ORIGINAL RESEARCH

Adolescents under semi-freedom social-educative measure: being-there-with#set in the everyday and possibilities for the nursing

Dilce Rejane Peres do Carmo^I; Stela Maris de Mello Padoin^II; Cristiane Cardoso de Paula^III; Ivis Emília de Oliveira Souza^IV

^IMS in Nursing, Technical Responsible of the Nursing Service of the Unit of the Socio-educational Center for Inpatient Care. Santa Maria, Rio Grande do Sul, Brazil. E-mail: dilcerpc@ibest.com.br
^IIPhD in Nursing, Adjunct Professor at the Department of Nursing of the Federal University of Santa Maria. Leader of the Health Care Research Group of individuals, families and society. Santa Maria, Rio Grande do Sul, Brazil. E-mail: stelamaris_padoin@hotmail.com
^IIIPhD in Nursing, Adjunct Professor at the Department of Nursing of the Federal University of Santa Maria. Leader of the Health Care Research Group of individuals, families and society. Santa Maria, Rio Grande do Sul, Brazil. E-mail: cris_depaula1@hotmail.com
^IVPhD in Nursing, Full Professor at the Anna Nery School of Nursing at the Federal University of Rio de Janeiro. Brazil. E-mail: ivis@superig.com.br

ABSTRACT

This phenomenological study conducted at a Social Education Foundation in Rio Grande do Sul, Brazil, aimed to understand the routine of adolescent-beings undergoing semi-custodial 'social education' measures. Nine adolescents were interviewed between February and May 2009. Heidegger analysis revealed that experiencing this social education measure means having difficulty coexisting, obeying and staying legal (not offending or absconding); being away from relatives and friends, missing mothers, thus learning to value them. This is shown in the manner of being-with people (family, peers and professionals). It is concluded that, in their relations, the adolescents limit themselves to the impersonality of what others expect of them. Sometimes, in relationships with mother or child, they appear as authentically being-themselves. Nursing can improve care given at the Foundation and construct a positive existential project, preventing recidivism in the social education system.

Keywords: adolescent health; institutionalized teenagers; nursing; child advocacy.

INTRODUCTION

The bio-psychosocial transformations occurring in the adolescence development phase characterizes a vulnerability time, in which behavior and relationship alterations can occur. It is the negative result of the relation between the material or symbolic resources availability and the access to social opportunities structures that comes from the State and the society¹.

In this population, the offending adolescent that is under socio-educational measures (SEM) stands out. In Rio Grande do Sul (RS), 1,158 adolescents are in SEM custody at the Socio-educational Care Foundation (SECF). From these, 43.3% are in units in the state countryside, 96.5% are male, 70.2% are aged between 15 and 18 years old, and 53.3% had studied until the fourth and sixth year of the elementary school. As for the infractional act, it is possible to mention: theft (48.7%), murder (12.5%), and narcotic traffic (10.4%)².

It must be pointed out that some factors may be associated with infractional acts and it should be considered that these get past the vulnerability concept, which takes us to three independent plans: individual, social and programmatic³.

The individual plan, which beholds the behavior, can be perceived by the use of drugs. In Brazil, alcohol and marijuana are the most used drugs by teenagers⁴. The licit drugs are used earlier than the illicit ones; among institutionalized children and adolescents, the prevalence of experimentation and use of drugs is high and premature, addressing the age range from 12 to 14 years old⁵. The early use of those psychotropic substances could lead to very serious behavior problems, ending up in the narrow relationship between the use and the abuse of alcohol, illicit drugs and delinquency^4,6-8.

In this context, crack is much more powerful and highly addictive than other drugs. The intense ephemeral moment of pleasure follows the urgency of repetition. Drug users, in addition to becoming targets of pulmonary and circulatory diseases that can be lead to death, can expose themselves to violence and dangerous situations that can also kill them^9,10.

The social plan embraces that, in primary socialization, the family's main purpose is to ensure mediated behaviors by affection and culture. The quality of the family relationship is a key factor in guiding juveniles to delinquency^1,10. It is important to highlight the importance of the rescue of the father figure. Based on studies, the antisocial behavior of any family member is more likely if the father is absent or nonparticipant^11,12.

Both the pro-social and the antisocial behavior are directly influenced by interactions. Behaviors are going to change by themselves, influenced by the environment demands. The urban violence, which is highlighted as one of the main social problems in Brazil, requires intersectoral and multidisciplinary actions for its prevention and refers to a combination of difficulties in the relationships with the family and society^13,14.

The programmatic plan points out to the their ability to make choices from their possibilities¹⁵. Adding the need of social, political and economic reconstruction, focused on the prevention and treatment of the families. Considering that an effective and adequate care provision to adolescents and their families can change their hopeless realities into life opportunities that open possibilities^10,16-18.

Running parallel to the individual, social and political demands of the presented problem, the production of knowledge regarding the adolescent health contemplates, in the majority of the studies, the epidemiological, social, cultural and legal approach. This article takes a critical look at the subjectivity, having as a guiding question: what is it like to be an adolescent and to serve socio- educational measures? In order to fulfill it, the aim was to understand the daily life of the adolescent- being that serves socio-educational measures of semi-freedom.

THEORETICAL-METHODOLOGICAL REFERENCE

The phenomenological approach of Martin Heidegger's referential seeks to reveal in the object of study the way it is in itself, and not only what it is, that is, a knowledge of the phenomenon and not only about it. In order to do so, it suspends the factual knowledge - what is already known about the facts - in search of the existential understanding of the phenomenon ¹⁹. Thus, it enables us to take a critical look at the adolescent in its own existential world in order to understand its uniqueness of being-in-the-world. This is possible through the inter- subjectivity between the researcher and research subject, in the search for the meanings that the subjects themselves attribute to their experience expressed in their own words, from the daily life, from their background knowledge and from their historicity.

The experience description with the phenomenological research and with the application of the Heideggerian hermeneutic analytical movement is a methodological possibility to the nursing research. This is a reflexive and also theoretical movement that begins in the research project construction when there is the need to find the research object and seek the convergence with the theoretical-methodological reference²⁰.

The development of the ontic dimension of the Heideggerian referential makes it possible to understand the meanings pointed out by the deponents in their daily lives. Culminating in the ontological dimension that allows unveiling senses of what has been experienced and enlarge the possibilities on health and nursing care²⁰.

The Heideggerian theoretical-philosophical- methodological referential seems coherent with the humanistic principles of nursing and with its study object due to the trend of researchers of turning their eyes to human-beings' subjective situations and care^19,20. It contributes to the approximations between theory and the care practice through the understanding of the phenomena that permeate the impact of the health situation of people, families and society, and particularly in this article, the population of institutionalized offending adolescents.

Method

This is a qualitative research, with phenomenological approach and theoretical-methodological referential of Martin Heidegger¹⁹. The field research phase was carried out with the approval of the Research Ethics Committee of the Federal University of Santa Maria/RS (CAAE: 23081.020554/2008-31), from February to May 2009. The ethical principles of the research were observed.

The data production scenario was a SECF unit of Rio Grande do Sul, Brazil: a Semi-freedom Service Center of Santa Maria (CASEMI - Centro de Atendimento em Semiliberdade de Santa Maria), with capacity for 25 adolescents. It is intended to the execution of SEM in semi-freedom determined by the judiciary to adolescents and young authors of an infractional act, originating in the jurisdiction of the Judge of Infancy and Youth of Santa Maria. The workforce is composed by a team of technicians in the following areas: Psychology, social work and education. The support team is composed of a nursing assistant with supervision of the nurse, a cook, a driver, monitors, administrative agents and the director. It also has a public and private social support network that helps to make activities feasible. Specialized health care is provided by the public network.

The inclusion of the research participants was based on the following criteria: adolescents between the ages of 12 and 18 (delimitation according to the Statute of the Child and Adolescent), who were under a socio-educational measure of semi-freedom in the SECF service unit of the municipality and who were not under suspicion of drug use during the period of data production (considering the prerogative that adolescents on a semi-feeedom regimen perform activities in the community and sometimes have access to drugs).

The adolescents were randomly included after receiving an invitation, during the creation of an operative group developed by the unit. It occurred after the Free and Informed Consent Term, which was signed by the Institution's director representative, because he is legally responsible for the adolescents. Also, a Free and Informed Consent Term was signed by the adolescent, demonstrating the willingness to participate in the research.

The access means to the teenagers was the phenomenological interview²¹. Such modality allows to account for the human-being's life, as the experience presents itself, through a comprehension movement. As a way to access the being, the interview is developed as a meeting, singularly established between the researcher and each subject researched. The meeting was mediated through empathy and inter-subjectivity, through the reduction of assumptions²¹. It was required from the researcher a positioning of decentering of himself, in order to intentionally direct the adolescents' understanding.

During the meeting, the researcher needs: to be aware of the ways of showing of the subject interviewed; to capture the said and the unsaid; to observe the other speech forms: the silenced, the gestures, the suspensions and pauses; and to respect the space and time of the other. This open position from the researcher towards the other enables to progressively improve the interview conduction. The interview started with the guiding question: what is it like to be an adolescent and to serve socio-educational measures? Throughout the interview, the researcher formulated emphatic questions, in order to avoid inducing answers, but highlighting matters expressed by the adolescents themselves, which needed to be discussed in greater details to a better understanding of the possible appointed meanings. To end the interview, a feedback was provided, asking if the adolescent would like to add something else and thanking them for the willingness to participate in the meeting.

The number of adolescents was not previously determined since the field stage found sufficient meaning expressed in the interviews, which have answered the objective of the research. At that point, nine interviews were concluded during this phase, since the results expressed in the interviews comprised the essential structures of the phenomenon of investigation²¹.

The interviews transcription respected the original wording as well as the silence pauses and body expressions observed by the interviewer. All the interviews were marked with the letter A (from the word 'adolescent') followed by numbers from 1 to 9.

The analysis method applied was the first Heideggerian methodical moment: a comprehensive analysis^19,20. There was a suspension of the researcher's assumptions by developing attentive listening and reading of interviews, in order to understand the daily life of the adolescent who serves SEM of semi-freedom, without imposing categories predetermined by theoretical/practical knowledge. Essential structures were underlined in the transcription, composing a chart of analysis. From such chart the meaning units and the phenomenological discourse were established, in order to compose a vivid concept, which serves as a guiding thread for the interpretation according to the methodical moment^19,20.

RESULTS AND DISCUSSION

The Heideggerian analysis helped to reveal the following meaning units: undergoing a socio- educational measure means experiencing difficulty of cohabiting, obeying and maintaining a legal status, of not breaking the law or running away, of being away from relatives, friends, and missing their mothers, learning how to value them.

When talking about cohabiting and withdrawal, the adolescent-being that is serving a socio- educational measure shows itself as a being-there, with its own relations in the world. The presence, that is, the way by which the adolescent-being positions itself in the daily life, happens in a spatiality: in the world. This spatiality indicates the context in which, in fact, a presence cohabits. Such presence not only is and lives in this world, but also relates to the world¹⁹.

To relate is essential for the constitution of the world, because it does not correspond to a geometric structure already given, in which the being is located. The world exists only in a system of relations, since isolated it is nothing. It is produced only in the being-together, movement of the presence (distancing/approaching) towards the (others or things) that comes to encounter. Thus, a fundamental structure of presence is denoted: being-in-the-world, which designates an articulated totality, for there is no world without being, just as there is no being without world¹⁹.

Being-there-in-the-world, the adolescent-being relates to the people who integrate their daily life: their family and peers, as well as the professionals of the institution. They also interact with themselves.

The being-there-with indicates the relational nature of the human, demonstrating that every being is always being-with, even in loneliness and isolation. The presence "is always a co-presence, the world is always world-shared, living is always conviviality"^21:319.

Having difficulties to live, obey and keep legal, without breaking the law or running away

When experiencing a socio-educational measure, the adolescent seems to be concerned about the possibility of meeting street rivals inside the unit. They mention the internment unit, where it was possible to avoid encounters because of the closed system characteristic; on the other hand, in the semi-freedom, the possibility of conflicts between them emerges.

Here is a report:

In their being-in-the-world-with-others, in the midst of the abandonment and arbitrariness of others, the adolescents point out their understanding of the socio-educational system. To be-in-the-world, I take my story with me, everything I have experienced and lived, which refers to historicity, in other words, it is the tradition of a legacy of the past, when I can appropriate and transform my history or simply use it as a guide in my life, following the norms and the familiar and coexistence behaviors already introduced¹⁹.

In most cases, the adolescent shows they are in-the- middle-of-the-system. They do not deny their tradition, but they allow it to happen in the daily life of the socio- educational measure, occupying themselves in being-in- the-world-with-the-others, sometimes following what their peers expect, sometimes following what the standards establish.

The adolescents say they intend to be well. However, when provoked and pressured, they react in an aggressive manner without requiring any protection, for they believe that such attitude will reveal fear. They also report that they are often invited by other adolescents to engage in undue acts in or out of the institution. If they refuse it, they should remain silent, without confirming that either they were aware of something or had seen something; otherwise they either may be threatened or even be beaten by those involved. Sometimes they think that they may just bother or fool around, like running away, using and bringing drugs. These behaviors complicate complying with the SEM, generating a new law sue and aggravating their own situation.

These are the statements:

The adolescent-being shows itself in an impersonality way of being at the time they do what their peers expect from their behavior. On a daily way of life, they reveal to be as everyone, and not as themselves, since the standardization imposes itself or is imposed. The standardization of all their possibilities excludes the participation of their own responsibility ^16-19. It expresses an impersonality on the way they present themselves day by day: like we, and not as themselves.

To be separated from relatives, friends and missing the mother, learning to value her.

They reveal that the characters of family connection and affection, some impaired, others interrupted by the death of the father, mother, brother and friends.

These are the statements:

The semi-freedom measure proposes to resume the history that was lived and modified, to go back to a person‟s own world besides the socio-educational system, in the possibility of leaving the being-in-the-middle to become being-with-others-in-the-world¹⁹.

The elementary historicity of the presence can remain hidden from itself, but it can also be found and become an object of special care^16-19. When the relationship between the adolescents and their family and friends is expressed in the statements, the adolescent reveals himself/herself as being-with-others.

The mother appears in the role of helper. She is the person who goes to the institution and keeps contacting the service, showing both affection and concern.

Here are the speeches:

The peculiarities of the existence as a clarification of the being can be captured by a single word: caring. Thus, one can refer to the world as the thing to which we care for and the being as the person who takes care of the world. So, the beings can be divided as caring for (that weights on the being as a load from the past) and taking care of (in relation to the possibilities projected in the future). This is comprised in the adolescent's speech:

By taking the care of themselves, the adolescents may reveal themselves as being-in-possibilities, listening to themselves, which their own silence may evoke to us the possibility of another way of listening. The consciousness is the authentic self calling itself out of its own impersonality, it is the calling of care, showing the incompleteness of being-in-the-world¹⁹.

The adolescent makes plans, wants to study, to work to help the mother. They say they need help and that, if they want, the institution can help them, revealing a power-to-be-in-the-world. Maybe the SEM may open this possibility.

Most of the times the adolescent ends the relationship when they are arrested, they suspect about infidelity, but they can resume dating, when leaving for weekend walks especially when they have children. The child is a motivation to comply with their measure and the desire to improve.

These are some statements:

Thus, the adolescent-being shows himself/herself in the way of being-with the people who integrate their daily life: family, friends and professionals of the institution. It is noticed that the adolescent, when relating, remains in the impersonality of what others expect them to do, either of the institution norms, or of the pairs that instigate them to participate in illicit activities or to silence before them¹⁹.

CONCLUSION

The Heideggerian analysis revealed that experiencing a socio-educational measure means having difficulties to live, obey and staying legal, without becoming a delinquent or fleeing; being away from parents, friends and missing their mothers, learning to value them. That way, the offending adolescents have revealed themselves as being able to care: about family, peers and professionals.

Thus, it is believed that the socio-educational measures applied and mediated with care based on subjectivity may create a space for listening, both for the adolescents and their families. Aiming at the emergence of other possibilities to escape this situation, building a movement between the being- there of the offending adolescent and the being-there that is part of adolescence.

In that way, nursing, sharing the world of SEM, sees the possibility to improve the care in the SECF units. It is necessary to promote a healthy development, to propose individual and group actions with dialogical space, aiming to assist in building a positive existential project, preventing the recidivism into the socio-educational system.

The study shows the limitations of a qualitative approach investigation, situated in the scenario and period in which it was developed. Therefore, the intention is not to generalize such findings, but to deepen the interpretation of the senses unveiled from the understanding of the meanings by the subjects of the research themselves.

REFERENCES

1. Bretas JRS. Vulnerabilidade e adolescência. Rev Soc Bras Enferm Ped. 2010; 10: 89-96.

2. Fundação de Atendimento Sócio-Educativo do Rio Grande do Sul [página da internet] Porto Alegre (RS). [citado em 22 nov 2009] Disponível em http://www.fase.rs.gov.br/portal/index.php

3. Ayres JRCM, Paiva V, França Jr I. From natural his- tory of disease to vulnerability: changing concepts and practices in contemporary public health. In: Parker R, Sommer M, organizadores. Routledge Handbook in Global Public Health. Abingdon (Oxon): Taylor and Francis, 2011. p. 98-107.

4. Martins MC, Pillon SC. A relação entre a iniciação do uso de drogas e o primeiro ato infracional entre os adolescentes em conflito com a lei. Cad Saúde Pública. 2008; 24: 1112-20.

5. Vasters GP, Pilon SC. O uso de drogas por adolescentes e suas percepções sobre adesão e abandono de tratamento es- pecializado. Rev Latino-Am Enfermagem. 2011; 19: 317-24.

6.Heim J, Andrade AG. Efeitos do uso o álcool e das drogas ilícitas no comportamento de adolescentes de risco: uma revisão das publicações científicas entre 1997 e 2007. Rev Psiquiatr Clín 2008; 35: 61-8.

7. Malhotra C, Sharma N, Saxena R, Ingle GK. Drug use among juveniles in conflict with the law. Indian Journal of Pediatrics 2007; 74: 353-6.

8. Guimarães CF, Santos DVV, Freitas RC, Araujo RB. Perfil do usuário de crack e fatores relacionados à crimi- nalidade em unidade de internação para desintoxicação no Hospital Psiquiátrico São Pedro de Porto Alegre (RS). Rev Psiquiatr RS. 2008; 30: 101-8.

9. Etchepare M, Dotto ER, Domingues KA, Colpo E. Per- fil de adolescentes usuários de crack e suas consequências metabólicas. Revista AMRIGS. 2011; 55: 140-6.

10. Bernardy CCF, Oliveira MLF. O papel das relações fa- miliares na iniciação ao uso de drogas de abuso por jovens institucionalizados. Rev esc enferm USP. 2010; 44: 11-7.

11.Pacheco JTB, Hutz CS. Variáveis familiares preditoras do comportamento anti-social em adolescentes autores de atos infracionais. Psicol Teor Pesqui. 2009; 25: 213-9.

12.Branco BM, Wagner A. Os adolescentes infratores e o empobrecimento da rede social quando do retorno à comunidade. Ciênc saúde coletiva. 2009; 14: 557-66.

13.Silva KL, Dias FLA, Vieira NFC, Pinheiro PNC. Reflexões acerca do abuso de drogas e da violência na adolescência. Esc Anna Nery. 2010; 14: 605-10.

14. Phebo L, Moura ATMS. Violência urbana: um desafio para o pediatra. J Pediatr. 2005; 81: S189-96.

15. Garbarino J. Por que os adolescentes são violentos. Ciênc saúde coletiva. 2009; 14: 533-8.

16. Higarashi IH, Baratieri T, Roecker S, Marcon SS. Atuação do enfermeiro junto aos adolescentes: identifi- cando dificuldades e perspectivas de transformação. Rev enferm UERJ. 2011; 19:375-80.

17. Ballani TSL, Oliveira MLF. Uso de drogas de abuso e evento sentinela: construindo uma proposta para avaliação de políticas públicas. Texto contexto – enferm. 2007; 16: 488-94.

18. Zappe JG, Dias ACG. Grades não prendem pensamen- tos: limites da institucionalização na reconstrução do projeto de vida do adolescente. Psico. 2011; 42: 220-7.

19.Heidegger M. Ser e tempo. Parte I. 6ª ed. Petrópolis (RJ): Vozes; 1997.

20. Paula CC, Cabral IE, Souza IEO, Padoin SMM. Analytical movement Heideggerian hermeneutics: methodological possibility for nursing research. Acta Paul Enferm. 2012; 25:984-9.

21. Paula CC, Padoin SMM, Terra MG, Souza IEO, Cabral IE. Modos de condução da entrevista em pes- quisa fenomenológica: relato de experiência. Rev Bras Enferm. 2014; 67.