Reflexão sobre Autonomia no Doente Mental: Aspectos Ético -Legais

São vários os significados que podemos atribuir à autonomia, variando de acordo com o olhar de quem se propõe estudá-la, ou como quer respeitá-la nas pessoas. De uma forma mais abrangente, a pessoa autónoma é aquela que tem liberdade de pensamento, livre de coações internas ou externas, para escolher entre as opções que lhe são apresentadas. A pessoa com doença mental pode ter a sua autonomia comprometida de forma transitória ou permanente, podendo este comprometimento variar de acordo com o grau de gravidade da doença. O enfermeiro, num encontro face a face com a pessoa com patologia psiquiátrica, procura restabelecer a ordem perturbada, possibilitando a lucidez de pensamento, domínio dos sentimentos e afirmação de uma vontade livre, de forma a favorecer a confiança em si mesmo e o crescimento em termos de autonomia. Ajudar a pessoa a descobrir um sentido realizador para a sua vida, intervir na melhoria da sua qualidade, e promover a sua autonomia são as principais tarefas do enfermeiro de saúde mental, tendo sempre presente que o doente é o primeiro agente do seu processo terapêutico. Algumas limitações do direito de autonomia do doente são justificadas no período em que as condições mentais alteram a sua capacidade de tomar decisões. Porém, logo que se recuperem, devemos ajudar para que ele próprio seja o decisor nas suas escolhas e opções. Por detrás do condicionalismo da doença mental existe uma pessoa em busca de sentido e de liberdade, que lança a toda a equipa variados desafios. Pretendemos com este trabalho reflectir sobre a nossa prática diária, de forma a promover a autonomia no acto de cuidar e, salvaguardar o respeito pela dignidade da pessoa doente, utilizando a competência humanizada e a atenção holística adequada a cada caso. There are several meanings that we can attribute to autonomy, varying according to the look of those who propose to study it, or how they want to respect it in people. In a broader sense, an autonomous person is one who has freedom of thought, free from internal or external coercion, to choose among the options presented to him or her. The person with mental illness may have their autonomy compromised temporarily or permanently, and this compromise may vary according to the severity of the illness. The nurse, in a face-to-face encounter with the person with psychiatric pathology, seeks to reestablish the disturbed order, enabling clarity of thought, mastery of feelings, and affirmation of a free will, in order to foster self-confidence and growth in terms of autonomy. Helping people discover a fulfilling meaning to their lives, intervening to improve their quality of life, and promoting their autonomy are the main tasks of the mental health nurse, always keeping in mind that the patient is the first agent of his therapeutic process. Some limitations to the patient's right to autonomy are justified in the period when mental conditions alter their ability to make decisions. However, as soon as he recovers, we must help him to be the decision-maker in his own choices and options. Behind the constraints of mental illness there is a person in search of meaning and freedom, who challenges the whole team. With this paper we intend to reflect on our daily practice, in order to promote autonomy in the act of caring, and to safeguard the respect for the patient's dignity, using humanized competence and holistic attention appropriate to each case.

Telehealth and the Psychiatric Mental Health Nurse Practitioner: Beyond the COVID-19 Pandemic

OBJECTIVE: Examine the advantages, disadvantages, and challenges of telehealth for the psychiatric mental health nurse practitioner (PMHNP) in practice and student education. Describe areas for future research and policy development regarding telehealth in PMHNP practice and training during and beyond the COVID-19 pandemic. METHODS: Review current evidence, standards of practice, and education for the PMHNP. RESULTS: Recent rapid pandemic-related shifts in utilization of telehealth for clinical practice and student education have highlighted the advantages, disadvantages, and areas in need of additional study. CONCLUSIONS: Postpandemic telehealth care delivery will likely persist or expand. PMHNPs must advocate for high practice and education standards.

Reflection and mental health nursing. Part seven: reflection as a tool for teaching and learning

Reflection is an important skill in the armoury of the mental health nurse. Most nurses are familiar with its use in the review and development of their clinical client-centred practice; however, its use for the nurse's own development is less well appreciated. The author highlights how the elements of a reflective learning process can be used by the clinically based nurse to enhance the support of their students' learning. The principles of reflection before, during and after action are then explored as a tool in enhancing the clinician's own experiential learning, examining the dynamic relationship between experience and reflection.