psychiatric institution / Fatores associados aos riscos de adoecimento da equipe de enfermagem no trabalho em instituição psiquiátrica / Factores asociados a los riesgos de enfermedad del equipo de enfermería que trabaja en una institución psiquiátrica

Objective: identify the associations between the sociodemographic, and work variables, health conditions and lifestyles, and the risks of illness of nursing workers in a psychiatric hospital. Method: analytical cross-sectional study. The sample of 74 workers answered a questionnaire for sociodemographic, work, health conditions and lifestyles survey characterization. The Work Context Assessment Scale and the Human Cost at Work Scale were used to evaluate the perception of the risks of illness in the interviewee's opinion. A descriptive and bivariate analysis was performed, with significance of 5%. Results: the factors associated with the risk of illness were: insomnia complaints, night work and workday. Conclusion: the associations between the work variables, health conditions and life habits can harm the health of the nursing staff of a psychiatric hospital.

Objetivo: identificar as associações entre as variáveis sociodemográficas, laborais, condições de saúde, hábitos de vida e os riscos de adoecimento do trabalhador de enfermagem de um hospital psiquiátrico. Método: estudo transversal analítico. A amostra de 74 trabalhadores respondeu a um questionário para caracterização sociodemográfica, laboral, levantamento de condições de saúde e hábitos de vida. Para avaliar a percepção dos riscos de adoecimento, na opinião do entrevistado, foram utilizadas a Escala de Avaliação do Contexto de Trabalho e a Escala de Custo Humano no Trabalho. Realizou-se análise descritiva e bivariada, com significância de 5%. Resultados: os fatores associados aos riscos de adoecimento foram: queixas de insônia, trabalho noturno e jornada de trabalho. Conclusão: há evidências de que as associações entre as variáveis laborais, condições de saúde e hábitos de vida podem prejudicar a saúde da equipe de enfermagem de um hospital psiquiátrico.

Objetivo: identificar las asociaciones entre las variables sociodemográficas, laborales, las condiciones de salud, los estilos de vida y de los riesgos de enfermedad de los trabajadores de enfermería en un hospital psiquiátrico. Método: estudio analítico transversal. La muestra de 74 trabajadores respondió a un cuestionario de caracterización sociodemográfica y laboral, condiciones de salud y estilos de vida. Para evaluar la percepción de los riesgos de enfermedad de acuerdo con el entrevistado, se utilizó la Escala de Evaluación del Contexto Laboral y la Escala de Coste Humano en el Trabajo. Se realizó un análisis descriptivo y bivariado, con una significación del 5%. Resultados: los factores asociados con el riesgo de enfermarse fueron: las quejas de insomnio, el trabajo nocturno y las horas de trabajo. Conclusión: existe evidencia de que las asociaciones entre las variables de trabajo, las condiciones de salud y los hábitos de vida pueden perjudicar la salud del personal de enfermería de un hospital psiquiátrico.

Adult Attention Deficit Hyperactivity Disorder in a Malaysian Forensic Mental Hospital: a Cross-sectional Study.

OBJECTIVE: To determine the prevalence of adult attention deficit hyperactivity disorder (ADHD) and comorbid mental disorders in a Malaysian forensic mental hospital. METHODS: All adult patients admitted to the forensic wards who were able to understand Malay or English language and give written informed consent were included. Participants were assessed using the Conners Adult Attention-Deficit Diagnostic Interview for DSM-IV (for presence of adult ADHD and a history of childhood ADHD) and the Mini International Neuropsychiatric Interview (for psychiatric comorbidities). Sociodemographic and offence-related data were also collected. RESULTS: Of 199 patients admitted, 120 were included for analysis. The mean age of participants was 36.3 years. 94.2% were men. 81.7% were single, divorced, or separated. 25% had a history of childhood ADHD. The prevalence of adult ADHD was 15.8%. The persistence rate was 63%. Among the 19 participants with adult ADHD, the most common psychiatric comorbidities were substance dependence (68.4%), lifetime depression (63.2%), and generalised anxiety disorder (47.4%). Compared with participants without ADHD, participants with adult ADHD were less likely to be married (0% vs 21.8%, p = 0.022) and more likely to have alcohol abuse (15.8% vs 2%, p = 0.028), lifetime manic/hypomanic episodes (42.1% vs 7.9%, p = 0.001), and generalised anxiety disorder (47.4% vs 19.8%, p = 0.017), and were of younger age at first offence (21.8 years vs 26.9 years, p = 0.021). CONCLUSIONS: Adult ADHD is common in a Malaysian forensic mental hospital and is associated with unmarried status, alcohol abuse, lifetime manic/hypomanic episodes, generalised anxiety disorder, and younger age at first offence.

A violência e os profissionais de saúde no hospital psiquiátrico / Violence and health professionals at the psychiatric hospital / La violencia y los profesionales de salud en el hospital psiquiátrico

CONTEXTO: A violência é um tema muito debatido atualmente em todo o mundo. Os trabalhadores da saúde estão entre os mais atingidos pelas agressões. As taxas de violência perpetradas pelos pacientes em relação aos profissionais de saúde são conhecidas por serem maiores em psiquiatria do que em outros campos. OBJETIVO: Identificar as produções disponíveis, on-line, na literatura científica sobre a violência sofrida por profissionais de saúde no hospital psiquiátrico. METODOLOGIA: Trata-se de revisão integrativa, com levantamento bibliográfico no mês de outubro de 2017, na Biblioteca Virtual de Saúde. Foram selecionados 09 artigos que atendiam ao critério de inclusão no período de 2007 a 2016 RESULTADOS: Foi sinalizada uma escassez de estudos na literatura, sobre o tema. Estudos internacionais apontam para taxas alarmantes de violência contra todos os profissionais da equipe de enfermagem que atuam em psiquiatria, além de estudos que abordam o assunto voltados para a prevenção da violência, característica das vítimas, tipos de agressão, atitudes e comportamentos que desencadeiam a violência. CONCLUSÃO: A violência sofrida impacta na saúde deste trabalhador, sendo necessários estudos que deem voz ao profissional de saúde de hospitais psiquiátricos, discutindo questões subjetivas, por vezes veladas, viabilizando conhecimento para conscientização da realidade da prática assistencial e possibilitando motivar e acionar este trabalhador para o cuidado de si próprio, assim como instrumentalizar a equipe dos serviços de saúde do trabalhador.

BACKGROUND: Violence is a much-debated theme worldwide. Health system workers are among the most frequently targeted by aggressions. The rate of violent acts committed by patients towards health-care professionals is known to be higher in the field of psychiatry when compared to other areas of treatment. AIM: Our goal was to identify the worms available in the scientific literature regarding violence suffered by health-care professionals in psychiatric hospitals. METHODS: This work comprises an integrative review, following bibliographic research carried out in October 2017 in the Virtual Health Library. We selected nine articles, published between 2007 and 2016 that matched our criteria. RESULTS: We detected a shortage of works addressing this particular matter. Internationally, several groups report alarming rates of violent acts over the entire psychiatric nursing team. In addition, the reviewed works address violence prevention, victims profiles, different forms of aggression and behaviors that lead to violence. CONCLUSION: The violence sustained by these professionals impacts their health, prompting the need for novel studies that discuss the ponint-of-view of the psychiatric hospital health-care professional, debating subjective, often veiled matters, leading to the acquisition of knowledge and raising awareness to the healthcare practice. These studies would additionally motivate and enable these professionals to care for their own health and would also provide new tools to be harnessed by the workers' healthcare team.

CONTEXTO: La violencia es una temática muy debatida actualmente en todo el mundo. Aquellos que trabajan en el campo de la salud están entre los más afectados por agresiones. Las tasas de violencia cometidas por pacientes contra los profesionales de salud son conocidamente más grandes en el campo de la psiquiatría que en los demás OBJETIVOS: Identificar los trabajos, disponibles en la literatura científica, acerca de la violencia sufrida por los profesionales de la salud en hospitales psiquiátricos. METODOLOGÍA: Este trabajo consiste en una revisión integrada, basada en una búsqueda bibliográfica realizada en octubre de 2017 en la Biblioteca Virtual de Salud. Fueron seleccionados nueve trabajos que atendían a los criterios de inclusión, publicados entre los años de 2007 y 2016. RESULTADOS: Se puede señalar una carencia de estudios sobre el tema en la literatura científica. Trabajos publicados en periódicos internacionales indican tasas alarmantes de actos de violencia practicados contra todos los profesionales del equipo de enfermería que actúan en el campo de la psiquiatría. Además, los trabajos revisados abordan la prevención de la violencia, características de las víctimas, el diferente tipo de agresiones y los comportamientos que desencadenan actos de violencia. CONCLUSIONES: La violencia sufrida genera impacto en la salud de los trabajadores, y se hacen necesarios nuevos estudios que lleven en cuenta la opinión del profesional de salud de los hospitales psiquiátricos, discutiendo cuestiones subjetivas, a veces veladas, que lleven a construcción de conocimiento y aumenten la consciencia en la práctica asistencial, lo que motivará y accionará estos trabajadores para que cuiden también de su propia salud. Estos estudios, además, crearán nuevas herramientas que podrán ser explotadas por la equipe de servicios de salud del trabajador.

Planejamento estratégico situacional em uma instituição psiquiátrica: contribuições e desafios / Situational strategic planning in a psychiatric institution: contributions and challenges / Planificación estratégica situacional en una institución psiquiátrica: contribuciones y desafios

OBJETIVO: aplicar o Planejamento Estratégico Situacional no serviço de enfermagem de uma instituição psiquiátrica. MÉTODO: pesquisa-ação em um hospital psiquiátrico do Nordeste Brasileiro, no período de dezembro/2015 a junho/2016, com a participação de 34 profissionais de enfermagem. Realizadas entrevistas e reuniões, as quais foram gravadas, transcritas e procedida análise de conteúdo. RESULTADOS: os problemas prioritários foram dimensionamento inadequado de pessoal, insegurança, falhas no gerenciamento de recursos materiais e déficit no cuidado integral prestado. Além disso, houve dificuldades para implementação - baixa governabilidade, comunicação deficiente e desmotivação profissional. CONCLUSÃO: o planejamento estratégico situacional é útil para o delineamento das ações em saúde mental e sua eficácia depende do comprometimento dos atores envolvidos.

OBJECTIVE: to aplly the situational strategic planning in the nursing service of a psychiatric institution. METHOD: action research in a psychiatric hospital of Northeast Brazil, during the period of December/2015 to June/2016, when 34 nursing staff participated. Enterviews and meetings were conducted, which were recorded/transcripted and content analysis performed. RESULTS: the priority problems were inadequate staffing, insecurity, failures in the material management and deficit in the comprehensive care provided. Besides that, the difficulties to implementation were- low governability, poor communication and staff desmotivation. CONCLUSION: situational strategic planning is useful to delineaction of actions in mental health and its efficacy depends on the envolved actors commitment.

OBJETIVO: aplicar la planificación estratégica situacional en un servicio de enfermería de una institución psiquiátrica. MÉTODO: investigación/acción en hospital psiquiátrico del nordeste brasileño, período entre diciembre de 2015 y junio de 2016, participación de 34 profesionales de enfermería. Realizadas las encuestas y las reuniones, que fueron registradas y transcritas, y se hizo análisis de contenido. RESULTADOS: los problemas primeros fueron la dimensión insuficiente de personal, inseguridad, faltas en la gestión de los recursos materiales y el déficit en la atención integral proporcionada. Incluso, las dificultades para la aplicación- baja de gestión, mala comunicación y baja motivación profesional. CONCLUSIÓN: planificación estratégica situacional es útil para la delineación de acciones en salud mental y su efectividad depende del compromiso de los actores ivolucrados.