RESEARCH ARTICLES

 
Continuing education as conceived by nurses in a high-complexity philanthropic hospital

ABSTRACT: Educational activities are part of the nursing work process. In that regard, this paper aimed to identify how nurses conceived continuing education. This qualitative, descriptive study was conducted in June and August 2011 at a high-complexity philanthropic hospital in northern Paraná State. The participants, selected by lot, were 18 nurses from different sectors and shifts, who had been with the institution for at least one year. The results showed that the nurses confuse continuing and permanent education. Better communication is needed between nurses of the continuing education sector and nurses on the wards, to discuss the matter further and, together with the managers, define issues in continuing education and ways of using permanent education as a management strategy.

Keywords: Continuing education; education in nursing; health education; nursing.

INTRODUCTION

Changes in the epidemiological profile of the population, social changes and technological advances lead to changes in the nursing work process, requiring nurses to train their staff¹.

Work and education are indivisible social practices and when associated complement each other². In this regard, education takes place either in formal moments, punctual and planned, as well as in informal conversations among those involved, but always becoming one of the avenues for the development of nursing staff, particularly nurses, on the team that has the role of caring, teaching and managing the process^3,4.

It is common at healthcare institutions the nurses are responsible for specific continuing education sectors aimed at nursing workers. In this study there is a continuing education sector that has an intense demand originating from different units of this institution; however, it is observed that many of these demands could be remedied by the actual unit nurse together with their team. This demonstrates that not understanding there is some confusion between the terms continuing education and permanent education.

This research may provide subsidies for which the direction of nursing will review the objectives of the sector and restructures it potentiating actions that result in better service to clients and reorganize the work processes in the different units.

Thus, the objective of this study was to identify the perception of the nurses of the studied institution on continuing education.

LITERATURE REVIEW

The general guidelines for the education of nursing professionals in the twenty-first century guide education, besides contemplating the integrality in care, should contribute to building a professional with skills to manage and enabling them for decision-making, communication, leadership and education, these being necessary skills for a nurse to conduct the process of working within a team⁵.

To ensure continuity and updating in professional training it is essential that nurses share their knowledge with different staff and rethink how to do the work in nursing. These are attitudes that go beyond worrying about the physical body, with the technique and the care of the demand that the health services demand of them. One of the ways of sharing knowledge is by means of educational actions⁶.

In this context, the most popular forms of education in health education process are: in-service education, permanent education and continuing education.

For in-service education, it is easy to understand educational actions within the work environment, which relate to the interests of the institution and seek efficiency in patient care⁷.

As continuing education it is understood that this is a learning within the daily life of organizations, based on significant learning and in the possibility of transforming the professional practices, this learning is constructed by means of the difficulties within the reality and takes into account the knowledge and previous experiences that the worker has, allowing the professional to transfer their learning in their work routine^8,9.

Now form of teaching called continuing education is seen as a process in which are included all the educational experiences carried out after the initial vocational training of the worker, and is meant to supplement the basic training, updating the knowledge of professionals in face of technological changes, allowing the personal and professional development of workers¹⁰.

Given the differences between the educational process, it takes commitment and educational methods that achieve the proposed objectives for the education of healthcare workers, being necessary to create strategies that encourage the participation of workers in their professional training¹¹.

Hospital departments called as a continuing education sector, continuing education service or other similar designations develop activities related not only continuing education but also for permanent education and in-service education¹².

METHODOLOGY

This is a descriptive research with a qualitative approach, carried out in a high complexity philanthropic hospital, located in the northern region of the State of Parana, Brazil.

The institution was chosen for being an internship site for Residency in Nursing Services Management, State University of Londrina, the institution where the author of this article had been a resident. This hospital maintains rotating shifts of two residents in their first year and eight of their second year, in different shifts and units and is an internship site for undergraduate courses in the healthcare area.

The participants were 18 nurses, and enrolled in the institution for at least one year, randomly selected among nurses and supervisors crowded in various sectors of the hospital and in different work shifts. There was no refusal from the professionals to participate in the study. The number of interviews was established when the saturation of information necessary for the purpose of the study was identified.

A pilot test was conducted with two nurses not belonging to the selected group, for possible readjustment of the proposed questionnaire items.

The randomly selected nurse participated in the survey after signing the Free and Informed Consent.
The data were collected in the period from June to August of 2011, by means of individual interviews, being used a questionnaire with questions relating to the profile of the subjects and the topic of continuing education.

The results of the interviews were evaluated by means of content analysis, which includes three phases: pre-analysis, material exploration and treatment of results¹³.

The phase of pre-analysis happens by reading the floating material collected using the completeness, representativeness, homogeneity, relevance and exclusivity, this way the material is organized, making it operational. In the operational phase of the material, build-if the categories, understood as classes that bring together elements of common characteristics and, finally, in the processing of results, performs the inference and interpretation of them.

In respect to the anonymity of the research subjects, the statements were identified by the letter (E) that represents the nurses interviewed, followed by the interview number.

This work was approved by the Committee of Bioethics and Ethics in Research of the institution where the study was carried out, in accordance with guidelines of the Resolution no. 466/2012 of the National Health Council/MS, under protocol no. 382/11.

RESULTS AND DISCUSSION

Nursing supervisors and nurses responsible for inpatient and outpatient sectors were interviewed, both the day shift as well as night shifts.

According to the questions that guided the questionnaire and in line with the statements of the interviewees, were defined four categories: define continuing education and correlating their activities; continuing education: responsibility of whom?; reasons that lead nurses to seek the service of continuing education; and finally, the purpose of continuing education.

Conceptualizing continued education and relating its activities

When asked about the conception of studied topic, nurses reported that continuing education is:

[...] a training service. (E1)

[...] service that contributes to the growth of the employee, updates, redeems and conducts courses. (E12)

It is noticeable the speeches, that respondents conceive continuing education based on training sessions, courses and updates, being the responsibility of a particular sector in the hospital.

Within approaches of continuing education are activities such as training and courses, which are based on technical-scientific knowledge and whose intention is to adjust professionals to the actions of their own work sectors¹¹.

The purpose of these educational actions is to improve the knowledge, performance, and improve the skills of workers in their work process. Such actions should cause growth of professionals, as the speech of one of the interviewees, since as a result of the various technological changes in the healthcare area, constant professional qualification is needed with the objective of providing a more efficient and effective care¹⁴.

When provoking development and professional growth, continuing education enriches the relationship between health workers facing the patients and their families. By improving their knowledge, professionals come to better understand the clients and health-disease process, reflecting the quality of care¹⁵.

Continuing education can be understood as training, but it is necessary to analyze whether the continuing education sectors have policies in line with the heads of the institutions and clarity of role and the need of these trainings. If they originate only from the specific demands of the nurses of the units, it is necessary to reevaluate, because it contradicts the concept of continuing education⁸.

When asked about the activities carried out by the sector continuing education, respondents replied:

[...] conducted through meetings which predetermine the date and time. (E2)

[...] updates, education, training on things that change and need to be updated to improve in service productivity. (E11)

[...] bring information about new techniques, new procedures, through lectures, training. (E15)

Some nurses answered in accordance with the concept of continuing education that provides for its occurrence in a systematic way, periodic, through workshops, courses and lectures¹⁴.

In this context, the data show that the continuing education refers to meetings for updates of new content, performed with a predetermined date and time. However, if these contents are related to the work process of the unit, they should be reflected, analyzed and discussed within the team itself without the necessity of workers being absent from their sector. Thus, this situation is more related with the concept of permanent education than continuing.

On the other hand, the statements above lead us to reflect on the importance of the existence of continued education in professional life of a healthcare worker, because at the same time that this is renewing their knowledge through courses, they consequently return to the working environment bringing those benefits. But is this what actually occurs? In accordance with the adult learning movement, they learn what has meaning to them, and, not always matters prepared in the continuing education sectors having significant meaning for the workers who are involved with the problems of their unit and team.

When questioned about the activities developed by continuing education, it became apparent that there was confusion in the responses of some interviewees, because they reported activities that are completely unsuited to the model of permanent education, because they involved daily actions, as exemplified in the following speeches:

[...] I think that in our daily routine people may be doing this continuing education with our team, with the patient, with everything. (E5)

[...] giving trainings and everything else, are training both within the sector that the employee works, in the practical-care part. When it is theoretical training, it is in auditoriums, amphitheaters. (E6)

It is clear, in the last two speeches, the lack of clarity between continuous and permanent education. If on one hand they show the nurse's responsibility to discuss the problems with their team, on the other, there is a tendency to resort to continuing education sector for another course and more training that most often, does not impact the worker. In this case, they are invited to leave their unit, at different times of their work, to discuss matters that should be treated with their team, giving them opportunity to all to verbalize opinions, in search for a solution to the problem in discussion. Next giving opportunity to be put into practice what has been decided and returning the group to review and, if necessary, a making a new decision. This form of conduct is in accordance with the principles of permanent education and not continuing education¹².

Continuing Education: whose responsibility is it?

Regarding the professional or sector responsible for continuing education, the interviewees were unanimous in reply that it is a function of nurses, as demonstrated in the following speeches:

[...] a nurse, but there is normally a person designated for this purpose, for example, the nurse of continuing education. (E6)

[...] Nurses from a sector of continuing education. (E14)

According to their testimonies, continuing education is performed by nurses of the institution who are crowded into specific sector for this purpose. In this perspective, nurses who are not tied to the sector of continuing education of the hospital has no responsibility with the educational process, which goes against one of their basic skills.

The study shows that the nurse is essential on participation and implementation of continuing education service, because he knows the reality of the work process, has technical-scientific and ethical skills as well as promotes motivation, participation and integration of work teams¹⁵.

In previous statements it is evident that, nurses themselves are excluded from the responsibility of carrying out continuing education, but on the other hand, would be of utmost importance that they had highlighted continuing education as their educational practice in the work unit, using the difficulties faced on the daily basis.

The speech below shows that nurses use to certain situations experienced within the team to be discussed:

[...] updates, meetings... Everyone ends up not being able to give, but the continuing education happens on the daily basis giving a feedback to the employees. For example, on a shift, sometimes I choose a topic, that is (generating) a problem in the sector, then I separate some minutes with the staff and talk to them and explain it. (E9)

The ignorance on permanent education and the incorrect use of the term continuing education still prevails. Continuing education should be offered sporadically and is focused on updating techniques while continuing education focuses on professional problems encountered in everyday life, that occur within teams, aiming at solving the daily problems and staff involvement in the construction of learning¹⁶.

Motives which lead nurses to pursue continuing education service

Workers reported seeking continued education service when they have questions related to the difficulties encountered in the process of their work, which is evidenced in the following statements:

[...] when I have a question about some technique, something I heard different, I look for continuing education. (E1)

[...] I particularly seek continuing education at the time of a doubt, a necessity. (E7)

[...] usually I seek the sector when I have some doubt, in relation to the techniques, for some medication. (E11)

It is evident in the statements that nurses seek the sector where there is doubt; however it is not clear whether the doubt is from them or the team under their responsibility. The testimonies also revealed how nurses continue valuing the technique in their working environment because the majority refers to continuing education as a sector to work on technical issues. There was no reference to issues relating to team work, interpersonal relationships and ethical - legal problems that permeate the day-to-day process of work and who are matters that should be treated by the team itself for best the result and updated on the level of continuing education.

Between the interviews, there were reports of nurses on the distancing from continuing education service This observation is shown below:

 [...] I do not have the option of seeking this service [nurse from night shift]. (E15)

[...] Hardly I seek the continuing education, only when I know that something has changed in the routine. (E13)

The fact that there were nurses who never sought the service of continuing education can occur due to lack of knowledge of the role of the sector in addition to that, nurses crowded in the night shift has less possibility of contact with the industry, due to their operation only during daytime hours.

The communication process is a key component for the human beings, but it is noticed, that there is a lack of communication and interaction between nurses and the industry of continued education of the institution¹⁷.

In this context, the need to improve communication is highlight between the sector of continuing education and the nurses from the units, adopting some measures, such as meetings, intranets, information murals... It is necessary that the continuing education topics meet the needs of the institution; however, more than that, there is a need for discernment between nurses and managers of the institution to adopt a permanent education as a strategy for managing the different units. It is still necessary to seek initiatives to stimulate the interest of nurses in performing educational activities seeking methodologies that encourage meaningful learning for their staff.

With this, it can be said that the participation of nurses is considered essential in the field of education, because these are health care professionals who are directly and in constant contact with the nursing team and in this way become the actors more qualified to understand, diagnose and assess the needs of hospital units and healthcare teams¹⁵.

The purpose of continuing education
           
When asked about the purpose of a continuing education sector, the following was found:

[...] it is a training to improve the skills of workers. (E3)

[...] Training of professionals who work in a hospital environment, aiming at improving the quality of care, work and the professional... So the purpose of continuing education is always for the greater good, both for the patient as well as for the service. (E6)

[...] make updates when they have any news regarding health, in relation to the care it is a sector which seeks professional growth. (E12)

These statements are in line with the concept that the continuing education allows the employee accompany the changes occurring in the institution in favor of their improvement¹⁸.

An updated and knowledgeable professional ensures beneficial changes in the institution, resulting in improvement of the quality of nursing care provided to patients.

Still highlighted in other responses related to the purpose of the continuing education approaching the concept of permanent education:

[...] purpose of this is to offer continuing education to recall the techniques, work routines, going to a place for problem solving, providing one on one training. (E5)

[...] training employees for their daily activities. [...] (E9)

Again the statements show a lack of clarity between continuing and permanent education. Continuing education search shape workers, contributing to a better utilization of teamwork, having appropriate professional knowledge, feeling empowered to perform the work in a more distinctively, generating a positive impact on healthcare of patients and, consequently, quality services to the population19,20. This educational aspect is defined as on-the-job learning, i.e. it happens in everyday life and is composed of real problems, taking into consideration the knowledge and previous experiences of the individual, and to do so using the problematization⁸.

The confusion presented by interviewees regarding the definition of continuous and permanent education, is present in the practice of nursing teams. The last statements, demonstrated that activities related to training and capacity building are allocated to the education sector continued without it being considered whether the problems presented by the workers relate to continuing education or are everyday difficulties of their teams, here are being used as the principles of permanent education.

CONCLUSION

Resuming the four emerging categories of statements, the study showed that to conceptualize continued education and its activities, the interviewed nurses showed lack of clarity, revealing that there is a need to discuss with them the conceptual difference between continuing education and permanent education.
As for the first category, it is essential that all team members understand the differences between these dimensions, otherwise persist as results of this research, in which the nurse, team leader, for lack of clarity, and remains linked endorsing the said continuing education sectors and end up forgetting their own role in this educational setting. To understand these concepts, the nurse shall establish their action and will act in a manner commensurate with the experienced reality and ensure a better patient care.

With the second category, the research showed that among health professionals, the nurse is responsible for the sectors of continued education, but these sectors need to be rethought and restructured and permanent education needs to be put into practice in teams to meet the needs of the patients' health.

With regard to the third category, there is a clear search by the nurse continuing education sector to remedy any doubt, independent if it is related only to their team.

This behavior reinforces the latter category, which shows the confusion between the nurses about the purpose of the continuing education sector.

It is necessary, though, the relationship between nursing managers of institutions and sectors of continuing education for the planning of educational activities and the methodologies used in each of them, in order to enhance the results and motivate employees, who benefit from these actions, for better quality of care.

REFERENCES

1. Girade MG, Cruz EMN, Stefanelli MC. Educação continuada em enfermagem psiquiátrica: reflexão sobre conceitos. Rev esc enferm USP. 2006; 40:106-10.

2. Silva JAM, Peduzzi M. Educação no Trabalho na Atenção Primária à Saúde: interfaces entre a educação permanente em saúde e o agir comunicativo. Saúde Soc. 2011; 20:1018-32.

3. Acioli S, David HMSL, Faria MGA. Educação em saúde e a enfermagem em saúde coletiva: reflexões sobre a prática. Rev enferm UERJ. 2012; 20:533-6.

4. Souza LB, Torres CA, Pinheiro PNC, Pinheiro AKB. Práticas de educação em saúde no Brasil: a atuação da enfermagem. Rev enferm UERJ. 2010; 18:55-60.

5. Ministério da Educação e Cultura (Br). Resolução CNE/CES n° 03 de 07 de novembro de 2001: Diretrizes Curriculares Nacionais do Curso de Graduação em Enfermagem. Diário Oficial da União, Brasília, 9 nov. 2001; p. 6.

6. Domingues TAM, Chaves EC. O conhecimento científico como valor no agir do enfermeiro. Rev esc enferm USP. 2005; 39:580-8.

7. Kurcgant P. Educação continuada: caminho para a qualidade. Rev Paul Enfermagem. 1993; 12(2):66-71

8. Ministério da Saúde (Br). Secretaria de Gestão do Trabalho e da Educação na Saúde. Política Nacional de Educação Permanente em Saúde. Brasília (DF): Ministério da Saúde; 2009. 64p.

9. Freire P. Pedagogia da esperança: um reencontro com a pedagogia do oprimido. Rio de Janeiro: Editora Paz e Terra; 1994.

10. Bezerra AL. O contexto da educação continuada em enfermagem. São Paulo: Lemar e Martinari; 2003.

11. Sardinha PL, Cuzatis GL, Dutra CT, Tavares, CMM, Dantas CAC, Antunes CE. Educação permanente, continuada e em serviço: desvendando seus conceitos. Enfermería Global. 2013. 29: 324-40,

12. Paschoal AS, Mantovani MF, Méier MJ. Percepção da educação permanente, continuada e em serviço para enfermeiros de um hospital de ensino. Rev esc enferm USP. 2007; 41:478-84.

13. Bardin, L. Análise de conteúdo. São Paulo: Edições 70; 2011.

14. Zamberlam C, Siqueira HCH. A terceirização nos serviços e consequências no cuidar em enfermagem. Rev Bras Enferm. 2005; 58:727-30.

15. Silva GM, Seiffert OMLB. Educação continuada em enfermagem: uma proposta metodológica. Rev Bras Enferm. 2009; 62:362-6.

16. Juliani CMCM, Kurcgant P. Educação continuada e gerência participativa: indicadores de qualidade da gestão de recursos humanos em enfermagem. Cienc cuid saúde. 2010; 9:456-63.

17. Marchiori M. Os desafios da comunicação interna nas organizações. Conexão – Comunicação e Cultura, USC. 2010; 9(17):145-59.

18. Souza MGG, Cruz EMTN, Stefanelli MC. Educação continuada e enfermeiros de um hospital psiquiátrico. Rev enferm UERJ. 2007; 15:190-6.

19. Paulino VCP, Bezerra ALQ, Branquinho NCSS, Paranaguá TTB. Ações de educação permanente no contexto da estratégia saúde da família Rev enferm UERJ. 2012; 20:312-6.

20. Trevisan MA, Mendes IAC, Mazzo A, Ventura CAA. Investment in nursing human assets: education and minds of the future. Rev Latino-Am Enfermagem. 2010; 18:467-71.