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SMAD. Revista eletrônica saúde mental álcool e drogas

versión On-line ISSN 1806-6976

SMAD, Rev. Eletrônica Saúde Mental Álcool Drog. (Ed. port.) vol.9 no.3 Ribeirão Preto dic. 2013 



Education workshops and nursing care systematization in mental health


Oficinas educativas y la sistematización de la asistencia de enfermería en salud mental



Nathália Aparecida de PaulaI; Alda Martins GonçalvesII

IMaster's student, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil
IIPhD, Adjunct Professor, Escola de Enfermagem, Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brazil




It presents the results of research on educational workshops focused on self-care, highlighting its applicability in the implementation of Nursing Care Systematization (NCS) in Mental Health. The workshops were based on the principles of Psychiatric Reform and were held as part of nursing care in a care service of children and adolescents Mental Health. The investigation was conducted by analyzing the workshop records held from April 2010 to November 2011.  It was concluded that the workshops are a space for nursing interventions, health promotion, corrections of self-care deficit and psychosocial rehabilitation, and effectively contribute to the process of Systematization of Nursing Care in mental health.

Descriptors: Psychiatric Nursing; Mental Health Assistance; Health Care Reform; Rehabilitation.


Se presenta los resultados de la averiguación sobre oficinas educativas dirigidas al autocuidado, destacando su aplicabilidad en la implementación de la Sistematización de la Asistencia de Enfermería (SAE) en Salud Mental. Las oficinas se fundamentaron en los principios de la Reforma Psiquiátrica y fueron realizadas como parte de la asistencia de enfermería en un servicio de atención a la Salud Mental del niño y del adolescente. La averiguación fue hecha del análisis de los registros de las oficinas realizadas en el período de abril de 2010 a noviembre de 2011. Se concluyó que las oficinas constituyeron en un espacio para intervenciones de enfermería, promoción de salud, correcciones del déficit de autocuidado y rehabilitación psicosocial, además de aportar, efectivamente, para el proceso de Sistematización de la Asistencia de Enfermería en salud mental.

Descriptores: Enfermería Psiquiátrica; Atención en Salud Mental; Reforma de la Atención de Salud; Rehabilitación.




For long decades, psychiatry is increasingly modifying its care pattern considering the importance of the family and socio-cultural environment.  For the Ministry of Health, although it is contemporary of the Health Reform, the Brazilian Psychiatric Reform process has its own history, within an international context of change by overcoming asylum violence(1). In the decade of 1970, with a crisis in the care model focused on hospital care related to social movements for users rights of mental health, in Brazil, started a process aiming at a psychiatric care reform. In 1978, emerges the Movement of Workers in Mental Health (MTSM), fundamental initiative to reformulate the field of psychiatry in the country(2). In 1987, the MTSM held, in Rio de Janeiro, a meeting of national impact with the motto "For a society without asylums."  This meeting influenced directly the restructuring of assistance in mental health and promoted the First National Conference on Mental Health.  At the conference were discussed ways to reorient the health care model provided in mental health(2).

The First National Conference on Mental Health, unfolding the Eighth National Health Conference is a milestone in Brazilian psychiatry, since it reflects the aspiration of the entire scientific community, which believes that national mental health policy needs to be integrated into the national social development policy of the Federal Government(3).

It was in this context that Paulo Delgado proposed a law to regulate the rights of people with mental disorders and the deactivation of asylums(1). This initiative was considered of great importance in the legalization of Psychiatric Reform process. In 1992, it was held the Second National Conference on Mental Health.

The Second National Conference on Mental Health has as an indicator of direction the effective participation of the users in the work group, in the plenary, debates and free tribunes. This participation was responsible for the emergence of a new dynamics of work organization, where personal testimonies, cultural interventions and rights defense transformed relations and exchanges between all participants(4).

In the following years, several initiatives, practices and Psychiatric Reform movements were continued. On April 6, 2001, after 11 years of debate in the House of Representatives and in the National Congress on the project of Paulo Delgado, Law 10,216 was approved, which  provides for the protection and rights of people with mental disorders and redirects the mental health care model(5).

After the approval of Law 10,216, in December of the same year, it was held, in Brasília, the Third National Conference on Mental Health, with the theme Caring, not excluding, considered ground zero for consolidation of principles governing the Psychiatric Reform in Brazil. It is in the context of the enactment of Law 10,216 and the Third National Conference on Mental Health, that the mental health policy of the Federal Government, aligned with the guidelines of the Psychiatric Reform, is consolidated, gaining greater support and visibility(1). Changes in mental health care field, combined with new principles recognized by the Brazilian Psychiatric Reform, have demanded the need to reinvent and create new ways   to care and live with the mental ill(6).

In order to consolidate these changes in care and make it more flexible and humane, the mental health professionals have improved their therapeutic techniques, through theoretical and practical foundations that allow them, besides the users participation, to reassess and develop new ways of care. Among the various proposals for changes in psychiatric care, group activities have multiplied and other professionals, in addition to doctors, started to have a therapeutic role(7). The practices of care provided by psychiatric nursing, historically focused on watching, restriction and restraint of patients, were reconsidered, requiring theoretical foundations, planning and organization of their actions.

Along with the transformation movements of psychiatry, the psychiatric nurse is also modified, whose concepts, more influenced by social psychiatry, emphasize the individual relationship with the patient, and support to the therapeutic environment and the expansion of the nursing work to better relation with patient, family and community(7).

In the late twentieth century, looking to qualify its professional assistance and to contribute to the Psychiatric Reform, Nursing expands the insertion of Nursing Care Systematization(NCS) for the mental health care. The NCS is a tool to facilitate the management and provision of nursing care. Their systematic application requires specific knowledge of nursing diagnoses, seeking to produce decisions on what needs to be done and what actions and nursing interventions contribute, in each case, to obtain the desired results: disease prevention, health promotion, treatment, relief, comfort, physical and psychosocial rehabilitation(8).

Through the Extension of the Care System Mental Health Nursing project, conducted in the Psychic Center for Childhood and Youth (CEPAI - in Portuguese), it was elaborated methodologies for the implementation and consolidation of NCS in Mental Health, in this scenario. This project, approved under the number SIEX 400374, became part of the teaching activities, research and extension of the School of Nursing at UFMG. CEPAI is a Mental Health unit from the Hospital Foundation of Minas Gerais (FHEMIG). In CEPAI, a place for child and youth care, the treatment includes the presence of a family member, as a companion during the period that requires hospitalization.  Therefore, it promotes family integration to the children and adolescents treatment, mitigating the risk of social exclusion and providing the right of family life provided in the Statute of Children and Adolescents, Law 8.069 / July 13th, 1990(9).

During the development of activities of the Nursing Care Systematization project in Mental Health and contact with patients, companions and nursing professionals, it was noticeable the need for a complementary action to the project activities. This action occurred through educational workshops with an emphasis on self-care, based on the principles of Psychiatric Reform. This paper aims to present the results of research on the application of these educational workshops, highlighting their applicability in implementing the Nursing Care Systematization (NCS) in Mental Health.



The social reproduction of how people with mental disorders are seen permeates clinical practice and it is a complex process. Thus, clinical practice in mental health care requires tools and strategies for the realization of resolving actions and assistance that holistically considers every human being. In this respect, the development of therapeutic approaches in mental health work is to improve the coping of psychiatric disorder promoting psychosocial rehabilitation of patients(10-11). Therapeutic educational workshops on mental health are used as a meeting between people on treatment, their companions and healthcare professionals, to promote citizenship and companionship with different people, through the activity(12). Nursing actions for health education are timely to promote integration between the companion, patient and nursing professionals, as well as being a place for promotion and prevention of health(13).

Ordinance 189 from 11/19/1991 of the Ministry of Health determines that the workshops practices in health care service should be characterized as group socialization activities, expression and social inclusion(14). However, to achieve the expected results, it is necessary that the educational workshops actions are planned, organized, based on theoretical foundations, based on a survey of existing demands, as defined in the Nursing Care Systematization process.

Health Education is any combination of learning experiences designed to predispose, enable and reinforce voluntary behavior that promotes the health of individuals, groups and communities. In turn, health promotion is a combination of educational and environmental supports that aim to achieve actions and conditions of living contributive to health(15-16). Health education includes encouragement of self-care and correction of deficit, when there is any. When an individual is unable to meet his/her requirements for self-care, a deficit occurs. The Nurse should determine these deficits and define the modalities of support(17).



This is an investigation based on an analysis of records on the development of educational workshops designed as a complement action to the process of implementation of the NCS at CEPAI. The workshops activities were hold from April 2010 to November 2011 after discussion and approval on the project by the unit professionals.

The workshops were inserted in the unit therapeutic routine and began to be held twice a week at a certain time. The activities were conducted with children and adolescents admitted to the unit with the participation of family companions. The records of daily conducted workshops consisted of weekly notes of comments of workshop instructors on the development of activities and their therapeutic interventions in the participants' routine.

The workshops were based on collaborative and participatory activities as an educational principle for health promotion, psychosocial rehabilitation and as space for interventions and corrections of self-care deficit. The following topics were addressed: healthy eating, oral hygiene, obesity, smoking, drug addiction, cosmetic and personal hygiene, physical activity, interpersonal relationship, self-esteem. There were moments of discussion and reflection and included group dynamics, recreational, physical and manual activities. To facilitate and mediate the work it was used as instruments and materials: paper, paint, brushes, crayons, colored pencils, hidrocor pens, cardboard, E.V.A. foam, scraps of fabric, balloons, popsicle stick, magazines, newspapers, scissors, glue, music and so forth.

The main objectives of the workshops were to provide participants the development of autonomy and critical view about self-care, involving nursing professionals in fulfilling the role of health educator.



The implementation of educational workshops, used as a method of health care, proved to be a valuable strategy for care provided by nurses. These workshops contributed effectively to the provision of nursing care in mental health, in a therapeutic way, and their systematization have enabled the development of autonomy, socialization and a critical view of the participants regarding self-care. Health promotion was combined with educational and environmental support for actions and conditions useful to health(15-16). It involved nursing professionals in fulfilling the role of health educators by organizing, planning activities, raising demands and serving the needs of participants.

Because of the educational workshops it was possible to raise individual and collective demands, enabling nurses to prepare accurate diagnoses and appropriate treatment plans. Such workshops formed, therefore, a methodology for correction of self-care deficit. There were moments of discussion and reflection, constituting a place for appropriate interventions for each patient and the group. It must be highlighted that the workshops strengthened the organization of the nursing professionals, encouraged their interaction with family members/companions and patients.  This result reaffirms the idea that therapeutic educational workshop on mental health can be used as a meeting between people on treatment, their companions and healthcare professionals, while promoting citizenship and familiarly experiences with different people, through the activity(12).

During the workshops the participants were encouraged to develop independent and autonomous activities. The discussions and reflections favored not only the practice of caring for oneself, but also teamwork, respect the limits of others and the development of critical view on self-care, self-esteem and healthy lifestyle. Prior knowledge of each participant on the issues discussed were brought together, considering their individuality and their sociocultural contexts, allowing them to express themselves as critical subjects capable of choices and contributions to the group. Thus, it facilitated the psychosocial rehabilitation of the people involved.

Offering to the patients the opportunity, individual and group, to discuss their experiences of illness and feelings with the nurse so they can create a environment of trust and support, preventing relapses and complications, stimulating the participation of the patients experience as independently as possible. Helping them to prepare themselves for the social reintegration(12).

The workshops were characterized as care devices for healthy social interaction during the period of hospitalization and for living with social interaction. Thereat, the workshops have encouraged them to arouse desire and courage to overcome difficulties related to self-care, self-esteem and social interaction, making the participants feel that their individuality were recognized and valued.



Educational workshops are part of a list of various therapeutic strategies that can be included in nursing interventions, because they enable support with general or specific demands of one or more diagnoses defined according to NCS.

It's always good to remember that the educational activity is not a conditioning process for people to accept, without questioning the orientations that are given to them. Simple information or dissemination or transmission of knowledge of how to have health or prevent illness, by itself, will not contribute to a population to be healthier and is not a factor that can contribute to desirable changes to improve the quality of life of the population(18).

The orientations of the Psychiatric Reform have launched major challenges to professionals, which must follow the restructuring assistance given to users of mental health services. These guidelines require constant improvement of care techniques, providing users autonomy and participation in actions involving the therapeutic plan. The results of this  research reaffirm Nursing Care Systematization in Mental Health as a methodology that ensures the organization and planning of care, producing improvement in quality of care(7). This methodology supports the principles and objectives proposed by the Psychiatric Reform, directing its actions to better adaptation and recovery of the individual regarding biopsychosocial aspects. The reorganization in mental health care emphasizes the need for its professional to develop capacity and improve their techniques, ensuring quality in care(19-20). It is essential that nursing professionals to exercise their role as educators, as a fundamental part of the planning, development and implementation of therapeutic strategies.



The results in this study have allowed us to highlight the relevance of the use of educational workshops as an important methodological strategy for the implementation of Nursing Care Systematization in mental health, in similar situations to that developed. The results depend necessarily on preparation, training and involvement of professionals with the use of educational workshops methodology.

We believe that the educational workshops were an experience that fostered learning for the recognition and development of new strategies for care and health education in nursing practice. The workshops activities provided to those involved reflection on the care provided by nursing professionals in mental health, enable them to learn and practice many ways and possibilities of providing quality care in accordance with the Psychiatric Reform.

We emphasize that this study addresses a local experience, therefore, not having the purpose of generalizing the results. However, we seek to contribute to future works or experiences with similar objectives and scenarios. We also encourage further studies to deepen the discussions of the results of this study.



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Received: Jan. 27th 2012
Accepted: Nov. 14th 2013