A ação territorial do Centro de Atenção Psicossocial (CAPS) enquanto indicativo de sua natureza substitutiva
The present dissertation aims to investigate the possibilities of action of a 
Psychosocial Care Center (CAPS) in relation to its territory. The theoretical reference 
provided by the Italian Democratic Psychiatry and by the experience from Santos of a 
mental health program introduces services which act as a replacement for the madhouse 
model as they promote a rupture concerning the psychiatric hospital work. The territory 
becomes a strategic actor to the transformation of the relationship among psychiatry, 
insanity and society. As a group of social references, of intrapersonal functioning codes 
which confront a social imaginary and reality that include or exclude the different, the 
territory is a stage of exercise to the cultural transformation in relation to the 
phenomenon of madness. 
In the context of SUS (Sistema Unico de Saude), the CAPS, created in order to 
replace the continuous treatments in psychiatric hospitals, is included in the category of 
health services by the ministerial decrees, and is spread nationally as a place of 
reference and treatment for people who suffer from psychiatric disorders. The 
production of substitutive services related to SUS challenges the services to break with 
a trajectory of a reform reduced to a technical-assistance dimension, in order to 
approach again to the ethical, conceptual, judicial and social transformations which are 
part of the Brazilian Psychiatric Reform movement. Therefore, it is necessary to go 
beyond the traditional clinic view, and include in the praxis different ways of knowing 
the patients, families and territory. 
A CAPS in the state of Rio de Janeiro was taken as a field of investigation in 
order to verify how its everyday praxis is organized, investigating the possibilities of its 
actions, either inside the institution or in relation to the territory, strengthen 
transformations in the ways of conceiving and dealing with insanity. A participant 
observation was used as well as semi-structured interviews with some professionals 
who work in the CAPS. The investigation emphasizes the importance of making the 
everyday work reach an understanding of the transformations it can operate.
Utopia da realidade : contribuições da desinstitucionalização para a invenção de serviços de saude mental
Nas duas ultimas decadas, o campo da atencao psiquiatrica no Brasil tem sido marcado por um processo de criticas e de propostas de transformacao denominado reforma psiquiatrica. No final dos anos 1980, a insignia ?Por uma sociedade sem manicomios?, formulada pelo Movimento dos Trabalhadores em Saude Mental, produziu uma ruptura com os marcos conceituais e as estrategias politicas e operativas ate entao delineados e abriu um novo campo de possibilidades e de desafios eticos, teoricos, sociais, institucionais e juridicos. Na decada de 1990, a afirmacao dos direitos de cidadania das pessoas com transtornos mentais e a superacao do modelo asilar foram definidas com as principais diretrizes para o processo de reforma e para a implementacao da politica nacional de saude mental, engendrando mudancas significativas nas dimensoes assistencial, legislativa e sociocultural. Atualmente, nao obstante a difusao das proposicoes da reforma e a producao de um amplo conjunto de iniciativas, o panorama nacional evidencia a centralidade do modelo asilar e o movimento instituinte de criacao de novos servicos e experiencias. A producao de projetos locais e de servicos substitutivos, em particular de servicos de atencao psicossocial, configura-se, portanto, como um dos principais desafios da reforma psiquiatrica no contexto do Sistema Unico de Saude. O presente trabalho tem por objetivo investigar o processo de construcao do Nucleo de Atencao Psicossocial da Zona Noroeste (NAPS) no contexto da experiencia de saude mental desenvolvida no municipio de Santos no periodo de 1989 a 1996, a partir das fontes documentais, da producao bibliografica, de pesquisa realizada anteriormente e de diarios de campo. A luz do referencial teorico da desinstitucionalizacao e em dialogo com as proposicoes de transformacao dos modos de pensar e agir em saude coletiva, busca elaborar e refletir sobre as principais tematicas para a producao do NAPS em seu fazer-se cotidiano como servico aberto, territorial, 24 horas e substitutivo, problematizando as inovacoes e as contradicoes identificadas nesse processo. Busca, ainda, apresentar e discutir que o saber critico construido nas praticas de transformacao da realidade das experiencias de Gorizia e Trieste expressa e propoe uma diferente perspectiva etica, teorica e politica para compreender a questao da loucura e as relacoes produzidas no contexto social. Nesse sentido, possibilita uma nova forma de pensar a invencao de servicos substitutivos, inscrevendo-a no complexo processo de desconstrucao de saberes, instituicoes, valores e cultura. Compreendendo os servicos substitutivos como instituicoes da desinstitucionalizacao, discute que os servicos tornam-se substitutivos na invencao de uma nova realidade que possibilite a criacao de novos dialogos com a complexidade da existencia-sofrimento, de itinerarios de exercicio de direitos e de um novo lugar social para a experiencia da loucura 
Abstract
Nurse responsiveness to cancer patient expressions of emotion.
OBJECTIVE
This theoretically based study examined nurse responses to cancer patient expressions of emotion using a videotaped, simulated cancer patient.


METHODS
This study used an experimental crossover design with a videotaped patient expressing anger, sadness, and neutral emotion to elicit nurse responses. Seventy-four nurses from eight sites participated. Responses were coded using Roter interaction analysis system. Correlations explored relationships between variables that impact communication (age, gender, work experience, trait anxiety, work stress, self-efficacy). Regression models explored the effect of variables on nurse affective responsiveness.


RESULTS
Patient expressions of sadness elicited more affective responses than anger. Expressions of anger or neutral emotion elicited more instrumental behaviors than sadness. Variables such as age, work stress and work experience were significantly correlated. No variables predicted affective responsiveness to patient expressions of anger or sadness.


CONCLUSION
Nurse communication showed significant variation in response to patient emotional expressions. Understanding the relationships between demographic, personality, and work variables, and identification of new variables that influence nurse-patient communication, has implications for interventional studies.


PRACTICE IMPLICATIONS
Over 90% of the participants indicated that the videotape simulation would be a useful method for teaching and practicing communication skills with patients expressing emotions.