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Original Article 

Biosci. J., Uberlândia, v. 31, n. 5, p. 1570-1575, Sept./Oct. 2015 

THE PERFORMANCE OF THE FAMILY HEALTH STRATEGY NURSE IN 
THE CARE OF CLIENTS IN PSYCHIC SUFFERING 

 
A ATUAÇÃO DOS ENFERMEIROS DA ESTRATÉGIA DE SAÚDE DA FAMÍLIA EM 

CLIENTES EM SOFRIMENTO PSÍQUICO 
 

Patricia Iolanda Coelho ALVES
1
; Lúcia Aparecida FERREIRA

2
; Ricardo Jader CARDOSO

3
; 

 Fernanda Bonato ZUFFI
4
; Leiner Resende RODRIGUES

5
; Marina Pereira REZENDE

6
;  

Guilherme Silva MENDONÇA
7
; Emerson Piantino DIAS

8
 

1. Nurse graduated from the undergraduate course in Nursing of the Federal University of Triângulo Mineiro, Uberaba, MG, Brasil; 2. 
Ph.D in Nursing, Professor at the Federal University of Triângulo Mineiro, Uberaba, MG, Brazil; 3. Ph.D in Nursing, Professor at the 
Federal University of Triângulo Mineiro, Uberaba, MG, Brazil; 4. Master Professor in Nursing, Professor at the Federal University of 
Triângulo Mineiro, Uberaba, MG, Brazil; 5. Ph.D. in Nursing , Professor at the Federal University of Triângulo Mineiro; 6. Ph.D. in 

Nursing; Professor at the Federal University of Triângulo Mineiro; 7. Pedagogue, Nurse, Specialist Distance Education, Master's student 
in the Postgraduate Program in Health Sciences at the Federal University of Uberlândia, Uberlândia, MG, Brazil. 

guilhermesilva@famed.ufu.br; 8. Master in Health Promotion from the University of Franca, Professor at the Federal University of 
Uberlândia, Uberlândia, MG, Brazil. 

 
ABSTRACT: Aim: To verify the performance of the nurses, in addition to identifying difficulties and facilities 

in assisting the client in psychic suffering. Design: Descriptive study, of exploratory and qualitative approach. Participants 
and context: The sampling consisted of 26 nurses of Primary Care - Family Health Strategy from Uberaba – MG, in 2012. 
Main measurements: It was used a semi-structured questionnaire, with guiding questions. Data were 
analyzed using content analysis. Results: Six categories emerged:  nurse assignments, access to medication; difficulty of 
access to the center of specialty, professional qualification, teamwork, and lack of facilities. Conclusion: ESF nurses' 
actions are routing, guidance and monitoring. Lack of training, access to medications and specialty centers were the 
difficulties encountered by them. And teamwork was considered a facilitator. 
 

PALAVRAS-CHAVE: Psychic suffering. Mental health. Family health strategy. 
  
INTRODUCTION 

 
Mental disorders remain an extremely 

complex field, full of theoretical concerns that 
challenge science in assistance to clients in psychic 
suffering (COSTA; ANJOS; ZAHER, 2007). 

Population is walking slowly toward the 
psychiatric post reform transformation, especially as 
regards the vision formed on the client in psychic 
suffering, which has as difficulties the insufficiency 
of information and the complications in the system 
modification (MONTEIRO; ET ALL.; 2012). 

A person in psychic suffering is considered 
an individual with rights and duties, and mental 
health care must be in accordance with his/her 
potential and participation in the treatment 
(MIELKE; OLCHOWSKY, 2010). 

Mental health is the ability to live 
overcoming losses and pains imposed by life, being 
the human being able to demonstrate and control 
feelings according to each situation and persons 
(GOUVEIA; ZACCARA; COSTA; LIMA; 
GADELHA, 2009). 

The Ordinance Nº. 224/92 from the Ministry 
of Health regulates the reduction of hospitalizations 
with the implementation of a new model of 

extramural psychiatric care as the Psycosocial 
Attention Centers (CAPS), Therapeutic Residential 
Services and Day-Hospitals (GOUVEIA; 
ZACCARA; COSTA; LIMA; GADELHA, 2009). 
The Family Health Program (PSF), later the Family 
Health Strategy (ESF) began in Brazil in 1991 with 
the purpose of reorganizing the health care, making 
professionals humanize the service and develop 
prevention and health recovery actions fully and 
continuously (SOUSA, 2007). 

The family health Strategy (FHS) develops 
preventive actions and early detection of mental 
illness because it is the closest to the community. It 
acts with the de-institutionalization reasoned on the 
principles of the Unified Health System (SUS) and 
the Psychiatric Reform, which recommend working 
in networks, based on territorial and transversal 
actions with other specific policies (REINALDO, 
2008), beyond embracement, dialogue, attachment 
and listening, for greater understanding of the client 
in psychic suffering, to meet their needs (MIELKE; 
OLSCHOWSKY, 2011). Is currently expected that 
nurses use the assumptions of the care system, 
scientifically characterizing the performance of 
nursing as a profession, with careful ruled in nursing 
diagnosis. The nursing process properly used in the 

Received: 13/04/15 
Accepted: 05/07/15 



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mental patient approach helps in decision-making, 
and subsidies for interventions in the psycho-
emotional problems (BETEGHELLI; TOLEDO; 
CREPSCHI; DURAN; 2005). 

Psychiatric nursing is based on actions that 
seek to improve the quality of life conditions of the 
client and his family for help in controlling the 
outbreak of the disease, making it stable and assist 
in social integration, cooperate on adherence and 
adaptation to treatment, since the client in psychic 
suffering, in its majority, has the autonomy reduced 
(ALMEIDA FILHO; MORAES; PERES; 2009). 

 In primary care/ESF the nurse even in the 
face of difficulties and/or facilities, has the 
possibility to early detect the distress of his client 
once his performance on this site allows him to 
establish ties with the community and get to know 
its reality. 

Providing nursing care in primary care 
services is not an easy task, individuals are 
diversified and the assistance to the client in psychic 
suffering requires the professional to have 
sensitivity, holistic look and expertise. 

The number of researches with this theme is 
scarce, besides the professional deficiency with 
training and specialization in Psychiatry and mental 
health in our country. 

The aim of this study was to check the 
performance of the nurses in the care of this client, 
identify difficulties and facilities with strategies that 
can extend the knowledge, expand information on 
provision of care according to the needs of each 
client. 
  
MATERIAL AND METHODS 

 
Study of exploratory, descriptive and 

qualitative approach.  All the nurses who worked in 
the family health Strategy (ESF) from the urban area 
of the city of Uberaba-MG participated in the study, 
except professionals who were on vacation and 
health license, making up a sampling of 26 nurses. 
As inclusion criteria to participate in the research is 
being nurse ESF. The exclusion criterion is not 
being a nurse ESF. Research began after obtained 
written consent Health Municipal Secretary of the 
city and evaluation and approval by the Ethics and 
Research Committee (CEP) of Universidade Federal 
do Triângulo Mineiro (UFTM), opinion Nº. 1999, in 
accordance with the Resolution 196/96 of the 
National Health Council, which deals with research 
involving humans.  

Data collection was based on two parts. The 
first part consisted of: initials, age, sex, marital 
status, number of children, religion, ESF of the city 

currently working and professional experience. The 
second part consisted of an instrument with guiding 
questions. 1. Have you ever assisted any client in 
Psychic suffering? 2. What is your performance in 
the assistance of a client in psychic suffering? 3. 
What are the facilities and difficulties encountered 
while attending a client in psychic suffering? It was 
research during the period from December 2011 to 
January 2012. The interview was performed by the 
researcher and occurred in the FHS in time 
scheduled by the nurse, in a separate room. The 
majority-16 did not allow recording the interview, 
responding in writing in the presence of the 
researcher. Respondents signed an informed consent 
prior to the start of the interview, maintaining the 
secrecy and anonymity by using letters followed by 
the number of the interview, E1, E2. 

With the data obtained in general the 
researcher must engage in a thorough reading of the 
material extracted from the collection, identify the 
units of meaning, categorize them according to 
themes, make inferences and analyze these findings 
according to their theoretical framework. Minayo 
(2004), the operationalization of the thematic 
analysis covers three stages: 1) Pre-analysis are 
determined at this stage, the registration units - key 
words or phrases, the context units, indentations, as 
categorization and general theoretical concepts that 
guide the analysis, taking into account the central 
and objective research question; 2) Exploration 
Material: is the transformation of the initial data, 
aiming to understand the text from your core sense. 
The procedure is the text of the cut in registration 
units and performs the classification and 
aggregation of data; 3) Treatment of Results 
Obtained: is the interpretation of data, as 
categorized by correlating them with the theoretical 
framework underlying the research. 
 
RESULTS AND DISCUSSION 

 
On sociodemographic characteristics of the 

respondents, it was found that from the 26 (100%) 
nurses interviewed in ESF, 24 (92.3%) were female 
and two (7.7%) were male. Only two (97.7%) 
concluded post-graduation Lato Sensu. The age 
ranged from 26 to 49 years. Related to the time of 
performance in ESF, 13 (50%), had an average of 
five years. All of the nurses interviewed (100%) 
replied they have treated clients in psychic suffering 
in the performance of their daily activities. 

With the data obtained in the survey 
analysis and categorization were made based on 
directives proposed by Minayo (2004), which 
covers three stages: pre-analysis; exploration of the 



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material, and processing of the results obtained. 
From the analyses drawn from the interviews, six 
categories have emerged as a result of the grouping, 
namely: 1. Assignments of nurses; 2. Access to the 
medication; 3. Difficulty of access to the specialty 
Centre; 4. training; 5. teamwork; 6. facilities 
absence. 
 
Nurse tasks 

In this category, it was highlighted that one 
of the roles of the nurse is to guide the client in 
psychic suffering and his family with regard to 
medications or even reference to other specialties 
through reference, counter reference, and follow up 
this client through the Family Health Strategy. 
Orientation and Follow up. (E01) 
  
First approach, second embracement, third referral, 
follow up. (E03) 
 It is more about referral, because we do not have 
support, there is no medication here, we have only 
one general practitioner, and then we end up having 
to guide them to the specialty. (E07)  
Orientation, referral and follow up. (E11) 

 The role of the nurse is to direct user and 
family regarding signs/symptoms, ways to prevent 
aggravations. Guide the user to the specialized 
sector. (E16) 

When working with the client in psychic 
suffering the nurse must break up with his own 
prejudices. These were imposed by society since the 
early days of “madness”, sort the client in psychic 
suffering as aggressive, and associate him to the 
asylums. For the nurse to develop his function with 
professionalism and commitment, he needs to 
acquire skill and detachment (RIBEIRO; ET ALL.; 
2010). Nursing care to the client in psychic 
suffering must be integral, see the client as a whole 
(ALENCAR; FERNANDES; 2010). It is a 
fundamental role of the nurse to develop resolutive 
health actions, listen to the client, therapeutic groups 
and home visits. However, such actions were not 
reported in the study carried out in Fortaleza-CE 
(CAVALCANTE; ET ALL.; 2011). Another study 
showed that the nurse, when faced with clients in 
psychic suffering makes the referral his main tool, 
and directs them to other professionals specialized 
in mental health  (AMARANTE; ET. ALL.; 2011) 
  
Access to medication 

The unavailability of specific drugs in the 
ESFs to the clients in psychic suffering was signed 
out as one of the greatest difficulties of the 
respondents when assisting this client. We can 
observe it through the following lines: 

 […] there are no medication in the basic attention 
[...]. (E03) 
  
[...]. Lack of medications and psychotropics in times 
of crisis. [...]. (E05) 
  
[…]There is no medication, no support, adherence, 
doctor, so, it is not possible to do much [...]. (E07) 

The lack of medication supply to clients in 
psychic suffering in ESF is a difficult point cited in 
the study conducted in four ESFs in the city of 
Salvador-BA in 2007 (NUNES; JUCÁ; 
VALENTIN; 2007), corroborating with this 
research. 
  

 
Difficulties in accessing the specialties center 
            In this category, the nurses point out as 
difficult the lack of integration between the ESF and 
the CAPS, as well as the absence of specialized 
professionals as the psychologist and psychiatrist. It 
was evidenced in reports: 
[...] Despite being defined the front doors, the 
accesses are hampered for the specialties in CAPS, 
psychiatry and psychology [...]. (E03) 
  
 Complex approach, also dependent on other 
professionals and attendances [...] difficulty for 
scheduling psychologist/psychiatrist [...]. (E14) 
  
[...]Our greatest difficulty is the lack of specialists 
in this area (psychiatrist). Our demand on 
psychiatric clients is very large. (E18) 
  

Health networks have sturdy and complex 
relationships, what makes difficult the integration 
and cooperation between these services. It is 
essential that the ESF and the mental health 
reference centers interact among themselves in order 
to encourage a broad and humanized care to the 
client in psychic suffering, promoting his best 
referral (SCHNEIDER, 2009).  

The inclusion of mental health actions in the 
ESFs is occurring slowly and gradually, due to the 
absence or insufficiency of services geared to 
mental health, the disarticulation of the customer 
care network to clients in psychic suffering, the lack 
of communication of the services and mental health 
knowledge in the territory from the ESF as a 
strategy in psychosocial rehabilitation (MIELKE; 
OLCHOWSKY, 2010). 
  
Professional qualification 

The lack of training in the area of 
Psychiatry/mental health is one of the difficulties 



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faced by professionals when assisting the clients in 
psychic suffering, as shown in the following lines:  
The first difficulty is not to have training 
opportunity for a better development of the work, 
because when client is presenting a psychotic 
manifestation we do not know the better ways of 
performing the assistance. (E04) 
  
Further clarification/training in the area. (E11) 
  
[...] lack of professional qualification. (E14) 
  
Preparation, qualification, handling, referral, 
reference, difficulty in requesting vacancy, vacancy 
provision (E16) 
  

In a study conducted in three ESF units in 
the city of Natal-RN, one of the goals was to 
identify the level of training of nurses from ESF 
when assisting the client in psychic suffering 
(RIBEIRO; ET. ALL.; 2010).  Lack of professional 
training and insufficient practical theoretical basis in 
mental health are difficult factors in the care of 
psychic suffering client (OLIVEIRA; CORREA; 
VIEIRA; 2011). 
 
Work team 
            Work teamwas considered as a facilitator 
point when assisting the client in psychic suffering. 
Workteam; humanization in health care[...]. (E05) 
  
Talking/dialogue/patience/prior experience/ 
multiprofissional team support(E16) 
  
I believe our greatest facility is the support the 
general practitioner from PSF offers us [...] we rely 
on the support of the psychologist from NASF (E18). 
  
Support in the health units by other professionals in 
service [...]. (E14) 
  

The team acts as the primary tool of 
intervention and production of customer care to the 
client in psychic suffering (YASUI; COSTA ROSA; 
2008). When talking about teamwork, 
interdisciplinarity and multidisciplinarity should be 
primary requirements, with the purpose of 
promoting exchange of experiences favoring the 
psychosocial rehabilitation of the client 
(SCHNEIDER, 2009). 
 
Absence of facilities 

Regarding to the care of clients in psychic 
suffering the nurses interviewed referred absence of 
facilities. This study reveals the following lines: 
  
I see no facilities. (E13) 
  
There are more difficulties, I can´t find facilities. 
(E17) 
  
Facility? No, I can´t see facility. [...]. (E20) 
  
None. (E10) 
  

In the daily life of the ESFs, the team faces 
difficult situations in mental health, due to the bond 
and closeness acquired with families. Actions 
relating to mental health in the family health teams 
must follow the precept of care networks, territorial 
base and transversal actions, paying attention to 
specific policies that meet the creation of 
attachments and reception to the client 
(MINISTÉRIO DA SAÚDE, 2003). 

It was noticed in this study that the actions 
taken by the nurses of ESF were guidance, 
orientation and monitoring, while attending a patient 
in psychic suffering. It was still noticed that one of 
the difficulties found is the lack of preparation to 
live and act in situations in which the client is in 
your threshold of "madness". The cultural roots, 
which stigmatizes the psychic client, are still strong. 
It was pointed out as a positive and facilitator point 
the work of the multiprofessional team, so that 
client care and monitoring can be carried out in its 
totality. 

ESF and Mental Health walk 
slowly.Managers must implement actions of public 
health policies that may offer the client in psychic 
suffering worthy, integral and continuous care, 
giving opportunity to those health professionals to 
attend training courses in mental health, physical 
and financial resources for the development of 
strategies aimed at the quality of life, respect and 
dignity to these clients. 

This study made it possible to show that 
there is no resolution in the basic attention, since the 
professional nurse prioritizes the referral of the 
client to other spheres of service, exempting himself 
from responsibility of completeness. It is necessary 
to review the concepts of psychic suffering, because 
most actors interviewed associates the pathology in 
the acute phase. 

  
 
 



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RESUMO: Objetivo: Verificar a atuação dos enfermeiros, além de identificar as dificuldades e facilidades ao 

atender o cliente em sofrimento psíquico. Estudo: descritivo, abordagem exploratória e qualitativa. Participantes e 
contexto: A amostragem foi de 26 enfermeiros da Estratégia Saúde da Família de Uberaba – MG, em 2012. Método: 
Utilizou-se questionário semi estruturado e com perguntas norteadoras. Os dados foram analisados utilizando análise de 
conteúdo. Resultados: Surgiram seis categorias: Atribuições do Enfermeiro; Acesso à medicação; Dificuldade de acesso ao 
centro de especialidade; Capacitação Profissional; Trabalho em Equipe; e Ausência de facilidades. A assistência de 
enfermagem ao cliente em sofrimento psíquico deve ser integral. É papel fundamental do enfermeiro desenvolver ações 
resolutivas de saúde. Conclusão: As ações dos enfermeiros de ESF são: encaminhamento, orientação e acompanhamento. 
A falta de capacitação, acesso aos centros de especialidades e medicamentos, foram as dificuldades encontradas por eles. E 
o trabalho em equipe um ponto facilitador. 
 

PALAVRAS-CHAVES: Sofrimento psíquico. Saúde mental. Estratégia saúde da família. 
________________________________________________________________________________________ 
 
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