1

INTRODUCTION

Providing care to a person is not an easy task to accomplish, every human being
he possesses that special gift to be able to provide it since this not only requires having a
a series of knowledge, but also of the perception with which it is provided; whose
The factor is important as it will greatly impact the results that
are obtained. Accompany patients who suffer from any mental disorder and
sharing the experience of struggle with them is a challenge and at the same time, a great
privilege.
A challenge because the act of accompanying implies believing every day in intrinsic value.

of emotional support accompanied by therapy for a condition, which due to its

deteriorating character, requires an investment of energy whose balance is sometimes difficult
to delimit. In this adaptation process, the family through tolerance to
process and frustration will be essential for treatment, recovery and
rehabilitation of the patient since they are unaware of their illness and go
need the support of the family; and thus avoid relapses and consequently possible
hospital readmissions.
It is a true lesson in life and emotional support that is done together.
to the patient, and this is the path to accepting one's own abilities and
limits, while also in those of the patient. And it is on this path where the
charm of emotional support. The following lines are dedicated to describing the
structure, content and sequence of the work presented below in order to
that the reader can get a globalized idea of its entirety.
The content of the work presented here is developed from a purpose which is.
Unveiling the perception of the nursing professional in nursing care in
patients with mental disorders, in the Adult Emergency unit of the Hospital
Dr. Rafael Zamora Arévalo. Consisting of five Moments which, are
they will be broken down in the following manner:
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Moment I: highlighted the description of the phenomenon, causes, and consequences, with
the respective questions and purposes and justification of it.
Moment II: aimed at providing bibliographic support, with the background and
theoretical, psychological, and legal elements, being an important contribution to the
research.
Moment III: in which the methodological approach to follow will be unveiled,
fundamenting the post-positivist paradigm, with a phenomenological method,
collecting information through the semi-structured interview and observation
participant to three key informants in a previously chosen scenario, in this
case the Adult Emergency of the Dr. Rafael Zamora Arévalo Hospital. To then give
an interpretation through categorization, structuring, and triangulation
respective.
Moment IV: headed by the findings from the interview and the observation
participant, in which the respective categories will emerge, which will be structured and
then contrasted or triangulated.
Moment V: this is the moment when the obtained results will be released to
float from the researcher's perspective, arriving at some final reflections.
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MOMENT I

APPROACH TO REALITY

Description of the Phenomenon

The training of nursing professionals prepares and equips them to provide

own responses directed towards a common goal: the resolution of health problems
of the user. This makes their necessary presence evident in most contexts.
socio-healthcare. Nursing diagnoses are essential to provide
high-quality nursing care, and its benefits are so numerous that it seems
It is obvious that its development and implementation should be a priority.
the implementation of nursing diagnoses involves a planning of
better and more conscious care, an improvement in nursing communication
patient, nursing-doctor and among nurses and a better understanding of the
phenomena that may be more difficult to assess and describe (aspects
psychological, spiritual, and sexual.
The Pan American Health Organization (2011) states that mental health is:
The core of a balanced lifelong development, which plays a role
important in interpersonal relationships, family life, and social integration
(p. 4). When this state is disturbed, it is known as a mental disorder,
reflecting states of loss of reality judgment and lack of self-control of
impulses manifesting an emotional imbalance through behavior.
These disorders are recognized as a significant public health issue,
which according to estimates and experts' opinions will continue to increase in the
passage of time. The World Health Organization (WHO) pointed out in the year
2011 that 1% of the world's population, approximately 450 million
people suffer from a mental or behavioral disorder, it is one of the ten
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most disabling diseases among those aged 15 to 44; however, the

the budget for mental health in most countries is less than 1% of
total health expenditure.
According to Zambrano (2008), mental health nurses play a role
key and increasingly important to address the new needs and demands of
citizens in relation to Mental Health, as well as to ensure the provision
high-quality health services that are accessible, equitable, efficient, and sensitive that
ensure continuity of care, guarantee rights and meet needs
of the citizens. They carry out their work with people and human responses
derivatives of the alterations in Mental Health, with the affective aspects that it
human behavior carries implicit and the potentiality of these to influence the
social integration capacity of individuals.
Mental health nursing staff are trained by their education to
provide specific care to the individual, the family, and the community,
promoting, preventing and addressing mental health issues and providing
such care using interpersonal relationships as a therapeutic tool.
The nursing care necessary for the achievement of these objectives is
to say, those actions that are aimed at achieving the expected results.
However, the perception of nursing professionals is immersed
subjectively, and they influence the care administered, According to Helmont (2012), "it is
the experience reported and expressed by the user and which, in most cases,
it has no relation to the scientific and technical aspects, but rather with the
needs for affection, understanding, protection, well-being, leisure, and information.
perception that individuals experience in certain situations includes
more complex processes than the simple processing of the
information.
Therefore, the perception of the nursing professional originates from the
senses and other sensory organs, is a process that involves organizing a
information to be able to issue judgments. According to the National Development Plan
Venezuelan (2011), which includes mental health programs for groups
 5

vulnerable populations whose objective is to improve their quality of life

population and the achievement of its social and economic integration have been undertaken

actions aimed at promoting mental health.

According to this National Mental Health policy, among the actions that the
The central government is promoting mental health and primary prevention.
of psychiatric disorders, based on support for actions that lead to
increase the importance of mental health in the values of society and to
employ social media and the forging of intra- and inter-alliance agreements
intersectoral. It seeks to integrate knowledge and techniques in this way
from mental health to policies, programs, and services dependent on others
sectors, in order to detect early behaviors that indicate problems in
the population. It is the nursing staff that helps in the recovery and
treatment of these types of patients, with their own perceptions about this care.
However, in Valle de la Pascua, in terms of psychiatric nursing and work
In psychiatric social services, the staff shortage is significant, and there is no university training.

specific incentives of any kind to attract and train these resources so

necessary for the mental health team, these patients being cared for as
any other, originating in nursing professionals' perceptions, based
in experiences and inexperiences. Thus the following arise then
questions:
What is the perception of the nursing professional in nursing care?
in patients with mental disorders, in the Adult Emergency unit of the Hospital
Dr. Rafael Zamora Arévalo?
What are the reflections on the perception of the nursing professional in
nursing care for patients with mental disorders, in the unit of
Adult Emergency of Dr. Rafael Zamora Arévalo Hospital?
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Purposes

Uncover the perception of the nursing professional in nursing care

in patients with mental disorders, in the Adult Emergency Unit of the Hospital
Dr. Rafael Zamora Arévalo.

Reflect on the perception of the nursing professional in care

nursing in patients with mental disorders, in the Adult Emergency unit
from Dr. Rafael Zamora Arévalo Hospital.

Justification of the Research

Considering that mental disorders are part of a group of

psychological alterations, which significantly affect the overall well-being of the
person who suffers from it, influencing their environment, family nucleus, community and

society. It is considered that the nursing professional is in the faculty

to perform broad functions to promote the recovery of people who
they suffer from it, therefore optimizing care, rehabilitation, and reintegration
The psychiatric patient's social environment, in their social role, is a valuable therapeutic element.

However, through the experiences with these patients, the professional

nursing is forming its own perceptions, which gives it a character
purely intrinsic and subjective, and little has been disclosed about it. Therefore, the
this research is focused on four relevant aspects, such as the
theoretical, practical, methodological, and social, which fully justifies it.
Having then that in the theoretical aspect, the different inquiries
references on the topic lead us to infer the few studies that have been
conducted on the perception of nursing professionals, therefore the study
requires an extensive bibliographic review. Following that, the practical aspect can
to improve, since once the study is researched and disclosed, it will serve as
antecedent for future research, achieving optimal professional practice,
 7

where human care serves as a standard. Likewise, in the methodological aspect,

As it is a qualitative research, it becomes predecessor and flexible, given to
that other researchers can continue it.
And finally, in the social aspect, the research results will allow
provide reliable information to health personnel, so that their intervention in the
real emotional needs of the patient and family be more effective, incorporating
intervention strategies, with the aim of improving and strengthening support
emotional support that the family provides to the patient with mental disorders, that makes

possible a continuous patient and family-oriented tracking system, and of this

way to reaffirm the educational work and strengthen the social work of the nurse
reorienting a positive emotional support from the family, with what will be achieved
reduce the number of hospital readmissions.
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MOMENT II

THEORETICAL REFERENCE

Research background

The documentary and bibliographic review has allowed for the identification of some

investigations related to the phenomenon under study; concerning the

nursing care for patients with mental disorders in Venezuela is perceived
as a theme in the process of evolution and expansion, being scarce the
specific investigations related to the topic, however, one of the studies
found, it is directly linked to the research topic and others
backgrounds even when they do not correspond directly, are related to the
perception of nursing professionals regarding disorders in relation to others
pathological entities, which represents a valuable contribution since this phenomenon and
purposes are similar to those described in the following study among which are
stand out:
Barroso and Guerra (2010) conducted a research study titled 'Attitude of the
Nursing Staff Towards the Care of Patients with Mental Disorders
Enter the Adult Emergency Clinical Unit of the hospital 'Dr. Luis'
"Razetti" from Barcelona with the purpose of determining this attitude. To do this, it
conducted a study based on a contemporary qualitative design, framed within
from a phenomenological study method. In which information is collected from
through participant observation and semi-structured interviews with 4 informants
key. As final reflections, it is evident that the nursing staff presents
beliefs, feelings, and positive behaviors when approaching and providing
care for the patient with altered mental health.
 9

This research is then becoming a direct precedent, as it

relates to the phenomenon under study, as it focuses on aspects such as: the
cognitive, affective, and behavioral components, which interrelate, to
determine the professional's attitude towards patients with mental disorders,
similar to what is proposed in the present research.
On the other hand, the methodological research of a phenomenological type, carried out by
Lunar (2010), titled, Attitude of Nursing Professionals Towards The
Palliative Care for Cancer Patients in Terminal Phase, Institute of
Oncology "Dr. Miguel Pérez Carreño, Valencia State Carabobo, whose purpose
It was to reveal the attitude of the nursing professional towards care.
provided to the patient with mental disorders, in its components: cognitive,
affective and behavioral, at the Dr. Miguel Pérez Carreño Institute in the city of
Valencia state Carabobo. The results after categorizing, structuring and
to contrast, they indicate that the considered aspects constitute very important elements

positives of the attitude shown by nursing professionals towards

palliative care provided to the cancer patient in terminal phase, and that
it allows us to infer the presence of a positive and favorable attitude on the part of these
professionals towards the implementation of palliative care for the patient
terminal cancer stage.
In this same line of thought, Mendoza (2010) titled his phenomenological work,
Perception That Nursing Professionals Have About Emotional Support
What Do Family Members Provide To The Schizophrenic Patient Entering For The First Time
See and Re-admission of the Psychiatry Services 1 and 20 of the Víctor Hospital
Larco Herrera 2009, Lima, Peru, collecting information through the
participant observation and the semi-structured interview with three key informants, and
Through categorization, structuring, and triangulation, the following was reached.
findings, when a schizophrenic patient is admitted for the first time to be
hospitalized has greater emotional support provided by his family which
will favor their treatment, recovery, and rehabilitation, while a patient
 10

that has relapses and consequently the family re-enters, deteriorating the support.
emotional support provided to the patient.

Another study conducted by Garrido (2010), under a qualitative research with

phenomenological method titled, Humanized Care for People with Problems
Mental Health At The 'Luis Guada Lacau' Outpatient Clinic Of IVSS In Naguanagua
Carabobo State, Year 2010. A study in which once the information was obtained by
Through the semi-structured interview, the following is reflected upon: to conclude
that human care enhances the healing of the patient and mostly the staff
the nursing staff does not maintain good communication and empathy with them. They
It is recommended that the nursing authorities of the health institution put in
educational actions aimed at guiding the studied population on the
the need to assess the patient in their family and social environment, which
it affects the quality of life of these patients.
Such investigations support this work as they are in agreement with the
theoretical elements inherent to the phenomenon under study, as it highlights the
perceptions and nursing care as foundations for patient care in
situation of mental disorders and aspects related to the dimensions are highlighted
holistic care provided.

Theoretical elements

In principle, information is knowledge; information constitutes in itself.

"a message". In this sense, Espinoza (2010) defines the term information

What is essentially sought is a support; the data is transformed.

in information when it is endowed with a specific value, there lies the
possibility of being recovered for their interpretation, thanks to which;
It will be possible to transform them into knowledge. (p.8).

Starting from this premise, we have that all knowledge has as its basis or root
the information, or data provided and contributed, which in the end are the essence of the
research. Consequently, the following references are provided.
theoretical frameworks that will provide the basis and support for the research.
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Perception
One of the main disciplines that has focused on the study of perception
It has been psychology and, in general terms, traditionally this field the
The Dictionary of the Royal Spanish Academy (2010) has defined perception as:

The cognitive process of consciousness that consists of recognition,

interpretation and significance for the formulation of judgments regarding the
sensations obtained from the physical and social environment, in which they intervene
other psychological processes including learning,
memory and symbolism. (p. 526).
Although perception has been conceived as a cognitive process, there is
authors who consider it as a more or less distinct process pointing out the
difficulties in outlining the differences it has with the process of
knowledge. For example, Allport (2012) points out that perception is, "something that
it encompasses both the understanding of the complex environmental circumstances and that of
each of the objects" (p. 7-8).
While some psychologists tend to assign this last consideration to the
cognition more than perception, both processes are found so intimately
related that is hardly feasible, especially from the theoretical point of view,
consider them separately from each other. Perception is a sensory experience
aware that it involves the interpretation of the stimuli received by giving it
meaning and organization. Through perception, we come into contact with the
external world. Perception is an act of cognitive nature, eminently
complex, in which the whole person is involved in its entirety.
According to Kolb (2012), he says that 'perception is based on cognitive aspects'
previous to then being an intellectual process, perception is the act of knowing
objects, images, and thoughts through sensory experiences or through
of memories" (p. 56). Perception is not a linear process of stimulus and
response about a passive subject, but rather, on the contrary, there is at stake a
a series of processes in constant interaction where the individual and society have
an active role in shaping particular perceptions for each social group.
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In the process of perception, experiential mechanisms are involved that

they implicate both the conscious and unconscious realms of the human psyche.
against the stance that confines perception within consciousness have been
formulated psychological approaches that consider perception as a
involuntarily built process in which the selection of
preferences, priorities, qualitative and quantitative differences of the individual regarding
of what is perceived (this process is called preparation); at the same time, they reject
may consciousness and introspection be characteristic elements of perception.
In this regard, Merleau-Ponty (2010) has pointed out that perception is not a
adding events to past experiences but rather a constant construction of
meanings in space and time.

Perceiving is not experiencing a multitude of impressions that would entail

some memories capable of complementing them; it is to see how it arises, from the
constellation of data, an immanent meaning without which it is not possible
make no invocation of memories. Remembering is not to place of
new under the gaze of consciousness a painting of the subsisting past
in itself, it is to penetrate the horizon of the past and progressively develop
his perspectives encapsulated until the experiences that he
resumes are lived again in their temporary situation. Perceiving is not
remember. (p. 44).
One of the aspects that has been privileged in both psychological studies
As philosophical discussions about perception revolve around the formation of judgments, which is proposed

as one of the basic characteristics of perception; human groups

through cultural guidelines and the appropriation of information from objects and
environmental events allow for the creation and recreation of evidence of their existence and to develop

meanings regarding such things give meaning and values to sensations,

structuring reality's vision in this way, while shaping the
evidence about the world, so that information from the environment is collected and
allows for proper interaction according to the conditions of the physical and social environment,

formulating judgments or opinions about them, confining to the perception in the

realm of the conscious mind.
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Based on the previous definitions, we have that perception is the

stimuli that come to us from the surrounding world and can be psychological and
sensory, through which people are able to understand their environment and
act according to the impulses they receive; it is about understanding and organizing
the stimuli generated by the environment and giving them meaning. In this way, it
The next thing the individual will do is send a response accordingly.
Regarding the research, the perception of nursing professionals and
the care of patients with mental disorders is viewed from subjectivity,
it turns out to be an experience that exceeds knowledge and develops based on
nursing care, as a fundamental tool, for the administration of
humanized care from a holistic perspective in all its dimensions.

Perception of the Nursing Professional

According to Helmholtz (2012), "it is the experience noticed and expressed by the user and
that, in most cases, has no relation to scientific aspects
and technical aspects, but with the needs for affection, understanding, protection, well-being,

leisure and information" (p. 53). The perception experienced by individuals in

certain situations include more complex processes than the use of
simple processing of information.
The perception of the nursing professional originates from the senses and
other sensory organs, it is a process that involves organizing information
in order to make judgments about the administration of nursing care, in the
patient with mental disorders. He has an upright character; that is to say, he will perceive as
a unique whole, is of a rational nature, will interpret according to the knowledge that
he has received before and according to his practical experiences; to later refer judgments about
from what was observed: and it is selective in nature because it is determined by causes
objectives and subjective. Due to the fact that the nursing professional will perceive
those messages to which he is exposed according to his beliefs, attitudes, interests,
scale of values and needs. That is, it will operate a processing of all the
information, in order to obtain a sensory response.
 14

Mental Disorders
The Severe Mental Disorders Care Program (TMS), included in the
Strategic Plan for the development of Mental Health Services of the Principality
of Asturias (SESPA), (2014) defines these disorders as

A group of nosological entities that meet severity criteria

clinical, persistence over time without improvement or with progression in the
deterioration with usual therapeutic procedures, and which present
a significant impact on family and social relationships These
pathologies produce a specific care demand, therefore they arise
various forms of organization, seeking continuity, the
accessibility of care longitudinally and transversally, and
ensuring that they are global and comprehensive. (p.10)

Mental illnesses are disturbances of cognitive and affective processes.

of development, considered abnormal in relation to the social group of
reference from which the individual originates. It may involve alterations in the
reasoning, behavior, the ability to recognize reality or to adapt
to the conditions of life.
According to the WHO (2011), mental disorders 'are a classification by categories
not exclusive, based on criteria with defining traits. They admit that there is no
definition that adequately specifies the limits of the concept, lacking
an operational definition that consistently encompasses all possibilities” (p. 3).
A disorder is a behavioral or psychological pattern of clinical significance.
which, whatever its cause, is an individual manifestation of a dysfunction
behavioral, psychological or biological. This manifestation is considered a symptom
when associated with discomfort (for example, pain), with a disability (due to
example, deterioration in an area of operation) or to a significantly increased risk
increased risk of death or suffering pain, disability, or loss of freedom.
Moreover, they claim, there is evidence that the symptoms and the course of a major
The number of disorders is influenced by ethnic and cultural factors. It is not necessary to
forgetting that the diagnostic category is only the first step for the appropriate plan
therapeutic, which requires more information than that needed for diagnosis.
 15

A very common misconception is to think that the classification of

mental disorders classify people; what it really does is classify the
disorders of the people who suffer from them.
However, when mental illnesses have traditionally been divided into
Organic Disorders and Functional Disorders, referring to the degree of
physiological or psychic genesis that determines the suffering, the clinic demonstrates
that both spheres are not independent of each other and that in pathology, as in the
the rest of the 'normal' psychic performance, both factors interact and
they correlate to generate the broad spectrum of human behavior as
we know it. In fact, biological alterations affect the psyche, just like
Psychological alterations affect or modify biology.
There are numerous categories of mental disorders, but according to the Manual
Diagnostic and Statistical Manual of Mental Disorders (2012), to a greater or lesser extent

gravity both in the individual's subjective experience and in its impact within
of social functioning, this refers to another classic classification:
1. Neurotic Disorders: Neuroses affect to a greater extent the
perception of the subject about themselves, and their level of liking, of fulfillment
and of the integration of the self, as well as its relationships with the social environment and
closer family; however, they do not present the usual symptoms of
disconnect from reality and a wide distance from social life,
they can perform both professionally and academically, and according to Freud and the
psychoanalytic schools this state is the natural condition of life
psychic.
2. Psychotic Disorders: Psychoses encompass the most significant manifestation
clearly associated with mental illness, its classic symptoms
include hallucinations, delusions, and severe affective disturbance and
relational, these disorders often have a significant organic factor.
pronounced as Depressive and Bipolar Disorders, although the
Schizophrenias are clearly those with the greatest personal and social impact.
and familiar given its chronic and degenerative nature characterized by the
elements common to all psychotic disorders to which one
they add disconnection from reality and emotional flattening. (p.
234-236).

Mental illness often degenerates into social isolation, inactivity, apathy,

disorder of the rhythm of life in general and, in certain cases and circumstances,
 16

violent behaviors and suicide attempts. Currently, the treatment of the

mental disorders have an integrative and multidisciplinary approach, in which
psychologists and psychiatrists, social educators, psychiatric nurses,
social workers, occupational therapists and other professionals. Each
integrative treatment, depending on the case, involves the administration of psychotropic medications such as

palliative methods for the most pronounced symptoms, as well as a process of

psychological intervention to address the origins and manifestations of the disorder
generate, in this way, a more solid, effective, and permanent state of well-being in
the people who suffer from this disease.

Nursing care for patients with mental disorders

According to Kozier (2008), nursing care is directed in three stages,
short, medium, and long term, having:
Sufficient nutrition, regularity of the emunctories, adequate rest and
Safe activity. Keep the patient in a safe environment.
Establish communication and build trust. Help the patient to participate.
in the therapeutic community. Increase the patient's ability to
communicate with others.
Reduction of hallucinations, delusional ideas, and other symptoms
psychotics. Reduce injury or impulsive behavior. Increase the
self-esteem. Identify and use strengths and potentials, and
develop a better self-image. Achieve and maintain a level
maximum functioning. Make the patient accept and confront
effectiveness for the disease its long-term nature, the need for
continue taking the foods. (p.765)

Nursing care for patients with mental disorders depends

basically of hallucinations, which are perceptions without an object; that is, of
an external stimulus without an origin in the outside world. They can be captured
through any of the senses sight, hearing, smell, touch, taste. The patients at
they act based on these internal perceptions, which can make a
more compulsive effect than external reality. Delusional ideas are beliefs
false and fixed beliefs that have no basis in reality. Patients may have
 17

different forms of delusional ideas. Someone may have some introspection about their
delirious state but cannot change it.
The patient tries to meet a need through the delusional idea, such as
it would be an increase in their self-esteem, achievement of security, support, punishment,

release of anxiety associated with feelings of guilt, fear. The sick

(especially those who suffer from paranoia) may have fixed delusional ideas
that can persist throughout their lives. Many psychotic patients have ideas
transitory deliriums, which do not have to persist all the time. They have been
three phases in the process of delusional thinking have been identified; first, the patient
he is completely devoted to his delirious imagination; secondly, with the delirious ideas
there coexists a reality test and trust in others, and thirdly the patient no longer
experiment delirious ideas. Remember: Delusional ideas are a protection and
they can only be abandoned when the patient feels self-sufficient and
Sure. Delusional ideas are not under the conscious control of the patient.

Nursing care for patients with mental disorders

For the nursing professional to achieve the care of patients with disorders
Mental health professionals must deeply understand the meaning of mental health, according to the Committee.

The World Health Organization's (WHO) Mental Health defines

The enjoyment of the highest level of health that can be achieved is one of the
fundamental and inalienable rights of the human being, without distinction of race,
religion, political ideology or economic and social condition.
Likewise, through the Mental Health Program, the professionals from
nursing will have a guide of a set of integrated activities, intended to
guarantee the right to mental health for the population, in coordination with the
health policies framed within the Social Policies established by the
Venezuelan state.
Mental health is also a process of seeking, a need of the individual,
the family and society. It is a dynamic balance in continuous movement, of each
person with herself and with her context to produce, reproduce, and transform her
 18

existence. It includes the idea of crisis, expected and unexpected, common to the condition
human, with the active participation of the person being decisive in the possibility
to respond to their own crises and to changes in the social context. Health
Mental is the possibility of participating in shared projects that allow for
a person transcending in their existence and seeing themselves reflected in the other, building their

own identity.
Once mental health is defined, the care of the nursing professional must
to have the Nursing Process as a basis, which according to the Manual of
Nursing (2012)
It is a continuous process but made up of different stages or
phases, logically ordered, that have as their fundamental objective the
adequate planning and execution of timely care for well-being
of the patient; where 5 phases can be distinguished:
1. Assessment Phase: This corresponds to the collection of
information based on observation and the interview with the patient; thus
like in other available sources.
2. Diagnosis Phase: Analysis and interpretation of data where
determine the specific problem that the patient presents and the sources
of difficulty that it causes.
3. Care Planning Phase: Strategies are planned
aimed at preventing, minimizing, or correcting the identified problems
previously.
4. Execution Phase: This is where the action plan is put into practice.
previously prepared to meet the patient's needs, Here
the relationship between the nursing staff and the patient takes its
maximum significance.
5. Evaluation Phase: Determination of the point at which it has been
achieved the previously proposed objectives (p.3-10).

It can be said that they are a set of steps or widely accepted procedures.
structured which will be carried out by the staff of
nursing that will allow for the application of previously organized care to the patient
with mental disorder, guaranteeing quality care.
 19

Psychological Reference

For Peplau, quoted by Marriner (2009): 'Nursing is a tool'

educational, a maturation force that aims to promote in the personality the
movement towards a creative, constructive, productive, personal life
community." (p. 245)
This author has described four phases to conceptualize the process of
personal interrelation: Guidance, identification, utilization, and resolution. Its
the work had a great impact, it was probably the first to develop a model
theoretical using knowledge extracted from the behavioral sciences.
It allowed nurses to expand their scope of intervention, defining the
model, in which the psychological meaning of events, feelings,
and behaviors could be exploited and incorporated into interventions
from nursing.
Psychodynamic nursing care requires the ability to understand
our own behavior in order to help others identify difficulties
perceived and apply principles of human relations to the problems that arise in
all levels of experience. Nursing is an important process
interpersonal and therapeutic. It operates in terms of cooperation with other processes.
humans who make health a possibility for individuals in the
communities.
Peplau discovers four phases of the nurse-patient relationship:
1. Orientation: During the orientation phase, the individual has a need
perceived and seeks professional assistance. The nurse helps the patient to
recognize and understand your problem.
Identification: The nurse facilitates the exploration of feelings for
help the patient cope with the illness.
3. Utilization: The patient tries to get the most benefit possible from it.
what is offered to him through the relationship.
 20

4. Resolution: The old goals are gradually being set aside.

measures that are adopted other new ones.

5. También describe varias funciones de la enfermería (concretamente seis):

a. Resource person function.
b. Unknown function.
c. Leadership function.
d. Teaching function (combines all functions)
e. Advisory function.
f. Substitute function.
Being Peplau an important psychological reference, given her experiences and
reports on the treatment of patients with mental disorders, as well as why
introduce the terms of psychodynamic nursing into the research, which
closely relates to the title of the research Perception of the professional
of nursing in the care of patients with mental disorders in the area of
adult emergency of Dr. Rafael Zamora Arévalo Hospital.

Legal References

Among the legal documents that support the investigation, the following can be considered:

Constitution of the Bolivarian Republic of Venezuela (2000)

Being the magna carta of all Venezuelans, and of which is
all the laws of the Bolivarian Republic of Venezuela are observed
following articles, which provide legal support to the investigation, in the following
articles which state:
Article 46.
Every person has the right to have their physical and mental integrity respected.
moral." (p. 18).
 21

Article 83.
Health is a fundamental social right, an obligation of the state, which
will guarantee as part of the right to life." (p.30).

Nursing Deontological Code of Venezuela (1999)

Article 6.
Nursing services are universal. In performing their function, the professional
nursing will make no distinction based on: age, race, sex, nationality, creed,
political opinion or socio-economic position.” (p.4)
Article 9.
The nurse-patient relationship will be based on respect for dignity.
human, as are responsibility and professional secrecy, as stipulated by the
moral norms and conditions that accompany the activity carried out by the
nursing professionals.” (p. 5)
Article 10.
Nursing professionals must practice freely the standards and criteria
scientists that allow to specify the appropriate attention for each type of patient.
(p. 5)
Article 11.
The duty of nursing professionals is: To alleviate human suffering,
this noble action does not allow personal, collective, or religious discrimination
policies.” (p. 5)

Law of Professional Practice of Nursing (2005)

Article 13. Without prejudice to what the legal provisions establish
currently, nursing professionals are obliged to:
1. Respect in all circumstances the life and the human person, as the
main duty of the nurse.
2. Assist users, responding only to their demands.
health, without discrimination based on race, sex, creed, or condition
social or political.
3. Act in accordance with the circumstances and knowledge
scientists that nurses have in states of unconsciousness and of
 22

health emergencies that may pose evident danger to life

of these.
4. Protect the patient while they are in your care from treatment
humiliating or any other type of offense to their dignity as a being
human. (p. 5).

Relating the previous articles to their respective laws with the

research, as they focus on the care of the human being from a point
from a holistic perspective, thus involving the mental and social aspect, which has a close
linking with the purpose of the research itself, which consists of
Unveiling the perception of the nursing professional in care
nursing in patients with mental disorders, in the Emergency unit
Adult of the Dr. Rafael Zamora Arévalo Hospital.
 23

MOMENT III

METHODOLOGICAL APPROACH

Foundation of the paradigm

The present research is focused on a qualitative investigation under the

post-positivist paradigm, and phenomenological research method, which included
with a scenario and key informants. Qualitative Research defines it
Sampieri (2010) states: 'Qualitative research focuses on understanding and
deepen the phenomena, exploring them from the perspective of the participants
in a natural environment and in relation to the context." (p. 45).
The qualitative approach is selected when seeking to understand the perspective
of the participants (individuals or small groups of people or what is
will investigate) the phenomena surrounding them to deepen their experiences,
perspectives, opinions and meanings, that is, the way in which the participants
they subjectively perceive their reality. They are guided by significant areas or themes of

research, however, instead of clarity on the questions of

Research and hypothesis precede the collection and analysis of data, the
qualitative studies can develop questions and hypotheses before, during and
after the collection and analysis of the data.

Method

According to the paradigm that guides this research, the aim is to capture the
meaning of things and to make an interpretation in the most rigorous way possible
from the words, actions, and gestures of the subjects studied, trying to understand their
singularity, from the context to which it belongs. Thus, the research is designed in
four stages, according to Martínez (2008), of a phenomenological type:
 24

First Stage
It is the preliminary or clarification stage of the researcher's assumptions.
Understood through bibliographic research, exhaustively analyzing the
related backgrounds that support the research.

Second Stage
Subsequent to the literature reviews and the analysis of the foundation
theoretical a description is made, that reflects the reality as best and faithfully as possible
vivid consistent in the facts of reality, in this research the
nursing professionals from the Adult Emergency area, of Dr. Rafael Hospital
Zamora Arévalo in Valle de la Pascua, Guárico State and the researcher in order to
to achieve a dialectical vision of reality.

Third Stage
It is the structural stage that involves the study and analysis of the phenomenon itself.
said. Incorporation of research into the natural environment, which includes the
interactive participation of researchers in the communicative medium, observing
thus the perceptions of nursing professionals in patient care
with mental disorders in the Adult Emergency Area of Dr. Rafael Hospital
Zamora Arévalo, in the Valley of La Pascua, Guárico State

Fourth Stage
At this stage, the aim is to relate the results obtained from the research.
with the conclusions or findings of other researchers to compare them,
to contrast them or complement them, and to better understand the possible differences or

similarities. In this way, it is possible to achieve greater integration and to a

enrichment of the "body of knowledge" of the studied area. As it will be able to
to observe, phenomenology, far from being a method of study, is a philosophy for
understand the true meaning of phenomena, but with a sequence of ideas and
steps that provide scientific rigor.
 25

Research Scenario

A scenario is a partial description of the behavior of the application in

a specific moment. The use of scenarios involves identifying different
situations and describe the action to be taken. They are very helpful in the
moment to specify requirements; and its main role is to allow the
communication between research experts and researchers, and analyze
specific aspects of a system, describing it in a concrete way. The advantage of
the scenarios are very similar to the way in which beings
humans understand and describe problems.
According to what Martínez, M (2008) expressed, it refers to the scenario
like the ecology of research; this means, to the environment or medium
socio-geographical context where this will take place and from where the informants will come out

population and sample with which we will work in order to obtain the data
necessary for the research. In this case, a geographic space is defined.
cultural will be the area where the researcher will operate to carry it out.
In this line of thought, it is about the perception of the nursing professional.
in the care of patients with mental disorders who come to Dr. Hospital
Rafael Zamora Arévalo in Valle de la Pascua, Guárico State, of which it can
to say that it is geographically located on January 23rd Street, between
Bolívar and Flowers from Valle de la Pascua, municipality of Leonardo Infante in the State

Guárico. It has a wide infrastructure where the different

public health programs, including mental health.

Key Informants

They are referred to as key informants, according to Martínez, M. (2008) 'those who'
group that has been selected as a sample for the application of the techniques and the
instruments chosen for the collection of the necessary data" (p. 78). In this
meaning, for this research, 3 Key Informants were selected, or three
people closely linked to the research problem and the same
 26

were distributed as follows: Informant I, Informant II and Informant

III and Informant IV, under the pseudonyms perception, interpretation, and understanding
(a) Informant I (Perception): Nursing graduate, 30 years old,
Coordinator of the Adult Emergency area with 2 years since graduation and 5 years

of work experience and 2 months in the area.

(b) Informant III (Interpretation): 26-year-old Nursing graduate,
with 4 years of graduation and 3 years of experience, in the morning shift.
(c) Informant IV (Comprehension) 35-year-old graduate in Nursing with
5 years since graduation, and 3 years working in the area on the night shift

Techniques and Instruments for Information Collection

In this research, the technique chosen was the semi-structured interview.

structured, participant observation. Regarding the semi-structured interview,
Martínez (2008) asserts that it takes the form of a colloquial dialogue, which is
indispensable for a fuller vision of realities, and the use of dialogue,
establishes an approach to everyday life that makes it much easier to understand the
process of acquiring knowledge and doing science, as it is identified with the
natural process of daily life. Similarly, regarding the observation
participant, Martínez (op.cit), points out that, 'it is the primary classic technique and most

used by qualitative researchers to acquire information. To this end, the

the researcher lives as much as possible with the people or groups they wish to investigate,
sharing their uses, customs, style, and modes of life (p. 138).
According to what the author cited, this study was based on observation.
participant and in the semi-structured interview, in order to gather
useful information to define the problems arising in the Emergency Area
from the Dr. Rafael Zamora Arévalo Hospital.
 27

Analysis and Interpretation Techniques of Information

This is a key moment in the systematization process, as it involves going further.

beyond the experience to understand and interpret it and carry out a process
ordered by abstraction that allows us to find the reason for what happened to
throughout the process. The interpretation of the findings was made through the
the next process, according to what Martínez (2008) stated, is to categorize
conceptualize or encode with a term or expression the content of each unit
theme (p. 11) that is clear and unequivocal.

integrating and reintegrating the whole and the parts, as the material is reviewed and
the meaning of each paragraph, event, fact, or piece of data is emerging; trying to
finding meaning in the things he examines. Secondly, follows the Structuring, which
It is a realistic and authentic understanding of the phenomenon studied. It is to relate,

interpret and theorize the information.

Third, the Contrasting, which consists of relating and contrasting your results.
with those parallel or similar studies that were presented in the theoretical framework
reference to see how they appear from different perspectives or about frameworks
wider theories and better explain what the study truly means. The
systematization ends when we come to understand the internal logic of the process
and obtain valuable learning regarding what happened that should translate into
higher knowledge that guides us towards a new intervention in that field. In that
The conclusions of a systematization are expressed as learnings.
In addition to producing new and deeper knowledge about the experience,
It can highlight gaps that drive the search and deepening of the analysis.
 28

MOMENT IV

THE FINDINGS

Semi-Structured Interview

Moment that is based on all the information gathered from key informants to
through participant observation techniques, Martínez (op.cit) indicates that, "it is
the primary and most commonly used classic technique by qualitative researchers to
acquire information. To do this, the researcher lives as much as possible with the
people or groups you wish to research, sharing their uses, customs, style and
"lifestyles" (p. 138) and the semi-structured interview, which generates the
elements for the analysis and interpretation of it. That is to say, one proceeds to
categorize, structure particular and general and triangulate the information.

Table 1. Categorization
Interviewer:
Interviewee: Bachelor of Nursing (Perception)
Location: Adult Emergency Area
09/16/2015
Time: 8:30 a.m.
Key informants Code. Raw note Indicator Category

Perception 1. What are they to you? (3-6) Disorders

2. mental disorders? mental
3. Son all those
4. disorders or conditions
.5. that affect health
6. mental of the patients Perception
7. How do you perceive it, (10-13)
8. mental disorders?
9. Sometimes, it gives me a little bit of
10. fear to attend to these
11. users, I perceive in them a
12. times sadness, anxiety,
depression and aggression in
some cases Care of
 29

15. How do you deal with (19-22)

the nursing
16 patients with disorders
17. mental?
I treat them like everyone else, Paper of
but with special attention Nursing
20. in suspicious
needs
21. emotional, psychological
22. y social
23. What is the role of (29-40)
nursing in care
25th of December
the disorders
26. mental?
27. The role of nursing is
28. fundamental, since the
29. the approach must include the
30. environment, family, since
are a fundamental part of
32. the society.
33. Administration of
34. medications
35. psychotropics, in many
36 cases containment
37. mechanics, learn to hear,
38. identify feelings of
39. apathy, anxiety
40. depression.

Source: Authors

Table 2. Categorization
Interviewer:
Interviewee: Bachelor's in Nursing (Interpretation)
Location: Adult Emergency Area
09/16/2015
9:30 a.m.
Key informants Code. Raw note Indicator Category
s
Interpretation 1. What are for you the (5-8) Disorders
2. mental disorders? mental
3. Mental disorders
4. son those what
.5. they understand alterations
6. of thought, of the Perception
7. emotions y of the
 30

8. behavior
9. How do you perceive it, (24-25)
10. mental disorders?
11. Well not always
can differentiate
clearly to a patient
14. with mental disorder, of Care of
15. one behavior nursing
16. normal, distinguish the
17. characteristic sorrow
18. of a disorder can be Paper of
19. due to deficit, because the line Nursing
20. divider between a person
with certain traits of
22. personality and another that
23. suffers from a disorder of
24. personality, can
It can be difficult to perceive.
26. How do you treat the(37--39)
27 patients with disorders
28. mental?
29. First, you need to take in
30. account, the care that is
31. they must toast for their
emotional imbalance
33. we should never take it to him
34. contrary to these patients,
35. not showing them fear and
never a no for an answer,
37. and treat him as if he were
38. another patient sine
discrimination
40. What is the role of (53-57)
41.nursing in care
42.de the disorders
43. mental?
Well, the first thing there is
45. what to take into account with
46. this type of patients, is
47. who are also beings
48. humans and they are beings
49. specials, which need
50. of the support and not of the
51. discrimination, as there is
 31

52, many people who it

53. put into practice, a
good family education
55. regarding care
56. necessary and follow-up
57 of the treatment.
Source: Authors

Table 3. Categorization
Interviewer:
Interviewee: Licensed Nurse (Understanding)
Location: Adult Emergency Area
09/16/2015
Time: 8:30 p.m.
Key informants Code. Raw note Indicator Category
s
Understanding What are [they] for you? (4-5) Disorders
2. mental disorders? mental
3. They are all those who
4. they affect the mental part,
.5. social and even spiritual of
6. the patients Perception
7. How do you perceive the (09-11)
8. mental disorders?
9. Well, I perceive them as
10. beings that need of
11. a lot of help, although it
12. the tower aggressive in
13 occasions.
14. How do you treat the(17--20) Care of
15 patients with disorders nursing
16.mental?
I treat them in such a way that
18. they sit well, and the Role of
19. relatives too, since Nursing
they are part of the process.
21. What is the role of (25-33)
nursing in care
23.de the disorders
24. mental?
25. It is very important that the
26. nursing professional
27. stay updated
28. in many fields, and this
 32

29. the health order

30. mental and psychiatry is one
31. from this, in order to apply
correctly the process
33. nurse.

Source: Authors

Definition of Categories
Mental Disorder: They are all those disorders or conditions that affect
the mental health of patients. They involve disturbances of thought,
of emotions and behavior. They affect the mental, social, and
spiritual entity.
2. Perception: fear of attending to these users, I sometimes perceive in them
sadness, anxiety, depression, and aggression. It can be diffuse to perceive it.
I perceive them as beings that need a lot of help.
3. Nursing Care: special attention to their needs
emotional, psychological, and social. Treat it as if it were another patient
without discrimination. I treat them in a way that makes them feel good, and the
family members as well, since they are part of the process.
4. Nursing Role: the approach must include the environment, family, as they are
fundamental part of society. Medication administration
psychotropics, in many cases mechanical restraint, learning to hear
identify feelings of apathy, anxiety, depression. a good
family education, regarding the necessary care and follow-up of the
treatment. It is extremely important that the nursing professional
keep updated in many fields, and this one regarding health order
mental health and psychiatry is one of them, in order to apply correctly the
nursing process.
33
 34

Mental Disorder: Care of

They are all those Nursing:
disorders or special attention to
conditions that your needs
affect health emotional,
mental of the psychological and
patients social
Perception Role of
I fear to attend to Nursing:
these users, approach must
I perceive in them a include the environment,
sometimes sadness, family, since they are
anxiety, depression fundamental part
and aggression. of society

Graph 1 Individual Perception Structure

 35

Mental Disorder:
Nursing Care:
they include alterations
Treat it as if it were
of thought, of the another patient without
emotions and of
discrimination.
behavior

Nursing Role:
Administration of
psychotropic medications,
in many cases containment
Perception: mechanics, learning to listen
It can become vague identify feelings of
perceive it. apathy, anxiety, depression.
a good family education,
regarding care
necessary and follow-up of
treatment

Graph 2 Individual Interpretation Structure

 36

Nursing Care:
I treat them in such a way that
Mental Disorder:
They affect the mental part,
they sit well, and the
family members too, already
social and even spiritual.
that they are part of the
process

Nursing Role: It is
very important that the
Perception: nursing professional
I perceive them as beings stay updated on
many fields, and this the
that they need a lot of mental health and
help psychiatry is one of them,
to be able to apply
correctly the process
nurse

Graph 3 Individual Structure of Understanding

 37

Mental Disorder:
Perception: They are all those Nursing Care:
disorders or conditions that Perception: special attention on
affect the mental health of the your emotional needs,
patients psychological and social
Interpretation: they understand Interpretation: Treat it as if
another patient out without
alterations of thought, of
the emotions and of discrimination
behavior Understanding: I try to
Understanding: They affect the part so that they feel
well, and the family members too, already
mental, social, and even spiritual.
that they are part of the process Nursing Role:
Perception: the approach must include the
environment, family, since they are part
Perception: fundamental of society
Perception fear to attend to Interpretation: Administration of
psychotropic medications, in many
I perceive in these users a mechanical restraint cases, learn to
sometimes sadness, anxiety, will hear, identify feelings of apathy,
depression and aggression. anxiety, depression. a good education
familiar, regarding the care
Interpretation: It may result necessary and treatment follow-up
difficult to perceive it.
Understanding: It is very important that the
Understanding: I perceive them as nursing professional remains
beings that need a lot of updated in many fields, and this the
in the field of mental health and psychiatry is
help one of them, in order to apply
correctly the nursing process

Graph 4 General Structure of the phenomenon under study.

 38

Table 4. Triangulation Matrix

Informant Categories Theoretical Reference Interpretation

Perception: They are all According to the WHO (2011), disorders

those disorders or Mental illnesses are
mental "are a classification by
conditions that alterations of cognitive processes
they affect mental health non-exclusive categories, based on
Disorders of the patients affective aspects of development, considered
criteria with defining characteristics.
Mental
as abnormal with respect to the group
They admit that there is no definition.
Interpretation: reference social from which it comes
understand that adequately specifies the
alterations of individual. It may be about alterations
limits of the concept, lacking a
thought, of the in reasoning, behavior, the
emotions and of consistent operational definition that
behavior faculty to recognize reality or to
encompass all possibilities” (p. 3).
adapt to the conditions of life.
Understanding: They affect
the mental, social part
and even spiritual
 39

Table 5. Triangulation Matrix

Informant Categories Theoretical Reference Interpretation

Fear perception Dictionary of the Royal Spanish Academy

attend to these (2010) has defined perception as: The perception of the professional of
users, I perceive in nursing originates from the
they sometimes sadness, The cognitive process of consciousness senses y the others organs
Perception which consists of recognition, sensory, it is a process that
anxiety, depression and
n interpretation and significance for the it involves organizing information
aggression.
development of judgments regarding the in order to make judgments about the
sensations obtained from the environment care management of
Interpretation: physical and social, in which they intervene nursing, in the patient with
It can be vague other psychic processes among the mental disorders. It is of a character
perceive it. that are found in learning, the integral; that is, it will perceive as
memory and symbolization. a unique all, it is of character
526). rational, it will interpret according to the
Understanding: The
knowledge received before
I perceive as beings and according to their practical experiences;
what they need from
to later refer judgments about it
a lot of help
observed: and it is selective in nature
because it is determined by causes
objectives and subjective.
 40

Table 6. Triangulation Matrix

Informant Categories Theoretical Reference Interpretation

Perception: special According to Kozier (2008), nursing care

attention in your Nursing care in
are directed in three times, short, medium and patients with mental disorders
needs
emotional, long term, having: basically depend on the
Care of hallucinations, which son
psychological and social
Nursing Sufficient nutrition, adequate rest and perceptions without an object; that is,
Interpretation: safe activity. Keep the patient in a from an external stimulus without
Treat it as if it were environment of security. Establish there is an origin in the world
another patient without communication and building trust. Helping to exterior. They can be captured by
discrimination patient to participate in the community any of the senses sight,
therapeutic. Increase the capacity of the hearing, smell, touch, taste. The
Understanding: The patient to communicate with others. patients often act with
I treat in such a way that Reduction of hallucinations, ideas based on these perceptions
they sit well, and delirious and other psychotic symptoms. internals, which can make a
the relatives too, Reduce the injury or the acting of impulses. more compulsive effect than the
since they are part Increase self-esteem. Identify and use external reality
of the process the forces and the potentialities, and develop
a better image of oneself. To achieve and
maintain a level maximum of
functioning. Make the patient accept
and effectively confront the disease its
long-term nature, the need for
continue taking the foods. (p.765)
 41

Table 7. Triangulation Matrix

Informant Categories Theoretical Reference Interpretation

Perception: approach must Peplau, (2008)
include the environment, family, It can be said
since they are part Care in psychodynamic nursing requires being what are a set
fundamental of society capable of understanding our own behavior in order to of steps o
Paper of procedures
Nursing Interpretation: help others identify perceived difficulties and widely
Administration of structured the
medications
apply principles of human relations to the problems that
what are they going to be
psychotropics, in many emerges at all levels of experience. Nursing is a
containment cases carried out by
mechanics, learn to hear important interpersonal and therapeutic process. It works in part of the staff of
identify feelings of nursing that is going to
terms of cooperation with other human processes that allow to apply a
apathy, anxiety
depression. a good they make health a possibility for individuals in the previously careful
family education organized the
as for the care communities patient with
necessary and follow-up disorder mental
of the treatment guaranteeing you
quality attention
Understanding: It is
very important that the
nursing professional
stay updated on
many fields, and this the
of mental health and
psychiatry is one of them,
in order to apply
correctly the process
nurse
 42

MOMENT V

FINAL REFLECTIONS

Once the phenomenon under study, whose purpose was to unveil the
perception of the nursing professional in the nursing care of patients
with mental disorders, in the Adult Emergency unit of Dr. Rafael Hospital
Zamora Arévalo. Based on the obtained results and to respond to the
From the description of the phenomenon, the following reflections can be inferred:

The perception of nursing professionals is based on the relationship of

beliefs, opinions, feelings and disposition, this allowed to demonstrate the
importance of the perception, motivation, and interaction that professionals have
of nursing, this influences behavior and attitudes, which can be
modified according to the experiences and knowledge that will be acquired in
relationship with patients with mental disorders.
Highlighting these, which are alterations of the affective cognitive processes of the
development, considered as abnormal with respect to the reference social group
from which the individual originates. It may involve alterations in reasoning, the
behavior, the ability to recognize reality or to adapt to conditions
of life
It was identified that the nursing professionals have information,
perception, opinions, and beliefs; when providing care to the patient with disorder
mental, which is favorable for the care of patients with this type of
condition. Likewise, it was evident that the feelings present in the
nursing professionals towards care significantly influence the
care management.
Similarly, nursing professionals demonstrated that only through the
Nursing process, applied in each of its phases, allows for the identification of
needs present in users with mental disorders, which in a
 43

a determined time will be achieved to satisfy and thus obtain an optimal result, and a
quality human care.
And lastly, the perception of the nursing professional originates from the
senses and other sensory organs, is a process that involves organizing a
information to make judgments about the management of care
nursing, in the patient with mental disorders. It is of integral character; that is to say, it goes
to perceive as a unique whole, is of a rational nature, will interpret according to the
knowledge they have received before and according to their practical experiences; to refer
then judgments about what was observed: and it is selective in nature because it is
determined by objective and subjective causes.
 44

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