Os sentidos da redução de danos nos discursos de profissionais de enfermagem da atenção primária à saúde

Abstract

Introduction: Despite recent changes in the National Drug Policy in Brazil, which excludes harm reduction and prioritizes the promotion and maintenance of abstinence, harm reduction (HR) practices are still strategies that guide the health care of people who use psychoactive substances in primary health care. HR also aims to reduce biological, psychological, social and other damage associated with the consumption of these substances. In the context of primary health care, nursing professionals play a fundamental role in the health care offered to users and their families, who experience situations involving the consumption of alcohol and other drugs. Main objective: Analyze the meanings produced in the discourses of nursing professionals from a São Paulo’s inland city, about their knowledge and practices related to Harm Reduction strategy in Primary Health Care, through their perceptions. Specific objectives: Apprehend the production of meanings about Harm Reduction strategy constitutive of nursing professionals´ discourses, which permeate their knowledge, from the production conditions in which they are inserted; Apprehend the production of meanings about the user of psychoactive substances and the motivations for consumption, constituting the discourses of nursing professionals, which permeates their knowledge, based on the production conditions in which they are inserted; Apprehend the production of meanings about Harm Reduction strategy constitutive of nursing professionals´ discourses, which pervade their practice, from the production conditions in which they are inserted. Methodology: Qualitative and exploratory study, based on the theoretical and methodological framework of French Matrix’s Discourse Analysis (DA). Fourteen semi-structured interviews were conducted with nursing professionals working in the Primary Health Care devices of a São Paulo’s inland city. For the analysis of the data obtained through the interviews, the discourse analysis technique was used according to the precepts of DA. Results and Discussion: Data analysis showed three discursive blocks: 1) Discursive memories that give meaning to the discourses on Harm Reduction conceptions. This block analyzed the discursive memories that permeated the knowledge of nursing professionals about Harm Reduction strategy. The predominance of discourses’ memories of biomedical, religious and moral models was noticed. The perspective of “extended clinic” was discreet, emphasizing the prevention of risks and damages from the use of psychoactive substances that affect the physiological dimension. 2) The imaginary formations of nursing professionals about the user who consumes SPAs and the motivations for their use. The respective block analyzed the imaginary formations built by nursing professionals about the user who consumes SPAs. It was observed that nursing professionals construct the user's imaginary formations as: unproductive, malnourished, violent, prostituted and criminal. 3) The effects of meaning that circulate the practice of nursing professionals. This block analyzed the effects of meaning that permeate the practices of nursing professionals. Most of the actions considered to be of HR focused on physical risks and damages. Some actions were aligned with the HR precepts, such as the dialog, agreement, and respect to their freedom of choice. Some professionals performed HR actions, even without identifying them as such. Collective actions to promote health and well-being were also mentioned. Final Considerations: The study can contribute to improve the professional training of nursing care provided to users of psychoactive substances, which is not limited to abstinence strategies, but to the implementation of care practices aligned with Harm Reduction and the precepts of the Psychiatric Reform.