New possibilities for the teaching of nursing in mental health : an experience in monitoring

This study aimed at reflecting on the possibilities of applying new methodological strategies in the teaching and learning in nursing. The study is a report of an experiment conducted from a monitoring project of a syllabus activity of nursing in mental and psychiatry health. The methodology was developed by introducing the student/monitor in the contents of theoretical practical learning that were performed by means of Active Methodologies in three academic semesters in 2010 and 2011, in the Nursing School of the Universade Federal do Pará, Brazil. The monitor performed activities to support professors as the ‘Ciclo de Estudos Aprender Fazendo’ (Cycle of Studies Learning Experiencing). It was revealed as a strengthening factor the new pedagogical proposal of the course and shown that the monitoring experience is presented as a new possibility of teaching in mental health from the introduction of different ways to approach the topic in class. Descriptors: Nursing; Teaching; Mental Health.


Introduction
Currently, the process of teaching and learning is concerned in acquiring, each day, new methodological strategies in the context of education.So, it is necessary that the educational institutions are committed with the transformation of the profile of the future health professionals, through the incorporation of strategies of reorientation directed to the domain of education and development of professional competencies and abilities, based on the principles and guidelines of the public system of health, besides being grounded on the enhanced concept of health and on the use of active methodologies of teaching/learning (1) .
According to the National Syllabus Guidelines of the Courses Graduation in Nursing, instituted by Resolution CES/CNE no. 3, as of November 7 th , 2001, the new pedagogical syllabus, centered on the students, and articulated between theory and practice, consider health as a condition of life, interpenetration and the transversality, besides that, they are based on the need to form professionals who are able to learn to learn and committed with the confrontation of the serious problems of our society (2) .
They also establish that the Courses of Graduation in Nursing present their essential contents based on the whole health disease process of the citizen, family and community, integrated to the epidemiological and professional reality, providing the integrality of the actions of the process of care in nursing (3) .So, they have the purpose to provide changes guided in providing the students with a flexible, critical, reflexive, versatile education articulated in the domain of work turned to the education of able professionals for the consolidation of the Unified Health System (4) .
The pedagogical project is a tool to guide strategies, describe the objectives and integrate the actions in order to guide the subjects who participate in the process of education (5) .So, with this tool is possible to project an analysis of how the education of the nursing profession is being developed (6) .
The pedagogical project of the Course of Nursing of the Universidade Federal do Pará, Brazil, presents in its context, a perspective of renewal in its syllabus structure grounded on the integration of knowledge, pursuits the incentive for the construction of knowledge and strengthens new methodological postures in the daily activities of the syllabus activities, among them the Nursing in Mental Health and Psychiatry and Semi-boarding School in Mental Health.These two syllabus activities are part, respectively, of the thematic units: Interventions of Nursing in the Educative and Health and Disease Processes, taught in the 4 th semester, and Nursing Pedagogical Practices taught in the 9 th semester of the course.
Both syllabus activities are taught under the perspective of developing a critical consciousness in the student.So, the construction and the education of the nursing professional is the objective and they should privilege situations of learning providing creative, critical and transforming attitudes assisting the needs of the population, especially in the Unified Health System and guaranteeing the integrality of attention, quality and humanization of the assistance.
It is important that the graduate students perceive themselves as protagonists in the process of personal and professional education, in order to take advantage of the many possibilities created along the course.For such, it is necessary to learn to mobilize and aggregate general knowledge of nursing and nursing in mental and psychiatry health, so that they can perform activities of care to patients going through difficult emotional occasions, or even with mental disorders, with the purpose to guarantee the integrality of the attention to health with quality, efficiency and resoluteness (7) .
The university, as an organ forming new nursing professionals, has an essential action in the theoretical/practical preparation of these health professionals.Under this perspective, it is understood that the monitoring activity is performed in an environment of learning in the academic context which collaborates in the process of education and improvement in the quality of teaching.And, besides that, it is a configuration of study which benefits the articulation among teaching, researching and extension.
This report deals with an experience lived from a project of academic monitoring linked to the syllabus activity 'Nursing in Mental Health and Psychiatry', offered in the 4 th semester of the course of Graduation in Nursing of the Universidade Federal do Pará, Brazil.The project was developed in three semesters in 2010 and 2011.The subjects involved were a monitoring colleger, the coordinating professor of the syllabus activity, a tutor of the faculty of the same and the 40 students regularly enrolled in each semester.
From the activities performed in the project of monitoring, the intention is to reflect on the possibilities of applying new methodological strategies in the process of teaching and learning in nursing.

Results
The course of Graduation in Nursing of the Universidade Federal do Pará had its syllabus structured renewed, and was based on the integration of knowledge that once was segmented in isolated subjects, in the establishment of greater links with society, through the development of the syllabus focused on the experiential learning, committed with the prevention, promotion and rehabilitation of human health and also based on the articulation of the bachelor of Nursing with a degree in Nursing (8) .
For such, it is essential that this process adopts measures which allow the change from current syllabus centered on the professor and on the students, to an innovating pedagogical project which values the student, the use of active methodologies and an integrated syllabus that enables the articulation of the several contents.
The challenge is to work the academic education through problems or problematic issues, pursuing ways that make the interdisciplinary approach feasible in the context of the teaching/learning process.So, the expectation is that the nursing student is integrated to the social reality, actively pursuing the construction of his knowledge through the relation with the research and the extension, so that the knowledge he acquires, can be effectively placed in practice and that the educative process supplies the necessary tools for the conception of knowledge (8:30-31) .But syllabus reorganization, per se, does not guarantee the aimed change, if it is not associated to the change in the methodological posture, in the permanent education and evaluation.So, the construction of a syllabus is necessary, integrating knowledge and practices, strategies and purposes with the innovation of evaluation processes being sure that, with this, the education of the nurse will be strengthened.
The syllabus activity of a nurse in mental health and psychiatry within the pedagogical proposal of the course is to work with the intention of providing the student, through theoretical and experience grounded, the opportunity to know the main facts and events of the history of psychiatry in Brazil, the current manners of assistance and treatment and the nursing care of the programs of mental health of the region where the health professionals works.

Discussion
The monitoring consists of a domain of learning which contributes for the process of education and improvement of its quality.It is consisted of a new proposal which helps the professor in his daily activities in a significantly manner in all the stages of the pedagogical process, and at the same time it has the purpose of improving the process of education providing the student with the possibility of enhancing the knowledge of a certain subject, arising the interest of the teaching and developing aptitudes and abilities in the domain of teaching in order to improve academic potential (9) .
According to the Pedagogical Project of the Nursing Course, the monitoring project brought incentive to the elaboration of knowledge and the strengthening of new methodological postures in the daily syllabus activities of nursing in mental health and psychiatry.
The methodological proposal was developed through the introduction of the monitor in the contents of theoretical practical learning, which were performed through the Active Methodologies.These are innovative methodologies in which the student becomes the main actor in his process of learning and the faculty assume the role of facilitators, and therefore, enable learning to learn, which assure and promote democratic relations (10) .
In this conjunction of actions of the monitor in programing the syllabus activity were directed to the use of new methodologies/technologies of teaching and learning, which stimulate the active participation of the students in the process of construction of knowledge, evaluation and resolution of problems of reality (10) .
The monitor, besides performing supporting activities to the professor, also participated in what was described as 'Ciclo de Estudos Aprender Fazendo' (Learning/Experiencing Cycle of Studies), which consisted in developing specific activities along the subject, articulated with the production of concomitant knowledge with the reflection of reality.
Within the plan of monitoring activities, the following tasks with the student were developed: 'Video-Forum'; inventory of practice and educational practices.These are described as follows: Video-Forum: the class was divided into subgroups of 6 students who participated in two sessions of films.The films analyzed were: 'Bicho de sete cabeças' and 'O Solista'.After the film session, a questionnaire with open questions concerning the theme approached in the film was provided and afterwards there was the presentation and discussion on the perception of what each student conceived.So, it is noticed that the use of videos as educative technology, offers subsides for the construction of knowledge, development of abilities with the intention to promote and improve the quality of education (11) .
Concerning the Inventory of Practice, it consisted in the application of three questions to be answered at distinct times which were: 'Report your expectation regarding the visit to the Hospital de Clínicas (Psychiatry ward)' and 'regarding the Center of Psychosocial Attention (before the visit)'; 'Report your impression regarding the environment visited' and 'describe your sensation and perception in Mental Health and Psychiatry considering the services'.Finally, to the strategies of the educative practice which consisted in the presentation of themes concerning mental health performed by outside guests (health professionals in the service of mental health and professors of the area).The themes were developed with the objective to arise dialog, reflections and debates on current issues in mental health.
The above mentioned activities have brought subsidies to a group reflection, both from the students as well as from the professors involved in the project, in order to rethink the manner how the syllabus activities in mental health and psychiatry is being developed in the context of the course of graduation in nursing of the Universidade Federal do Pará.The experiences of the 'Ciclo de Estudos Aprender Fazendo' reinforce, furthermore, the need to bring the new proposal of health policies for the people with mental disorders into the academic scenario.
Consequently the monitor assumes a new posture facing his education as educating nurse and facilitator of the process of teaching and learning.It is therefore understood that, it is possible to have a rupture with the model responsible for the simple transmission of information without commitment with the construction of knowledge (12) .
In university nursing teaching goes through a period of construction and experience of a new pedagogical model where university, service and community are involved.So, the development of the human potentiality is directly linked to the continuous process of change of experiences and knowledge, which students and professors are part of, who interceded by communicative actions, raising questionings, provoking investigation, promoting discoveries and favoring the creation and innovation of that knowledge in favor of social commitment.According to the above mentioned, the construction of the knowledge, under this perspective, is made through dialog and valuing of the interpersonal relations, aiming at reaching new postures and attitudes from professors and students in the experiences of the social relations and exchange of experiences which allow new ways of considering knowledge and doing (13) .

Final Considerations
The academic monitoring developed in the graduation course in nursing of the Universidade Federal do Pará brought significant moments for the syllabus activities in mental health and psychiatry.It was also revealed, as a factor of strengthening of a new pedagogical proposal of this course, once a pedagogical renovation is needed which requires adoption of active methodological strategies, in which the syllabus is configured in an integrated manner.
However, developing the monitoring project was not an easy task, once not all the professors of the syllabus activity under question were receptive to the insertion of the monitor student in the activity, once they did not show any interest in participating in the proposed activities.Yet, on the confronted difficulties, there was resistance and little commitment in the group of students who only participated in the activities after being informed of what those would add to the evaluations.
Otherwise, it was possible to verify the growing process of acceptance and change of thought of those students regarding the referred syllabus activities.Nowadays, it is possible to listen to these statements which do not stigmatize the person with mental disorder or the syllabus activities of mental health and psychiatry.
Facing the reflections above mentioned, the experience of monitoring as a new possibility of teaching and mental health should be highlighted from the introduction or different manners to approach the theme in classes, in order to instigate the student to a critical and concerned look on the needs of health of the population.
The context of mental health in the process of education in health and nursing is a challenge facing all the pedagogical requirements of the current times, because they demand internal reflections of converging values with a human, critical and creative posture, coherent with what is thought and what is done.

Collaborations
Freitas KFS and Oliveira MFV contributed on the orientation, conception of work, data collection and analysis of data, writing of the article and on the final version of the article to be published.Lopes MMB and Garcia TE collaborated on the interpretation of the data and writing of the article.Santos MS and Dias GAR contributed on the writing of the article and on the final approval of the version to be published.