Rev. Enferm. UFSM - REUFSM
Santa Maria, RS, v. 11, e23, p. 1-22, 2021
DOI: 10.5902/2179769244220
ISSN 2179-7692
Submission: 05/11/2020 Approval: 10/20/2021 Publication: 03/11/2021
Original article
Psychic suffering of university nurses in the context of academic life
Sofrimento psíquico dos universitários de enfermagem no contexto da vida acadêmica
El sufrimiento psicológico de los estudiantes de enfermería en el contexto de la vida académica
Deivson Wendell da Costa LimaI
Jaciara Sampaio GonçalvesII
Lívia Dayane Sousa AzevedoIII
Alcivan Nunes VieiraIV
Rosane Pilot PessaV
Margarita Antonia Villar LuisVI
I Nurse, master, University of São Paulo, Ribeirão Preto, São Paulo, Brazil. Email: deivsonwendell@gmail.com, Orcid: https://orcid.org/0000-0002-7020-2172
II Nurse, specialist, State University of Rio Grande do Norte, Mossoró, Rio Grande do Norte, Brazil. Email: jaciara_sampaio22@hotmail.com, Orcid: https://orcid.org/0000-0002-0708-9349
III Graduate, Nutritionist, University of São Paulo, Ribeirão Preto, São Paulo, Brazil. Email: liviaazevedo.nutri@gmail.com, Orcid: https://orcid.org/0000-0002-0019-9342
IV Nurse, doctor, State University of Rio Grande do Norte, Mossoró, Rio Grande do Norte, Brazil. Email: alcivan_nunes@yahoo.com.br, Orcid: https://orcid.org/0000-0003-4222-6262
V Nutritionist, doctor, University of São Paulo, Ribeirão Preto, São Paulo, Brazil. Email: rosane@eerp.usp.br, Orcid: https://orcid.org/0000-0002-6301-6830
VI Nurse, doctor, University of São Paulo, Ribeirão Preto, São Paulo, Brazil. Email: margarit@eerp.usp.br, Orcid: https://orcid.org/0000-0002-9907-5146
Abstract: Objective: to analyze the psychic suffering among nursing students in the context of academic life. Method: descriptive research, with a qualitative approach, carried out with 20 university students from the last semester of nursing, from a public university in the Northeast, Brazil. The data were produced by open-ended questions, between March 2016 and February 2017, and evaluated by content analysis. Results: the reasons for psychological suffering were the difficulties of adapting the university students at the beginning of the course, conflicts during training and expectations regarding the end of graduation. Given this, the consequences identified were dietary difficulties, stress and symptoms of depression. The way of life of university students is influenced by academic experiences, including eating habits, overwork and lack of leisure. They can be precursors of serious health problems, such as suicidal ideation. Conclusion: it is suggested to expand prevention and clinical management strategies at the university linked to mental health services.
Descriptors: Nursing; Mental health; Psychological suffering; Students, nursing; Universities
Resumo: Objetivo: analisar o sofrimento psíquico entre universitários de enfermagem no contexto da vida acadêmica. Método: pesquisa descritiva, de abordagem qualitativa, realizada com 20 universitários do último semestre de enfermagem, de uma universidade pública no Nordeste, Brasil. Os dados foram produzidos por perguntas abertas, entre março de 2016 a fevereiro de 2017, e avaliados pela análise de conteúdo. Resultados: os motivos de sofrimento psíquico foram as dificuldades de adaptação dos universitários no início do curso, conflitos durante a formação e expectativas quanto ao término da graduação. Diante disso, as consequências identificadas foram dificuldades alimentares, estresse e sintomas de depressão. Os modos de viver dos universitários são influenciados pelas vivências acadêmicas, inclusive os hábitos alimentares, excesso de trabalho e falta de lazer. Eles podem ser precursores de problemas graves de saúde, como ideação suicida. Conclusão: sugere-se ampliar estratégias de prevenção e manejo clínico na universidade articulado aos serviços de saúde mental.
Descritores: Enfermagem; Saúde mental; Sofrimento psíquico; Estudantes de enfermagem; Universidades
Resumen: Objetivo: analizar el sufrimiento psicológico en estudiantes de enfermería en el contexto de la vida académica. Método: investigación descriptiva, con enfoque cualitativo, realizada con 20 estudiantes universitarios del último semestre de enfermería, de una universidad pública del Noreste, Brasil. Los datos se elaboraron mediante preguntas abiertas, entre marzo de 2016 y febrero de 2017, y se evaluaron mediante análisis de contenido. Resultados: los motivos del sufrimiento psicológico fueron las dificultades de adaptación de los universitarios al inicio del curso, los conflictos durante la formación y las expectativas sobre el final de la graduación. Ante esto, las consecuencias identificadas fueron dificultades dietéticas, estrés y síntomas de depresión. La forma de vida de los estudiantes universitarios está influenciada por las experiencias académicas, incluidos los hábitos alimentarios, el exceso de trabajo y la falta de ocio. Pueden ser precursores de problemas de salud graves, como la ideación suicida. Conclusión: se sugiere ampliar las estrategias de prevención y manejo clínico en la universidad vinculadas a los servicios de salud mental.
Descriptores: Enfermería; Salud mental; Sufrimiento psíquico; Estudiantes de enfermería; Universidades
Introduction
The academic context brings, for the university student, a differentiated and more complex high school experience. Requires research, socialization with new colleagues and teachers, compliance with institutional rules and learning content, which can contribute to situations of psychological distress.1
In this study, the concept of psychological suffering was used, characterized as a manifestation of subjective issues that cause emotional and relational discomfort, psychic malaise and difficulties in dealing with personal, family or social life.2 It was based on the reference to the model of psychosocial attention that underlies the Psychiatric Reform in Brazil; it is part of an apprehension of the plot of the existence of university students in their life situation, which takes place in daily relationships and in a space of time in which biological, economic, cultural and social determinants are present.3
At university, young people are confronted with personal, family and social changes that have direct repercussions on their lives. They are exposed to various situations that mobilize their psychic suffering, such as: detachment from the family environment, love conflicts, adaptations to the demands imposed by the academic environment and different expectations regarding their professional future. All these changes may lead the young person to psychic suffering and compromise his or her learning process at the beginning, middle or end of the graduation course. Each of these phases is marked by different demands that can help in the understanding of the mental health of this population group.1,4-5
National research, conducted with graduates of Federal Institutions of Higher Education, identified difficulties that most affect academic performance. In particular, the lack of study subjects (28.4%), financial difficulties (24.7%), excessive student workload (23.7%), emotional problems (23.7%) and travel time to university (18.9%).6 Such aspects of the academic context have contributed to the increase in the number of students in psychic distress, as they require behavioral changes to adapt and organize themselves to the academic demands.1,5
It is estimated that university students are more vulnerable to the development of psychic suffering when compared to young adults who do not experience this reality.5 Studies point out that about 41 to 43.5% of nursing graduates may present some psychic suffering during their training.7-8 In addition, it was shown that the worse the adaptation to the university, the greater the probability of psychic suffering.8 Faced with this problem, it is a question of research: how the psychic suffering of nursing graduates can be related to their academic life?
This research brings an important discussion to the academic universe, since the university is understood as an institution of subject formation, articulator and promoter of knowledge, an environment that contributes to stability, control and order, instead of potentiating situations of psychic suffering to its students.4-5,8 Thus, it was sought to analyze the psychic suffering among university nursing students in the context of academic life.
Method
Descriptive, qualitative approach research carried out at a public university in the interior of the Northeast, Brazil. The population was selected by means of purposeful sampling, in which the university students enrolled in the last semester of the nursing undergraduate course of the aforementioned institution were considered.
As previously agreed with the direction of the nursing undergraduate course, the approach took place through a meeting to deliver an invitation letter to the university students in a classroom of the teaching institution. On this occasion, all the possible participants were present, total universe of 22 in 2016 and 20 in 2017. They were informed about the objective, justification and methodology of the research, as well as the guarantee of anonymity and freedom of choice in participating or not in the research. Those who agreed to participate were scheduled to conduct the interview with the definition of date, time and place for data collection. The purpose of this appointment was not to interfere in the dynamics of their academic life. The interviews were carried out in a room of the university, in a calm place and without interruptions, maintaining the privacy of the participants of the study.
As for the inclusion criteria, it was defined to be a nursing graduate, to be enrolled in the last semester and to affirm that he had psychic suffering at some point in his academic life. The exclusion criteria were: being on maternity leave; on vacation; or with a certificate due to illness during the data collection period.
The research population was composed of 42 university students who were enrolled in the last semester of the undergraduate nursing course. Of these, eight did not accept to participate in the study and 14 had no psychic suffering related to the context of the university; already 20 of them reported some psychic suffering experienced throughout their academic training and were included as participants in the research.
For the data collection, only one researcher of this study was responsible for conducting the semi-structured interview, which had the following guiding questions: During your stay at the university, up to the present moment, have you experienced or are you experiencing any psychic suffering? What were the reasons that led you to this suffering? How have the consequences of this suffering affected your life?
The answers were recorded for an average duration of 45 minutes and then transcribed in full, and no notes were taken during or after the interviews. The data were collected from March 2016 to February 2017, according to the availability and concession of the university students through the Free and Informed Consent Term.
In order to maintain the anonymity of the interviewees and the organization of the statements, the letter "U" of university student was used, followed by Arabic numerals to identify them. The numbering applied had no relation with the order of the interviewees. The empirical material was processed by means of content analysis, which started with the pre-analysis, went through the exploration phase of the material and ended with treatment/interpretation of the results obtained. In the first phase, a floating reading of the interviewees' speeches was carried out in order to promote an appropriation of the content. The second phase consisted of a more in-depth reading of the material to be analyzed, which made it possible to define the emerging categories around which the statements were organized. In the third and last one, significant categories were constructed through the interpretation of the material analyzed and established to the inferences, relating them to the authors who help in the discussion of the study.9
The research was approved by the Ethics and Research Committee on February 26, 2015, through Opinion Consubstantiated number 970,857, according to protocol REC/CAAE 41357215.3.0000.5294. The recommendations of Resolution 466/2012 governing scientific research with human beings of the National Health Council were respected.
Results
Of the 20 interviewees, 18 were female, 16 single and childless, ranging in age from 21 to 28 years, 16 did not work, and ten lived in other cities. As for the academic characteristics, 14 had scholarships and 12 were entering the institution through the quota policy.
The testimonies of the university students of nursing were evidenced and organized in units of record, according to their similarities and pertinence, which emerged a quantitative of 79 units of analysis of content grouped in ten themes, which will be presented in two categories: reasons of the psychic suffering of the university students of nursing; consequences of the psychic suffering of the university students of nursing.
In the first category, the difficulties of adaptation at the beginning of the course, the personal, affective and family conflicts during the formation and the expectations about the end of the graduation were considered the main reasons of the psychic suffering by the nursing students. The second category brings the consequences of the psychic suffering manifested through the alimentary difficulties, stress and depression symptoms.
Reasons for the psychic suffering of university nurses
At the moment of entering university, students generate expectations about their experiences in the course. The lack of connection between expectations and academic reality can emotionally weaken the graduate and make his or her initial adaptation to the course difficult, as reported in the following statement:
When I entered university, I was very strange and mentally ill. I came from a school that didn't demand much from the student. [...] In the early periods of the course, I thought nursing was one thing and it was quite different. It was my biggest conflict, I didn't want to continue. It was the phase that I got sick the most. (U19)
The new rhythm of studies in the course is mentioned as one of the reasons of psychic suffering:
We have a lot of content to study in a short time, a lot of things to do [...] the college routine is very stressful, in the morning and afternoon, in the evening millions of texts and things to do. So I suffered a lot for not being able to reconcile everything. (U7)
Another reason for the suffering that emerged from the interviewees is about the time they leave their home towns to live in another state or municipality:
I had to leave home to live here. It's hard not having a mother and father to work things out. You have to turn around on your own and it's well suffered. (U5)
One of the reasons that influences the emergence of psychic suffering during the academic period is related to conflicts in interpersonal relationships, especially between university students and teachers. This situation of suffering reported, happened in the classroom:
There was a friction with one of the teachers of a subject. It turned into a snowball because the other teachers of this subject got involved [...] and that made me sick, made us very sick, almost the whole class got sick. (U13)
According to the interviewees, some professors used authoritarianism to impose themselves in front of the class and, with this, the university students felt persecuted, as it is shown in the following statement:
It was the feeling of abuse of authority even though some had with the whole class [...] it was persecution with us, I felt it was really persecution against us [...] they had a different attitude from his speech, they spoke a lot in collective, but they didn't understand our difficulties, they didn't stop to listen to our suffering. [...] The overload of this discipline and the way these teachers treated us affected my disapproval not in that discipline, but in another that was good and I didn't value it so much. This problem happened with several members of the class. (U9)
University students reported that affective conflicts were also reasons for psychic suffering during graduation:
I never managed to reconcile dating and college. It was work on top of work, I didn't have time to dedicate to anyone. (U19)
I had a relationship that was not very healthy [...] had many things to do from college, he wanted very much to leave home to the bar, shopping, beach. I was very dependent and wanted to go with him. I couldn't, suffered too much and he didn't understand. (U8)
Concerns about family members motivated psychological suffering and difficulties in keeping up with the activities required by academic life:
Grandma had cancer when I was at the end of the third period of college, she was diagnosed with lung cancer. I missed many days of class to be with her. I knew it would hurt me in the course, but I wanted to be with her. (U20)
I was really shaken by my mother's mental problem, I couldn't do anything else right. She is my safe haven. (U1)
The first contact of university students with supervised internship in the hospital was another contributing reason for the emergence of psychic suffering at the end of the course. These experiences provided the emergence of ambivalent feelings: on the one hand they were motivated to learn what it is to be a nurse in the hospital, but on the other hand they were concerned with correctly performing what was learned in the classroom:
I really wanted to get to the last periods of college, but it's worrying when you're there in the hospital with a life in your hands, any mistake can compromise that person's life or health integrity. (U6)
Another triggering reason for the psychic suffering mentioned by the interviewees refers to the extensive workload of the nursing course, which provides the university student with an overload of studies. Some curricular components of the final periods of the course are hindered by the condensation of many contents into a single component, resulting in a high workload to be fulfilled in a short period of time.
I would have had a lot less trouble if I didn't have so much workload here. This period has a discipline that concentrates six contents that could be each content a discipline. It was very stifling and very tight for us, it was extremely difficult. (U4)
In addition to the extensive teaching load of the course, it was possible to identify that university students were in psychological distress due to the need to participate in research and extension activities:
To improve your resume, to try to grow professionally, we need to submit to extension projects, do research, all this outside the workload of the disciplines. Classes were in the morning and afternoon and at night for other activities. It's a burden, it's a lot of suffering, there are hours to give up. (U18)
The Undergraduate thesis (UT) was also mentioned by university students as one of the reasons for psychic suffering at the end of graduation. The coincidence between the development of UT, supervised internships and other academic activities implies physical attrition and psychic suffering.
We go morning and afternoon every day to the final stage of the course, when we get home at night I'm extremely tired, I don't have any energy left for anything. I'm having difficulty in UT, to develop, and it's because I'm already two months away from delivering [...] there's no way you can devote yourself to UT because the overload is too great. (U11)
And, finally, another reason for suffering that has emerged in the final periods of academic life is the anguish related to the professional future:
Now at the end of the course I wonder what it will be like afterwards. I will finish and do what? Will I stop being a student to be unemployed? Will I pass a contest? It's very distressing all this. (U15)
Everyone believes that everything will improve after I finish college. What do they expect from me? I feel pressured by society to be a good professional and by the family to give a return on everything they invested in my education. (U17)
The testimonies of the interviewees ratify that the course of the graduation configures as moments of great adaptive difficulties, in face of the changes of habits, uncertainties and challenges found. Thus, the reasons for the psychic suffering were not limited to carrying out only the academic activities, but also to those that involved the subjectivities of these students, arising from their life context.
Consequences of suffering experienced in the life of university nurses
The university students reported that the routine in nursing graduation is exhaustive and in these conditions they cannot maintain a healthy diet. They become dependent on fast-prepared or ready-made foods with low nutritional quality, and sometimes fail to make some meals as a justification for the lack of time:
With so much to do, I think: how will I prepare the food? Something that is faster and easier. I go to the cafeteria and eat a quick snack with soda to go back to college soon. (U5)
There was so much running around here in college that I just ate bullshit. Sometimes I forgot to eat during the day and only at night I ate a lot. It was an anguish that made me eat too much and sleep too little (U14)
I spent days without eating, I had a day that I came to class without eating because I didn't have time to make the food. I spent the whole day in college without eating anything, I didn't feel like eating. If I wasn't hungry and my stomach didn't hurt, I wouldn't eat. (U10)
The occurrence of weight gain or loss is related to food choices and can influence concentration, attention, motivation and satisfaction in the university context.
I barely ate, I only had time to make two meals in the day. I got very thin, more than I already am. I couldn't concentrate in the classes so weak. (U12)
I gained 13 kilos in college in a short time, I arrived with 58 kilos, today I am with 71 kilos, it affected my self-esteem. When I'm anxious as hell. I don't feel like going to college, I feel ugly and fat. We suffer a lot in this process of losing weight and getting fat. I lose weight due to running away from college, then I get anxious, eat more and get fatter (U9)
Another consequence is the stress experienced by university students in the academic environment in search of adapting to the demands related to the course and the institution.
Our course is integral, an immense overload, so much charge that it easily stressed me, I always cried. (U1)
Sometimes I got stressed with college and even angry. Other people from other courses can have a normal life, have leisure, walk, leave home, but I can't. We lose doing things that we like, I stop staying with my family, with my friends to take care of college chores. (U7)
The university students presented physical and psychological symptoms related to stress, which impaired their academic performance:
My stress was so strong that I had many headaches, high blood pressure, lack of attention, irregular menstrual cycle, it was easy to get irritated and even aggressive. I couldn't read the texts, I couldn't concentrate. (U4)
The symptoms of depression also arise as a consequence of the daily routine of university nurses, which influences their family, affective, academic and social relationships.
Every day I cried [...] I became sadder, depressed, I became quieter at home and more alone. I was always very sensitive, so I cried a lot, really cried. I think I had depression. When I got home after college I cried even more. I know I needed professional help, I needed antidepressants, but I didn't go after. (U2)
I didn't feel like doing anything. I didn't want to leave home; I stayed in bed for several days. I had no energy to prepare my food, I couldn't study. During the night, I got sadder; I cried [...] I was afraid to sleep, afraid to have bad dreams. I had all the symptoms of depression. (U16)
Respondent U3 describes depression as a reaction to conflicting circumstances and/or as a response to frustrations or losses experienced:
I had illness problems at home and with the overload of studies in subjects at the end of college I became more depressed. I was so depressed that I didn't want to leave home and see anyone, even my parents. When the internships came, I didn't feel like going, I didn't feel prepared, I think I remembered my grandmother's illness. It's true that I still don't know how to deal with losses, with deaths. When you fall it's because you already have so much weight on your back that whatever comes, be it heavy or light, is enough to bring you down. And with me it was like this, I ended up falling into depression, I took psychotropics, I was diagnosed with depression by a psychiatrist. (U3)
Among university students who referred to depression, there were reports of some suicidal ideation or presented a history of attempted suicide:
I had several things to do from college, but I couldn't. My grades were getting lower and lower, I didn't feel like doing anything. [...] First I gave myself up to depression, then I almost killed myself, I even took a knife and held it in my hand. I sat from three in the morning until seven in the morning in front of the computer with the monitor turned off doing nothing because I was in the mood to die, so a mood that I never felt in my life. [...] Nothing in my life made more sense. (U10)
It was identified that the ways of living and health conditions of these students are influenced by their experiences in the academic context, including eating habits, excessive academic activities and lack of leisure. These conditions can be precursors for the development of more serious health problems, such as suicidal ideation.
In this way, it was verified that the university context contributed for the students to develop some kind of psychic suffering and, as a consequence of this suffering, losses were generated to other aspects of their lives.
Discussion
The university students researched were predominantly female, young adults, single, with no children, had no paid activities and lived in other cities. This reality presents similar socio-demographic characteristics with a Brazilian study carried out in a city of São Paulo State, Brazil. Young and jobless university students are predisposing conditions for psychic suffering, which deserve the attention of teachers and managers of educational institutions.10
The entrance to the university was seen by the interviewees as a period of adaptation and emotional fragility. Psychic suffering is directly related to institutional demands, the rhythm of study and the distance from the family.
Generally, the transition from high school to university is not an easy and simple process. The academic context requires the incorporation of new standards and customs inherent to social coexistence, constituting a space for adaptation to the demands of the course and the rules of the institution.11 These requirements influence the development of emotional, educational and relational problems of the students, and this is aggravated mainly when their expectations are not met right after entering university.2
The way classes are organized and divided, the division of time into semesters, the density of contents and the quantity of books and texts to study make the university student face a situation to which he needs to adapt in the best possible way. When this transition does not occur, a feeling of frustration and failure can emerge at this stage.11
The report of the National Forum of Deans of Community and Student Affairs (FONAPRACE) revealed that 16% of university students complain about situations experienced at the university.6 The family plays an important role in the academic life and when there is a break in the direct living with their relatives, these university students feel fearful, insecure and present difficulties in assuming new responsibilities related to the context of life.8
Therefore, the difficulties in assuming and conducting this academic reality may emerge moments of psychic suffering and, consequently, even withdrawal at the beginning of the undergraduate course. To adapt the university student to the academic context, it is then considered the need to develop institutional actions for these students in this process of confronting the changes. Other important issues to be addressed are discussions about what a university is, the pedagogical project of the course, and the regulations of the higher education institution. It is necessary to establish spaces for discussion about the possible situations in which the university student will encounter and how he should act when faced with the problems.
The interviewees mentioned that conflicts with teachers, during their training, were one of the reasons for the emergence of psychic suffering. The relationship between teacher-student may or may not favor the mental health of university students. They seek a network of support and a feeling of belonging to deal with difficulties in order to adapt to academic reality. However, if there are impasses in the relationships, this can generate suffering.5
This teacher-student relationship is the result of historical influences of traditional education, which have as their characteristic the centrality of the formative process in the teacher who reproduces the image of an incontestable and unquestionable being, as the only possessor of knowledge.12 To deconstruct this model, it is necessary to promote less rigid and retrograde attitudes in the academic environment, such as listening spaces for greater proximity between university students and teachers. The use of active teaching methodologies also allows university students to assume the autonomy of their learning construction process.
It was verified by the university students that affective and family conflicts were constituted as experiences of psychic suffering during graduation. Many times, the graduate's daily routine was modified by the feeling of insecurity in relation to the partner and by the concern with some sick family member. A study carried out with students of the nursing course, in four Brazilian higher education institutions, revealed that they had difficulty in managing the time of academic activities with the personal, emotional and social demands.13 This implies a few moments of family and social coexistence, which may generate the non-adaptation of the university student, during his academic career, and increased risk to his mental health. The construction of affective bonds inside and outside the university may be relevant to the teaching-learning process, to the permanence of the university student in the course and to the improvement of his quality of life.14
The final phase of graduation was considered challenging by the students, demanding decisions inherent to the professional exercise of nursing. The experience of the internship allows the students to build an identity in their performance and, consequently, their concern in demonstrating articulation of the theoretical knowledge with real situations, which impels them to perform their role with quality, skill and safety.15
The structure and organization of the nursing course, the exacerbated pace of studies and the rigidity of schedules contribute to the emotional exhaustion of university students. Many don't get rest and stop experiencing important moments, as a leisure activity with their relatives, friends and companions.13-14
When it arrives at the end of the course, the UT should be in the process of being finalized, as its construction is procedural and begins from the first semester. However, interviewees mentioned that sometimes they could not adjust and balance their study schedules of the UT with the activities of the internships, due to fatigue and reduced time. These academic demands force student behavioral changes to face such demands, such as new rest routines, forms of time organization and study strategies.5
At the end of the nursing degree course, the students said they faced moments of fear, anguish and insecurities in face of the expectations of their families and of an increasingly competitive and selective labor market. In face of these feelings, restlessness arise about the experiences lived in the graduation, and if these will meet sufficiently the requirements for their professional performance.16
It is also noted that there are limitations between supply and demand for work by nursing in Brazil. This contributes to an increase in the number of nurses who have concluded their graduation and, due to lack of opportunity, do not enter the job market or do not work in the training area or act without corresponding to their professional achievement.17
In the face of these motives of psychic suffering experienced by university students at the beginning, during and at the end of the course, one of the consequences was the difficulties in eating. They reported that consumption and eating behavior were affected by time, feelings, beliefs, values, culinary ability, financial resources, variety and accessibility to food. A study conducted with undergraduate students from a Brazilian public university in the area of health showed that habitual food intake was characterized by low consumption of grains, vegetables and fruits and excess consumption of fast, processed and ultra-processed foods.18-19
In this study, students reported having more importance with their academic performance than with the quality of their diet, which can generate health risks. Another research points to a higher prevalence of obesity and overweight than eutrophy and malnutrition among university students. This is a reality due to the low consumption of fruits and vegetables, fish and whole grains and by the reduction in the frequency of meals and increase in the consumption of sweets, sugary and alcoholic beverages.18-19 Strategies to promote an adequate and balanced diet, with preference to in natura and minimally processed foods, will be necessary and valuable for the development of health promotion in institutions of higher education.
Another consequence mentioned by the university students was stress, which can directly influence the mental health of nursing students. Distance from the family, new interpersonal relationships, confronting the unknown, concern with learning and overloading activities are stressful situations of adaptation to the academic context. Throughout the course, these stress factors are gradually accentuated, since each phase requires students to develop new knowledge and new practices.13-16
Health students experience high levels of stress in the teaching-learning process, especially undergraduate nursing students, because of the need to promote ethical and humanized care. A study conducted with 190 nursing graduates from a Brazilian public university, identified a prevalence of stress in 79.5% of them. The main physical symptoms identified were: constant tiredness (77.3%) and sensation of physical wear (76.8%). The symptoms related to psychic suffering were: excessive tiredness (70.5%) and irritability (58.4%).20-21
The symptoms of depression have also been mentioned by university students as a consequence of their academic experiences, which sometimes go unnoticed or are neglected. They reported living with feelings of frustration, anguish and sadness, often without the help of a professional, a condition that can get worse during the course.5
The person affected by depression can present irritable mood, partial or total decrease in mood and ability to feel pleasure, decrease in energy. Therefore, the person feels constantly tired and discouraged to perform daily activities, which causes him/her discomfort. She may still feel indifferent, disinterested and unable to project the future.22 Another study identified that nursing graduates seek little follow-up from a mental health service or professional; and among those who make regular use of psychotropic drugs, 61% declared use of antidepressants and 28% claimed to use benzodiazepines.7
It is highlighted that depression is more present in the final periods of the course due to the concern with the quality of care in stages when dealing with life and death situations, as well as the decision of the professional future, which involves self-concept and identity with the profession.22 Research developed with 203 nursing students from a Brazilian public university, revealed that among the participants 19.2% had moderate or severe levels of depression.23
One of the interviewees declared that he had suicidal ideas attributed to the adversities experienced at the university. He mentioned deep sadness and lack of interest in academic activities as consequences of a lack of will to live. Suicide ideation affects about 18.8% of university students worldwide and is strongly associated with the presence of depressive symptoms and low school performance.24-26
Interventions to promote mental health in universities are incipient, despite the growing number of students in psychological distress7,8,24 in this study the students of the graduation course in nursing stand out. This reality reinforces the important role of these institutions in formulating strategies to minimize vulnerabilities in mental health and promote quality of life among university students
The study presented as a limitation the accomplishment of only one interview with the students of the last semester of the course of a single university. It is suggested the organization of a nucleus of mental health care in the academic field, constituted by a multi-professional team, to carry out prevention strategies and clinical management, articulated with mental health services professionals.
Conclusion
The psychic suffering of university students is related to their academic trajectory and directly implicated with the modus operandi of their education. The reasons for the psychic suffering mentioned were the difficulties of adaptation at the beginning of the course, personal, affective and family conflicts that emerged during their academic life, and expectations regarding the end of their graduation. The consequences of the psychic suffering were identified as the emergence of dietary difficulties, stress and depression.
As proposals for intervention in this reality, the Pedagogical Project of the Course and the formative process can be considered, which need to take into consideration the way university students deal with the formation process and their mental health. It is suggested as curricular changes, the reorganization of the subjects' workload, an increase in the extension of the course to ten teaching periods, the evaluation of contents and teaching methodologies, the carrying out of academic activities in a way that is considered with the formation objectives that also consider the students' needs to have access to leisure and to maintain contact with their family and social network.
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Chief Scientific Publisher: Cristiane Cardoso de Paula
Associate Editor: Daiana Foggiato de Siqueira
Promotion / Acknowledgement: Not applicable
Corresponding author
Deivson Wendell da Costa Lima
Email: deivsonwendell@gmail.com
Address: Rua Prof. Hélio Lourenço, 3900, Monte Alegre, Ribeirão Preto-SP
CEP: 14040-902
Authors Contributions
1 – Deivson Wendell da Costa Lima
Study planning and execution and writing of the article.
2 – Jaciara Sampaio Gonçalves
Study design, data collection and interpretation.
3 – Lívia Dayane Sousa Azevedo
Interpreting the data and writing the article.
4 – Alcivan Nunes Vieira
Interpreting the data and writing the article.
5 – Rosane Pilot Pessa
Critical review of the article content and approval of the final version to be published.
6 – Margarita Antonia Villar Luis
Critical review of the article content and approval of the final version to be published.
How to cite this article
Lima DWC, Gonçalves JS, Azevedo LDS, Vieira AN, Pessa RP, Luis MAV. Psychic suffering of university nurses in the context of academic life. Rev. Enferm. UFSM. 2021 [Access on: Year Month Day]; vol.11 e23: 1-22. DOI: https://doi.org/10.5902/2179769244220