El análisis institucional en la producción científica en salud: una revisión integradora de literatura

Kasper, Maristel; Fortuna, Cinira Magali; Braghetto, Gláucia Tamburú; Marcussi, Thalita Caroline; Feliciano, Adriana Barbieri; L’Abbate, Solange

doi:10.1590/S1980-220X2018046203587

Brasil

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Review • Rev. esc. enferm. USP 54 • 2020 • https://doi.org/10.1590/S1980-220X2018046203587 linkcopiar

El análisis institucional en la producción científica en salud: una revisión integradora de literatura

Autoría SCIMAGO INSTITUTIONS RANKINGS

Resumen

Objetivo: Analizar, en los estudios del área sanitaria, la utilización del marco de referencia teórico metodológico del Análisis Institucional y del concepto central de institución en sus tres momentos - instituido, instituyente e institucionalización.

Método: Revisión integradora llevada a cabo en las bases de datos PubMed/Medline, LILACS, Scopus, CINAHL, incluyéndose en la búsqueda artículos originales de investigación, publicados entre 2012 y 2017.

Resultados: Fueron analizadas 26 publicaciones. Se encontró una pluralidad de objetos de estudio, siendo los más comunes los relacionados con la salud colectiva: salud mental, violencia, relación familia-equipo, salude de la familia, atención primaria, salud de la mujer, infancia y adolescencia, salud bucal, educación permanente, micropolítica del trabajo en salud, vigilancia en salud, VIH, derecho, prácticas pedagógicas, educación escolar y Autismo. La enfermería y la psicología fueron las áreas que más optaron por el Análisis Institucional. La polisemia del concepto de institución se confirma en los hallazgos, señalando una riqueza en los modos y usos de los conceptos.

Conclusión: El Análisis Institucional presenta conceptos herramienta capaces de operar análisis de prácticas en salud acordes con el Sistema Único de Salud.

Descriptores: Análisis Institucional; Organicaciones; Salud Pública; Técnicas de Investigación; Revisión

Authors	Journal	Frequency
^{Romagnoli RC, Magnani NR, 2012}^(⁸)^{Fortuna CM, Monceau G, Valentim S, Mennani KLE, 2014}^(³³) Romagnoli RC, 2015a^(⁹)	Fractal: Revista de Psicologia (UFF)	12.1%
^{Pezzato LM, L'Abbate S, 2012} ^(¹¹) ^{Archanjo AM, Schraiber LB, 2012} ^(¹²)	Saúde e Sociedade (USP)	7.7%
^{Pezzato LM, L'Abbate S, Botazzo C, 2013} ^(¹⁷) ^{Sanches ICP, Couto IRR, Abrahão AL, Andrade M, 2013} ^(¹⁹)	Ciência & Saúde Coletiva (ABRASCO)
^{Gontijo TL, Xavier CC, Freitas MIF, 2012} ^(¹⁵) ^{Fortuna CM, Mesquita LP, Matumoto S, Monceau G, 2016} ^(³⁰)	Cadernos de Saúde Pública (FIOCRUZ)
^{Garcia RA, L'Abbate S, 2015}^(²⁴) Dóbies DV, L'Abbate S, 2016^(³¹)	Saúde em Debate (CEBES)
^{Muniz MP, Tavares CMM, 2012} ^(¹⁶) ^{Silva AB, Gomes BCF, Torres OM, Siniak DS, 2013} ^(²²)	Revista de Pesquisa: Cuidado é Fundamental Online (UNIRIO)
Zambenedetti G, ^{Silva RAN, 2015}^(²⁹)	Estudos de Psicologia (Natal) (UFRN)	3.8%
^{Garcia RA, L'Abbate S, Arakaki J, 2015} ^(²⁷)	Interface (Botucatu) (UNESP)
^{Pereira WR, Ribeiro MRR, Santos NC, Depes VBS, 2012} ^(¹⁴)	Acta Paulista de Enfermagem (UNIFESP)
^{Fortuna CM, Matumoto S, Camargo-Borges C, Pereira, MJB, Mishima SM, Kawata LS et al., 2012} ^(¹⁰)	Revista da Escola de Enfermagem da USP (USP)
^{Depes VBS, Pereira WR, 2013} ^(²⁰)	Revista Gaúcha de Enfermagem (UFRGS)
^{Romagnoli RC, 2015}b^(²⁵)	Barbarói (UNISC)
^{Lima AIO, Severo AK, Andrade NL Soares GP, Silva LM, 2013} ^(²¹)	Temas em Psicologia (SBP)
^{Silveira L, Nunes MO., 2013} ^(¹⁸)	Polis e Psique (UFRGS)
^{Zambenedetti G, Piccinini CA, Sales ALLF, Paulon SM, Silva RAN, 2014} ^(²³)	Psicologia: Ciência e Profissão (CFP)
^{Silva DCR, 2015} ^(²⁶)	Psicologia da Educação (PUC/SP)
^{Barreto L, Dimenstein M, Leite JF, 2013} ^(¹³)	Athenea digital (UAB/Spain)
^{Passos ICF, Vieira K, Moreira L, Rodrigues F, Amorim M, Santos C et. al., 2017} ^(³²)	Santé Mentale au Québect - Érudit (EdeM/Canada)
^{Spagnol CA, L'Abbate S, Monceau G, Jovic L, 2016} ^(²⁸)	Recherche en Soin Infirmiers (Cairn/France)

Object/Question/Objective of the study	Type of study	Techniques and/or Tools	Data analysis
To configure and problematize the relationships in the team-family territory and show what makes the effective family participation difficult in the treatment of children attended at the Renato de Avelar Azeredo Psychopedagogical Center (Portuguese acronym: CPP) of the Municipality of Nova Lima^(⁸).	Intervention research Cartography	Semi-structured interview, Observation, General assemblies	Institutional analysis
To investigate violence against women in Montes Claros, Minas Gerais^(⁹).	Qualitative and quantitative research	Document analysis Participant observation	Schizoanalysis SPSS
To map the instituted and instituting movements in the work of the Family Health Strategy with regard to the composition of their care practices^(¹⁰).	Intervention research	Group meetings	Schizoanalysis
To present the methodological strategy produced and exercised during the development of a doctoral research in which the theoretical-methodological framework of Institutional Analysis in Collective Health was adopted^(¹¹).	Action-intervention research	Diary, Discussion groups	Socioanalysis
To study the performance of psychologists in Health Centers (Portuguese acronym: UBS - Unidade Básica de Saúde)^(¹²).	Qualitative research	Semi-structured interview	Content analysis
To discuss the care offered to women in situations of violence with mental disorders and/or treated at the psychosocial care network (Portuguese acronym: RAPS) in two agencies that make up the care network for women: Reference Center and Shelter Home^(¹³).	Intervention research	Semi-structured interview	Institutional analysis
To know the pedagogical practices developed in the teaching of undergraduate Nursing courses for the identification and analysis of those that promote subjectification processes which reinforce students’ desire to learn^(¹⁴).	Qualitative research	Semi-structured interview Focus group	Institutional analysis
To understand the difficulties and facilities for the implementation of the Kangaroo Method in Brazilian maternities with training by the Ministry of Health, from the perspective of health professionals, managers and mothers of low birth weight newborns treated in these services^(¹⁵).	Qualitative research	Semi-structured interview	Grounded Theory
To analyze the nursing team’s understanding of the educational processes experienced by them in a psychiatric hospital^(¹⁶).	Exploratory, qualitative research	Participant observation	Institutional analysis
To reflect on the effects and meanings provoked by an instituting proposal put under analysis by a group of oral health professionals working in primary health care in the city of Campinas (state of São Paulo)^(¹⁷).	Socioanalytical Intervention	Diary	Socioanalysis
To put into analysis the modes of subjectification of madness through the experiences of users of a Psychosocial Care Center (in Portuguese CAPS) in Pentecostal religions by identifying possible articulations between these institutions^(¹⁸).	Qualitative research Ethnography	Semi-structured interview Participant observation	Discourse analysis
To know the perception and difficulties experienced in the exercise of hospital follow-up in surgical inpatient units of a public hospital in the city of Niterói (state of Rio de Janeiro) from the perspective of the inpatient and discuss them in the light of the concepts of Institutional Analysis (IA)^(¹⁹).	Qualitative research Descriptive research	Semi-structured interview Observation	Content analysis
To understand how the training process in the Master in Nursing contributed to the mobilization of formal and political aspects of scientific knowledge by graduates working in health services^(²⁰).	Qualitative research Exploratory research	Semi-structured interview	Content analysis
To analyze the care provided by Family Health Teams to mental health users^(²¹).	Qualitative research	Semi-structured interview, Diary, Participant observation, Focus Group	Institutional analysis
To present the concepts, perceptions and experiences brought by Mental Health professionals in relation to their daily lives in services^(²²).	Qualitative research	Diary, Participant observation, Conversation group, Questionnaire	Categorized results
To present an intervention study conducted with Community Health Agents from Family Health Teams of a district management in the city of Porto Alegre (state of Rio Grande do Sul)^(²³).	Intervention research	Discussion groups	Not mentioned
To analyze the institutionalization process of Health Surveillance in Campinas (state of São Paulo) based on the theoretical-methodological framework of Institutional Analysis in the socio-historical perspective^(²⁴).	Institutional analysis	Semi-structured interview	Socio-historical
To investigate quantitatively and qualitatively the violent acts against women in the city of Montes Claros, Minas Gerais^(²⁵).	Qualitative and quantitative research	Document analysis - occurrence reports	Institutional analysis SPSS
To analyze the relationships based on (mis)encounters between health and education workers, and the sources of tension between these professionals and the students’ families in the form of demands and referrals from the school^(²⁶).	Intervention research Socioanalysis	Diary, Group meetings, Evaluation report	Concepts of the philosophy of difference
Analizar y comprender cómo se realizan las acciones de Vigilancia en Salud en el municipio de Moreno, cómo se articulan con los efectores de la Atención Primaria de la Salud, y qué dispositivos se han implementado para que estos procesos se hagan efectivos ^(²⁷)	Qualitative research	Diary, Participant observation	Institutional analysis
Décrire et analyser l´utilisation d´un dispositif socianalytique comme outil de collecte de données dans une approche de recherche qualitative en sciences infirmières, ceci en créant un espace pour l’analyse de la pratique professionnelle et des relations de travail, auprès d´un groupe d´infirmières de l´Hôpital universitaire UFMG, Brésil ^(²⁸)	Qualitative research Intervention research Socioanalysis	Analysis of professional practices Meetings Questionnaire	Institutional analysis Socioanalysis
Analysis of the paradoxical dimension of the territory and the processes of stigmatization in access to HIV diagnosis in the context of Primary Health Care^(²⁹).	Analytical-institutional perspective	Observation Focus group Restitution	Institutional analysis
To analyze the involvement of researchers during the process of an intervention study and the interferences caused by this analysis^(³⁰).	Qualitative research, Intervention research	Semi-structured interview Restitution, Meetings, Researchers group, Analysis workshop, Notes	Institutional analysis Socioclinic
To analyze a resistance movement of a Collegiate Forum of Mental Health in Campinas (state of São Paulo), where the current situation puts at risk its innovative history and the care network in mental health because of the organizational stiffening and the tension between the current municipal government and the partner entity in this area^(³¹).	Qualitative research	Semi-structured interview, Diary, Participant observation	Institutional Analysis concepts
Contribuer au développement intersectoriel et interdisciplinaire du réseau local, notamment du Sistema de Garantia dos Direitos Humanos da Criança e do Adolescente (SGDHCA), pour faire face à des vulnérabilités psy-chosociales des enfants et des adolescents, spécialement celles liées aux situations de violences sexuelles et à l’usage de drogues ^(³²)	Critical action Research Cartography	Workshops	Institutional analysis Schizoanalysis Schizodrama
To present and discuss the production process of socioclinic research on parenting developed in Gennevilliers, France, during 2011 and 2012^(³³).	Intervention research	Participant observation, Restitution, Discussion groups, Informal interviews	Institutional analysis

AUTHORS	CONCEPT OF INSTITUTION
INSTITUTION AS NORMS, RULES AND LAWS
^{Fortuna, Matumoto, Camargo-Borges, Pereira, Mishima, Kawata, Silveira and Oliveira, 2012} ^(¹⁰)	"They constitute what is given, which is allowed and accepted".
^{Sanches, Couto, Abrahão and Andrade, 2013} ^(¹⁹)	Norms, rules, regulations transmitted to groups.
^{Depes and Pereira, 2013} ^(²⁰)	"Tree of logical compositions which, depending on their materialization and degree of formalization adopted, can be laws or norms if described, or can be guidelines, regularities of behavior when they are not stated in a manifest way."
^{Silva, Gomes, Torres e Siniak, 2013} ^(²²)	"Set of laws, rules and practices."
^{Lima, Severo, Andrade, Soares and Silva, 2013} ^(²¹)	"Dominant forces in our society, values, rules, made official or not, which are configured as a network, a fabric of institutions."
^{Silveira and Nunes, 2013} ^(¹⁸)	"Institution as a social practice historically produced and made natural by an effect of forgetting the power/knowledge practices." "Institutions are vectors affecting the modes of existence that cross and are crossed by material bodies."
INSTITUTION IS IMMATERIAL
^{Pezzato and L'Abbate, 2012} ^(¹¹)	"It is immaterial, it is never directly understandable. It can only be apprehended through the materiality of the organization".
^{Depes and Pereira, 2013} ^(²⁰)	Institution is abstract and is materialized by the organization and unfolds into smaller units (establishments).
^{Pezzato, L'Abbate and Botazzo, 2013} ^(¹⁷)	"The institution is immaterial". "It can only be apprehended through the materiality of the organization".
^{Fortuna, Monceau, Valentim, Mennani, 2014} ^(³³)	"They are abstract logics, but also material, resulting from a dialectical process consisting of a more fixed part (the instituted), which is their most visible part, a mutable part (the instituting) that causes ruptures with traditional pacts, and a third moment called institutionalization, in which the instituting is incorporated by the institution and becomes instituted".
INSTITUTION IS COMPOSED IN THREE MOMENTS: INSTITUTING, INSTITUTED AND INSTITUTIONALIZATION
^{Pezzato and L'Abbate, 2012} ^(¹¹)	Result of the dynamic and dialectical movement between instituted, instituting and institutionalization.
^{Pezzato, L'Abbate and Botazzo, 2013} ^(¹⁷)	"Dynamic and dialectical movement between three moments: the instituted, the instituting and the institutionalization".
^{Spagnol, L'Abbate, Monceau and Jovic, 2016} ^(²⁸)	"Concept dialectique."
^{Fortuna, Monceau, Valentim, Mennani, 2014} ^(³³)	"They are abstract logics, but also material, resulting from a dialectical process consisting of a more fixed part (the instituted) which is their most apparent part, a mutable part (the instituting) that causes ruptures with traditional pacts, and a third moment called institutionalization, in which the instituting is incorporated by the institution and becomes instituted".
^{Garcia and L'Abbate, 2015} ^(²⁴)	"It is the result of the dynamic articulation between three moments: the instituted, the instituting and the institutionalization".
^{Garcia, L'Abbate, Arakaki, 2015} ^(²⁷)	"Que reconoce três momentos de descomposición: instituído, instituyente, institucionalización."
INSTITUTION IN ITS THREE MOMENTS: INSTITUTING, INSTITUTED AND INSTITUTION
^{Silva, Gomes, Torres and Siniak, 2013} ^(²²)	"Three moments: institution, instituted and instituting."
INSTITUTION AS TWO MOMENTS: INSTITUTED AND INSTITUTING
^{Romagnoli and Magnani, 2012} ^(⁸)	"Field of forces of the instituted and the instituting".
^{Fortuna, Matumoto, Camargo-Borges, Pereira, Mishima, Kawata, Silveira e Oliveira, 2012} ^(¹⁰)	Interplay between the instituting and the instituted.
^{Archanjo e Schraiber, 2012} ^(¹²)	Constant movement between the instituted and the instituting.
^{Silveira e Nunes, 2013} ^(¹⁸)	It has flows that move and/or conserve it.
^{Fortuna, Mesquita, Matumoto e Monceau, 2016} ^(³⁰)	"A dynamic, they are always in motion, a game between maintenance and creation, conservation and dissolution".
Dóbies and L'Abbate, 2016^(³¹)	"Institutions are dialectically constituted by instituted and instituting moments".
Passos, Vieira, Moreira, Rodrigues, Amorim, Santos, Abreu, Gomes, Mendes, Lima, Moura, França, Ferraz, 2017^(³²)	"Paradigme institutionnel pour l'analyse des logiques sociales (les institutions) en intervenant sur le fonctionnement collectif et sur les thématiques et procédés de recherche. Elle présente des concepts pour la compréhension du fonctionnement de la réalité dans ses aspects contradictoires: les aspects institués et anti-productifs et ceux instituants et productifs."
INSTITUTION AS ORGANIZATION OR ESTABLISHMENT
^{Muniz, Tavares, 2012} ^(¹⁶)	Organization or establishment.
INSTITUTION AS MULTIPLE CRYSTALLIZED MEANINGS
Zambenedetti and ^{Silva, 2015}^(²⁹)	Something that can be interrogated in its multiple crystallized meanings.
LOGICAL BODIES OF MEANINGS
^{Barreto, Dimenstein and Leite, 2013} ^(¹³)	"Logical bodies of meanings".
AUTHORS	INSTITUTED MOMENT
DIALECTICAL FORCES
^{Romagnoli, 2015}a^(⁹)	"These are dialectical forces".
^{Romagnoli, 2015}b^(²⁵)	"They are dialectical forces".
VISIBLE PART OF THE INSTITUTION
^{Fortuna, Monceau, Valentim, Mennani, 2014} ^(³³)	"The most fixed part (the instituted) that is their most visible part".
PLAN OF FORMS ALSO CALLED ORGANIZATION PLAN
^{Romagnoli and Magnani, 2012} ^(⁸)	"The plan of forms, also called the organization plan, corresponds to what is socially instituted".
CONSERVATIVE AND ESTABLISHED
^{Pezzato and L'Abbate, 2012} ^(¹¹)	"What is set, established".
^{Muniz, Tavares, 2012} ^(¹⁶)	The instituted is the fixed institution, it denies the social knowledge. It resists changes.
^{Archanjo and Schraiber, 2012} ^(¹²)	"What is given". "Established order according to the values and modes of representation of the organization, considered normal. It corresponds to what is already known".
^{Depes and Pereira, 2013} ^(²⁰)	As conservative and established.
^{Pezzato, L'Abbate and Botazzo, 2013} ^(¹⁷)	Instituted moment that is set, established, norms and laws.
^{Zambenedetti, Piccinini, Sales, Paulon and Silva, 2014} ^(²³)	"Crystallized aspects of reality".
^{Garcia, L´Abbate and Arakaki, 2015} ^(²⁷)	Refers to the established things.
Dóbies and L'Abbate, 2016^(³¹)	"The established order, the values, the modes of representation and organization, considered normal". "The instituted depends on the instituting to make progress".
^{Fortuna, Mesquita, Matumoto and Monceau, 2016} ^(³⁰)	"Effect of instituting action and is imbricated with the equipment and its functions. It tends to reproduce other instituted forms and maintain the order".
NORMS AND LAWS
^{Pezzato and L'Abbate, 2012} ^(¹¹)	Norms, laws, universal.
^{Pezzato, L'Abbate and Botazzo, 2013} ^(¹⁷)	Norms and laws.
^{Silveira and Nunes, 2013} ^(¹⁸)	"From the norm, hegemonic in the asylum logic".
^{Garcia, L'Abbate and Arakaki, 2015} ^(²⁷)	"Las normas."
KNOWLEDGE AND PRACTICE
^{Garcia, L'Abbate and Arakaki, 2015} ^(²⁷)	"Los conocimientos y la práctica."
INCESSANT REPRODUCTION
^{Fortuna, Matumoto, Camargo-Borges, Pereira, Mishima, Kawata, Silveira and Oliveira, 2012} ^(¹⁰)	"Incessant (instituted) reproduction".
GAMES OF FORCE THAT TRY TO PRODUCE IMMOBILITY
^{Archanjo and Schraiber, 2012} ^(¹²)	"Games of force that try to produce immobility [...] in constant contradiction with instituting forces".
Passos, Vieira, Moreira, Rodrigues, Amorim, Santos, Abreu, Gomes, Mendes, Lima, Moura, França, Ferraz, 2017^(³²)	"Aspects institués et anti-productifs."
CONTINUING EDUCATION
^{Muniz, Tavares, 2012} ^(¹⁶)	"The spaces for continuing education must become instituted, guaranteed and supported in their instituting potential to subsidize changes".
HIERARCHIZED, VERTICAL AND FUNCTIONAL
^{Silva, 2015} ^(²⁶)	Hierarchized, vertical and functional.
AUTHORS	INSTITUTING MOMENT
PRESSURES EXERTED
^{Sanches, Couto, Abrahão and Andrade, 2013} ^(¹⁹)	"Pressures exerted by groups or individuals".
^{Romagnoli, 2015}a^(⁹)	"These forces are dialectical".
^{Romagnoli, 2015}b^(²⁵)	They are dialectical forces.
PRODUCTIVE AND INNOVATIVE FORCE
^{Gontijo, Xavier and Freitas, 2012} ^(¹⁵)	"The instituting ideas are innovative that provide changes or improvements in technologies or in social reorganization". They also bring the implementation of the kangaroo method as an instituting force.
^{Pereira, Ribeiro, Santos and Depes, 2012} ^(¹⁴)	Potential, transforming. "New, the motivation". "It always conveys a dynamic, changeable and mutant characteristic. Where the new insinuates itself and reaffirms itself". "Transforming, creative and revolutionary side. [...] It is informed by the instituted that generates it, that makes it appear and then, ends up being regenerated by it (instituted). Thus, both are necessary and neither exists without its opposite, they are complementary, they live in an always unstable balance".
^{Muniz, Tavares, 2012} ^(¹⁶)	"Opening escape lines, operating innovative practices".
^{Archanjo and Schraiber, 2012} ^(¹²)	"Renovation, urging creative processes". "Capacity for innovation."
^{Depes and Pereira, 2013} ^(²⁰)	"Productive/innovative forces that tend to be the foundation of institutions". "Final effect, exhausted from the instituting activity".
^{Zambenedetti, Piccinini, Sales, Paulon and Silva, 2014} ^(²³)	"It refers to the movement, the possibility of creating new meanings, strategies and solutions".
Dóbies and L'Abbate, 2016^(³¹)	"Capacity for innovation".
^{Fortuna, Mesquita, Matumoto and Monceau, 2016} ^(³⁰)	Creation.
Passos, Vieira, Moreira, Rodrigues, Amorim, Santos, Abreu, Gomes, Mendes, Lima, Moura, França, Ferraz, 2017^(³²)	"Aspects instituants et productifs."
DENIAL OF THE INSTITUTED, THE CONTESTATION
^{Pezzato and L'Abbate, 2012} ^(¹¹)	"It expresses the particularity, the denial of the instituted, of the universal, the contestation, the questioning of the instituted by the project of what is not yet but can come to be". "Unshaping everyday life"
^{Archanjo and Schraiber, 2012} ^(¹²)	"Represent contestation".
^{Pezzato, L'Abbate and Botazzo, 2013} ^(¹⁷)	"The denial of the instituted, the contestation".
^{Silva, Gomes, Torres and Siniak, 2013} ^(²²)	"As the transformer/questioner of this process".
^{Silveira and Nunes, 2013} ^(¹⁸)	"Subversive, counter-hegemonic, being able to radicalize the production of new encounters with madness and the madman".
^{Garcia and L'Abbate, 2015} ^(²⁴)	"The instituting denies the instituted in the opposite meaning to the idea of renovation/innovation".
^{Garcia, L'Abbate and Arakaki, 2015} ^(²⁷)	Denies the instituted.
Dóbies and L'Abbate, 2016^(³¹)	Contestation.
INSTITUTING MAY BE CONSERVATIVE IN RELATION TO THE INSTITUTED
^{Garcia and L'Abbate, 2015} ^(²⁴)	"The instituting can be conservative in relation to the instituted".
PROCESS OF TRANSFORMATION
^{Fortuna, Camargo-Borges, Pereira, Mishima, Kawata, Silveira and Oliveira, 2012} ^(¹⁰)	"Movements of change (instituting)."
^{Muniz, Tavares, 2012} ^(¹⁶)	"The instituting is the movement for changes in the institution. In other words, the instituting breaks with the instituted in search of free subjectification".
^{Silva, Gomes, Torres and Siniak, 2013} ^(²²)	"The act of transformation and self-management of a subject belonging to an institution".
^{Fortuna, Monceau, Valentim, Mennani, 2014} ^(³³)	"A changing part (the instituting) that causes ruptures with traditional pacts".
^{Fortuna, Mesquita, Matumoto and Monceau, 2016} ^(³⁰)	"The transformation processes".
THE NEW, THE STRANGE, THE UNKNOWN
^{Archanjo and Schraiber, 2012} ^(¹²)	"It corresponds to the new, the strange, the unknown". "Mobilizers of reflection and criticism regarding their practices and assumptions (psychologists)".
THE CRISIS
^{Silveira and Nunes, 2013} ^(¹⁸)	The crisis (madness) covers and reveals the instituting power that speaks of the lack of strength of the instituted.
AUTHORS	INSTITUTIONALIZATION MOMENT
GAME BETWEEN THE INSTITUTED AND THE INSTITUTING
^{Pezzato and L'Abbate, 2012} ^(¹¹)	"The result of the relationship between two moments - instituted and instituting - Is institutionalization, the moment of singularity, that is, metastable balance in perpetual becoming and not definitive synthesis". Virtual object produced by the analysis that elaborates it, while interpreting it at the same time.
^{Archanjo and Schraiber, 2012} ^(¹²)	"Permanent struggle between the instituted-instituting, all are somehow involved and assume a position and role that contribute to the institution always being an open field, in which forces coming from multiple directions interact, negotiate and, at times, have tension between themselves".
^{Pezzato, L'Abbate and Botazzo, 2013} ^(¹⁷)	"The result of the relationship between instituted and instituting". "The singularity, the balance".
^{Fortuna, Monceau, Valentim, Mennani, 2014} ^(³³)	"Third moment called institutionalization in which the instituting is incorporated by the institution and becomes instituted".
^{Romagnoli, 2015}a^(⁹)	"It will sustain exactly the conflict of institutional forces between the instituted and the instituting".
^{Garcia and L'Abbate, 2015} ^(²⁴)	"It implies duration, temporality and historicity". "The permanent confrontation between the instituted (that which seeks to maintain) and the instituting (forces of subversion and change)".
^{Garcia, L'Abbate, Arakaki, 2015} ^(²⁷)	Moment of synthesis between instituted and instituting.
PROCESS BY WHICH THE INSTITUTION PRODUCES ITSELF
^{Muniz, Tavares, 2012} ^(¹⁶)	"It is continuity, not interruption"
Dóbies and L'Abbate, 2016^(³¹)	"The process by which the institution produces itself is not always positive to the extent that each institution lives with its denial all the time".

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Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
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[TFN1] Source: Virtual Health Library; 2018.