CASE REPORT

PROMOTION OF MENTAL HEALTH IN COLLEGE STUDENTS: A PERSONAL TESTIMONY

PROMOCIÓN DE LA SALUD MENTAL ENTRE ESTUDIANTES UNIVERSITARIOS: RELATO DE EXPERIENCIA

PROMOÇÃO DA SAÚDE MENTAL ENTRE UNIVERSITÁRIOS: RELATO DE EXPERIÊNCIA

https://doi.org/10.31011/reaid-2023-v.97-n.1-art.1428

¹Bruna Pereira de Andrade

²Raiza Amanda Gonçalves de Souza

³Helvis Eduardo Oliveira da Silva

⁴Maria Vitória Ribeiro da Silva

⁵Claudiana de Alcântara Costa

⁶Kely Vanessa Leite Gomes da Silva

¹Orcid: https://orcid.org/0000-0002-9133-1547

²Orcid: https://orcid.org/0000-0002-1391-2098

³Orcid: https://orcid.org/0000-0001-5152-5024

⁴Orcid: https://orcid.org/ 0000-0002-4376-0486

⁵Orcid: https://orcid.org/ 0000-0003-2220-7179

⁶Orcid: https://orcid.org/0000-0001-5179-8962

Authors' contributions

Bruna Pereira de Andrade

Universidade Regional do Cariri- URCA. Rua Cel. Antônio Luíz, 1161 - Pimenta, Crato - CE, Brazil. 63105-010

Submission: 15-06-2022

Approval: 11-01-2023

ABSTRACT

Objective: to report the experience of nursing students in the practice of health education with a focus on mental health promotion in a higher education institution in the interior of Ceará, Methods: This is an experience report of the practice of mental health promotion of college students, through planning, script development and theatrical performance for college students with the following reflection of the reactions and interactions of the target audience about the theme under study. Results: The theater was used to approach themes such as: stress, anxiety and depression as problems generated in the university environment and current literature for the following reflection. The activity promoted a moment of relaxation and encounter with the themes of stress, anxiety and depression, positively affecting the participants' knowledge and perception of the influence of the university routine on the onset of mental disorders, as well as for the nursing students, who experienced, in a genuine way, the planning and practice of health education. Final Considerations: positive feedback was observed from those who participated in the activity, understanding the main factors, symptoms and alternatives for mental stress care.

Keywords: Health Education; Mental Health; Nursing Education.

RESUMEN

Objetivo: relatar la experiencia de estudiantes de enfermería en la práctica de educación para la salud con enfoque en la Promoción de la Salud Mental en una institución de enseñanza superior del interior de Ceará, Métodos: Se trata de un relato de experiencia de la práctica de promoción de la salud mental de estudiantes universitarios, a través de la planificación, elaboración de guión y puesta en escena teatral para estudiantes universitarios con la siguiente reflexión de las reacciones e interacciones del público objetivo sobre el tema en estudio. Resultados: Utilizó el teatro para abordar temas como: el estrés, la ansiedad y la depresión como problemas generados en el ámbito universitario y la literatura actual para la siguiente reflexión. La actividad promovió un momento de descontracción y encuentro con la temática acerca del estrés, la ansiedad y la depresión, repercutiendo positivamente en el conocimiento y la percepción de los participantes sobre la influencia de la rotación universitaria en el surgimiento de trastornos mentales, así como para los académicos de enfermería que experimentaron de forma genuina el planeamiento y la práctica de la educación en salud. Consideraciones finales: Se observaron comentarios positivos de quienes participaron en la actividad, comprendiendo los principales factores, síntomas y alternativas para la atención del estrés mental.

Palabras clave: Educación para la Salud; Salud Mental; Educación en Enfermería.

RESUMO

Objetivo: Relatar a experiência de acadêmicos de enfermagem na prática de educação em saúde com foco na promoção da saúde mental em uma instituição de ensino superior no interior cearense, Métodos: Trata-se de um relato de experiência da prática de promoção da saúde mental de estudantes universitários, através do planejamento, elaboração de roteiro e encenação teatral para acadêmicos universitários com a seguinte reflexão das reações e interações dos público alvo acerca da temática em estudo. Resultados: Utilizou-se do teatro para abordar temáticas como: estresse, ansiedade e depressão como problemas gerados no ambiente universitário e da literatura atual para a seguinte reflexão. A atividade promoveu um momento de descontração e encontro com a temática acerca do estresse, ansiedade e depressão, repercutindo positivamente no conhecimento e percepção dos participantes sobre a influência da rotina universitária no surgimento de transtornos mentais, assim como para os acadêmicos de enfermagem que experienciaram de forma genuína o planejamento e a prática de educação em saúde. Considerações Finais: Observou-se o feedback positivo daqueles que participaram da atividade, compreendendo os principais fatores, sintomas e alternativas para cuidado do estresse mental.

Palavras-chave: Educação em Saúde; Saúde Mental; Educação em Enfermagem.

1 INTRODUCTION

The academic environment is an important source of stressors, conflicts, anxiety and depression. A space of collections, deadlines, commitments, requests, evaluations and often inferiorization, in addition to inflexible schedules, factors that contribute to the growth and development of important mental disorders that compromise the quality of academic and personal life of students^(1).

Stress is naturally a primitive physiological response of struggle or flight, a complex hormonal process that alters body homeotase to the proper needs of the moment. However, this hormonal complex when in excess is responsible for many physical and psychological exhaustion, being one of the main reasons for triggering mental disorders of greater severity⁽²⁾.

The most prevalent disorders acquired in the academic community are depression and anxiety⁽³⁾. Gradually one is the progression of the other when not properly cared for. Anxiety is characterized as an emotion proper to human nature, a natural and necessary reaction for self-preservation, but this can become a pathological condition, where it manifests a different and more pronounced intensity of symptoms, which generate suffering and anguish, leading to impairment of everyday life, academic evasion, abandonment of to-do and substance abuse, and being one of the main triggers for depression⁽⁴⁾.

In this scenario, it is observed the need for activities that can collaborate with the prevention of these disorders and the solidification of mental health education practices of this community, through nursing practices, known as a category capable of promoting health through educational practices. It corroborates the need to implement actions to promote, prevent and education in mental health of this public, as presented in which health promotion occurs through the participation of students in the process of self-care and coping with the stressful moments of daily life⁽⁵⁾.

Nursing must reinvent itself in different contexts, developing new techniques and work practices capable of delighting, educating and promoting health in numerous fields, with different audiences, thus highlighting the performing arts, being a challenge for nursing its use as a form of care instrument⁽⁶⁾.

Thus, it highlights the importance of developing activities to prevent and promote the mental health of these students still in the university, working on routine stress-generating issues, bringing situations of the reality of the university environment and showing alternatives that allevise stressful situations.

The study aims to report the experience of nursing students in the practice of health education with a focus on mental health promotion in a higher education institution in the interior of Ceará, through dramatization taking into account the advantages of this technique in health practices aimed at young people, promoting the identification and self-assessment of interlocutors with the theme exposed.

2 MATERIAL AND METHOD

This is a descriptive study in the form of an experience report, conducted by nursing students during practical classes of the nursing course schedule in the Mental Health Care Process. The themes addressed were: Stress, Anxiety and Depression as problems generated and/or intensified in the university environment.

2.1 Planning of health education activity

The choice of the academic environment for the development of this activity is the fact that anxiety and depression are pathologies of great prevalence among university students and that most of the time, they end up being little discussed and neglected, since they do not have opportunities to debate the subject. Thus, the choice of this public is related to the fact of the need to talk about mental health with the university public⁽⁷⁾.

In this sense, the sensitized approach to dramatization was directed considering it as an important tool in the academic sphere for the promotion of the identification of those who attend, and thus show relevance in health education for younger audiences, in order to build a teaching and learning process that collaborates both in the education of nursing students and in the effective promotion of the health of the target public⁽⁸⁾.

It is noteworthy that to achieve results of the practices of professionals in the health process of the population it is necessary to plan the actions by students and health professionals, implying that health education is a complex activity and that it is necessary to follow some steps for its implementation, in principle the planning that is the qualification of the work process, and therefore in the evaluation and monitoring of the results of educational actions⁽⁹⁾.

Thus, it is possible to verify that this tool represents a strong proposal for health education, since the students start to appropriate effectively the theme having a greater understanding when allied to tools such as scenic art. In addition, prior support is needed on the subject to be addressed in to succeed in the health promotion process.

To delimit the actions that would cover the activity, a priori two meetings were held for organization and planning, later in the search for research for the theoretical framework that would support the main concepts and factors involved in these pathologies that should be present in the speeches and behaviors of students/authors during the dramatization. Then, the script was written for the elaboration of the story, as well as the context of speeches and the division of roles. In summary, a sequence of ordinary scenes was created in the lives of students, focused on dialogues that permeatestress aspects in the financial, emotional area, lack of family support and collections of teachers, which would be driving agents of the appearance of some mental disorders. We chose the use of theater as a method of approach, which through staging would allow to expose the reality experienced by many students of higher education.

2.2 From the script to dramatization

Based on the planning of the educational action, it was reflected on the socio-family issues that influence the lives of young students, contributing to the development of complexes and mental pathologies. Then, after participatory discussions, it was decided the possibility of using theater as a methodology to talk about these themes. Thus, the script was elaborated with the speeches that would be used during our meetings with the academics, so between the group's planning meetings, a short script was written, circulating life situations that are common place in the daily lives of university students while being stressing sources.

The role of dramatization was aimed at showing the story of an academic overwhelmed with activities and who did not succeed in the evaluative tests of discipline, the same suffered pressures on the quality of the loving relationship as well as the parents.

In turn it was formed by 4 characters:

Character 1: Academic with many college activities who were not able to meet the deadlines of the tasks proposed by the teachers, resulting in poor performance in tests and work and that was subject to the disapproval of a discipline. These facts are related to pathological stress, anxiety and depression, such as tremors in the hands, insomnia, sweating, crying crisis, lack of concentration and lack of appetite, consequently these factors made it difficult in their studies for the final evaluation.

Character 2: Girlfriend of the academic who demanded his presence and who refused to offer support in his studies.

Character 3: A mother who insistently charged her son to have more responsibility for his studies, saying at all times that if he did not succeed in the semester, he would return to live at home to work helping his father on the site.

Character 4: Classmate who, seeing all the situation of the young man, set out to help him in his studies, encouraging him to seek help for the mental disorders acquired with the search for complementary therapies and helping him to see with another look all the pressures around him, including suggestions for organizing his routine.

This simple moment involves all the complexity of human life and the interrelations of social roles where the Being child; Being a student; Being a lover are inseparable from the human protagonist of the story.

Finally, the speech adjustment, the previous training of the staging and the presentation in some classrooms chosen randomly in the university field, with an average duration of 15 minutes, were performed. Health education using dramatization was carried out in 06 classrooms reaching an average of 180 students from different courses, where at the end a reflexive moment was promoted and guidelines for autonomy to promote their mental health under the supervision of a teacher specialized in mental health.

3 RESULTS AND DISCUSSION

In this perspective, the exploration of body expression was a key part in the transmission of the message, to describe the clinical characteristics and behaviors of the reported disorders, as well as tremors, sweating, impatience, physical exhaustion, constant pain, social isolation, feeling of incapacity and failure. The emphasis on expressions was proposed to serve as a warning for students to perceive the signs and symptoms of these pathologies in their daily activities and the evaluation of the need for assistance. Thus, we sought to develop in students a reflection and self-assessment in situations of anxiety and depression that are disorders very present in academic life⁽¹⁰⁾.

3.1 The application in the practice of health education activity

The first contact of nursing students with the classes was perceived the curiosity of the public, since the staging was a novelty and at the same time identified a greater appropriation with the theme, where they were portrayed in the small theater.

Communication is necessary for the effectiveness of the health education process, promoting the participation of each one in its health process, highlighting art, as an education promoter, and theater as a tool of educational work with the community, due to the ease of their language and access to the public⁽⁹⁾.

Thus, during the staging one can observe an identification of the students with the narrated story, evidencing that stress, anxiety and depression are part of the reality near the walls of the classroom, showing that it is necessary to address and debate these themes among the students of the most diverse courses, because the need to leave the health blocks and enter all possible areas has been identified, since mental health care is a reality present in all areas⁽¹¹⁾.

In this context, the importance of active methodologies as an educational practice in health is highlighted, since they generate in students a greater reflection and criticality in the learning process. Thus, the contact with everyday situations portrayed through the theater helps in a narrowing of the students with the theme addressed, in addition to a consequent appropriation by assuming critically solutions to the experiences faced in the university environment⁽¹²⁾.

In addition, it was observed that the participating students immediately presented an identification with the symptoms presented by the protagonist, where they placed themselves as an integral part of the story as they recognized themselves and were involved in each facial expression of the character who suffered from anxiety and depression. Thus, the spectators were able to appropriate the practice of this theme and thus identify the main signs and symptoms of these pathologies, which is a reality faced by many in the university context⁽⁷⁾.

In this perspective, the dramatization manages to promote a significant break in the way information reaches the individual, and develops a positive return in health education behaviors and is an innovative educational tool capable of inducing the critical reflection of the subject participating in the process⁽¹³⁾.

Thus, the activity provided the promoters of the action, an unparalleled experience for the practice of mental health promotion, and exercise of the knowledge accumulated throughout previous studies, enhancing the teaching and learning process of the students about the pathologies worked through the innovations of educational practices, with appropriation of concepts, and management of stressful situations, contributing to the professional growth of nurses in training.

It was also highlighted the indication of some techniques that help in the prevention and control of mental diseases, such as the practice of physical exercises, dialogue, massages, music therapy, acupuncture. The study demonstrates that these mechanisms channel stress, and when aggregates have a therapeutic role for numerous physical and mental diseases⁽⁸⁾.

These techniques are called Integrative and Complementary Practices (PIC), and in turn have the purpose of promoting health through some alternative measures such as acupuncture, homeopathy, medicinal plants and phytotherapy that are natural therapies and without much cost that aim to seek a welcoming listening and directed care. Thus, the PICs have as main focus the stimulus of the global promotion of care and the incentive to self-care, enabling the construction of an integral therapy to the individual⁽³⁾.

In a way, theater is a mechanism of excellence for health promotion and, therefore, it is important to use it more frequently in the academic environment with probabilities of a considerable transformation in the teaching and learning process. This tool, through the daily situation shown in the scenes, allows the individual to identify more quickly with that situation and intrinsically assists in nursing therapeutic approaches⁽⁹⁾.

In addition, the nursing professional needs to be aware of the importance and the various possibilities that this practice makes possible in the field of health education. Therefore, it is necessary to have a greater incentive during the graduation of the use of this type of methodology, in order to stimulate a greater transformation in health and collaborate with the professional training of nursing students.

3.2 The repercussion of the staging on anxiety in the lives of students

The repercussion of this activity occurred through the self-report of the students themselves participating during the staging, where they reported that they had already experienced anxiety, depression or that they even knew or had someone in the family who had already experienced a situation similar to the one that was staged. Thus, the interaction of personal and academic factors are important triggers for the triggering of mental disorders⁽¹⁴⁾.

It was verified that there was a more in-depth appropriation of the content of the theme by nursing students enabling the target audience to recognize the symptoms of the pathologies addressed. A proof of this was the repercussion that the theater caused in the students, where many by recognizing themselves in that staging sought the students and the teacher responsible solidifying the importance of working mental health in the academic sphere and assisting for an effective promotion of health. In addition, it can be observed how sensitized nursing students were at each stage and were able to take more ownership of the contents that were worked in the classroom, showing the importance of the link between theory and practice in their education.

University students deal with varied intensities of stress during academic life, this may result from the academic environment along with moments experienced during this period such as frustrations, fears, changes, anxieties and growth, thus becoming a triggering factor of pathological disorders⁽¹⁵⁾.

Many young people claimed that they were going through changes in personal/social life such as city change, extensive curriculum, difficulty in reconciling extracurricular activities with exams and content, lack of psychological support from the college and family. In addition, there was a concern focused on learning among university students and disappointment with evidence scores.

FINAL CONSIDERATIONS

It was noticed that there is an overload of the faculty in the students' lives, which is a very expressive fact for them when reporting on the extensive curriculum, in addition to the demands required such as extracurricular productions, participation of extension projects and research. It was observed that many identified with the stressors and with the reactions that the character of the staging represented, it is important to note this, considering possible physical and psychological problems in the lives of these young people. In addition, it was found that active methodologies such as staging is an extremely assertive tool for health promotion, even it can be seen that this methodology was essential to address important issues within mental health.

Therefore, it is necessary to conducted more studies with this public, working on stress issues in the university environment, suggesting for the subsequent, development and validation of evaluative instruments for such activities, and thus enhancing the production of knowledge and health education practices in this field. The present study allowed the scope of the meaning of integrality in health of the nursing course, besides providing effective communication and an exchange of experience that demonstrated the importance of health education in various fields, especially mental health.

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