Scientific production of mental health nursing using phenomenology’s theoretical framework

Producción científica en enfermería de salud mental bajo el marco fenomenológico

ABSTRACT

Objective:

To map and characterize the studies produced by stricto sensu postgraduate programs on mental health nursing care using the theoretical framework of phenomenology.

Method:

Bibliographic, retrospective, and descriptive research, carried out in October 2022 using the Catalog of Theses and Dissertations of the Coordination for the Improvement of Higher Education Personnel as a data source. The search strategy associated the term “phenomenology” with the Boolean operator “AND” and the descriptor “Mental Health”.

Results:

22 studies were identified, 15 were MS dissertations and (68%) and 7 (32%) were PhD theses. The main phenomenological framework was the work of Schütz.

Final considerations:

The scientific production of nursing in mental health, in the light of phenomenology, is highly variable. Although still incipient, the interest in' phenomenology’s framework illuminates new perspectives for paradigms of care that value users' singularities and potentialities.

Keywords:
Nursing; Mental health; Nursing research

RESUMEN

Objetivo:

Mapear y caracterizar los estudios producidos por programas de posgrado stricto sensu sobre el cuidado de enfermería en salud mental utilizando el marco teórico de la fenomenología.

Método:

Investigación bibliográfica, retrospectiva y descriptiva, realizada en octubre de 2022, utilizando como fuente de datos el Catálogo de Tesis y Disertaciones de la Coordinación para el Perfeccionamiento del Personal de Educación Superior. Para la estrategia de búsqueda se utilizó el término libre “fenomenología”, asociado al operador booleano "AND" y al descriptor "Salud Mental".

Resultados:

Se identificaron 22 estudios, de los cuales 15 (68%) eran disertaciones de maestría y 7 (32%) eran tesis doctorales. Hubo un predominio del pensamiento de Schütz como referencia fenomenológica.

Consideraciones finales:

Las producciones científicas de la enfermería en salud mental a la luz de la fenomenología reflejan un panorama oscilante. Aunque todavía incipiente, el interés por el marco teórico de la fenomenología ilumina las perspectivas de un paradigma de atención que valora las singularidades y potencialidades de los usuarios.

Palabras clave:
Enfermería; Salud mental; Investigación en enfermería

RESUMO

Objetivo:

Mapear e caracterizar os estudos produzidos pelos programas de pós-graduação stricto sensu acerca do cuidado de enfermagem em saúde mental a partir do arcabouço teórico da fenomenologia.

Método:

Pesquisa bibliográfica, retrospectiva e descritiva, realizada em outubro de 2022, tendo como fonte de dados o Catálogo de Teses e Dissertações da Coordenação de Aperfeiçoamento de Pessoal de Nível Superior. Para a estratégia de busca, utilizou-se o termo livre “fenomenologia” associado ao operador booleano “AND” e ao descritor “Saúde Mental”.

Resultados:

Identificaram-se 22 estudos, destes, 15 (68%) foram do tipo dissertação e sete (32%), teses de doutoramento. Houve predominância do pensamento de Schütz como referencial fenomenológico.

Considerações finais:

As produções científicas de enfermagem em saúde mental à luz da fenomenologia refletem um panorama oscilante. Embora ainda incipiente, o interesse pelo arcabouço de fenomenologia acende perspectivas para um paradigma de cuidado que valorize as singularidades e potencialidades dos usuários.

Palavras-chave:
Enfermagem; Saúde mental; Pesquisa em enfermagem

INTRODUCTION

In the field of mental health, changes in psychiatric health care around the world influenced a Psychiatric Reform in Brazil, which was carried out in the 1970s by mental health and institutional assistance workers. At the time, several reports emerged about their work conditions, including mistreatment, ineffective therapies, and precarious facilities1^,2. This reform was only made official with the approval of Federal Law No. 10.216/2001, which stipulates the protection and rights of mental health users, reorienting the health care model3.

As a way to consolidate the deinstitutionalization and the expansion of the services that would replace these institutions, ministerial orders were instituted to broaden, implement, and guarantee effective changes in mental health treatments, which led to the creation of the Psychosocial Care Network (RAPS)4^,5.

Studies showed that mental health services with prescriptive and disciplinary measures; however, they emphasize that the transformations brought by the Psychiatric Reform in Brazil and in the world reoriented mental health care using policies to humanize and value the user, which enabled practices in accordance with the principles and meta-paradigms of this field of knowledge, of the Single Health System (SUS), and of humanization policies6.

In this regard, this overview collaborated to reorient the role of the nurse in the field of mental health, leading them to adopt care practices whose fulcrum is the therapeutic relationship with the user. Furthermore, the need for changes in the field of assistance facilitated the reorganization of the work process of the workers involved in providing health care to persons in mental distress.

Currently, the use of the Nursing Process is considered to be an important work tool, a powerful instrument that contributes to be reflective and critical in one's practice, enabling systematized and individualized nursing care7^,8.

In this context, investments were focused on a new idea of care, based on practices to replace the asylum model. These recognized the user as a biopsychosocial being, a citizen with rights, who demands a more comprehensive look, one that goes beyond the aspects related with the disease7. We believe that, as one plans a form of care, one must have a practical plan, which must include both the person who is cared for, and the person who provides that care, since this situation involves the existential sphere, which is associated with interpersonal relationships and lived experience. Therefore, assuming a perspective of coexistence implies in a form of participation, since care is a process of joint construction9.

Thus, when nurses favor interpersonal and intersubjective relationships, they recognize these elements as essential for the practice of care, and, also, for the production of new knowledge10. In this regard, phenomenology provides us with knowledge that enables the construction of meaning from lived experience, and, as a result, has been used in investigations in the field of nursing, especially when it comes to mental health.

Consequently, the relevance of this study is in the need to discover the production of knowledge regarding mental health as associated with phenomenology references, providing support for an understanding of the state of the art, and observing its peculiarities and applications.

To do so, we propose the following research question: What are the characteristics of scientific production from stricto sensu post-graduation programs in nursing about nursing in mental health in the light of phenomenology? Our objective was to map and characterize studies produced by stricto sensu post-graduation programs in nursing about nursing in mental health in the light of phenomenology's theoretical framework.

By producing this overview, we hope to aid the development of phenomenological studies, which can promote better practices in nursing, giving support to other forms of care, especially in mental health.

METHOD

This is a bibliographic, retrospective, and descriptive research. Data collection took place in October 2022, and used as a data source the Database of Theses and Dissertations from the Coordination for Higher Education Personnel Improvement (CAPES), which gathers theses and dissertations from post-graduation programs in the country. The search strategy was the association of the term "phenomenology" in association with the Boolean operator "AND" and with the descriptor "Mental Health".

This study followed seven stages: 1) the subject was determined; 2) literature revision; 3) research question and objective design; 4) elaboration of the research protocol; 4) elaboration of the research protocol; 5) data collection; 6) analysis; 7) synthesis with presentation of the results11.

Inclusion criteria consider works from the nursing field, in nursing care in the light of phenomenology, and publications available in full. We considered studies regardless of year of publication, owning to the scarcity of studies on the topic. We excluded works which, despite being found in our research, were not available in full in the platforms and whose authors did not send us the complete work, as well as duplicates, and publications unrelated with our subject of interest: studies whose participants were under psychic distress, and/or health workers who care for patients in psychic distress, and/or services that are part of the Psychosocial Care Network. The protocol of this research was registered on the Open Science Framework (OSF) (doi: https://doi.org/10.17605/OSF.IO/K9USQ).

For data collection, tables created in a Microsoft Excel® spreadsheet were used, in order to orient data and allow for a synthesis. The spreadsheet contained the following information: author, title, type of course, year of publication, post-graduation program, Higher Education Institution (HEI), city and state of the HEI, topics addressed, philosophical framework, participants, and research abstract with goals and research results.

The search found 30 studies, two of which were excluded after a triage. One was excluded as it was unavailable in the platform, and another because it was a duplicate. After these exclusions, we were left with 28 works, whose abstracts were skimmed to ascertain whether they were related with the goals of our study. Therefore, after the exclusion of works which were not in line with the objectives of this research, we selected 22 documents, which formed the final sample. We organized these documents in a matrix using Microsoft Excel®, with the following information: type of study, period of publication, territory distribution, context and topics, theoretical framework, and participants.

Two authors of this study analyzed data from the initial survey independently, until the final sample was formed. A third author worked as mediator to reach a consensus in cases where the two responsible for data analysis disagreed.

To analyze and interpret data, we used content analysis, including a stage of pre-analysis, with data organization, followed by the exploration of materials. Then, we treated the results, generated interpretations which were the origin of the findings below12. This study did not require appreciation from an Ethics Committee, as it only used public data, available and free-to-access platforms. Nonetheless, all ethical and copyright aspects were respected13.

RESULTS

The sample of this study included production from 2001 to 2020. Details about the studies included in our sample is in Figure 1.

The CAPES Database of Thesis and Dissertations showed that nursing post-graduation programs produced 22 studies involving the topic of nursing care, focused on mental health with a phenomenological approach, representing approximately 73% of the total studies consulted in the platform, from the perspective of phenomenology, in the field of knowledge of nursing. 15 (65%) of these publications were MS dissertations, while 7 (32%)were PhD theses, as Figure 1 shows.

Figure 1 -
Included studies, published in the CAPES Database of Thesis and Dissertations regarding nursing care in mental health with a phenomenological framework. Salvador, Bahia, Brazil, 2022

Chart 1, below, shows the synthesis of the findings, including authors, titles, course, year of publication, and federative unit (FU).

Chart 1 -
Synaptic table of the sample of the study. Salvador, Bahia, Brazil, 2022

Author	Title	Type	Year of publication	FU
Monteiro, Ana Ruth Macêdo	The family of the problem-child at school: sociological phenomenology applied to nursing	Thesis	2001	Ceará
Campoy, Marcos Antonio	The teaching of nursing in mental and psychiatric health: the point of view of social phenomenology from the perspective of professors and students	Thesis	2003	São Paulo
Souza, Luciana Gomes Almeida de	Caring for children with mental disabilities: unveiling the experiences of parents in their being-with-the-son	Dissertation	2003	São Paulo
Santana, Maria Teresa Brito Mariotti de	The meaning and the significance of the body of the health worker as they care for a dying other	Thesis	2005	Ceará
Guimarães, Jacileide	About time: praise for the denied institution	Thesis	2006	São Paulo
Chagas, Natália Rocha	The family caregiver and the care for children with cancer receiving chemotherapy at home: a social phenomenology approach	Dissertation	2006	Ceará
Vargas, Ma.Guadalupe Ojeda	The experience of nurses in the care to the hospitalized terminal elder - a phenomenological perspective	Thesis	2007	São Paulo
Nogueira, Mariana Lima	Nursing practices in a psychiatric hospital and the process of deinstitutionalization in the context of mental health	Dissertation	2008	Rio de Janeiro
Furlan, Marcela Martins	The meaning of being hospitalized in a psychiatric hospital in the light of Heidegger's phenomenology	Dissertation	2008	São Paulo
Lanza, Lara de Faria	Being a child with cancer in the last stages of treatment - their perspective about the future	Dissertation	2009	São Paulo
Silva, Máguida Gomes da	Clinical care to children and adolescents in psychic distress at the CAPSi	Dissertation	2009	Ceará
Silva, Kely Vanessa Leite Gomes da	Providing attention to the family of adults in psychic distress: a challenge for nursing care	MS	2010	Ceará
Mello, Rita Mello de	Psychiatric hospitalization in general hospitals: what it means for the family	Dissertation	2010	Rio Grande do Sul
Camatta, Marcio Wagner	Mental health-focused actions in the family health strategy: team goals and expectations of users and families	Thesis	2010	Rio Grande do Sul
Távora, Rafaela Carolini de Oliveira	The typical family of children and adolescents under psychic distress - reflections for clinical nursing care	Dissertation	2011	Ceará
Machineski, Gicelle Galvan	Time spent by the families of users in a center for child psychosocial care	Thesis	2011	Rio Grande do Sul
Silva, Adao Ademir da	The self-care of mental health nursing workers	Dissertation	2011	Rio Grande do Sul
Tavares, Suzane de Fátima do Vale	Experiences in care at the Center for Children and Adolescent Psychosocial Care: family motivation and professionals	Dissertation	2012	Ceará
Freitas, Fernanda Franceshi de	Meanings attributed by the family to the discharge of the person with mental disorder	Dissertation	2012	Rio Grande do Sul
Biffi, Debora	Center for Alcohol and Other Drugs Psychosocial Care from the perspective of the user: subsidies to improve nursing consultations	Dissertation	2014	Rio Grande do Sul
Oliveira, Andressa de	The meaning of patient Safety to the Multiprofessional Team of a Psychiatric Hospitalization Unit at a General Hospital: study supported by Social Phenomenology	Dissertation	2018	São Paulo
Limeira, Caren Santos	The family of the users: perceptions of workers from the Center for Alcohol and Other Drugs Psychosocial Care	Dissertation	2020	Bahia

• Source: Research data, 2022.

The frequency of productions was quite inconstant in the period analyzed (Graph 1), mostly focused in the years of 2010 and 2011, with six studies, three in each. The years of 2003, 2006, 2008, 2009, and 2012 follow, with two publications each year. The years of 2001, 2005, 2007, 2014, 2018, and 2020 presented, each, a single publication. There were no studies in accordance with our objective in other years.

Graph 1 -
Percentage of studies, published in the CAPES Database of Thesis and Dissertations regarding nursing care in mental health, according with phenomenological framework and year of publication. Salvador, Bahia, Brazil, 2022

Regarding territory distribution, Northeast and Southeast, each, presented eight theses and dissertations on the topic. The South followed, with six works, as Figure 2 shows. No studies on the topic from other regions were found.

Figure 2 -
Territory distributions of the studies published in the CAPES Database of Thesis and Dissertations regarding nursing care in mental health, according with their phenomenological framework. Salvador, Bahia, Brazil, 2022

Regarding the philosophical framework used, the most common author mentioned was Alfred Schütz (59%); followed by Martin Heidegger (14%); Merleau-Ponty (9%); Yolanda Forghieri and Edmund Husserl, with 4,5% each; and Merleau-Ponty and Paul Ricoeur (9%). From the works found, the following contexts in the field of mental health stand out: process of care/caring (35%); family care (35%), self-care (5%), institutionalization (5%), hospitalization (5%), collaborative care planning (5%), teaching-learning process (5%), and patient safety (5%). This data can be found in Chart 2.

Chart 2 -
Correlation between topics in the field of mental health and the philosophical-theoretical phenomenology framework in nursing production (N=22). Salvador, Bahia, Brazil, 2022

Theoretical framework/Topic in the field of mental health	Alfred Schütz	Martin Heidegger	Merleau-Ponty	Yolanda Forghieri	Edmund Husserl	Merleau-Ponty e Paul Ricoeur
Self-care						1
Family care	5	1		1
Institutionalization.					1
Hospitalization	1
Collaborative care planning	1
Care/caring process	4	2	2			1
Teaching learning process	1
Patient safety	1
Total	13	3	2	1	1	2

• Source: Research data, 2022.

Regarding the participants of the studies at hand, the most common were families (36.4%), followed by health workers (31.8%), and users of the health services (18.2%). Studies that involved professors and students from the nursing course, as well as research with health workers, service users, and their families, presented the lowest percentages, with 4.5% each.

DISCUSSION

Studies that discussed the topic of nursing care focused on mental health with a phenomenological approach, found in the CAPES platform, despite involving several fields in their study, were substantially produced by researchers in the field of nursing.

Reiterating this finding, previous research highlights the importance of investigations from a phenomenological perspective, since this theoretical framework is in accordance with the goals of nursing, in regard to caring from the perspective of the person being cared and of the person who is caring14^-16, which may explain the percentage found.

The phenomenological approach seeks to recover perceived experience from lived experience, identifying the human presence as a phenomenon, and not as a subject15^,16. In this regard, phenomenology is essential to support anu understanding of care as a therapeutic search towards reaching the essence of another, starting with the recovery of subjectivity as a possibility9. As a result, researchers attempted to understand the essence of phenomenon, in order to improve the use of the phenomenological method in nursing investigations that uncovered the meaning of lived experience17.

In this regard, as we look at the transformations in the field of mental health, the phenomenological approach shows itself as a viable path to favor an understanding of this reality, also including the subjective dimension that involves this field of knowledge18. Therefore, from this perspective, it can be said that the Brazilian mental health care model uncovers the dilemmas of the psychiatric reform, as well as its contradictions, advances, and the challenges of the Psychosocial Health Care Network.

In regard to the irregularity of production on the topic, results found are similar from those of another study, which also shows oscillations through time in the number of nursing phenomenological research10. It can be inferred that this variation is due to the fact that phenomenology is yet to be consolidated in academia, since its construction is questioned by a field permeated by the Cartesian model, as it cannot provide generalizations, principles, and laws, which are common and sought by natural science19^,20.

Regarding territory distribution, the regions with the largest percentage of studies involving phenomenology were from Northeast and Southeast. As opposed to the results from an earlier investigation10, in this study, the appearance of the Northeast suggests that researchers in this region invested more in the goal of unveiling phenomena and giving support to their studies, considering the theoretical framework of phenomenology. The predominance in the Southeast, also found in previous research, can be justified by the fact that the region has more stricto sensu post-graduation programs10^,21. Nonetheless, the scarcity of publications in the other regions of the country hinders the production of knowledge in nursing.

It is essential to strengthen and consolidate the development of research in these regions, from interdisciplinary, intersectoral, and complex perspectives, supported by phenomenology. This would have repercussions on the improvement of social and health care to attend to the needs of the population, especially considering demands still unknown in these territories, as CAPES prescribes21^,22

The studies selected showed how heterogeneous were research topics in regard to the specific area of mental health. No justification was found in literature to explain the focus on these topics in the researches. It is worth noting that the phenomenological method contributes for existential reflection and allows the development of practices of humanization and health promotion, as well as the identification of the real needs of the users, workers, and managers, enabling health care to be based on the respect to the singularities and characteristics of the sociocultural and historical contexts of each individual20^,22.

Research to characterize academic production in nursing, based on a phenomenological approach, indicate a predominance of authors such as Alfred Schütz, Martin Heidegger, Merleau-Ponty, Paul Ricoeur, corroborating our results22^,23. The most common author was Schütz, who considers and understands human action according with social context, that is, understands daily life considering actors and their social relations17.

According with literature, concepts associated with Schütz's social phenomenology allow an in-depth analysis of questions from the several stages of life of social actors, contemplating the many different populations in the academic nursing production, reiterating how necessary this theoretical framework is for the needs of nursing care19. This study showed that the use of his work in mental health contributes for the valuation of the uniqueness, subjectivity, and autonomy of the actor and their individuality, which, in the context of lived experience, unveil the being-in-the-world, based on previous experiences17.

Furthermore, we believe that the prevalence of Schütz work in this research is due to studies whose topics and/or context is family care, and to the fact that care/caring are in line with the perspective of this theoretician, considering an understanding of the action of subjects in the social world, especially in intersubjective relationships inscribed in their experiences9. A study on the phenomenological production of knowledge associated with caring and being cared for, indicates a form of responsibility when in front of another, and the deep dive in this process. As a result, human action can only be understood if we find its motivation in a horizon of existence24^,25.

Most studies had families as their participants, followed by health workers, mainly nurses10^,23. This is evidence of a new paradigm of care, which goes beyond biology and seeks a more humane nursing3. Understanding the world of the life of the actor being cared for and its uniqueness favor the adoption of strategies of care that encourage autonomy and strengthen the protagonism of the action, as well as their social participation and the transformation of asylum culture.

The main contributions of this study for health, especially for nursing, permeate the possibility of valuing phenomenology as a path to give support to research and practices in the field of mental health, since, as we unveil daily phenomena using phenomenology's theoretical framework, problematizing the lived experience of the individual (user/professional and family), it is possible to have a more profound understanding of the phenomenon analyzed, despite the superficiality of the facts. Additionally, it increases the visibility of a field that is still in its early days. Therefore, we hope to favor the expansion and growth of phenomenological research in the field of mental health.

Limitations of this study include potential inconsistencies in the recovery of data, due to instabilities in the platform used.

FINAL CONSIDERATIONS

This study showed that scientific production in stricto sensu post-graduation programs about nursing care in mental health, in the light of phenomenology, reflect a variable, broader context, which encourages more reflective practices, focused on human existentialism. Moreover, it was found that interest about phenomenology's theoretical framework illuminates new perspectives regarding the paradigms of care in mental health nursing, based on a therapeutic process which values user singularities and potential.

This research showed that Alfred Schütz's social phenomenology was the most commonly used, as it encourages reflecting on actors as unique beings-in-the-world, considering their personal relationships and unveiling unique meanings and motivations, from an understanding perspective that is free from generalization and judgment. Considering the phenomenological strategies for mental health nursing, we encourage the implementation and advancement of practices and attitudes of care based on human singularity, which allow understanding the actor and their dimensions, inherent to each reality.

In this regard, this study contributes to strengthen phenomenology as a framework that can consolidate nursing practices and knowledge according with human existentialism, including dimensions that transcend biological and psychosocial perspectives, reverberating in the possibility of understanding environmental and spiritual correlations. As a result, we can see potential a potential contribution to give new meaning to the knowledge and practice of nursing in the field of mental health. Furthermore, we hope to encourage the development of phenomenological research in the field of mental health, to encourage the growth and consolidation of this theoretical framework in nursing.

Acknowledgments:

To the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brazil (the Institution for Higher Education Personnel Improvement - CAPES), according with process 88887.643413/ 2021-00. Funding code 001. To CNPq, for the Productivity Scholarship, process No. 205736/2018-1.

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Edited by

Associate editor:

Helena Becker Issi

Editor-in-chief:

Maria da Graça Oliveira Crossetti

Publication Dates

• Publication in this collection
  28 Apr 2023
• Date of issue
  2022

History

• Received
  14 July 2022
• Accepted
  23 Dec 2022