SciELO - Scientific Electronic Library Online

 
vol.21 issue3The process of knowledge transference: a matter concerning of teaching of psychiatric nursingMotivations and repercussions regarding crack consumption: the collective discourse of users of a Psychosocial Care Center author indexsubject indexarticles search
Home Pagealphabetic serial listing  

Services on Demand

Journal

Article

Indicators

Related links

Share


Escola Anna Nery

Print version ISSN 1414-8145On-line version ISSN 2177-9465

Esc. Anna Nery vol.21 no.3 Rio de Janeiro  2017  Epub June 01, 2017

http://dx.doi.org/10.1590/2177-9465-ean-2016-0379 

RESEARCH

Instituto de Psiquiatria da Universidade do Brasil as internship field of Escola Anna Nery (1954-1962)

Instituto de Psiquiatria da Universidade do Brasil como campo de práctica de la Escola Anna Nery (1954-1962)

Bárbara Tavares da Silva1 

Juliana Cabral da Silva Guimarães1 

Gisele Fernandes Tarma1 

Tânia Cristina Franco Santos1 

Antonio José de Almeida Filho1 

Maria Angélica de Almeida Peres1 

1Federal University of Rio de Janeiro. Rio de Janeiro, RJ, Brazil.


Abstract

Objective:

To analyze the early years of internship course in psychiatric nursing of the Escola Anna Nery (EAN) at the Instituto de Psiquiatria da Universidade do Brasil (IPUB).

Methodology:

Documentary study, which sources were oral and written documents belonging to the collection of EAN. The starting point (1954) refers to the beginning of psychiatric nursing practice activities of EAN at IPUB, and the end point (1962), the year in which was installed a crisis in Psychiatric Nursing discipline.

Results:

The following thematic categories emerged: Context of the insertion of Psychiatric Nursing internship of EAN in IPUB; Development of training course in Psychiatric Nursing in IPUB; Psychiatric Nursing education crisis in EAN; Developments to overcome the crisis in nursing care in the EAN/IPUB.

Conclusion:

The presence of EAN in IPUB, provided advances in technical and scientific assistance and in psychiatric nursing education.

Keywords: Psychiatric Nursing; History of Nursing; Schools Nursing; Mental Health

Resumen

Objetivo:

Analizar los primeros años del curso de capacitación en enfermería psiquiátrica de la Escola Anna Nery (EAN) en el Instituto de Psiquiatría de la Universidade do Brasil (IPUB).

Metodología:

Estudio documental, cuyas fuentes fueron documentos escritos y orales de la colección de EAN. El punto de partida (1954) se refiere al inicio de las actividades prácticas de enfermería psiquiátrica de EAN en IPUB, y el marco final (1962), al año en el que se instala una crisis en la disciplina de enfermería psiquiátrica.

Resultados:

Emergieron las siguientes categorías temáticas: Contexto de la inserción de la práctica en Enfermería Psiquiátrica de EAN en IPUB; Desarrollo de la práctica en IPUB; Crisis en la enseñanza en EAN; Desarrollos para superar la crisis en la asistencia de enfermería en EAN/IPUB.

Conclusión:

La presencia de EAN en el espacio IPUB, ha proporcionado avances en la asistencia técnica-científica y la enseñanza de enfermería psiquiátrica.

Palabras clave: Enseñanza; Enfermería Psiquiátrica; Historia de la Enfermería; Escuelas de Enfermería; Salud Mental

Resumo

Objetivo:

Analisar os primeiros anos do estágio em enfermagem psiquiátrica da Escola Anna Nery (EAN) no Instituto de Psiquiatria da Universidade do Brasil (IPUB).

Metodologia:

Estudo documental, cujas fontes foram documentos escritos e orais pertencentes ao acervo da EAN. O marco inicial (1954) refere-se ao início das atividades práticas de enfermagem psiquiátrica da EAN no IPUB e, o marco final (1962), ao ano em que se instalou uma crise na disciplina de Enfermagem Psiquiátrica.

Resultados:

Chegou-se as seguintes categorias temáticas: Contexto da inserção do estágio de Enfermagem Psiquiátrica da EAN no IPUB; Desenvolvimento do estágio em enfermagem psiquiátrica no IPUB; Crise no ensino de Enfermagem Psiquiátrica na EAN; Desdobramentos para superar a crise da assistência de enfermagem na EAN/IPUB.

Conclusão:

A presença da EAN no espaço do IPUB, proporcionou avanços na assistência técnica-científica e no ensino de enfermagem psiquiátrica.

Palavras-chave: Ensino; Enfermagem Psiquiátrica; História da Enfermagem; Escolas de Enfermagem; Saúde Mental

INTRODUCTION

The study focuses on the development of the psychiatric nursing internship at the Escola Anna Nery (EAN) of the Universidade do Brasil (UB) from 1954 to 1962. The starting point is the year in which the School began the psychiatric nursing internship at the Institute of Psychiatric of the UB ("IPUB"); and the final mark, the year in which a crisis in the discipline of Psychiatric Nursing was installed due to the teacher's absence, leading the school to seek a specialist in psychiatric nursing to take over this seat.

At EAN, inaugurated in 1923, the introduction of content related to psychiatry took place gradually, beginning in 1925 with theoretical instruction, taught by professors of the Faculty of Medicine of UB, in the discipline of Mental Hygiene. In 1931, the discipline Psychiatry was included in the curriculum, also theoretical and administered by physicians, making nursing training in this specialty very influenced by medical discourse. Psychiatric Nursing was introduced in the curriculum in 1933, taught by EAN nurse professor, consisting of two blocks in the classroom, one theoretical and the other with training of nursing techniques used in psychiatry.1,2

This trajectory of teaching psychiatry to nursing through medical discourse was not exclusive to EAN. Psychiatrists have assumed the knowledges for the training of nursing staff, through the creation of nursing schools and/or the implementation of informal methods of teaching within the work institutions, for two reasons: that there are no nursing professionals qualified for such task and to promote the moralization of the same, so that they were able to execute what was known by Moral Treatment.3

Since EAN is a school recognized by Decree no. 20,109 of 1931 as the standard model of Nursing education in the country until 1949, maintained strict discipline and moral conduct in its spaces, and therefore, the psychiatric hospital by its characteristics in the decades of 1920-1950, was not considered suitable place for the practical teaching with students. The so-called "asylum" was a place of segregation of persons, in which brute force and punitive practices were used to approach psychiatric treatment, including physical restraint, mechanics, electroshock, cardiac shock, insulin shock, among others.4-6

A reformulation of care practices in psychiatry occurred in the 1960s, starting with the movement so-called "new psychiatry", aimed at transforming psychiatric hospitals into centers of healing and rehabilitation, going beyond the intention of only housing the mentally ill.4 However, the treatment did not change to the point of turning the asylum into an environment conducive to nursing education to EAN standards. This was related to the lack of qualification of nursing professionals and also to the prejudice and stigma that these professionals showed around the behavior of the mentally ill. Thus, these professionals were not prepared to supervise the practical teaching in psychiatric nursing nor to serve as a model for the students.3,7

Until now, in Brazil and in other countries, it is difficult to prepare professional nurses to work in psychiatry. This is directly related to teaching, since the role of universities in the formulation of educational strategies for the improvement of mental health curricula is essential. To address current recruitment problems, an important strategy is the nurse's specialization in mental health.8,9

The EAN stayed away from the psychiatric stage until 1950, when the Law no. 775/49 made its existence compulsory, requiring all nursing schools in the country to take steps to obtain a field of practice in psychiatry. The promulgation of the Law led to changes in the concept of assistance in psychiatric nursing, directing nursing to a care model of prevention and arousing the nurse's observation to asylum problems.4

In order to remain in legal status with regard to the training of nurses, the EAN had to begin the internship in psychiatry. In the articles of the Revista Annaes de Enfermagem of the 1950s, nurses discussed how to obtain internships in psychiatry in order to to place the students in the face of more up-to-date experiences, noting that this was not possible in Brazil, since asylums, in general, did not have registered nurses and nursing care was provided by attendants and practical nurses, that is, those trained before the "Anna Nery Standard".6,10

With the purpose of complying with the Law, from 1950 to 1953, EAN carried out an internship at the National Psychiatric Center ("CPN"), located in the district of Engenho de Dentro, in Rio de Janeiro. The visit to the CPN was strategic, since there was another nursing school, the Escola de Enfermagem Alfredo Pinto (EEAP), which has had close links with psychiatry since 1890 and, in this way, both the students and the EAN teacher would have the opportunity to learn from it.1,4 But the internship in psychiatry at the CPN was limited only to observation, without the assistance of EAN students.

To qualify the teaching at EAN, the director of this school invited Professor Maria Dolores Lins de Andrade, first responsible for internship in Psychiatry at EAN, so as to realize specialization in psychiatric nursing in the United States of America (USA) with a scholarship. Professor Maria Dolores attended her specialization in psychiatric nursing in the Teacher College of Columbia University from September 1952 to July 1953 where she received a teaching based on the concept of interpersonal therapeutic relationship with the theorist Hildegard Peplau, returning to Brazil later that year. With the return of the specialist professor, the field of internship was transferred to the Instituto de Psiquiatria da Universidade do Brasil (IPUB) still in 1954.

In view of the above, the objective of the study is to analyze the first years of the psychiatric nursing internship at the IPUB.

The study is justified by the need to record the historical development of the practical teaching of Psychiatric Nursing in Brazil, which offers possibilities for theoretical reflections that can lead to an understanding of aspects that are currently being experienced, such as the fact that, in the midst of the Psychiatric Reform, there are still difficulties in the training of nurses in the area.

This research will bring contributions to nursing in mental health as well as to the history of nursing, since it will reveal aspects of the trajectory of teaching psychiatry in a given period, in addition to the nursing care provided in a school hospital, providing diffusion of knowledge from the dissemination of its results to society, especially to the scientific community.

METHODOLOGY

It is a documentary study that aims to describe and understand a historical fact from several documents, using methods and techniques ranging from the collection of information, through stages and procedures that allow to categorize and, finally, to analyze the data found.11 In addition, the information is obtained through a comparative historical method, being the proper investigated document the justification of the need for analysis.12

For the development of the study, a written Law, a Decree and eight official letters were selected as written documents, located in the Documentation Center ("CDOC") of Escola de Enfermagem Anna Nery at the Universidade Federal do Rio de Janeiro (EEAN/UFRJ) and oral documents - recorded interviews of two EAN teachers, Isabel da Cunha Dantas (2003) and Teresa de Jesus Sena (1990), who donated it to the collection of oral history of this Center for use in other research. Data collection took place from April to May 2015.

The selected documents were organized in an analysis table with information about the year, the authorship and the subject. The technique of data analysis was used based on the selection criteria of the contents that would serve the purpose of the research, which consists of a process of interpretation and inferences about the information present in the documents investigated.13

The results are presented in the following thematic categories: Context of the insertion of the Psychiatric Nursing internship of EAN in the IPUB; Development of the psychiatric nursing internship at the IPUB and the crisis in the teaching of psychiatric nursing at EAN; Developments to overcome the nursing care crisis at the EAN/IPUB.

This research, because it is documentary, was not submitted to the Research Ethics Committee.

RESULTS AND DISCUSSION

Context of the insertion of Psychiatric Nursing internship of Escola Anna Nery in Universidade do Brasil

Nursing schools, under the law 775/49, began a process of adaptation of their curricula to the new requirements for nursing teaching. According to art. 7th of the Official Gazette, Session I of 1949:

[...] "the practice and the internships will be made through the rotation of students in hospital services, clinics and health units" leaving the school free to choose the size, category, organization, purposes and objectives of the institution.14

However, finding traineeships in the areas of public health and psychiatry was a great difficulty since these services, because of their characteristics at the time, were considered inadequate to receive the nursing students, which led the nurses to request the necessary measures for the changes in the conception of care, directing the nurse to the problems of nursing homes, where the mentally ill, the sclerosed old people and the handicapped children were crowded together.15,16

With the aim of modifying the chaotic reality of most psychiatric services, due to the obsolescence of the asylum model, the nursing schools, with the support of the Associação Brasileira de Enfermagem (ABEn), articulated with the directors and the nursing chiefs of health services, arguing that it would only be possible to teach qualified nursing if the students observed and lived with an up-to-date nursing practice.

The admission of EAN into the IPUB was convenient, since both belonged to the same university. The IPUB was preparing to improve its role as a school-hospital, which implied changes in its care model, and the EAN sought a field to develop psychiatric care to serve as an example for its students. Thus, there were two institutions with interests that were consistent: to develop assistance and teaching in the area of psychiatry.1,4

In 1955, a Psychiatric Nursing consultant, Verna Fraser, brought from the USA by the Special Public Health Service ("SESP" in Portuguese), to provide advice to Brazilian nursing schools, stated that when preparing students to begin the internship, the psychiatry teacher had to make use of theoretical bases on mental illness, its symptoms and strategies to deal with the patient, since "one of the greatest obstacles to satisfactory psychiatry internship is the fear of the mentally ill, which the apprentice student brings with him".17

However, the discussion on fields of practice extended to other areas such as infectious and parasitic diseases and public health, since a reformulation of the rules of nursing education in schools would contribute to their improvement, as well as providing a basis for a reconfiguration of care in the services.1

In order to support in the discussions between the schools, the "I Seminar on Nursing Education in Rio de Janeiro" was promoted by ABEn in 1956, in which the limitations of psychiatric nursing education were explained and the following measures emerged: to standardize the curricula of schools; to correlate theory with practice and organize appropriate fields to the students' internship in public health nursing and psychiatric nursing.18

In addition, a "Psychiatric Nursing Commission" was organized, which developed a document with considerations and recommendations on the subject. This document was presented in 1957 at the IX Brazilian Congress of Nursing and contained:

Considering the importance of the psychiatric nursing internship for a better understanding of human dynamism and behavior; it is recommended that nursing schools provide students with at least eight weeks of psychiatric nursing training. Considering the shortage of properly trained nurses in psychiatric nursing; it is recommended to the Nursing Schools to favor means for advanced studies in psychiatry, for nurses who wish to dedicate themselves to this branch of nursing. Considering the need for all instructors to assist the students in applying the psychological and psychiatric principles to the situation of life and work and that the majority of instructors are not qualified for this function; It is recommended to the Nursing Schools that properly trained nurses in psychiatry be requested to cooperate with the teaching staff in order to assist the instructors in their work.18

It is seen in the content of the document above that is assigned to psychiatric nursing the value of favoring a more enlightened understanding of human behavior and promoting improvements in social relations. This justifies the importance of psychiatric nursing in the formation of all students, regardless of the professional career they will follow, besides the need for the teachers to be able to understand and apply specialized knowledge in the other fields of training, expanding to all health services and the community the new concept of Psychiatric Nursing that was beginning to be used by scholars in the area.4

From this perspective, the articulation between the EAN and the IPUB took place, having as a common point of interest the development of a new psychiatric model, with its reformulations in the scientific and care space.

Development of training course in Psychiatric Nursing in IPUB and the crisis in the teaching of psychiatric nursing at EAN

The number of teachers at EAN was insufficient to monitor students in traineeships in all disciplines as required by Law No. 775/49, as can be seen in the explanatory memorandum which the director at the time, Waleska Paixão, addressed to the president of UB's budget commission, in a letter dated 09/28/1960:

Ten years in the direction of the EAN, I try to get the number of nurses necessary for the guidance of our students, in internships, without achieving it. [...] the old extraordinary staff of MEC, consigned to EAN 42 nurses. Today, for various reasons, some absolutely unjustifiable, that number is reduced to 28. [...] How to advance nursing teaching in such conditions?

The importance of the practical internship for the students' learning was one of the concerns of the EAN, especially with regard to psychiatry, as it can be noticed by the evaluation of a Schoolteacher:

An important contribution to nursing education is the programmed orientation of students in the hospital internship [...]. The training course in nursing internship is still in the process of organization. Many and serious are the problems to be solved, such as: personnel problem in quantity and quality, inadequacy of physical environment and material resources of the hospital.19

After two years of use of the IPUB as a practical field, the nursing service was still not ideal to attend the teaching of psychiatric nursing according to the standards acquired with the North American consultant. With the replacement of the Professor Maria Dolores Lins de Andrade, who traveled to a specialization course, by a public health teacher, in 1957, the situation got worse, causing an interruption in the didactic-pedagogical project of EAN in the IPUB.

The public health teacher, Isabel da Cunha Dantas, had to go to the internship field only with the theoretical knowledge about psychiatry, acquired as an EAN student. In addition, according to the testimony of the same, there was only one nurse trained by the EEAP, with the majority of the nursing staff of the IPUB composed of old attendants, under the supervision of an administrative officer, without training. That made it difficult for them to work in the field, because besides not having any position in IPUB, she did not have at that moment the power conferred by specialized knowledge.

The new teacher was supposed to remain in the discipline from July to December 1957, but as Maria Dolores did not return in the expected time, the permanence of Professor Isabel Dantas was extended. While awaiting the return of Professor Maria Dolores, despite all the obstacles, the EAN persisted in maintaining the IPUB internship field in order to resume the necessary changes to the development of the knowledge of psychiatric nursing.

From that moment on, the discourse of psychiatric nursing underwent a radical transformation, finding support only in the personal resources of a public health teacher who, initially, faced the same fears and anguishes as the students. This is not to say that the practice of psychiatric nursing ceased to exist, but that the production of a knowing about this practice had a new starting point.

In preparing the students to begin the internship, the psychiatry teacher should make use of theoretical bases on the mental illness, its symptoms and strategies to deal with the patient. Although without the support of a psychiatric theory, Professor Isabel Dantas was able to develop convincing strategies for the students to enter the psychiatric space, from the process of adaptation to it, which became a resource to care, allowing the continuity of the internship in the psychiatric IPUB.20

Even without proper preparation, the performance of a nursing teacher and her students in the space of the IPUB certainly contributed to the overall quality of care when they were there, since the care provided by the students was still of a better quality than those provided by the IPUB, mainly because to them lacked theoretical basis, which made them devoid of initiative to improve the condition of the assistance.

Professor Isabel Dantas says that the most agitated patients were practically unassisted. Facing this, her strategy was to try to correct the situation without, however, reprimanding the employee:

I found a [patient] tied, so I came and said: what is this, boy? He's not in jail! I made as if I did not understand what it was and took him out. I would undo the wrong things that they did, but without showing.20

Thus, changes in nursing care occurred slowly, through small changes in their routine and, despite their lack of preparation, the presence of an EAN teacher was, by itself, a factor of improving nursing care in IPUB, by imposing an ordering on the assistance provided by the students, establishing a therapeutic relationship between the mental patient and the nursing staff.

Accordingly, it can be seen from the following report that the adaptation to the environment of the IPUB took place in a concrete way, so much that the classes of psychiatric nursing happened to be mainly taught in the institute:

It depended on the subject, if I wanted to illustrate with a patient, we stood there [in the IPUB]. Later I enjoyed it so much and the girls too, that we stayed there all day [...]. We improved a lot [...] I stayed with the girls all day, I stayed until the evening.20

The EAN teacher also collaborated effectively in the organization and operation of the service, a fact that helped her image of a Teacher to be well accepted: "The work environment was good, by the way, I was always lucky, all the doctors where I went to called me 'Teacher Isabel' and they respected me".20

In this sense, because there is no reference in the testimony of Professor Isabel Dantas to conflicts with physicians, it can be consider as an analysis the use of a strategy to avoid confrontation with medical power, because there was no theoretical support from her part, that is, not having well structured and divergent knowledge.

The persistence of Professor Isabel Dantas allowed, above all, the continuity of the occupation of the IPUB, since her figure was accepted and she remained in the institution without direct confrontations. In addition, with the knowledge and experience she had, even in another specialty, the teacher promoted improvements in care for the mentally ill.

Nevertheless, it is considered that in this period of the 1950s, the teaching of psychiatric nursing in the EAN was in crisis, due to the loss of characterization of the practice of psychiatric nursing in the field of internship, by the substitution of a specialist teacher in the area by another without specific knowledge. This led the EAN director to make great efforts to overcome the problem.

Developments to overcome the crisis in nursing care in the EAN/IPUB

The situation of the discipline of Psychiatric Nursing at EAN was delicate: Professor Isabel Dantas, who had been responsible for it since 1957, had been diverted from her position for two years. Despite the fact that the EAN had a psychiatrist, which remained in the USA, taking a specialization course in didactics applied to nursing at Teacher's College and ended up constituting family and staying in that country.

Convinced that the crisis in Psychiatric Nursing teaching could not be solved by Professor Maria Dolores's return, from 1959 on, the director of EAN decided to make efforts to hire a new teacher, a specialist in psychiatric nursing, although there were few nurses at the time with this specialty in Brazil.

Thus, the Rector of UB resorted to several requests from EAN to hire specialists to act as teachers at EAN, without success. In view of this, the director used as an initial resource to put two students of the last year of graduation at the EAN as fellows at the IPUB to assist the teacher Isabel Dantas at that time.

On the other hand, the American consultant of Psychiatric Nursing, Verna Fraser, was mediator in the solution of this critical problem for the teaching standards of the EAN, since she had visited the Hospital Central do Juqueri, in São Paulo, where the nurse Teresa de Jesus Sena, head of the Nursing Department, acted competently in conducting care. Teresa Sena had experience as a nurse and as a professor of "Psychiatric Nursing", "Neurology" and "Neurological Nursing" at the Nursing School of Universidade Federal da Bahia, as well as being an employee of the Department of Psychopathic Assistance ("DAP", in Portuguese) in São Paulo.21

Teresa Sena met Verna Fraser at the beginning of her work at the Hospital do Juqueri and, since she did not speak English, testified that she began to learn the language with Verna, since both were very interested in being understood. On one occasion, Verna asked Teresa if she would not like to take a course in the USA if she got a scholarship.22 During the two years in which Verna Fraser worked in Brazil, Teresa Sena was the only Brazilian nurse she nominated for a scholarship in the USA, where she embarked in January of 1958 to take her Master's Degree in Psychiatric Nursing at the College of Nursing/Wayne State University - Detroit, Michigan. She also did internships at Saint Elizabeth's Hospital in Washington, and in the Health, Education and Comfort Department, returning in 1959.21

In December 1959, Teresa Sena was working as the head nurse of the Hospital Psiquiátrico do Juqueri and, as supervisor of the internship of the students of the Nursing School of the Universidade de São Paulo (USP), when the director of the EAN sought her to make a proposal. In her testimony, Teresa Sena said that she did not personally know Waleska Paixão and that was by a phone call that she received an invitation to go to Rio de Janeiro to talk about the possibility of teaching psychiatric nursing at EAN.

The haste shown by Waleska Paixão on the telephone indicated the urgency she was in to get a qualified teacher to solve problems in the field of internships and to reshape the discipline of psychiatric nursing. Her choice of a skilled nurse with experience in teaching and care reflects her intention to improve both theoretical-practical teaching and psychiatric nursing care. It also met the needs of the IPUB, which was in the process of adapting to the "new psychiatry".

However, enormous bureaucratic difficulties presented themselves to the arrival of Teresa Sena to EAN: on the one hand, EAN, belonging to the UB, could only admit her by competition or as an interim; on the other hand, the "DAP" of São Paulo refused to let go of her, although she had officially requested her resignation and had already come to work at EAN, even without authorization, needing to return to the hospital in São Paulo for five months to supervise.

In order to make possible the hiring of Teresa Sena, the director of the EAN officially admitted, before the Rectory, that the teacher Maria Dolores Lins de Andrade would not return to the discipline of psychiatric nursing and asked for her replacement. The strategy that proved effective at the time for Teresa's stay in EAN ended up being her hiring by the National Campaign Against Tuberculosis ("CNCT" in Portuguese), which could hire employees for a year.

As stated in official letter No. 36 of January 18, 1960, on December 31, 1959, Teresa Sena presented herself to EAN as a nurse ceded by the National Tuberculosis Service ("SNT" in Portuguese), the CNCT's supervisory body, being assigned to teach the discipline of Psychiatric Nursing in April 1960. With this, the discipline "Psychiatric Nursing" became the responsibility of Professor Teresa Sena and the disciplines of "Mental Hygiene" and "Psychiatry" continued to be taught by a doctor.

The year 1960 was marked by several attempts by EAN to bring Teresa Sena to work in her staff through articulations with several service directors and, above all, with the UB's Rector. The director of the EAN officiates to the Rector, announcing the return of Isabel Dantas to the discipline "Nursing in Tisiology", but, at the same time, maintains her as responsible for the discipline "Psychiatric Nursing", although since January 1960 both teachers [Isabel and Teresa] were teaching theoretical classes and supervising the students' internship in the IPUB. In the opportunity, she reiterates the request of the EAN of a professional specialized in the subject.

The previous crisis period was characterized as a resumption of positivity in the path of psychiatric nursing in EAN and IPUB, since the knowledge produced by the performance of Professor Isabel Dantas served as a basis for the later work developed by Professor Teresa Sena. It was observed the construction of new propositions and the development of descriptions and verifications that could unfold in results and theories.

However, Professor Isabel Dantas continued to collaborate with Professor Teresa Sena, since her return to public health was gradual. Isabel gave classes in both specialties until dedicating herself entirely to one, but without losing contact with psychiatry. The arrival of Professor Teresa Sena really gave a new boost to the nursing of the IPUB, in the perception of Professor Isabel:

Teresa ended with the fear people had, even mine. I would sit around, everyone would come out in the afternoon and I would sit there alone with the patients, I would put them round like that, everyone wanted to know one thing, each thing more bizarre, I would talk and I would love that.20

For the official admission of Teresa Sena as an EAN employee, Waleska Paixão's commitment was for an interim appointment, with numerous requests being made to the rector of the UB, to the director of Human Resources of the Ministry of Education and Culture (MEC) and the President of the Budgets Committee of UB. In the content of the letters issued by EAN from September 1960, to this finality, the requests for UB's rector, Pedro Calmon, to obtain from the President of the Republic, Jânio Quadros, authorization for the nomination, stand out.

In justifying its request to the President of the Budgets Committee of UB, EAN stresses the importance of the workforce of its teachers in the hospitals that served as a training camp for EAN and also for the Faculdade Nacional de Medicina (FNM), which teaching was greatly benefited by this work. The director cites as example the Hospital São Francisco de Assis, where the EAN was responsible for 370 beds, being 260 of FNM, which brought them an overload. Therefore, EAN's support to FNM, of which medical professors used to facilitate the obtaining of "support for research and other activities", served as a strong argument for the referral of the problem.

At the beginning of 1961, EAN had only two places to fill, but four nominations were made, of nurses approved in the last competition held. Then, the director of the EAN verified that among the four names, it appeared that of a nurse who was not in the approved list. In denouncing this situation to the Minister of Education and Culture, Professor Brígido Tinoco, through letter no. 96 of 08/02/1961, she proposed to negotiate, asking for a solution to the serious problem that afflicted EAN:

Therefore, leaving aside, at the moment, the divergences between the number of vacancies noted in the UB for the EAN and those recorded in the MEC, I request your Excellency. urgent solution for the interim appointment of [...] Teresa de Jesus Sena [...].

The documents show that in 1962, Teresa Sena was inducted as Nurse of the Extraordinary Board of UB. From then on, the disciplines "Mental Hygiene" and "Fundamentals of Clinical Psychiatry" began to be taught by Teresa Sena instead of medical teachers. In assessing the teaching of the discipline up to that point, Teresa Sena described it as "fifty years late".22

The theoretical-practical model of psychiatric nursing, under construction at EAN, needed a professional with a profile to take on, the head of the IPUB nursing service and the teaching of the psychiatric nursing discipline. This strategy of articulating care and teaching had already been successfully adopted by the EAN in several hospitals such as Hospital São Francisco de Assis, Maternidade-Escola and Instituto de Neurologia.

With the arrival of a specialist teacher nurse to lead the nursing service of the IPUB, gradual changes were imposed in the construction of theoretical, practical and power relations that resulted in an assistance and pedagogical reform in the IPUB and EAN.4

CONCLUSION

In Rio de Janeiro, specifically in UB, the reformulation of the practice of psychiatric nursing occurred from the presence of the EAN in the space of the IPUB, providing changes in technical-scientific assistance, in virtue of a Law that made compulsory the internship in psychiatry. Firstly, the EAN provided for the specialization abroad of a teacher, but she ended up leaving the discipline, being replaced by another teacher in the area of ​​public health, when it is considered that the teaching of psychiatric nursing went into crisis.

Therefore, EAN made efforts to hire a specialist teacher for the EAN, aiming at ending the crisis that had arisen in psychiatric nursing education and adjusting the internship fields to comply with current teaching legislation, which prompted the emergence of a new discourse of psychiatric nursing based on specialized knowledge.

Thus, studying the strategies implemented to promote adequacy in the teaching of psychiatric nursing in the EAN and the IPUB, allowed to unveil aspects of the development of teaching and care for the mentally ill, which was influenced by the education policies in Brazil and from ABEn, which reflected directly in the training of the nursing professional.

REFERENCES

1 Carvalho MS, Martins GCS, Dias NL, Santos TCF, Almeida Filho AJ, Peres MAA O ensino de enfermagem psiquiátrica na Escola Ana Néri, na primeira metade do século XX. Rev Eletr Enferm [Internet]. 2015 jan/mar; [cited 2016 Dec 13]; 17(1):[aprox. 9 telas]. Available from: http://revistas.ufg.br/fen/article/view/23546. http://dx.doi.org/10.5216/ree.v17i1.23546Links ]

2 Pereira MM, Padilha MI, Oliveira AB, Santos TCF, Almeida Filho AJ, Peres MAA. Discourses on the nursing and psychiatric nurse models, published in the Annals of Nursing (1933-1951). Rev Gaúcha Enferm [Internet]. 2014 jun; [cited 2016 Dec 13]; 35(2):[aprox. 6 telas]. Available from http://seer.ufrgs.br/index.php/RevistaGauchadeEnfermagem/article/view/25736/29919. http://dx.doi.org/10.1590/1983-1447.2014.02.25736Links ]

3 Kirschbaum DIR. Análise histórica das práticas de enfermagem no campo da assistência psiquiátrica no Brasil, no período compreendido entre décadas de 20 e 50. Rev Latinoam Enferm [Internet]. 1997 maio; [cited 2016 Dec 13]; 5(nspe):[aprox. 12 telas]. Available from http://www.revistas.usp.br/rlae/article/view/1262. http://dx.doi.org/10.1590/S0104-11691997000500003Links ]

4 Peres MAA, Barreira IA. Uma nova enfermagem psiquiátrica na universidade do Brasil nos anos 60 do século XX. Esc Anna Nery [Internet]. 2008 Mar [cited 2016 Dec 13]; 12(1):108-14. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1414-81452008000100017&lng=en. http://dx.doi.org/10.1590/S1414-81452008000100017Links ]

5 Guimarães NA, Borba LO, Larocca LM, Maftum MA. Mental health treatment according to the asylum model (1960 to 2000): nursing professionals' statements. Texto Contexto Enferm [Internet]. 2013 Jun [cited 2016 Dec 05]; 22(2):361-9. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0104-07072013000200012&lng=en. http://dx.doi.org/10.1590/S0104-07072013000200012Links ]

6 Decreto n. 20.109 de 15 de junho de 1931 (BR). Regula o exercício da enfermagem no Brasil e fixa as condições para a equiparação das escolas de enfermagem. Diário Oficial da União [periódico na internet], Brasília (DF). 15 jun 1931 [cited 4 May 2017]. Available from: http://www.planalto.gov.br/ccivil_03/decreto/1930-1949/D20109impressao.htmLinks ]

7 Rodrigues AAP, Xavier ML, Santos TCF, Figueiredo MAG, Almeida Filho JA, Peres MAA. Casa de Saúde Esperança: assistência de enfermagem psiquiátrica em um modelo tradicional (1975-1993). Rev Enferm UERJ [Internet]. 2013 [cited 2016 Dec 13]; 21(2):202-7. Available from: http://www.facenf.uerj.br/v21n2/v21n2a11.pdfLinks ]

8 Neville C, Goetz S. Quality and substance of educational strategies for mental health in undergraduate nursing curricula. Int J Ment Health Nurs [Internet]. 2014 Apr; [cited 2016 Dec 11]; 23(2):128-34. Available from: http://onlinelibrary.wiley.com/doi/10.1111/inm.12025/abstract doi: 10.1111/inm.12025 [ Links ]

9 Happell B. A better way to do this? Views of mental health nursing directors about preparation for mental health nursing practice. Aust Health Rev [Internet]. 2014 Dec; [cited 2016 Dec 13]; 39(2):211-6. Available from: http://www.publish.csiro.au/AH/AH14099. doi: 10.1071/AH14099. [ Links ]

10 Mello e Souza MCB, Alencastre MB. Produção da enfermagem psiquiátrica no Brasil, 1932-1993. Rev Bras Enferm [Internet]. 1999 jun [cited 2016 Dec 05]; 52(2):271-82. Available from: http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0034-71671999000200014&lng=en. http://dx.doi.org/10.1590/S0034-71671999000200014Links ]

11 Sá-Silva JR, Almeida CD, Guindani JF. Pesquisa documental: pistas teóricas e metodológicas. Rev Bras Hist Ciênc Soc [Internet]. 2009 jul; [cited 2016 Dec 13]; 1(1):[aprox. 15 telas]. Available from: https://www.rbhcs.com/rbhcs/article/view/6Links ]

12 Valles MS. Técnicas cualiltativas de investigacion social: Reflexion metodológica y práctica profesional. Madrid: Editorial Sintesis; 1999. 416p. [ Links ]

13 Pimentel A. O método da análise documental: seu uso numa pesquisa historiográfica. Cad Pesqui [Internet]. 2001 nov; [cited 2016 Dec 13]; 114:179-95. Available from http://www.scielo.br/pdf/cp/n114/a08n114.pdfLinks ]

14 Lei n. 775 de 06 de agosto de 1949 (BR). Dispõe sobre o ensino de enfermagem no país e dá outras providências. Diário Oficial da União [periódico na internet], Brasília (DF). 13 ago 1949 [cited 4 May 2017]. Available from http://www.planalto.gov.br/Ccivil_03/leis/1930-1949/L775.htmLinks ]

15 Sena TJ. A evolução da enfermagem psiquiátrica, através de uma visão histórica. In: Primeiro Encontro de Enfermeiras Psiquiátricas; 1973; Rio de Janeiro (GB), Brasil. [ Links ]

16 Dourado HG. O serviço de enfermagem psiquiátrica em quatro sanatórios. Rev Bras Enfermagem. 1954 dez;7(4):394-402. [ Links ]

17 Fraser VB. Três aspectos do Programa de Educação de enfermagem relacionados à saúde mental. Rev Bras Enfermagem. 1955 set; ano VIII, nº 3. [ Links ]

18 Comissão De Enfermagem Psiquiátrica. Recomendações ao IX Congresso Brasileiro de Enfermagem. Rev Bras Enfermagem. 1956 set; Rio de Janeiro, ano IX, nº 3. [ Links ]

19 Souza EF. Uma experiência em ensino clínico. Rev Bras Enfermagem. Rio de Janeiro, ano IX, nº 4, dez. 1956. [ Links ]

20 Escola Anna Nery. Depoimento de Isabel da Cunha Dantas. Acervo de História Oral; 2003. Um cassete sonoro (ca. 40 min) Transcrição - 16 p. [ Links ]

21 Escola Anna Nery. Depoimento de Teresa de Jesus Sena. Acervo de História Oral; 1990. Três cassetes sonoros (ca. 150 min). Transcrição: 50 p. [ Links ]

22 Escola Anna Nery. Depoimento de Teresa de Jesus Sena. Acervo de História Oral; 2002. Um cassete sonoro (ca. 60 min). Transcrição: 23 p. [ Links ]

Received: January 06, 2017; Accepted: February 27, 2017

Corresponding author: Maria Angélica de Almeida Peres. E-mail: angelica.ufrj@uol.com.br

Creative Commons License This is an Open Access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.