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Mental health Nursing interventions in Primary Health Care: scoping review

Abstract

Objective

To map and synthesize the mental health interventions performed by nurses working in Primary Health Care in Brazil.

Method

This is a scoping review, carried out in the following databases: VHL, PUBMED, CINAHL, EMBASE, SCOPUS, Web of Science, PsycINFo, EBSCO, BMC Psychology, BMC Nursing, BMC Psychiatry, PEPsic, Google Scholar, CAPES Theses and Dissertations Database. Data were analyzed and synthesized in a narrative form.

Results

A total of 60 studies were included in the review. Most studies were published in Brazilian journals. The mapping of mental health nurses’ interventions in Primary Health Care suggests that the most common actions are assisting the users and referring them to the medical doctor or to specialized mental health services.

Conclusion

There is a wide scope of interventions within the competence of Primary Health Care nurses, but the lack of technical-scientific knowledge restricts care to the biomedical model.

Nurses’s hole; Mental health assistance; Primary health care; Mental health; Psychiatric nursing

Resumo

Objetivo

Mapear e sintetizar as intervenções em saúde mental realizadas pelos enfermeiros que atuam na Atenção Primária à Saúde no Brasil.

Métodos

Trata-se de uma revisão de escopo, realizada nas seguintes fontes de informações: BVS, PUBMED, CINAHL, EMBASE, SCOPUS, Web of Science, PsycINFo, EBSCO, BMC Psychology, BMC Nursing, BMC Psychiatry, PEPsic, Google Acadêmico, Banco de Teses e Dissertações CAPES. Os dados foram analisados e sintetizados de forma narrativa.

Resultados

Foram incluídos 60 estudos na revisão. O maior número de estudos foi publicado em periódicos brasileiros. O mapeamento das intervenções dos enfermeiros em saúde mental na Atenção Primária à Saúde sugere que essas são predominantemente de acolhimento e encaminhamento do usuário ao profissional médico ou aos serviços especializados em saúde mental.

Conclusão

Há amplo escopo de intervenções que competem aos enfermeiros na Atenção Primária à Saúde, mas a carência de conhecimento técnico-científico restringe o cuidado ao modelo biomédico.

Papel do profissional de enfermagem; Assistência à saúde mental; Atenção primária à saúde; Saúde mental; Enfermagem psiquiátrica

Resumen

Objetivo

Mapear y sintetizar las intervenciones en salud mental realizadas por enfermeros que trabajan en la Atención Primaria de Salud en Brasil.

Métodos

Se trata de una revisión de alcance, realizada en las siguientes fuentes de información: BVS, PUBMED, CINAHL, EMBASE, SCOPUS, Web of Science, PsycINFo, EBSCO, BMC Psychology, BMC Nursing, BMC Psychiatry, PEPsic, Google Académico, Banco de Tesis de Doctorado y Maestría CAPES. Los datos fueron analizados y sintetizados de forma narrativa.

Resultados

Se incluyeron 60 estudios en la revisión. El mayor número de estudios fue publicado en revistas especializadas brasileñas. El mapeo de las intervenciones de los enfermeros en salud mental en la Atención Primaria de Salud sugiere que estas son predominantemente de contención y derivación del usuario a un profesional médico o a servicios especializados en salud mental.

Conclusión

Hay un amplio alcance de intervenciones que competen a los enfermeros en la Atención Primaria de Salud, pero la falta de conocimiento técnico-científico restringe el cuidado al modelo biomédico.

Rol de la enfermeira; Atención a la salud mental; Atención primaria de salud; Salud mental; Enfermería psiquiátrica

Introduction

Psychiatric nursing has undergone profound changes in its way of acting and relating with society in recent decades. The premises of the mental health reform and the election of the territory as the place of care gave a new status to the profession, requiring it to change from a care that actively contributed to the asylum model previously in force in psychiatric hospitals to actions guided by psychosocial rehabilitation, based on tools that put the individuals affected by mental disorders and/or users of alcohol and other drugs on the center of care. In this context, professional knowledge and practices stopped being focused on caring for the insane, locked in asylums, and expand their care to territorial actions outside hospitals.(11. Duarte VF, Lavorato Neto G, Rodrigues L, Campos CJ. Academic sayings from the past and the present about the Nursing Role in the Process and Routine of Deinstitutionalization. Rev Eletr Saúde Mental Álcool Drog. 2016;12(2):116-36.)

Historically, territories are important spaces for Primary Health Care (PHC) teams to provide psychological and social assistance to users affected by mental disorders, recognizing them as members of the community, even when they are referred to other levels of care. Therefore, mental healthcare actions must be conducted by teams, guided by a territorial work process with a limited population and linked to local networks, providing an individualized care to users and maintaining bonds between families and the community.(22. Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Ações Programáticas Estratégicas. Coordenação Geral de Saúde Mental, Álcool e Outras Drogas. Saúde Mental em Dados – 12, ano 10, nº 12. Brasília (DF): Ministério da Saúde; 2015 [citado 2020 Dez 22]. Disponível em: : https://www.mhinnovation.net/sites/default/files/downloads/innovation/reports/Report_12-edicao-do-Saude-Mental-em-Dados.pdf
https://www.mhinnovation.net/sites/defau...
)

Following these guidelines, the Psychosocial Care Networks (RAPS) were implemented in 2011, including health services in all levels of care and prioritizing PHC as the network device that is the gateway to community care and the organizer of mental health care, being co-responsible for the referral of users to the specialized network.(33. Brasil. Ministério da Saúde. Portaria n. 3.088, de 23 de dezembro de 2011. Institui a Rede de Atenção Psicossocial para pessoas com sofrimento ou transtorno mental e com necessidades decorrentes do uso de crack, álcool e outras drogas, no âmbito do Sistema Único de Saúde (SUS). Brasília (DF): Ministério da Saúde; 2011 [cited 2019 Mar 19]. Disponível em: http://bvsms.saude.gov.br/bvs/saudelegis/gm/2011/prt3088_23_12_2011_rep.html
http://bvsms.saude.gov.br/bvs/saudelegis...
)

The nurse is the healthcare professional that works in all network devices, having a leading role in the mental health care offered to the users in the territory. However, even though the role of PHC nurses in the field of mental health has been discussed, encouraged and recognized as an important strategy for coping with psychosocial demands in the territory, the description and classification of their competences and interventions are not thoroughly specified in the literature.(44. Ferreira SR, Périco LA, Dias VR. The complexity of the work of nurses in Primary Health Care. Rev Bras Enferm. 2018;71(Suppl 1):704-9.) Most of the time, their role is described through general interventions shared by a multidisciplinary team, highlighting the difficulties of these professionals in meeting this demand in territorial services.(55. Pereira AA, Reinaldo AM, Andrade DC. Proposta educativa em saúde mental para enfermeiros da atenção primária à saúde. Rev Políticas Públicas. 2015;14(2):17;26.)

This scenario can favor an expanded practice in relation to the growing demand for mental health care in PHC services. However, studies have shown that the tools used by nurses for psychosocial care are fragile when compared to the lines of care used with other priority groups.(66. Batista EH, Guedes HC, Júnior JN, Januário DC, Pordeus AC, Pereira VC. Difficulties of nurses in basic care in view mental illness. Rev Enferm UFPE On Line. 2018;12(11):2961-8.,77. Chaves SC, Nobrega MP, Silva TS. Non-pharmacological interventions offered to the user with a common mental disorder in primary health care. J Nurs Health. 2019;9(3):e199302.) Thus, for nurses to be able to provide effective mental health care in PHC, it is necessary to identify and map nursing interventions in mental health in these scenarios. These interventions can be interpreted as competences defined and guided by knowledge and skills, which will be reflected in their specific actions in this scenario.(88. Neves HG, Lucchese R, Munari DB. Mental health in primary attention: needed constitution of competences. Rev Bras Enferm. 2010;63(4):666-70.)In mental healthcare, these interventions are characterized by a set of actions based on the competences and skills of nurses, built since college, experienced in the course of their professional career, improved through technical-scientific knowledge and capable of improving psychosocial care, reducing stigma and increasing the problem-solving capacity within the territory.(99. Peters MD, Godfrey C, McInerney P, Baldini Soares C, Khalil H, Parker D. Chapter 11: scoping reviews. Joanna Briggs Institute Reviewer’s Manual. Adelaide: The Joanna Briggs Institute; 2017 [cited 2021 Dec 22]. Available from: https://synthesismanual.jbi.global.https://doi.org/10.46658/JBIMES-20-12
https://synthesismanual.jbi.global.https...

10. Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Social Res Methodol. 2005;8(1):19-32.

11. Rocha EN, Lucena AF. Single Therapeutic Project and Nursing Process from an interdisciplinary care perspective. Rev Gaúcha Enferm. 2018;39:e2017-0057.

12. Pinto VA. Os sentidos atribuídos pelos profissionais da estratégia saúde da família aos casos de saúde mental [tese]. Rio de Janeiro: Fundação Oswaldo Cruz; 2017. 163 p. [citado 2020 Dez 22]. Disponível em: https://pesquisa.bvsalud.org/portal/resource/pt/int-5238
https://pesquisa.bvsalud.org/portal/reso...

13. Martins AK. Saúde mental na estratégia saúde da família: estudo sobre as competências de enfermeiros [tese]. Fortaleza: Universidade Federal do Ceará; 2014. 188 p. [citado 2020 Dez 22]. Disponível em: http://www.repositorio.ufc.br/handle/riufc/9208
http://www.repositorio.ufc.br/handle/riu...

14. Jorge MS, Vasconcelos MG, Junior EF, Barreto LA, Rosa LR, Lima LL, et al. Solvability of mental health care in the Family Health Strategy: social representation of professionals and users. Rev Esc Enferm USP. 2014;48(6):1060-6.

15. Lucchese R, Castro P, Ba S, Rosalem V, Silva A, Andrade M, et al. Professional knowledge in primary health care of the person/family in mental distress: Le Boterf perspective. Rev Esc Enferm USP. 2014;48(Spe 2):123-31.

16. Azevedo DM, Guimarães FJ, Dantas JF, Rocha TM. Atenção básica e saúde mental: um diálogo e articulação necessários. Rev APS. 2014;17(4):537-43.

17. Fioramonte A, Bressan BF, Silva EM, Nascimento GL, Buriola AA. Health care of mental disorder patients and their family: the nurse role at the fhs. Cien Cuid Saude. 2013;12(2):315-22.

18. Rangel CT, Miranda FA, Oliveira KK. Communitarian therapy and nursing: the phenomenon and its context. J Res Fundam Care Online. 2016;8(1):3770-9.
-1919. Silva PM, Costa NF, Barros DR, Silva-Júnior JA, Silva JR, Brito TS. Saúde mental na atenção básica: possibilidades e fragilidades do acolhimento. Rev Cuidarte. 2018;19;10(1):e617.)

Considering that the RAPS has included health services in all levels of care, prioritizing PHC as the network device that is the gateway to community care and the organizer of mental health care; that nurses working in PHC must have minimum knowledge and skills in mental health so they can care for the needs of patients affected by mental disorders and/or alcohol and drug users living in the community; and that mental health interventions performed by nurses working in PHC are limited and not specific, as shows in the literature, which makes it difficult for this professional to put their knowledge and skills into practice; the following question was raised: “What is knowledge produced on mental health interventions performed by nurses working in PHC in Brazil?””. The objectives of this study were to identify and map the knowledge about mental health interventions performed by nurses working in PHC.

Methods

Study design

Systematic scoping review,(2020. Damasceno VC, Sousa FS. Mental health care for the elderly: the nurse’s perception. Rev Enferm UFPE On Line. 2018;12(10):2710-6.) which aims to map the main concepts of a given area of knowledge; examine the scope, reach and nature of the investigation; summarize and disseminate research data; and identify existing research gaps. In addition to the items for systematic reviews and meta-analyses (PRISMA)(2121. Santana TF, Pereira MA. Mental health care in primary care: a cartography. Rev Enfermagem UERJ. 2018;26:e32305.), the research also followed the specific PRISMA extension for scoping reviews (PRISMA-ScR), which is ideal for describing the research decision process in detail, considering the method used.(2222. Campos DB, Bezerra IC, Jorge MS. Mental health care technologies: Primary Care practices and processes. Rev Bras Enferm. 2018;71(Suppl 5):2101-8.) The PCC strategy (P: Population = Nurses, C: Concept = Mental Health Interventions, C: Context = Primary Health Care) was used for the elaboration of the study’s guiding question, which was: “What is the production of knowledge about mental health interventions carried out by nurses working in PHC in Brazil?”

Search strategy

The search strategy was conducted in three stages. The first stage of the search was conducted at the platforms PUBMED and VHL, analyzing the words in the title and abstract of studies using the following keywords: “Primary Health Care”, “Nurse’s Role”, “Mental Health”. In the second stage, the studies were identified using a search strategy adapted to each electronic database: Embase, Web of Science (WoS), Scopus, Medical Literature Analysis and Retrieval System Online – MEDLINE (acessed via PubMed) and Cumulative Index to Nursing and Allied Health Literature (CINAHL). The search was conducted with the following terms – in PubMed, adapted for the other databases: (“Primary Health Care” OR “Basic Health” OR “Community Health” OR “Family Health” OR “Health Center” ) AND (“Professional Competence” OR Nursing OR “Nurse’s Role” OR “Technical Expertise” OR “Clinical Competence” OR “Knowledge” OR “Attitude”) AND (“Mental Health” OR “Community Mental Health Centers” OR “ Community Mental Health Services” OR “Mental Health Nursing” OR “Psychosocial Nursing”). In the third step, the references of the selected articles were analyzed to find studies that were not collected by the search strategy. After collecting all references, duplicate articles were excluded using the Endnote software (Clarivate Analytics®). The searches in electronic data sources were carried out from April 4 to April 30, 2019.

Selection of studies

The selection of studies was carried out by the authors in two phases. Titles and abstracts of potentially relevant studies and articles that seemed to meet the inclusion criteria based on their abstracts were independently examined. In phase 2, the same reviewers read the full-text of all selected articles independently and excluded studies that did not meet the inclusion criteria. Any disagreement, whether in the first or second phase, was resolved through discussion and agreement between the authors. If consensus was not reached, a third reviewer was involved for the final decision.

Data collection process and synthesis of results

A tool adapted to SUMARI® was used to extract from each article the following information: participants, concept, context and study design. The results were presented in diagrams and tables, including a map of interventions and a conceptual framework with a narrative summary.

Results

A total of 11,450 records were identified in the database search and 46 studies were included after reviewing the reference lists. The studies were selected after reading the abstract and titles; after excluding those that did not meet the criteria, 60 studies remained and were used in this review. The entire process followed the steps shown in the flowchart available in figure 1.

Figure 1
PRISMA Flowchart for study selection

The analysis of published research on mental health interventions performed by nurses working in PHC in Brazil resulted in the mapping and classification of 11 mental health interventions under the responsibility of PHC nurses in Brazil (Table 1). These interventions are composed of a set of actions/activities (n=33), which are called, in this study, as sub-interventions (Chart 1).(1111. Rocha EN, Lucena AF. Single Therapeutic Project and Nursing Process from an interdisciplinary care perspective. Rev Gaúcha Enferm. 2018;39:e2017-0057.

12. Pinto VA. Os sentidos atribuídos pelos profissionais da estratégia saúde da família aos casos de saúde mental [tese]. Rio de Janeiro: Fundação Oswaldo Cruz; 2017. 163 p. [citado 2020 Dez 22]. Disponível em: https://pesquisa.bvsalud.org/portal/resource/pt/int-5238
https://pesquisa.bvsalud.org/portal/reso...

13. Martins AK. Saúde mental na estratégia saúde da família: estudo sobre as competências de enfermeiros [tese]. Fortaleza: Universidade Federal do Ceará; 2014. 188 p. [citado 2020 Dez 22]. Disponível em: http://www.repositorio.ufc.br/handle/riufc/9208
http://www.repositorio.ufc.br/handle/riu...

14. Jorge MS, Vasconcelos MG, Junior EF, Barreto LA, Rosa LR, Lima LL, et al. Solvability of mental health care in the Family Health Strategy: social representation of professionals and users. Rev Esc Enferm USP. 2014;48(6):1060-6.

15. Lucchese R, Castro P, Ba S, Rosalem V, Silva A, Andrade M, et al. Professional knowledge in primary health care of the person/family in mental distress: Le Boterf perspective. Rev Esc Enferm USP. 2014;48(Spe 2):123-31.

16. Azevedo DM, Guimarães FJ, Dantas JF, Rocha TM. Atenção básica e saúde mental: um diálogo e articulação necessários. Rev APS. 2014;17(4):537-43.

17. Fioramonte A, Bressan BF, Silva EM, Nascimento GL, Buriola AA. Health care of mental disorder patients and their family: the nurse role at the fhs. Cien Cuid Saude. 2013;12(2):315-22.

18. Rangel CT, Miranda FA, Oliveira KK. Communitarian therapy and nursing: the phenomenon and its context. J Res Fundam Care Online. 2016;8(1):3770-9.

19. Silva PM, Costa NF, Barros DR, Silva-Júnior JA, Silva JR, Brito TS. Saúde mental na atenção básica: possibilidades e fragilidades do acolhimento. Rev Cuidarte. 2018;19;10(1):e617.

20. Damasceno VC, Sousa FS. Mental health care for the elderly: the nurse’s perception. Rev Enferm UFPE On Line. 2018;12(10):2710-6.

21. Santana TF, Pereira MA. Mental health care in primary care: a cartography. Rev Enfermagem UERJ. 2018;26:e32305.

22. Campos DB, Bezerra IC, Jorge MS. Mental health care technologies: Primary Care practices and processes. Rev Bras Enferm. 2018;71(Suppl 5):2101-8.

23. Subrinho LQ, Sena EL, Santos VT, Carvalho PA. Cuidado ao consumidor de drogas: percepção de enfermeiros da Estratégia de Saúde da Família. Saude Soc. 2018;27(3):834-44.

24. Souza J, Almeida LY, Luis MA, Nievas AF, Veloso TM, Barbosa SP, et al. Mental health in the Family Health Strategy as perceived by health professionals. Rev Bras Enferm. 2017;70(5):935-41.

25. Eslabão AD, Coimbra VC, Kantorski LP, Pinho LB, Santos EO. Mental health care network: the views of coordinators of the Family Health Strategy (FHS). Rev Gaucha Enferm. 2017;38(1):e60973.

26. Mesquita, KSF. Flow chart of support for decision making for the nursing care person in psychic suffering in primary care [dissertação]. Maceió: Universidade Federal de Alagoas; 2016. 162 p. [citado 2020 Dez 22]. Disponível em: http://www.repositorio.ufal.br/handle/riufal/3278
http://www.repositorio.ufal.br/handle/ri...

27. Paiva DC. The Family Health Teams daily experience of caring of patients under psychological distress [dissertação]. São Paulo: Escola de Enfermagem, Universidade de São Paulo; 2015. 99 p. [citado 2020 Dez 22]. Disponível em: https://teses.usp.br/teses/disponiveis/7/7144/tde-11012016-134535/pt-br.php
https://teses.usp.br/teses/disponiveis/7...

28. Merces AM, Souza BM, Silva TL, Silva TT, Cavalcanti AM. Nursing practices in mental health in the family health strategy: an integrative review. Cogitare Enferm. 2015;20 (2):413-21.

29. Silva JA, Ferreira LA, Zuffi FB, Cardoso RJ, Rezende MP, Mendonça GS, et al. Psychiatric client embracement on primary health care. Biosci J. 2015;31(4).

30. Silva PM, Costa NF, Barros DR, Silva-Júnior JA, Silva JR, Brito TS. Saúde mental na atenção básica: possibilidades e fragilidades do acolhimento. Rev Cuidarte. 2018;10(1):e617.

31. Coelho BP, Silva AP, Souza LP, Silva KM, Silva EP, Pinto IS, et al. Mental health in the work of Nurse the Primary Care of a municipality in Brazil. Rev Cubana Enferm. 2015;31(1):1-14.

32. Pelisoli C, Sacco AM, Barbosa ET, Pereira CD, Cecconello AM. Acolhimento em saúde: uma revisão sistemática em periódicos brasileiros. Estud Psicol. 2014;31(2):225-35.

33. Gonçalves RM, Pedrosa LA, Oliveira MA, Silva QC, Abreu RM, Pinho PH. Promoção da saúde mental: Ações dos enfermeiros inseridos na atenção primária. Rev Port Enferm Saúde Mental. 2013;10(10):49-56.

34. Sucigan DH, Toledo VP, Garcia AP. Welcoming and mental health: professional challenge in the family health strategy. Rev Rene. 2012;13(1).

35. Correia VR, Barros S, Colvero LD. Mental health in primary health care: practices of the family health team. Rev Esc Enferm USP. 2011;45(6):1501-6.

36. Schneider DR, Lima DS. Implicações dos modelos de atenção à dependência de álcool e outras drogas na rede básica em saúde. Psicol. 2011;42(2):168-78.

37. Gonçalves RM, Pedrosa LA. Perfil dos enfermeiros da estratégia saúde da família e suas habilidades para atuar na saúde mental. Cien Cuid Saude. 2009;8(3):345–51.

38. Lima MA, Rückert TR, Santos JL, Colomé IC, Acosta AM. Atendimento aos usuários em situação de violência: concepções dos profissionais de unidades básicas de saúde. Rev Gaucha Enferm. 2009;30(4):625-32.

39. Facundo FR, Castillo MM. Acquisition of alcohol use of in a group of mexican adolescents. Rev Eletr Saúde Mental Álcool Drog. 2005;1(2):1-13.

40. Silva AT, Silva CC, Ferreira Filha MO, Nóbrega MM, Barros S, Santos KK. Mental health in the PSF and the work of nursing. Rev Bras Enferm. 2005;58(4):411–5.

41. Jorge MS, Diniz AM, Lima LL, Penha JC, Jorge MS, Diniz AM, et al. Matrix support, individual therapeutic project and production in mental health care. Texto Contexto Enferm. 2015;24(1):112-20.

42. Souza DA, Dantas AL, Veloso LC, Amorim AM. Atender a los pacientes con trastornos mentales desde la perspectiva de la enfermera de atención primaria. Cultura de los cuidados. 2013;17(37):72-83.

43. Santos JA. Avaliação do Estabelecimento da Política de Atenção Integral ao Consumidor de Álcool e outras Drogas: um estudo de caso [dissertação]. Maringá: Universidade Estadual de Maringá; 2011.

44. Oliveira FB, Lima Júnior JF, Silva AO, Silva JC, Guedes HK, Pereira JD. Reconstruindo novos paradigmas do cuidado em saúde mental na estratégia saúde da família. J Nursing UFPE On Line. 2014;8(4):919-26.

45. Valeria Ozorio S. Atenção à saúde mental na Estratégia Saúde da Família no município de Parnamirim / RN: a opinião de profissionais, pessoas com transtorno mental e seus cuidadores [tese]. Natal: Universidade Federal do Rio Grande do Norte; 2012. 162 p.

46. Duarte EO, Nasi C, Camatta MW, Schneider JF. Characterization of the assistance practices in mental health care networking: an integrative review. Rev Gaúcha Enferm. 2012;33(4):191-9.

47. Amarante AL, Lepre AS, Gomes JL, Pereira AV, Dutra VF. As estratégias dos enfermeiros para o cuidado em saúde mental no programa saúde da família. Texto Contexto Enferm. 2011;20(1):85-93.

48. Ribeiro LM, Medeiros SM, Albuquerque JS, Fernandes SM. Mental health nursing and the family health strategy: how the nurse is working? Rev Esc Enferm USP. 2010;44(2):376–82.

49. Rosenstock KI, Neves MJ. Papel do enfermeiro da atenção básica de saúde na abordagem ao dependente de drogas em João Pessoa, PB, Brasil. Rev Bras Enferm. 2010;63(4):581–6.

50. Furegato F, Regina A, Candido MC, Costa Jr ML. Comparing knowledge and opinions on depression among nurses in the health services. Rev Salud Pública. 2009;11(2):200-11.

51. Matumoto S, Manso BT. Nurse’s clinical work: beyond chronic diseases. J Res Fundamental Care On Line. 2015;7(4):3430-41.

52. Vargas DD, Maciel ME, Bittencourt MN, Lenate JS, Pereira CF. O ensino de enfermagem psiquiátrica e saúde mental no Brasil: análise curricular da graduação. Texto Contexto Enferm. 2018;27(2):2-9.

53. Waidman MA, Marcon SS, Pandini A, Bessa JB, Paiano M. Nursing care for people with mental disorders, and their families, in Primary Care. Acta Paul Enferm. 2012;25(3):346–51.

54. Azevedo DM, Santos AT. Mental health actions in primary care: Knowledge of nurses about the psychiatric reform. J Res Fundamental Care On Line. 2012;4(4):3006–14.

55. Magno CS, Rangel TE, Sabóia VM, Cavalcanti VG. Home visit with regard to mental health. Cien Enferm. 2011;17(3):125-36.

56. Oliveira FB, Silva JC, Silva VH, Cartaxo CK. The mental health nursing work in the Family Health Strategy. Rev Rene. 2011;12(2):229-37.

57. Souza AJ, Matias GN, Gomes KF, Parente AC. A saúde mental no Programa de Saúde da Família. Rev Bras Enferm. 2007;60(4):391-5.

58. Rosa WA, Labate RC. A contribuição da saúde mental para o desenvolvimento do PSF. Rev Bras Enferm. 2003;56(3):230-5.

59. Jorge MS, Sousa FS, Franco TB. Apoio matricial: dispositivo para resolução de casos clínicos em saúde mental na atenção básica. Rev Bras Enferm. 2013;66(5):738-44.

60. Prates MM, Garcia VG, Moreno DM. Support team and collective elaboration of the Mental Healthcare work within the Family Health Program: space of discussion and care. Saude Soc. 2013;22(2):642-52.

61. Penido CM. Analysis of the involvement of supporters and workers of the family health strategy in the matrix support in mental health [tese]. Belo Horizonte: Federal University of Minas Gerais; 2012. 172 p. [citado 2020 Dez 22]. Disponível em: https://repositorio.ufmg.br/handle/1843/GCPA-95YPJF
https://repositorio.ufmg.br/handle/1843/...

62. Souza J, Luis MA. Demands of mental health: nurses’ perceptions of family health teams. Acta Paul Enferm. 2012;25(6):852-8.

63. Neves HG, Lucchese R, Munari DB, Vera I, Santana FR. The process of formation of mental health for nurses in primary health care. Rev Rene. 2012;13(1):53-63.

64. Nóbrega MP, Fernandes MF, Silva PF. Application of the therapeutic relationship to people with common mental disorder. Rev Gaúcha Enferm. 2017;38(1):e63562.

65. Mielke FB. Evaluation of psychosocial care management in family health strategy: with word coordinators [tese]. Porto Alegre: Escola de Enfermagem, Universidade Federal do Rio Grande do Sul; 2013. 218 p. [citado 2020 Dez 22]. Disponível em: https://www.lume.ufrgs.br/handle/10183/79620
https://www.lume.ufrgs.br/handle/10183/7...

66. Sobral FR, Campos CJ. Nurses and mental health education in primary care. Rev Eletr Saúde Mental Álcool Drog. 2012;8(2):100-7. Review.

67. Guedes TG. Matrices of care in family planning for women with mental disorder [tese]. Fortaleza: Faculdade de Farmácia, Odontologia e Enfermagem, Universidade Federal do Ceará; 2011. 123 p. [citado 2020 Dez 22]. Disponível em: http://www.repositorio.ufc.br/handle/riufc/2152
http://www.repositorio.ufc.br/handle/riu...

68. Koga M, Furegato AR, Santos JL. Opinions of the staff and users about the quality of the mental health care delivered at a family health program. Rev Lat Am Enfermagem. 2006;14(2):163-9.

69. Carvalho JL, Nóbrega MP. Complementary therapies as resources for mental health in Primary Health Care. Rev Gaúcha Enferm. 2017;38(4):e2017-0014.

70. Azevedo EB. Typology of Nurses Therapists Community Perspective in Weber [tese]. João Pessoa: Centro de Ciências da Saúde, Universidade Federal da Paraíba; 2015. 186 p. [citado 2020 Dez 22]. Disponível em: https://repositorio.ufpb.br/jspui/handle/tede/5168
https://repositorio.ufpb.br/jspui/handle...

71. Araruna MH, Ferreira Filha MO, Dias MD, Braga LA, Moraes MN, Rocha IA. Formação de terapeutas comunitários na Paraíba: impacto na Estratégia Saúde da Família. Rev Eletr Enferm. 2012;14(1):33-41.

72. Silva P, Nóbrega M, Oliveira E. Knowledge of the nursing team and community agents on suicide behavior. Rev Enferm UFPE On Line. 2018;12(1):112-17.

73. Goncalves DA, Fortes S, Campos M, Ballester D, Portugal FB, Tófoli LF, et al. Evaluation of a mental health training intervention for multidisciplinary teams in primary care in Brazil: a pre-and posttest study. Gen Hosp Psychiatry. 2013;35(3):304-8.

74. Gomes EC. Early detection and brief intervention for the use of risky or harmful drugs: evaluation of barriers to implementation in primary health care in three municipalities in Paraná [dissertação]. Curitiba: Universidade Federal do Paraná; 2008. 109 p. [citado 2020 Dez 22]. Disponível em: http://hdl.handle.net/1884/22733
http://hdl.handle.net/1884/22733...
-7575. Bolsoni E, Heusy I, Silva Z, Padilha M, Rodrigues J. Mental health nursing consultations in primary health care. Rev Eletr Saúde Mental Álcool Drog. 2015;11(4):199-7.)It is worth noting that some sub-interventions were identified in more than one of the interventions mapped. Based on this result, the scope of the 11 interventions mapped and the actions and skills involved in their inclusion in nursing practices in PHC, both in expanded clinics (in multiprofessional and interdisciplinary teams), in individual, family and community contexts and in their spaces of action, were defined (Chart 2).(1212. Pinto VA. Os sentidos atribuídos pelos profissionais da estratégia saúde da família aos casos de saúde mental [tese]. Rio de Janeiro: Fundação Oswaldo Cruz; 2017. 163 p. [citado 2020 Dez 22]. Disponível em: https://pesquisa.bvsalud.org/portal/resource/pt/int-5238
https://pesquisa.bvsalud.org/portal/reso...

13. Martins AK. Saúde mental na estratégia saúde da família: estudo sobre as competências de enfermeiros [tese]. Fortaleza: Universidade Federal do Ceará; 2014. 188 p. [citado 2020 Dez 22]. Disponível em: http://www.repositorio.ufc.br/handle/riufc/9208
http://www.repositorio.ufc.br/handle/riu...

14. Jorge MS, Vasconcelos MG, Junior EF, Barreto LA, Rosa LR, Lima LL, et al. Solvability of mental health care in the Family Health Strategy: social representation of professionals and users. Rev Esc Enferm USP. 2014;48(6):1060-6.

15. Lucchese R, Castro P, Ba S, Rosalem V, Silva A, Andrade M, et al. Professional knowledge in primary health care of the person/family in mental distress: Le Boterf perspective. Rev Esc Enferm USP. 2014;48(Spe 2):123-31.

16. Azevedo DM, Guimarães FJ, Dantas JF, Rocha TM. Atenção básica e saúde mental: um diálogo e articulação necessários. Rev APS. 2014;17(4):537-43.

17. Fioramonte A, Bressan BF, Silva EM, Nascimento GL, Buriola AA. Health care of mental disorder patients and their family: the nurse role at the fhs. Cien Cuid Saude. 2013;12(2):315-22.

18. Rangel CT, Miranda FA, Oliveira KK. Communitarian therapy and nursing: the phenomenon and its context. J Res Fundam Care Online. 2016;8(1):3770-9.

19. Silva PM, Costa NF, Barros DR, Silva-Júnior JA, Silva JR, Brito TS. Saúde mental na atenção básica: possibilidades e fragilidades do acolhimento. Rev Cuidarte. 2018;19;10(1):e617.

20. Damasceno VC, Sousa FS. Mental health care for the elderly: the nurse’s perception. Rev Enferm UFPE On Line. 2018;12(10):2710-6.

21. Santana TF, Pereira MA. Mental health care in primary care: a cartography. Rev Enfermagem UERJ. 2018;26:e32305.

22. Campos DB, Bezerra IC, Jorge MS. Mental health care technologies: Primary Care practices and processes. Rev Bras Enferm. 2018;71(Suppl 5):2101-8.

23. Subrinho LQ, Sena EL, Santos VT, Carvalho PA. Cuidado ao consumidor de drogas: percepção de enfermeiros da Estratégia de Saúde da Família. Saude Soc. 2018;27(3):834-44.

24. Souza J, Almeida LY, Luis MA, Nievas AF, Veloso TM, Barbosa SP, et al. Mental health in the Family Health Strategy as perceived by health professionals. Rev Bras Enferm. 2017;70(5):935-41.

25. Eslabão AD, Coimbra VC, Kantorski LP, Pinho LB, Santos EO. Mental health care network: the views of coordinators of the Family Health Strategy (FHS). Rev Gaucha Enferm. 2017;38(1):e60973.

26. Mesquita, KSF. Flow chart of support for decision making for the nursing care person in psychic suffering in primary care [dissertação]. Maceió: Universidade Federal de Alagoas; 2016. 162 p. [citado 2020 Dez 22]. Disponível em: http://www.repositorio.ufal.br/handle/riufal/3278
http://www.repositorio.ufal.br/handle/ri...

27. Paiva DC. The Family Health Teams daily experience of caring of patients under psychological distress [dissertação]. São Paulo: Escola de Enfermagem, Universidade de São Paulo; 2015. 99 p. [citado 2020 Dez 22]. Disponível em: https://teses.usp.br/teses/disponiveis/7/7144/tde-11012016-134535/pt-br.php
https://teses.usp.br/teses/disponiveis/7...

28. Merces AM, Souza BM, Silva TL, Silva TT, Cavalcanti AM. Nursing practices in mental health in the family health strategy: an integrative review. Cogitare Enferm. 2015;20 (2):413-21.

29. Silva JA, Ferreira LA, Zuffi FB, Cardoso RJ, Rezende MP, Mendonça GS, et al. Psychiatric client embracement on primary health care. Biosci J. 2015;31(4).

30. Silva PM, Costa NF, Barros DR, Silva-Júnior JA, Silva JR, Brito TS. Saúde mental na atenção básica: possibilidades e fragilidades do acolhimento. Rev Cuidarte. 2018;10(1):e617.

31. Coelho BP, Silva AP, Souza LP, Silva KM, Silva EP, Pinto IS, et al. Mental health in the work of Nurse the Primary Care of a municipality in Brazil. Rev Cubana Enferm. 2015;31(1):1-14.

32. Pelisoli C, Sacco AM, Barbosa ET, Pereira CD, Cecconello AM. Acolhimento em saúde: uma revisão sistemática em periódicos brasileiros. Estud Psicol. 2014;31(2):225-35.

33. Gonçalves RM, Pedrosa LA, Oliveira MA, Silva QC, Abreu RM, Pinho PH. Promoção da saúde mental: Ações dos enfermeiros inseridos na atenção primária. Rev Port Enferm Saúde Mental. 2013;10(10):49-56.

34. Sucigan DH, Toledo VP, Garcia AP. Welcoming and mental health: professional challenge in the family health strategy. Rev Rene. 2012;13(1).

35. Correia VR, Barros S, Colvero LD. Mental health in primary health care: practices of the family health team. Rev Esc Enferm USP. 2011;45(6):1501-6.

36. Schneider DR, Lima DS. Implicações dos modelos de atenção à dependência de álcool e outras drogas na rede básica em saúde. Psicol. 2011;42(2):168-78.

37. Gonçalves RM, Pedrosa LA. Perfil dos enfermeiros da estratégia saúde da família e suas habilidades para atuar na saúde mental. Cien Cuid Saude. 2009;8(3):345–51.

38. Lima MA, Rückert TR, Santos JL, Colomé IC, Acosta AM. Atendimento aos usuários em situação de violência: concepções dos profissionais de unidades básicas de saúde. Rev Gaucha Enferm. 2009;30(4):625-32.

39. Facundo FR, Castillo MM. Acquisition of alcohol use of in a group of mexican adolescents. Rev Eletr Saúde Mental Álcool Drog. 2005;1(2):1-13.

40. Silva AT, Silva CC, Ferreira Filha MO, Nóbrega MM, Barros S, Santos KK. Mental health in the PSF and the work of nursing. Rev Bras Enferm. 2005;58(4):411–5.

41. Jorge MS, Diniz AM, Lima LL, Penha JC, Jorge MS, Diniz AM, et al. Matrix support, individual therapeutic project and production in mental health care. Texto Contexto Enferm. 2015;24(1):112-20.

42. Souza DA, Dantas AL, Veloso LC, Amorim AM. Atender a los pacientes con trastornos mentales desde la perspectiva de la enfermera de atención primaria. Cultura de los cuidados. 2013;17(37):72-83.

43. Santos JA. Avaliação do Estabelecimento da Política de Atenção Integral ao Consumidor de Álcool e outras Drogas: um estudo de caso [dissertação]. Maringá: Universidade Estadual de Maringá; 2011.

44. Oliveira FB, Lima Júnior JF, Silva AO, Silva JC, Guedes HK, Pereira JD. Reconstruindo novos paradigmas do cuidado em saúde mental na estratégia saúde da família. J Nursing UFPE On Line. 2014;8(4):919-26.

45. Valeria Ozorio S. Atenção à saúde mental na Estratégia Saúde da Família no município de Parnamirim / RN: a opinião de profissionais, pessoas com transtorno mental e seus cuidadores [tese]. Natal: Universidade Federal do Rio Grande do Norte; 2012. 162 p.

46. Duarte EO, Nasi C, Camatta MW, Schneider JF. Characterization of the assistance practices in mental health care networking: an integrative review. Rev Gaúcha Enferm. 2012;33(4):191-9.

47. Amarante AL, Lepre AS, Gomes JL, Pereira AV, Dutra VF. As estratégias dos enfermeiros para o cuidado em saúde mental no programa saúde da família. Texto Contexto Enferm. 2011;20(1):85-93.

48. Ribeiro LM, Medeiros SM, Albuquerque JS, Fernandes SM. Mental health nursing and the family health strategy: how the nurse is working? Rev Esc Enferm USP. 2010;44(2):376–82.

49. Rosenstock KI, Neves MJ. Papel do enfermeiro da atenção básica de saúde na abordagem ao dependente de drogas em João Pessoa, PB, Brasil. Rev Bras Enferm. 2010;63(4):581–6.

50. Furegato F, Regina A, Candido MC, Costa Jr ML. Comparing knowledge and opinions on depression among nurses in the health services. Rev Salud Pública. 2009;11(2):200-11.

51. Matumoto S, Manso BT. Nurse’s clinical work: beyond chronic diseases. J Res Fundamental Care On Line. 2015;7(4):3430-41.

52. Vargas DD, Maciel ME, Bittencourt MN, Lenate JS, Pereira CF. O ensino de enfermagem psiquiátrica e saúde mental no Brasil: análise curricular da graduação. Texto Contexto Enferm. 2018;27(2):2-9.

53. Waidman MA, Marcon SS, Pandini A, Bessa JB, Paiano M. Nursing care for people with mental disorders, and their families, in Primary Care. Acta Paul Enferm. 2012;25(3):346–51.

54. Azevedo DM, Santos AT. Mental health actions in primary care: Knowledge of nurses about the psychiatric reform. J Res Fundamental Care On Line. 2012;4(4):3006–14.

55. Magno CS, Rangel TE, Sabóia VM, Cavalcanti VG. Home visit with regard to mental health. Cien Enferm. 2011;17(3):125-36.

56. Oliveira FB, Silva JC, Silva VH, Cartaxo CK. The mental health nursing work in the Family Health Strategy. Rev Rene. 2011;12(2):229-37.

57. Souza AJ, Matias GN, Gomes KF, Parente AC. A saúde mental no Programa de Saúde da Família. Rev Bras Enferm. 2007;60(4):391-5.

58. Rosa WA, Labate RC. A contribuição da saúde mental para o desenvolvimento do PSF. Rev Bras Enferm. 2003;56(3):230-5.

59. Jorge MS, Sousa FS, Franco TB. Apoio matricial: dispositivo para resolução de casos clínicos em saúde mental na atenção básica. Rev Bras Enferm. 2013;66(5):738-44.

60. Prates MM, Garcia VG, Moreno DM. Support team and collective elaboration of the Mental Healthcare work within the Family Health Program: space of discussion and care. Saude Soc. 2013;22(2):642-52.

61. Penido CM. Analysis of the involvement of supporters and workers of the family health strategy in the matrix support in mental health [tese]. Belo Horizonte: Federal University of Minas Gerais; 2012. 172 p. [citado 2020 Dez 22]. Disponível em: https://repositorio.ufmg.br/handle/1843/GCPA-95YPJF
https://repositorio.ufmg.br/handle/1843/...

62. Souza J, Luis MA. Demands of mental health: nurses’ perceptions of family health teams. Acta Paul Enferm. 2012;25(6):852-8.

63. Neves HG, Lucchese R, Munari DB, Vera I, Santana FR. The process of formation of mental health for nurses in primary health care. Rev Rene. 2012;13(1):53-63.

64. Nóbrega MP, Fernandes MF, Silva PF. Application of the therapeutic relationship to people with common mental disorder. Rev Gaúcha Enferm. 2017;38(1):e63562.

65. Mielke FB. Evaluation of psychosocial care management in family health strategy: with word coordinators [tese]. Porto Alegre: Escola de Enfermagem, Universidade Federal do Rio Grande do Sul; 2013. 218 p. [citado 2020 Dez 22]. Disponível em: https://www.lume.ufrgs.br/handle/10183/79620
https://www.lume.ufrgs.br/handle/10183/7...

66. Sobral FR, Campos CJ. Nurses and mental health education in primary care. Rev Eletr Saúde Mental Álcool Drog. 2012;8(2):100-7. Review.

67. Guedes TG. Matrices of care in family planning for women with mental disorder [tese]. Fortaleza: Faculdade de Farmácia, Odontologia e Enfermagem, Universidade Federal do Ceará; 2011. 123 p. [citado 2020 Dez 22]. Disponível em: http://www.repositorio.ufc.br/handle/riufc/2152
http://www.repositorio.ufc.br/handle/riu...

68. Koga M, Furegato AR, Santos JL. Opinions of the staff and users about the quality of the mental health care delivered at a family health program. Rev Lat Am Enfermagem. 2006;14(2):163-9.

69. Carvalho JL, Nóbrega MP. Complementary therapies as resources for mental health in Primary Health Care. Rev Gaúcha Enferm. 2017;38(4):e2017-0014.

70. Azevedo EB. Typology of Nurses Therapists Community Perspective in Weber [tese]. João Pessoa: Centro de Ciências da Saúde, Universidade Federal da Paraíba; 2015. 186 p. [citado 2020 Dez 22]. Disponível em: https://repositorio.ufpb.br/jspui/handle/tede/5168
https://repositorio.ufpb.br/jspui/handle...

71. Araruna MH, Ferreira Filha MO, Dias MD, Braga LA, Moraes MN, Rocha IA. Formação de terapeutas comunitários na Paraíba: impacto na Estratégia Saúde da Família. Rev Eletr Enferm. 2012;14(1):33-41.

72. Silva P, Nóbrega M, Oliveira E. Knowledge of the nursing team and community agents on suicide behavior. Rev Enferm UFPE On Line. 2018;12(1):112-17.

73. Goncalves DA, Fortes S, Campos M, Ballester D, Portugal FB, Tófoli LF, et al. Evaluation of a mental health training intervention for multidisciplinary teams in primary care in Brazil: a pre-and posttest study. Gen Hosp Psychiatry. 2013;35(3):304-8.

74. Gomes EC. Early detection and brief intervention for the use of risky or harmful drugs: evaluation of barriers to implementation in primary health care in three municipalities in Paraná [dissertação]. Curitiba: Universidade Federal do Paraná; 2008. 109 p. [citado 2020 Dez 22]. Disponível em: http://hdl.handle.net/1884/22733
http://hdl.handle.net/1884/22733...
-7575. Bolsoni E, Heusy I, Silva Z, Padilha M, Rodrigues J. Mental health nursing consultations in primary health care. Rev Eletr Saúde Mental Álcool Drog. 2015;11(4):199-7.)

Table 1
General characterization of included studies, according to data extraction (n = 60)
Chart 1
Mapping of mental health interventions and respective sub-interventions performed by nurses in Primary Health Care in Brazil
Chart 2
Definition of the scope of the 11 interventions mapped in the studies included in the scoping review (n = 60)

Discussion

This scoping review allowed mapping and identifying interventions that are the responsibility of PHC nurses in Brazil. Due to the use of this methodology, the studies included were not subjected to critical evaluation. Therefore, this study did not intend to address the effectiveness of the interventions.

Even though the studies selected were limited to PHC, it was possible to find nursing interventions focused on the mental health population and on the possibilities of improving psychosocial care in the territories. Corroborating these data, the results indicate interventions within the scope of PHC, such as: welcoming, home visits, nursing consultations, referrals, medicalization and health education groups.(1515. Lucchese R, Castro P, Ba S, Rosalem V, Silva A, Andrade M, et al. Professional knowledge in primary health care of the person/family in mental distress: Le Boterf perspective. Rev Esc Enferm USP. 2014;48(Spe 2):123-31.,1717. Fioramonte A, Bressan BF, Silva EM, Nascimento GL, Buriola AA. Health care of mental disorder patients and their family: the nurse role at the fhs. Cien Cuid Saude. 2013;12(2):315-22.,2020. Damasceno VC, Sousa FS. Mental health care for the elderly: the nurse’s perception. Rev Enferm UFPE On Line. 2018;12(10):2710-6.,3535. Correia VR, Barros S, Colvero LD. Mental health in primary health care: practices of the family health team. Rev Esc Enferm USP. 2011;45(6):1501-6.,3838. Lima MA, Rückert TR, Santos JL, Colomé IC, Acosta AM. Atendimento aos usuários em situação de violência: concepções dos profissionais de unidades básicas de saúde. Rev Gaucha Enferm. 2009;30(4):625-32.,4848. Ribeiro LM, Medeiros SM, Albuquerque JS, Fernandes SM. Mental health nursing and the family health strategy: how the nurse is working? Rev Esc Enferm USP. 2010;44(2):376–82.)

The scoping review analysis methodology allows exploring the analysis of concepts. In this context, we can affirm that the interventions found are not restricted to the nurse-patient relationship. These relationships are broad and include families and the community, as, by intervening in mental health situations, nurses are applying the therapeutic function.

The samples show the nurse is able to establish a bond based on mutual trust, welcoming the users, understanding their desires and giving them autonomy.(1010. Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Social Res Methodol. 2005;8(1):19-32.,2424. Souza J, Almeida LY, Luis MA, Nievas AF, Veloso TM, Barbosa SP, et al. Mental health in the Family Health Strategy as perceived by health professionals. Rev Bras Enferm. 2017;70(5):935-41.,4141. Jorge MS, Diniz AM, Lima LL, Penha JC, Jorge MS, Diniz AM, et al. Matrix support, individual therapeutic project and production in mental health care. Texto Contexto Enferm. 2015;24(1):112-20.) Although we mention that bonding is an intervention in mental health, we expanded its concept and concluded that the bond, when established, can be part of all interventions in a responsible and humane manner, especially in complex situations such as in the field of mental health.(3434. Sucigan DH, Toledo VP, Garcia AP. Welcoming and mental health: professional challenge in the family health strategy. Rev Rene. 2012;13(1).,3939. Facundo FR, Castillo MM. Acquisition of alcohol use of in a group of mexican adolescents. Rev Eletr Saúde Mental Álcool Drog. 2005;1(2):1-13.)

In contrast with the concept of welcoming the user with qualified listening and bonding, the findings show that nurses perform reception as a duty and listening as an act of complaint, centered on the disease. This way, the bond is fragile, which limits care, especially for users of alcohol and other drugs.(77. Chaves SC, Nobrega MP, Silva TS. Non-pharmacological interventions offered to the user with a common mental disorder in primary health care. J Nurs Health. 2019;9(3):e199302.,3737. Gonçalves RM, Pedrosa LA. Perfil dos enfermeiros da estratégia saúde da família e suas habilidades para atuar na saúde mental. Cien Cuid Saude. 2009;8(3):345–51.,3939. Facundo FR, Castillo MM. Acquisition of alcohol use of in a group of mexican adolescents. Rev Eletr Saúde Mental Álcool Drog. 2005;1(2):1-13.,4141. Jorge MS, Diniz AM, Lima LL, Penha JC, Jorge MS, Diniz AM, et al. Matrix support, individual therapeutic project and production in mental health care. Texto Contexto Enferm. 2015;24(1):112-20.,4747. Amarante AL, Lepre AS, Gomes JL, Pereira AV, Dutra VF. As estratégias dos enfermeiros para o cuidado em saúde mental no programa saúde da família. Texto Contexto Enferm. 2011;20(1):85-93.)

The limitation of care is identified in studies in which nurses cite as a mental health intervention the act of receiving the mental health patient and referring them to the doctor or to specialized health services, transferring the responsibility of the care and reducing their intervention capacity.(44. Ferreira SR, Périco LA, Dias VR. The complexity of the work of nurses in Primary Health Care. Rev Bras Enferm. 2018;71(Suppl 1):704-9.,1212. Pinto VA. Os sentidos atribuídos pelos profissionais da estratégia saúde da família aos casos de saúde mental [tese]. Rio de Janeiro: Fundação Oswaldo Cruz; 2017. 163 p. [citado 2020 Dez 22]. Disponível em: https://pesquisa.bvsalud.org/portal/resource/pt/int-5238
https://pesquisa.bvsalud.org/portal/reso...
,2020. Damasceno VC, Sousa FS. Mental health care for the elderly: the nurse’s perception. Rev Enferm UFPE On Line. 2018;12(10):2710-6.,2424. Souza J, Almeida LY, Luis MA, Nievas AF, Veloso TM, Barbosa SP, et al. Mental health in the Family Health Strategy as perceived by health professionals. Rev Bras Enferm. 2017;70(5):935-41.,3030. Silva PM, Costa NF, Barros DR, Silva-Júnior JA, Silva JR, Brito TS. Saúde mental na atenção básica: possibilidades e fragilidades do acolhimento. Rev Cuidarte. 2018;10(1):e617.,4444. Oliveira FB, Lima Júnior JF, Silva AO, Silva JC, Guedes HK, Pereira JD. Reconstruindo novos paradigmas do cuidado em saúde mental na estratégia saúde da família. J Nursing UFPE On Line. 2014;8(4):919-26.,3434. Sucigan DH, Toledo VP, Garcia AP. Welcoming and mental health: professional challenge in the family health strategy. Rev Rene. 2012;13(1).,3535. Correia VR, Barros S, Colvero LD. Mental health in primary health care: practices of the family health team. Rev Esc Enferm USP. 2011;45(6):1501-6.,3939. Facundo FR, Castillo MM. Acquisition of alcohol use of in a group of mexican adolescents. Rev Eletr Saúde Mental Álcool Drog. 2005;1(2):1-13.,5555. Magno CS, Rangel TE, Sabóia VM, Cavalcanti VG. Home visit with regard to mental health. Cien Enferm. 2011;17(3):125-36.,5757. Souza AJ, Matias GN, Gomes KF, Parente AC. A saúde mental no Programa de Saúde da Família. Rev Bras Enferm. 2007;60(4):391-5.) These findings are in contradiction with the ability and autonomy of PHC nurses to provide care to users with conditions considered as priority and with the predominant diseases in the territory, since, through the nursing consultation, they can prescribe and request exams, as recommended in technical manuals, except in the case of psychotropic drugs.

The results showed that nursing consultations with a focus on mental health are still incipient.(6161. Penido CM. Analysis of the involvement of supporters and workers of the family health strategy in the matrix support in mental health [tese]. Belo Horizonte: Federal University of Minas Gerais; 2012. 172 p. [citado 2020 Dez 22]. Disponível em: https://repositorio.ufmg.br/handle/1843/GCPA-95YPJF
https://repositorio.ufmg.br/handle/1843/...
,7575. Bolsoni E, Heusy I, Silva Z, Padilha M, Rodrigues J. Mental health nursing consultations in primary health care. Rev Eletr Saúde Mental Álcool Drog. 2015;11(4):199-7.) The nursing process is developed without theoretical references and is restricted to physical examination and anamnesis.(4444. Oliveira FB, Lima Júnior JF, Silva AO, Silva JC, Guedes HK, Pereira JD. Reconstruindo novos paradigmas do cuidado em saúde mental na estratégia saúde da família. J Nursing UFPE On Line. 2014;8(4):919-26.) The analysis of data showed that mental health care is focused on the disease, clinical care and medical diagnosis done by physicians. This reinforces the biomedical conception, reducing care to treatments restricted to medications(3434. Sucigan DH, Toledo VP, Garcia AP. Welcoming and mental health: professional challenge in the family health strategy. Rev Rene. 2012;13(1).,3737. Gonçalves RM, Pedrosa LA. Perfil dos enfermeiros da estratégia saúde da família e suas habilidades para atuar na saúde mental. Cien Cuid Saude. 2009;8(3):345–51.,4646. Duarte EO, Nasi C, Camatta MW, Schneider JF. Characterization of the assistance practices in mental health care networking: an integrative review. Rev Gaúcha Enferm. 2012;33(4):191-9.) and specialized services. Nurses do intervene through the activities determined the Ministry of Health, in specific populations; however, the interventions are influenced by the biomedical model, valuing the clinical findings above other aspects.

The analysis of the mental health interventions with the support of specialized services through matrix support show that the nurse acts as the facilitator of interdisciplinary actions in matrix care.(2222. Campos DB, Bezerra IC, Jorge MS. Mental health care technologies: Primary Care practices and processes. Rev Bras Enferm. 2018;71(Suppl 5):2101-8.,4141. Jorge MS, Diniz AM, Lima LL, Penha JC, Jorge MS, Diniz AM, et al. Matrix support, individual therapeutic project and production in mental health care. Texto Contexto Enferm. 2015;24(1):112-20.,5454. Azevedo DM, Santos AT. Mental health actions in primary care: Knowledge of nurses about the psychiatric reform. J Res Fundamental Care On Line. 2012;4(4):3006–14.) The nurse is in the coordination of PHC teams and has the role of interlocutor between the health service, the family and the user, ensuring that care is provided at different levels of care in the network. Therefore, matrix discussions related to users with mental disorders aim to enhance the relationships between professionals, the division of care and the accountability for the implementation and execution of comprehensive health care, in the logic of psychosocial rehabilitation.(33. Brasil. Ministério da Saúde. Portaria n. 3.088, de 23 de dezembro de 2011. Institui a Rede de Atenção Psicossocial para pessoas com sofrimento ou transtorno mental e com necessidades decorrentes do uso de crack, álcool e outras drogas, no âmbito do Sistema Único de Saúde (SUS). Brasília (DF): Ministério da Saúde; 2011 [cited 2019 Mar 19]. Disponível em: http://bvsms.saude.gov.br/bvs/saudelegis/gm/2011/prt3088_23_12_2011_rep.html
http://bvsms.saude.gov.br/bvs/saudelegis...
,3131. Coelho BP, Silva AP, Souza LP, Silva KM, Silva EP, Pinto IS, et al. Mental health in the work of Nurse the Primary Care of a municipality in Brazil. Rev Cubana Enferm. 2015;31(1):1-14.,3939. Facundo FR, Castillo MM. Acquisition of alcohol use of in a group of mexican adolescents. Rev Eletr Saúde Mental Álcool Drog. 2005;1(2):1-13.,5151. Matumoto S, Manso BT. Nurse’s clinical work: beyond chronic diseases. J Res Fundamental Care On Line. 2015;7(4):3430-41.)

In contrast to the matrix support, the referrals to specialized services are considered by PHC nurses as mental health interventions. The literature showed that this action hinders bonding and co-responsibility and makes it difficult to implement psychosocial rehabilitation in PHC,(33. Brasil. Ministério da Saúde. Portaria n. 3.088, de 23 de dezembro de 2011. Institui a Rede de Atenção Psicossocial para pessoas com sofrimento ou transtorno mental e com necessidades decorrentes do uso de crack, álcool e outras drogas, no âmbito do Sistema Único de Saúde (SUS). Brasília (DF): Ministério da Saúde; 2011 [cited 2019 Mar 19]. Disponível em: http://bvsms.saude.gov.br/bvs/saudelegis/gm/2011/prt3088_23_12_2011_rep.html
http://bvsms.saude.gov.br/bvs/saudelegis...
,1919. Silva PM, Costa NF, Barros DR, Silva-Júnior JA, Silva JR, Brito TS. Saúde mental na atenção básica: possibilidades e fragilidades do acolhimento. Rev Cuidarte. 2018;19;10(1):e617.,2525. Eslabão AD, Coimbra VC, Kantorski LP, Pinho LB, Santos EO. Mental health care network: the views of coordinators of the Family Health Strategy (FHS). Rev Gaucha Enferm. 2017;38(1):e60973.,4242. Souza DA, Dantas AL, Veloso LC, Amorim AM. Atender a los pacientes con trastornos mentales desde la perspectiva de la enfermera de atención primaria. Cultura de los cuidados. 2013;17(37):72-83.,4444. Oliveira FB, Lima Júnior JF, Silva AO, Silva JC, Guedes HK, Pereira JD. Reconstruindo novos paradigmas do cuidado em saúde mental na estratégia saúde da família. J Nursing UFPE On Line. 2014;8(4):919-26.) as it does not follow any established criteria or flowcharts, requiring communication between referral services.(2525. Eslabão AD, Coimbra VC, Kantorski LP, Pinho LB, Santos EO. Mental health care network: the views of coordinators of the Family Health Strategy (FHS). Rev Gaucha Enferm. 2017;38(1):e60973.,4141. Jorge MS, Diniz AM, Lima LL, Penha JC, Jorge MS, Diniz AM, et al. Matrix support, individual therapeutic project and production in mental health care. Texto Contexto Enferm. 2015;24(1):112-20.) These situations are more evident in cases involving users of alcohol and other drugs.(3636. Schneider DR, Lima DS. Implicações dos modelos de atenção à dependência de álcool e outras drogas na rede básica em saúde. Psicol. 2011;42(2):168-78.,4949. Rosenstock KI, Neves MJ. Papel do enfermeiro da atenção básica de saúde na abordagem ao dependente de drogas em João Pessoa, PB, Brasil. Rev Bras Enferm. 2010;63(4):581–6.)

Given the above, we reinforce the need for nurses to re-signify their care practices, transpose their knowledge and be decisive, exploring the possibilities of implementing creative interventions to overcome care gaps in the field of mental health in PHC.(5151. Matumoto S, Manso BT. Nurse’s clinical work: beyond chronic diseases. J Res Fundamental Care On Line. 2015;7(4):3430-41.)

Research addresses the weaknesses and lack of training of nurses, which result in the insecurity of PHC nurses when dealing with mental health demands. This fact may be related to the reduction of the workload of mental and psychiatric health in undergraduate nursing curricula.(5252. Vargas DD, Maciel ME, Bittencourt MN, Lenate JS, Pereira CF. O ensino de enfermagem psiquiátrica e saúde mental no Brasil: análise curricular da graduação. Texto Contexto Enferm. 2018;27(2):2-9.) This impairs the training of generalist nurses in mental health, resulting in nurses with a deficit in knowledge regarding specific mental health issues, which generates insecurity and reduces their ability to perform mental health interventions.

This context can be modified by recognizing the need to increase the workload of mental health and psychiatric content in universities, as it is known that mental health care will be required at all levels of health care, not just in specialized services. In addition to the increased workload, the quality of teaching is of paramount importance since the subject of mental health can often be too abstract for the undergraduate nursing student. Therefore, the use of active teaching-learning methodologies centered on the student, through pedagogical strategies such as the Flipped Classroom, Project Based Learning, Problem Based Learning and dramatization can improve the teaching of mental health at universities. In addition, the use of these strategies in continuing health education (CHE) can increase the self-efficacy of generalist nurses when carrying out mental health interventions.(7676. Lemos AS, Dutra ED, Rezende MD. Tecnologias digitais para a educação permanente em saúde: uma revisão de escopo de experiências nacionais. Porto Alegre: Redeunida; 2021 [citado 2021 Ago 19]. Disponível em: https://www.arca.fiocruz.br/bitstream/icict/47849/2/TECNOLOGIAS%20DIGITAIS%20PARA%20A%20EDUCA%C3%87%C3%83O.pdf
https://www.arca.fiocruz.br/bitstream/ic...
)

In this context, CHE and active teaching-learning methodologies enable PHC nurses to develop theoretical and practical actions in their work environment. This is one of the bets of the Ministry of Health for the implementation of the SUS based on its essential principles: transforming workspaces into spaces for education and learning, which favors the development and transformation of mental health practices.(7777. Brasil. Ministério da Saúde. Secretaria de Gestão do Trabalho e Educação na Saúde. Departamento de Gestão da Educação na Saúde. Política Nacional de Educação Permanente em Saúde. Brasília (DF): Ministério da Saúde; 2009 [citado 2021 Ago 19]. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/politica_nacional_educacao_permanente_saude.pdf
https://bvsms.saude.gov.br/bvs/publicaco...
)

In addition, the results show that there is a possibility of expanding the scope of mental health interventions in PHC, as users and family members recognize nurses as professionals that are trained to support them socially and to meet their psychosocial demands(5050. Furegato F, Regina A, Candido MC, Costa Jr ML. Comparing knowledge and opinions on depression among nurses in the health services. Rev Salud Pública. 2009;11(2):200-11.,5353. Waidman MA, Marcon SS, Pandini A, Bessa JB, Paiano M. Nursing care for people with mental disorders, and their families, in Primary Care. Acta Paul Enferm. 2012;25(3):346–51.,7474. Gomes EC. Early detection and brief intervention for the use of risky or harmful drugs: evaluation of barriers to implementation in primary health care in three municipalities in Paraná [dissertação]. Curitiba: Universidade Federal do Paraná; 2008. 109 p. [citado 2020 Dez 22]. Disponível em: http://hdl.handle.net/1884/22733
http://hdl.handle.net/1884/22733...
). One of these possibilities is the construction of a Singular Therapeutic Project (PTS),(1111. Rocha EN, Lucena AF. Single Therapeutic Project and Nursing Process from an interdisciplinary care perspective. Rev Gaúcha Enferm. 2018;39:e2017-0057.,1717. Fioramonte A, Bressan BF, Silva EM, Nascimento GL, Buriola AA. Health care of mental disorder patients and their family: the nurse role at the fhs. Cien Cuid Saude. 2013;12(2):315-22.) which is developed through case discussions (5151. Matumoto S, Manso BT. Nurse’s clinical work: beyond chronic diseases. J Res Fundamental Care On Line. 2015;7(4):3430-41.) involving users, family members and health professionals. This can be implemented with the help of formal and informal networks, independently of the support of specialists.

The implementation of interventions can value social and family aspects in a therapeutic approach, combined with non-pharmacological resources recommended in PHC. In this sense, the nurse is considered responsible for the co-management of care.(4141. Jorge MS, Diniz AM, Lima LL, Penha JC, Jorge MS, Diniz AM, et al. Matrix support, individual therapeutic project and production in mental health care. Texto Contexto Enferm. 2015;24(1):112-20.,4343. Santos JA. Avaliação do Estabelecimento da Política de Atenção Integral ao Consumidor de Álcool e outras Drogas: um estudo de caso [dissertação]. Maringá: Universidade Estadual de Maringá; 2011.,4444. Oliveira FB, Lima Júnior JF, Silva AO, Silva JC, Guedes HK, Pereira JD. Reconstruindo novos paradigmas do cuidado em saúde mental na estratégia saúde da família. J Nursing UFPE On Line. 2014;8(4):919-26.)In view of this, it is possible to say that the nurses’ interventions in mental health are complex and that they are opposed to promotion and prevention in their usual care practice. These interventions, when found, are mostly individualized. Individual mental health care generates a bottleneck in the work process and work overload of nurses; therefore, it is necessary to implement group interventions.(11. Duarte VF, Lavorato Neto G, Rodrigues L, Campos CJ. Academic sayings from the past and the present about the Nursing Role in the Process and Routine of Deinstitutionalization. Rev Eletr Saúde Mental Álcool Drog. 2016;12(2):116-36.,66. Batista EH, Guedes HC, Júnior JN, Januário DC, Pordeus AC, Pereira VC. Difficulties of nurses in basic care in view mental illness. Rev Enferm UFPE On Line. 2018;12(11):2961-8.,1818. Rangel CT, Miranda FA, Oliveira KK. Communitarian therapy and nursing: the phenomenon and its context. J Res Fundam Care Online. 2016;8(1):3770-9.,2424. Souza J, Almeida LY, Luis MA, Nievas AF, Veloso TM, Barbosa SP, et al. Mental health in the Family Health Strategy as perceived by health professionals. Rev Bras Enferm. 2017;70(5):935-41.,3434. Sucigan DH, Toledo VP, Garcia AP. Welcoming and mental health: professional challenge in the family health strategy. Rev Rene. 2012;13(1).,3535. Correia VR, Barros S, Colvero LD. Mental health in primary health care: practices of the family health team. Rev Esc Enferm USP. 2011;45(6):1501-6.,4343. Santos JA. Avaliação do Estabelecimento da Política de Atenção Integral ao Consumidor de Álcool e outras Drogas: um estudo de caso [dissertação]. Maringá: Universidade Estadual de Maringá; 2011.,4444. Oliveira FB, Lima Júnior JF, Silva AO, Silva JC, Guedes HK, Pereira JD. Reconstruindo novos paradigmas do cuidado em saúde mental na estratégia saúde da família. J Nursing UFPE On Line. 2014;8(4):919-26.,5757. Souza AJ, Matias GN, Gomes KF, Parente AC. A saúde mental no Programa de Saúde da Família. Rev Bras Enferm. 2007;60(4):391-5.,6161. Penido CM. Analysis of the involvement of supporters and workers of the family health strategy in the matrix support in mental health [tese]. Belo Horizonte: Federal University of Minas Gerais; 2012. 172 p. [citado 2020 Dez 22]. Disponível em: https://repositorio.ufmg.br/handle/1843/GCPA-95YPJF
https://repositorio.ufmg.br/handle/1843/...
,6565. Mielke FB. Evaluation of psychosocial care management in family health strategy: with word coordinators [tese]. Porto Alegre: Escola de Enfermagem, Universidade Federal do Rio Grande do Sul; 2013. 218 p. [citado 2020 Dez 22]. Disponível em: https://www.lume.ufrgs.br/handle/10183/79620
https://www.lume.ufrgs.br/handle/10183/7...
)

In this scoping review, health education in PHC is identified as an intervention that occurs in all the healthcare devices in the territory, referred to with different names in the programmed group activities.(1919. Silva PM, Costa NF, Barros DR, Silva-Júnior JA, Silva JR, Brito TS. Saúde mental na atenção básica: possibilidades e fragilidades do acolhimento. Rev Cuidarte. 2018;19;10(1):e617.,2020. Damasceno VC, Sousa FS. Mental health care for the elderly: the nurse’s perception. Rev Enferm UFPE On Line. 2018;12(10):2710-6.,3333. Gonçalves RM, Pedrosa LA, Oliveira MA, Silva QC, Abreu RM, Pinho PH. Promoção da saúde mental: Ações dos enfermeiros inseridos na atenção primária. Rev Port Enferm Saúde Mental. 2013;10(10):49-56.,4747. Amarante AL, Lepre AS, Gomes JL, Pereira AV, Dutra VF. As estratégias dos enfermeiros para o cuidado em saúde mental no programa saúde da família. Texto Contexto Enferm. 2011;20(1):85-93.,6565. Mielke FB. Evaluation of psychosocial care management in family health strategy: with word coordinators [tese]. Porto Alegre: Escola de Enfermagem, Universidade Federal do Rio Grande do Sul; 2013. 218 p. [citado 2020 Dez 22]. Disponível em: https://www.lume.ufrgs.br/handle/10183/79620
https://www.lume.ufrgs.br/handle/10183/7...
,6666. Sobral FR, Campos CJ. Nurses and mental health education in primary care. Rev Eletr Saúde Mental Álcool Drog. 2012;8(2):100-7. Review.) Group consultations to specific populations and/or health conditions are consolidated interventions in PHC. The construction of specific groups for mental health can be therapeutic(3434. Sucigan DH, Toledo VP, Garcia AP. Welcoming and mental health: professional challenge in the family health strategy. Rev Rene. 2012;13(1).,3535. Correia VR, Barros S, Colvero LD. Mental health in primary health care: practices of the family health team. Rev Esc Enferm USP. 2011;45(6):1501-6.) or exclusionary. Therefore, as health groups are already established and encouraged in PHC, nurses are expected to be able to address mental health issues in a comprehensive manner, including people with mental disorders and substance users.(33. Brasil. Ministério da Saúde. Portaria n. 3.088, de 23 de dezembro de 2011. Institui a Rede de Atenção Psicossocial para pessoas com sofrimento ou transtorno mental e com necessidades decorrentes do uso de crack, álcool e outras drogas, no âmbito do Sistema Único de Saúde (SUS). Brasília (DF): Ministério da Saúde; 2011 [cited 2019 Mar 19]. Disponível em: http://bvsms.saude.gov.br/bvs/saudelegis/gm/2011/prt3088_23_12_2011_rep.html
http://bvsms.saude.gov.br/bvs/saudelegis...
,66. Batista EH, Guedes HC, Júnior JN, Januário DC, Pordeus AC, Pereira VC. Difficulties of nurses in basic care in view mental illness. Rev Enferm UFPE On Line. 2018;12(11):2961-8.,7171. Araruna MH, Ferreira Filha MO, Dias MD, Braga LA, Moraes MN, Rocha IA. Formação de terapeutas comunitários na Paraíba: impacto na Estratégia Saúde da Família. Rev Eletr Enferm. 2012;14(1):33-41.)

Integrative and Complementary Practices (PIC) require specific competences and skills that can be acquired through specialization courses recognized by the Ministry of Education (MEC), with a specific amount of hours for each practice.(7878. Conselho Federal de Enfermagem (COFEN). Resolução COFEN Nº 197/1997. Estabelece e reconhece as Terapias Alternativas como especialidade e/ ou qualificação do profissional de Enfermagem. Brasília (DF): COFEN; 1997 [citado 2018 Dez 21]. Disponível em: http://www.cofen.gov.br/resoluo-cofen-1971997_4253.html
http://www.cofen.gov.br/resoluo-cofen-19...

79. Conselho Federal de Enfermagem (COFEN). Resolução COFEN Nº 0500/2015. Revoga, expressamente, a Resolução Cofen nº 197, de 19 de março de 1997, a qual dispõe sobre o estabelecimento e reconhecimento de Terapias Alternativas como especialidade e/ou qualificação do profissional de Enfermagem, e dá outras providências. Brasília (DF): COFEN; 2015 [citado 2018 Dez 21]. Disponível em: http://www.cofen.gov.br/resolucao-cofen-no-05002015_36848.html
http://www.cofen.gov.br/resolucao-cofen-...
-8080. Conselho Federal de Enfermagem (COFEN). Resolução COFEN No 585/2018. Estabelece e reconhece a acupuntura como especialidade e/ou qualificação do profissional de Enfermagem. Brasília (DF): COFEN; 2018 [citado 2018 Dez 21]. Disponível em: http://www.cofen.gov.br/resolucao-cofen-no-585-2018_64784.html
http://www.cofen.gov.br/resolucao-cofen-...
) However, Integrative Community Therapy (TCI) has been proven possible and is becoming a new instrument of mental health care,(4444. Oliveira FB, Lima Júnior JF, Silva AO, Silva JC, Guedes HK, Pereira JD. Reconstruindo novos paradigmas do cuidado em saúde mental na estratégia saúde da família. J Nursing UFPE On Line. 2014;8(4):919-26.) building community spaces with the objective of welcoming users, through a methodology that can add knowledge and help the community members to share their suffering and, in a social perspective, promote therapeutic group meetings and interpersonal relationships.(66. Batista EH, Guedes HC, Júnior JN, Januário DC, Pordeus AC, Pereira VC. Difficulties of nurses in basic care in view mental illness. Rev Enferm UFPE On Line. 2018;12(11):2961-8.,1818. Rangel CT, Miranda FA, Oliveira KK. Communitarian therapy and nursing: the phenomenon and its context. J Res Fundam Care Online. 2016;8(1):3770-9.,4444. Oliveira FB, Lima Júnior JF, Silva AO, Silva JC, Guedes HK, Pereira JD. Reconstruindo novos paradigmas do cuidado em saúde mental na estratégia saúde da família. J Nursing UFPE On Line. 2014;8(4):919-26.,5757. Souza AJ, Matias GN, Gomes KF, Parente AC. A saúde mental no Programa de Saúde da Família. Rev Bras Enferm. 2007;60(4):391-5.,7070. Azevedo EB. Typology of Nurses Therapists Community Perspective in Weber [tese]. João Pessoa: Centro de Ciências da Saúde, Universidade Federal da Paraíba; 2015. 186 p. [citado 2020 Dez 22]. Disponível em: https://repositorio.ufpb.br/jspui/handle/tede/5168
https://repositorio.ufpb.br/jspui/handle...
,7171. Araruna MH, Ferreira Filha MO, Dias MD, Braga LA, Moraes MN, Rocha IA. Formação de terapeutas comunitários na Paraíba: impacto na Estratégia Saúde da Família. Rev Eletr Enferm. 2012;14(1):33-41.)

The TCI is within the competence of nurses, which makes them community therapists that are autonomous and can promote interventions based on social insertion, providing a transforming care that transcends the biomedical model that was instituted since their training and throughout their professional trajectory.(4444. Oliveira FB, Lima Júnior JF, Silva AO, Silva JC, Guedes HK, Pereira JD. Reconstruindo novos paradigmas do cuidado em saúde mental na estratégia saúde da família. J Nursing UFPE On Line. 2014;8(4):919-26.,7171. Araruna MH, Ferreira Filha MO, Dias MD, Braga LA, Moraes MN, Rocha IA. Formação de terapeutas comunitários na Paraíba: impacto na Estratégia Saúde da Família. Rev Eletr Enferm. 2012;14(1):33-41.)

Nurses are trained to meet demands according to health conditions and life cycles, within parameters pre-established in biomedical models, based on technical manuals. Thus, nurses who work in PHC do not need to become mental health specialists, but, as in other situations in health care, their training should allow them to reinvent their psychosocial care practice, giving them the right abilities and increasing their autonomy,(7070. Azevedo EB. Typology of Nurses Therapists Community Perspective in Weber [tese]. João Pessoa: Centro de Ciências da Saúde, Universidade Federal da Paraíba; 2015. 186 p. [citado 2020 Dez 22]. Disponível em: https://repositorio.ufpb.br/jspui/handle/tede/5168
https://repositorio.ufpb.br/jspui/handle...
) expanding clinical care with approaches centered on the person,(5151. Matumoto S, Manso BT. Nurse’s clinical work: beyond chronic diseases. J Res Fundamental Care On Line. 2015;7(4):3430-41.) and valuing their therapeutic role.

Conclusion

This scoping review allowed identifying the interventions in the field of mental health as reported by nurses and consolidated and recommended in PHC. The findings reveal a wide variety of mental health interventions, but also point out that nurses are restricted to welcoming and referring users, transferring the responsibility of care to other services - making this care bureaucratic, fragmented and focused on the biomedical model. Permanent and continuing education should provide the PHC with the skills to intervene in psychosocial care in a competent manner. They also should be able to reduce the gaps associated with the lack of technical and scientific knowledge, especially in matters involving the use of alcohol and other drugs. In this review, we raise possibilities of expanding the scope, identifying that nurses intervene in groups that involve families and communities. Some limitations of this review should be considered, such as the fact that the studies mapped in the Brazilian literature are qualitative, reflective and derived from reviews, which results in the perception of nurses and PHC teams in relation to mental health interventions. Therefore, it is necessary to conduct studies aimed at PHC nurses, with methodologies capable of showing the effectiveness of the interventions identified, for a later validation of mental health competencies. To consolidate psychosocial interventions in PHC, it is necessary to disseminate scientific knowledge and elaborate protocols that support decision-making according to the psychosocial dimensions, without being restricted to the biomedical model, standardizing nurses’ actions in Brazil. Finally, nurses must recognize their therapeutic role in care so they can develop appropriate skills and abilities and use their knowledge to improve psychosocial care in PHC territories.

Referências

  • 1
    Duarte VF, Lavorato Neto G, Rodrigues L, Campos CJ. Academic sayings from the past and the present about the Nursing Role in the Process and Routine of Deinstitutionalization. Rev Eletr Saúde Mental Álcool Drog. 2016;12(2):116-36.
  • 2
    Brasil. Ministério da Saúde. Secretaria de Atenção à Saúde. Departamento de Ações Programáticas Estratégicas. Coordenação Geral de Saúde Mental, Álcool e Outras Drogas. Saúde Mental em Dados – 12, ano 10, nº 12. Brasília (DF): Ministério da Saúde; 2015 [citado 2020 Dez 22]. Disponível em: : https://www.mhinnovation.net/sites/default/files/downloads/innovation/reports/Report_12-edicao-do-Saude-Mental-em-Dados.pdf
    » https://www.mhinnovation.net/sites/default/files/downloads/innovation/reports/Report_12-edicao-do-Saude-Mental-em-Dados.pdf
  • 3
    Brasil. Ministério da Saúde. Portaria n. 3.088, de 23 de dezembro de 2011. Institui a Rede de Atenção Psicossocial para pessoas com sofrimento ou transtorno mental e com necessidades decorrentes do uso de crack, álcool e outras drogas, no âmbito do Sistema Único de Saúde (SUS). Brasília (DF): Ministério da Saúde; 2011 [cited 2019 Mar 19]. Disponível em: http://bvsms.saude.gov.br/bvs/saudelegis/gm/2011/prt3088_23_12_2011_rep.html
    » http://bvsms.saude.gov.br/bvs/saudelegis/gm/2011/prt3088_23_12_2011_rep.html
  • 4
    Ferreira SR, Périco LA, Dias VR. The complexity of the work of nurses in Primary Health Care. Rev Bras Enferm. 2018;71(Suppl 1):704-9.
  • 5
    Pereira AA, Reinaldo AM, Andrade DC. Proposta educativa em saúde mental para enfermeiros da atenção primária à saúde. Rev Políticas Públicas. 2015;14(2):17;26.
  • 6
    Batista EH, Guedes HC, Júnior JN, Januário DC, Pordeus AC, Pereira VC. Difficulties of nurses in basic care in view mental illness. Rev Enferm UFPE On Line. 2018;12(11):2961-8.
  • 7
    Chaves SC, Nobrega MP, Silva TS. Non-pharmacological interventions offered to the user with a common mental disorder in primary health care. J Nurs Health. 2019;9(3):e199302.
  • 8
    Neves HG, Lucchese R, Munari DB. Mental health in primary attention: needed constitution of competences. Rev Bras Enferm. 2010;63(4):666-70.
  • 9
    Peters MD, Godfrey C, McInerney P, Baldini Soares C, Khalil H, Parker D. Chapter 11: scoping reviews. Joanna Briggs Institute Reviewer’s Manual. Adelaide: The Joanna Briggs Institute; 2017 [cited 2021 Dec 22]. Available from: https://synthesismanual.jbi.global.https://doi.org/10.46658/JBIMES-20-12
    » https://synthesismanual.jbi.global.https://doi.org/10.46658/JBIMES-20-12
  • 10
    Arksey H, O’Malley L. Scoping studies: towards a methodological framework. Int J Social Res Methodol. 2005;8(1):19-32.
  • 11
    Rocha EN, Lucena AF. Single Therapeutic Project and Nursing Process from an interdisciplinary care perspective. Rev Gaúcha Enferm. 2018;39:e2017-0057.
  • 12
    Pinto VA. Os sentidos atribuídos pelos profissionais da estratégia saúde da família aos casos de saúde mental [tese]. Rio de Janeiro: Fundação Oswaldo Cruz; 2017. 163 p. [citado 2020 Dez 22]. Disponível em: https://pesquisa.bvsalud.org/portal/resource/pt/int-5238
    » https://pesquisa.bvsalud.org/portal/resource/pt/int-5238
  • 13
    Martins AK. Saúde mental na estratégia saúde da família: estudo sobre as competências de enfermeiros [tese]. Fortaleza: Universidade Federal do Ceará; 2014. 188 p. [citado 2020 Dez 22]. Disponível em: http://www.repositorio.ufc.br/handle/riufc/9208
    » http://www.repositorio.ufc.br/handle/riufc/9208
  • 14
    Jorge MS, Vasconcelos MG, Junior EF, Barreto LA, Rosa LR, Lima LL, et al. Solvability of mental health care in the Family Health Strategy: social representation of professionals and users. Rev Esc Enferm USP. 2014;48(6):1060-6.
  • 15
    Lucchese R, Castro P, Ba S, Rosalem V, Silva A, Andrade M, et al. Professional knowledge in primary health care of the person/family in mental distress: Le Boterf perspective. Rev Esc Enferm USP. 2014;48(Spe 2):123-31.
  • 16
    Azevedo DM, Guimarães FJ, Dantas JF, Rocha TM. Atenção básica e saúde mental: um diálogo e articulação necessários. Rev APS. 2014;17(4):537-43.
  • 17
    Fioramonte A, Bressan BF, Silva EM, Nascimento GL, Buriola AA. Health care of mental disorder patients and their family: the nurse role at the fhs. Cien Cuid Saude. 2013;12(2):315-22.
  • 18
    Rangel CT, Miranda FA, Oliveira KK. Communitarian therapy and nursing: the phenomenon and its context. J Res Fundam Care Online. 2016;8(1):3770-9.
  • 19
    Silva PM, Costa NF, Barros DR, Silva-Júnior JA, Silva JR, Brito TS. Saúde mental na atenção básica: possibilidades e fragilidades do acolhimento. Rev Cuidarte. 2018;19;10(1):e617.
  • 20
    Damasceno VC, Sousa FS. Mental health care for the elderly: the nurse’s perception. Rev Enferm UFPE On Line. 2018;12(10):2710-6.
  • 21
    Santana TF, Pereira MA. Mental health care in primary care: a cartography. Rev Enfermagem UERJ. 2018;26:e32305.
  • 22
    Campos DB, Bezerra IC, Jorge MS. Mental health care technologies: Primary Care practices and processes. Rev Bras Enferm. 2018;71(Suppl 5):2101-8.
  • 23
    Subrinho LQ, Sena EL, Santos VT, Carvalho PA. Cuidado ao consumidor de drogas: percepção de enfermeiros da Estratégia de Saúde da Família. Saude Soc. 2018;27(3):834-44.
  • 24
    Souza J, Almeida LY, Luis MA, Nievas AF, Veloso TM, Barbosa SP, et al. Mental health in the Family Health Strategy as perceived by health professionals. Rev Bras Enferm. 2017;70(5):935-41.
  • 25
    Eslabão AD, Coimbra VC, Kantorski LP, Pinho LB, Santos EO. Mental health care network: the views of coordinators of the Family Health Strategy (FHS). Rev Gaucha Enferm. 2017;38(1):e60973.
  • 26
    Mesquita, KSF. Flow chart of support for decision making for the nursing care person in psychic suffering in primary care [dissertação]. Maceió: Universidade Federal de Alagoas; 2016. 162 p. [citado 2020 Dez 22]. Disponível em: http://www.repositorio.ufal.br/handle/riufal/3278
    » http://www.repositorio.ufal.br/handle/riufal/3278
  • 27
    Paiva DC. The Family Health Teams daily experience of caring of patients under psychological distress [dissertação]. São Paulo: Escola de Enfermagem, Universidade de São Paulo; 2015. 99 p. [citado 2020 Dez 22]. Disponível em: https://teses.usp.br/teses/disponiveis/7/7144/tde-11012016-134535/pt-br.php
    » https://teses.usp.br/teses/disponiveis/7/7144/tde-11012016-134535/pt-br.php
  • 28
    Merces AM, Souza BM, Silva TL, Silva TT, Cavalcanti AM. Nursing practices in mental health in the family health strategy: an integrative review. Cogitare Enferm. 2015;20 (2):413-21.
  • 29
    Silva JA, Ferreira LA, Zuffi FB, Cardoso RJ, Rezende MP, Mendonça GS, et al. Psychiatric client embracement on primary health care. Biosci J. 2015;31(4).
  • 30
    Silva PM, Costa NF, Barros DR, Silva-Júnior JA, Silva JR, Brito TS. Saúde mental na atenção básica: possibilidades e fragilidades do acolhimento. Rev Cuidarte. 2018;10(1):e617.
  • 31
    Coelho BP, Silva AP, Souza LP, Silva KM, Silva EP, Pinto IS, et al. Mental health in the work of Nurse the Primary Care of a municipality in Brazil. Rev Cubana Enferm. 2015;31(1):1-14.
  • 32
    Pelisoli C, Sacco AM, Barbosa ET, Pereira CD, Cecconello AM. Acolhimento em saúde: uma revisão sistemática em periódicos brasileiros. Estud Psicol. 2014;31(2):225-35.
  • 33
    Gonçalves RM, Pedrosa LA, Oliveira MA, Silva QC, Abreu RM, Pinho PH. Promoção da saúde mental: Ações dos enfermeiros inseridos na atenção primária. Rev Port Enferm Saúde Mental. 2013;10(10):49-56.
  • 34
    Sucigan DH, Toledo VP, Garcia AP. Welcoming and mental health: professional challenge in the family health strategy. Rev Rene. 2012;13(1).
  • 35
    Correia VR, Barros S, Colvero LD. Mental health in primary health care: practices of the family health team. Rev Esc Enferm USP. 2011;45(6):1501-6.
  • 36
    Schneider DR, Lima DS. Implicações dos modelos de atenção à dependência de álcool e outras drogas na rede básica em saúde. Psicol. 2011;42(2):168-78.
  • 37
    Gonçalves RM, Pedrosa LA. Perfil dos enfermeiros da estratégia saúde da família e suas habilidades para atuar na saúde mental. Cien Cuid Saude. 2009;8(3):345–51.
  • 38
    Lima MA, Rückert TR, Santos JL, Colomé IC, Acosta AM. Atendimento aos usuários em situação de violência: concepções dos profissionais de unidades básicas de saúde. Rev Gaucha Enferm. 2009;30(4):625-32.
  • 39
    Facundo FR, Castillo MM. Acquisition of alcohol use of in a group of mexican adolescents. Rev Eletr Saúde Mental Álcool Drog. 2005;1(2):1-13.
  • 40
    Silva AT, Silva CC, Ferreira Filha MO, Nóbrega MM, Barros S, Santos KK. Mental health in the PSF and the work of nursing. Rev Bras Enferm. 2005;58(4):411–5.
  • 41
    Jorge MS, Diniz AM, Lima LL, Penha JC, Jorge MS, Diniz AM, et al. Matrix support, individual therapeutic project and production in mental health care. Texto Contexto Enferm. 2015;24(1):112-20.
  • 42
    Souza DA, Dantas AL, Veloso LC, Amorim AM. Atender a los pacientes con trastornos mentales desde la perspectiva de la enfermera de atención primaria. Cultura de los cuidados. 2013;17(37):72-83.
  • 43
    Santos JA. Avaliação do Estabelecimento da Política de Atenção Integral ao Consumidor de Álcool e outras Drogas: um estudo de caso [dissertação]. Maringá: Universidade Estadual de Maringá; 2011.
  • 44
    Oliveira FB, Lima Júnior JF, Silva AO, Silva JC, Guedes HK, Pereira JD. Reconstruindo novos paradigmas do cuidado em saúde mental na estratégia saúde da família. J Nursing UFPE On Line. 2014;8(4):919-26.
  • 45
    Valeria Ozorio S. Atenção à saúde mental na Estratégia Saúde da Família no município de Parnamirim / RN: a opinião de profissionais, pessoas com transtorno mental e seus cuidadores [tese]. Natal: Universidade Federal do Rio Grande do Norte; 2012. 162 p.
  • 46
    Duarte EO, Nasi C, Camatta MW, Schneider JF. Characterization of the assistance practices in mental health care networking: an integrative review. Rev Gaúcha Enferm. 2012;33(4):191-9.
  • 47
    Amarante AL, Lepre AS, Gomes JL, Pereira AV, Dutra VF. As estratégias dos enfermeiros para o cuidado em saúde mental no programa saúde da família. Texto Contexto Enferm. 2011;20(1):85-93.
  • 48
    Ribeiro LM, Medeiros SM, Albuquerque JS, Fernandes SM. Mental health nursing and the family health strategy: how the nurse is working? Rev Esc Enferm USP. 2010;44(2):376–82.
  • 49
    Rosenstock KI, Neves MJ. Papel do enfermeiro da atenção básica de saúde na abordagem ao dependente de drogas em João Pessoa, PB, Brasil. Rev Bras Enferm. 2010;63(4):581–6.
  • 50
    Furegato F, Regina A, Candido MC, Costa Jr ML. Comparing knowledge and opinions on depression among nurses in the health services. Rev Salud Pública. 2009;11(2):200-11.
  • 51
    Matumoto S, Manso BT. Nurse’s clinical work: beyond chronic diseases. J Res Fundamental Care On Line. 2015;7(4):3430-41.
  • 52
    Vargas DD, Maciel ME, Bittencourt MN, Lenate JS, Pereira CF. O ensino de enfermagem psiquiátrica e saúde mental no Brasil: análise curricular da graduação. Texto Contexto Enferm. 2018;27(2):2-9.
  • 53
    Waidman MA, Marcon SS, Pandini A, Bessa JB, Paiano M. Nursing care for people with mental disorders, and their families, in Primary Care. Acta Paul Enferm. 2012;25(3):346–51.
  • 54
    Azevedo DM, Santos AT. Mental health actions in primary care: Knowledge of nurses about the psychiatric reform. J Res Fundamental Care On Line. 2012;4(4):3006–14.
  • 55
    Magno CS, Rangel TE, Sabóia VM, Cavalcanti VG. Home visit with regard to mental health. Cien Enferm. 2011;17(3):125-36.
  • 56
    Oliveira FB, Silva JC, Silva VH, Cartaxo CK. The mental health nursing work in the Family Health Strategy. Rev Rene. 2011;12(2):229-37.
  • 57
    Souza AJ, Matias GN, Gomes KF, Parente AC. A saúde mental no Programa de Saúde da Família. Rev Bras Enferm. 2007;60(4):391-5.
  • 58
    Rosa WA, Labate RC. A contribuição da saúde mental para o desenvolvimento do PSF. Rev Bras Enferm. 2003;56(3):230-5.
  • 59
    Jorge MS, Sousa FS, Franco TB. Apoio matricial: dispositivo para resolução de casos clínicos em saúde mental na atenção básica. Rev Bras Enferm. 2013;66(5):738-44.
  • 60
    Prates MM, Garcia VG, Moreno DM. Support team and collective elaboration of the Mental Healthcare work within the Family Health Program: space of discussion and care. Saude Soc. 2013;22(2):642-52.
  • 61
    Penido CM. Analysis of the involvement of supporters and workers of the family health strategy in the matrix support in mental health [tese]. Belo Horizonte: Federal University of Minas Gerais; 2012. 172 p. [citado 2020 Dez 22]. Disponível em: https://repositorio.ufmg.br/handle/1843/GCPA-95YPJF
    » https://repositorio.ufmg.br/handle/1843/GCPA-95YPJF
  • 62
    Souza J, Luis MA. Demands of mental health: nurses’ perceptions of family health teams. Acta Paul Enferm. 2012;25(6):852-8.
  • 63
    Neves HG, Lucchese R, Munari DB, Vera I, Santana FR. The process of formation of mental health for nurses in primary health care. Rev Rene. 2012;13(1):53-63.
  • 64
    Nóbrega MP, Fernandes MF, Silva PF. Application of the therapeutic relationship to people with common mental disorder. Rev Gaúcha Enferm. 2017;38(1):e63562.
  • 65
    Mielke FB. Evaluation of psychosocial care management in family health strategy: with word coordinators [tese]. Porto Alegre: Escola de Enfermagem, Universidade Federal do Rio Grande do Sul; 2013. 218 p. [citado 2020 Dez 22]. Disponível em: https://www.lume.ufrgs.br/handle/10183/79620
    » https://www.lume.ufrgs.br/handle/10183/79620
  • 66
    Sobral FR, Campos CJ. Nurses and mental health education in primary care. Rev Eletr Saúde Mental Álcool Drog. 2012;8(2):100-7. Review.
  • 67
    Guedes TG. Matrices of care in family planning for women with mental disorder [tese]. Fortaleza: Faculdade de Farmácia, Odontologia e Enfermagem, Universidade Federal do Ceará; 2011. 123 p. [citado 2020 Dez 22]. Disponível em: http://www.repositorio.ufc.br/handle/riufc/2152
    » http://www.repositorio.ufc.br/handle/riufc/2152
  • 68
    Koga M, Furegato AR, Santos JL. Opinions of the staff and users about the quality of the mental health care delivered at a family health program. Rev Lat Am Enfermagem. 2006;14(2):163-9.
  • 69
    Carvalho JL, Nóbrega MP. Complementary therapies as resources for mental health in Primary Health Care. Rev Gaúcha Enferm. 2017;38(4):e2017-0014.
  • 70
    Azevedo EB. Typology of Nurses Therapists Community Perspective in Weber [tese]. João Pessoa: Centro de Ciências da Saúde, Universidade Federal da Paraíba; 2015. 186 p. [citado 2020 Dez 22]. Disponível em: https://repositorio.ufpb.br/jspui/handle/tede/5168
    » https://repositorio.ufpb.br/jspui/handle/tede/5168
  • 71
    Araruna MH, Ferreira Filha MO, Dias MD, Braga LA, Moraes MN, Rocha IA. Formação de terapeutas comunitários na Paraíba: impacto na Estratégia Saúde da Família. Rev Eletr Enferm. 2012;14(1):33-41.
  • 72
    Silva P, Nóbrega M, Oliveira E. Knowledge of the nursing team and community agents on suicide behavior. Rev Enferm UFPE On Line. 2018;12(1):112-17.
  • 73
    Goncalves DA, Fortes S, Campos M, Ballester D, Portugal FB, Tófoli LF, et al. Evaluation of a mental health training intervention for multidisciplinary teams in primary care in Brazil: a pre-and posttest study. Gen Hosp Psychiatry. 2013;35(3):304-8.
  • 74
    Gomes EC. Early detection and brief intervention for the use of risky or harmful drugs: evaluation of barriers to implementation in primary health care in three municipalities in Paraná [dissertação]. Curitiba: Universidade Federal do Paraná; 2008. 109 p. [citado 2020 Dez 22]. Disponível em: http://hdl.handle.net/1884/22733
    » http://hdl.handle.net/1884/22733
  • 75
    Bolsoni E, Heusy I, Silva Z, Padilha M, Rodrigues J. Mental health nursing consultations in primary health care. Rev Eletr Saúde Mental Álcool Drog. 2015;11(4):199-7.
  • 76
    Lemos AS, Dutra ED, Rezende MD. Tecnologias digitais para a educação permanente em saúde: uma revisão de escopo de experiências nacionais. Porto Alegre: Redeunida; 2021 [citado 2021 Ago 19]. Disponível em: https://www.arca.fiocruz.br/bitstream/icict/47849/2/TECNOLOGIAS%20DIGITAIS%20PARA%20A%20EDUCA%C3%87%C3%83O.pdf
    » https://www.arca.fiocruz.br/bitstream/icict/47849/2/TECNOLOGIAS%20DIGITAIS%20PARA%20A%20EDUCA%C3%87%C3%83O.pdf
  • 77
    Brasil. Ministério da Saúde. Secretaria de Gestão do Trabalho e Educação na Saúde. Departamento de Gestão da Educação na Saúde. Política Nacional de Educação Permanente em Saúde. Brasília (DF): Ministério da Saúde; 2009 [citado 2021 Ago 19]. Disponível em: https://bvsms.saude.gov.br/bvs/publicacoes/politica_nacional_educacao_permanente_saude.pdf
    » https://bvsms.saude.gov.br/bvs/publicacoes/politica_nacional_educacao_permanente_saude.pdf
  • 78
    Conselho Federal de Enfermagem (COFEN). Resolução COFEN Nº 197/1997. Estabelece e reconhece as Terapias Alternativas como especialidade e/ ou qualificação do profissional de Enfermagem. Brasília (DF): COFEN; 1997 [citado 2018 Dez 21]. Disponível em: http://www.cofen.gov.br/resoluo-cofen-1971997_4253.html
    » http://www.cofen.gov.br/resoluo-cofen-1971997_4253.html
  • 79
    Conselho Federal de Enfermagem (COFEN). Resolução COFEN Nº 0500/2015. Revoga, expressamente, a Resolução Cofen nº 197, de 19 de março de 1997, a qual dispõe sobre o estabelecimento e reconhecimento de Terapias Alternativas como especialidade e/ou qualificação do profissional de Enfermagem, e dá outras providências. Brasília (DF): COFEN; 2015 [citado 2018 Dez 21]. Disponível em: http://www.cofen.gov.br/resolucao-cofen-no-05002015_36848.html
    » http://www.cofen.gov.br/resolucao-cofen-no-05002015_36848.html
  • 80
    Conselho Federal de Enfermagem (COFEN). Resolução COFEN No 585/2018. Estabelece e reconhece a acupuntura como especialidade e/ou qualificação do profissional de Enfermagem. Brasília (DF): COFEN; 2018 [citado 2018 Dez 21]. Disponível em: http://www.cofen.gov.br/resolucao-cofen-no-585-2018_64784.html
    » http://www.cofen.gov.br/resolucao-cofen-no-585-2018_64784.html

Edited by

Associate Editor (Peer review process): Thiago da Silva Domingos (https://orcid.org/0000-0002-1421-7468) Escola Paulista de Enfermagem, Universidade Federal de São Paulo, SP, Brazil

Publication Dates

  • Publication in this collection
    29 Aug 2022
  • Date of issue
    2022

History

  • Received
    05 June 2021
  • Accepted
    07 Dec 2021
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