FLUXO DE AÇÕES PARA APOIAR O CUIDADO DO ENFERMEIRO À USUÁRIOS DE ÁLCOOL

Objective: Propose a flow of actions to support the work of nurse in the care of alcohol users in Primary Health Care. Method: Exploratory study, of the methodological type, carried out in August 2022, in a municipality in the interior of Mato Grosso, Brazil. Data collection was divided into two stages, the first with health service users and the second with Primary Health Care nurses, with the application of the Alcohol Use Disorders Identification Test. Data analysis was performed by thematic analysis. For the elaboration of the flow, the diagnosis that nurses and users made about what would be needed to improve the assistance was considered, arriving at the needs, grouped into thematic axes that consolidated a didactic structure, the flow of actions. Results: The flow was presented in three axes, knowledge of the territory and demands, awareness and training, and dialogue with specialized services. Conclusion: With this flow of actions, it will be possible to plan the assistance and support the work processes of the nurse and the team in the management of care for alcohol users, in a clear and strategic way.


INTRODUCTION
Alcohol is the most consumed and accepted psychoactive substance in the world.
Globally, alcohol is responsible for almost 50% of annual deaths, mainly related to external factors (1) . There are numerous aspects that imply and interfere with alcohol consumption, such as culture and beliefs, availability of points of sale in the community, socioeconomic crises and problems, life cycles, family history, mental disorders, low effectiveness of actions and services in the community aimed at prevention and follow-up, and interference of costconsumption variables (alcohol content, price and acquisition of the drink) (1)(2)(3) .
In Brazil, the reasons that make women consume alcohol are related to socialization, and for men with the purpose of relieving tension and finding well-being (4) . However, although there are different reasons for this consumption and different prevalence between men and women (5) , there are recommendations that disregard the difference between genders for defining policies and establishing care strategies, because, despite the physiological and psychoemotional particularities, speed of intoxication, period of dependence and probabilities of recovery, health risks and social impacts are similar (6) .
People in the condition of chemical dependency have higher rates of medical comorbidities, including liver disease, chronic kidney disease, ischemic vascular disease and chronic obstructive pulmonary disease (7) . In addition, they show a significantly higher level of anxiety, hostile behavior, depression and obsessive-compulsive symptoms, especially among those younger in age, people with low education and contact with alcohol in younger age groups (8) .
Community-based services for nonemergency alcohol care provide users with greater security and support (9) . However, the stigmatization process stems from two perspectives, the moral/criminal and the disease itself (10) . This makes it difficult for many people with alcohol problems to access traditional services (11) , often opting, when aware of the need for care, for support modalities, such as digital platforms, considered more flexible and/or with less exposure (12) .
In the United States, alcohol screening and evaluation rates are relatively high among adults who attend health services, but intervention rates are low, even when individuals are identified as users, at risk consumption, harmful use and with disorders due to alcohol use (13) . This behavior impairs users' access and adherence to therapeutic projects, as the spontaneous search for help in the face of alcohol abuse and dependence in general is low (14) .
In the national territory, the services that make up Primary Health Care (PHC) stand out as great welcoming and with the potential to manage the care demands required by this clientele profile, as well as there is evidence that ORIGINAL ARTICLE interventions carried out from the first consultation of nursing in this care context are effective in reducing alcohol consumption in individuals with dangerous or harmful use patterns (15) .
In PHC, nurses stand out for managing all the assistance provided in the health service, having a bond with the community under their responsibility and contributing directly to changing lifestyles, mitigating risk factors, as well as promoting the capacity for autonomy and self-assessment of the user in their own care (16) .
On the other hand, some PHC nurses also have negative feelings regarding the demand of alcohol users, which can interfere in the care process (17) .
In Brazil, not all PHC services use instruments for screening or identifying care needs. It is common to observe the use of several instruments only for scientific purposes and few directed to care practice, intervention to alcohol users. In Rio Grande do Sul (BR), to identify the consumption phase of alcohol users and the actions directed to their care, professionals base themselves on the periodicity of use; amount and type of substance used; repercussions of misuse; and the place it occupies in the person's life (18) , but without the use of a specific standard instrument.
Specifically, in the nursing consultation with alcohol users, the inclusion of instruments facilitates, orders and personalizes care (19) . Thus clear description (20) .
To support the construction of the flow, two data collections were carried out, by a single pre-trained nurse, with the subjects that integrate the nursing consultation: nurses and patients.
These stages took place in a medium-sized municipality, with 107,631 inhabitants, in the interior of Mato Grosso, Central Region of Brazil (21) . This municipality was chosen because it corresponds to a regional health center and does not have a Psychosocial Care Network (RAPS) structured for the profile of the region.
The study consisted of two profiles of participants (service users and nurses). As for service users, inclusion criteria were being over   (22) .
The AUDIT was applied to nurses, as there is evidence that these professionals who consume alcohol have more positive attitudes towards the patient who also consumes alcohol than other abstemious professionals, and this probably reveals other forms of care (17) .
The empirical material from the interviews was organized into spreadsheets in Microsoft Excel 2019, with the construction of a

RESULTS AND DISCUSSION
The participating nurses were between  There could be more doctors to attend to; Have faster calls; Sometimes medicines are missing. In the case of users, according to their categorization by pattern of use, the main axis that refers to the quality of assistance provided in the service, there seems to be a delay for these users to have access to their treatment or for their demand to be met, either due to lack of medical professionals who attend, make a quick referral or schedule a new referral to a specialized service, either due to lack of medication. It is evident that most do not feel well attended.
In the elaboration of the flow, considering the diagnosis that nurses and users make about what needs to be done to improve care, the following needs are highlighted:

Knowledge of the territory in terms
of the demands of alcohol users in the different patterns (screening with the frequent public in the service and active search). In the end, it was observed that the axes were reduced to three that, acting in a circular and continuous way, can improve the quality of user assistance, a desire of this group. training (23,24) .

Sensitization and
It is understood that it is important to invest in the continuing education of these professionals based on the principles of permanent education, questioning the social demands of the territory where they work and considering both the socioeconomic and structural conditions of professionals and users of health services (25) . Hence, the flow included the axis of knowledge of this territory with the demands of users who inhabit it and those who work there, acting in assistance.
As mentioned by the nurses participating in this study, in PHC factors such as lack of resources (human, financial and physical) and the lack of comprehensiveness and intersectoriality of the care network, limits and even makes promotion, prevention and rehabilitation actions impossible (26,27) .
Therefore, the work of preventing the use of alcohol and other drugs cannot be disconnected from conjunctural analyzes, aiming to raise awareness, in addition to population groups, professionals and managers (28) . Therefore, there are suggestions for actions/procedures presented in the flow axes.
As a limitation of the study, we