RESEARCH ARTICLES

Training pathway of graduates from an Undergraduate Course in Nursing: expanding horizons

Diana Coelho Gomes^I; Bruna Pedroso Canever^II; Bruna Helena de Jesus^III; Lia Beatriz Bortollotto Spillere^IV; Marta Lenise do Prado^V; Kenya Schmidt Reibnitz^VI

^I Nurse. Master degree in Nursing. Nursing Specialist at Intensive Care Unit. Florianópolis, Santa Catarina, Brazil. E-mail: dianacoelhog@yahoo.com.br
^II Nurse. Master degree in Nursing and PhD in Nursing by the Nursing Graduation Program of the Federal University of Santa Catarina. Brazil. E-mail: brunacanever@gmail.com.br
^III Nurse. Master degree in Nursing. Nursing Specialist at Intensive Care Unit. Nurse of the Family Health Strategy of Palhoça City Hall. Santa Catarina, Brazil. E-mail: brunahelena_j@yahoo.com.br
^IV Nurse. Master degree in Neuroscience of the South Extreme University of Santa Catarina. Nurse of the Family Health Strategy of Caravaggio City Hall. Florianópolis, Santa Catarina, Brazil. E-mail: liaspillere@hotmail.com
^V PhD in Nursing. Professor of the Nursing Department and Post-graduation Nursing Program of the Federal University of Santa Catarina. Brazil. E-mail: marta.lenise@ufsc.br
^VI PhD in Nursing. Professor of the Nursing Department and Post-graduation Nursing Program of the Federal University of Santa Catarina. Florianópolis, Santa Catarina, Brazil. E-mail: kenyasrei@gmail.com

DOI: http://dx.doi.org/10.12957/reuerj.2015.10509

ABSTRACT

This qualitative, exploratory, descriptive study to examine how the graduates of an undergraduate nursing course perceive the contribution of non-mandatory activities in the process of their training and placement on the labor market. Data were collected in 2011 by structured interviews of 15 graduates of the undergraduate nursing course at the Federal University of Santa Catarina (Brazil), who had graduated in the two years before this study and were already in employment. Data analysis was performed as proposed by Minayo. From the analysis the category 'graduation pathway' emerged, with the subcategory 'expanding horizons'. The results attest to the need to integrate curricula, make better use of clinical practice experiences, and value research, as well as the importance of education based on dialogue between students and teachers.

Keywords: Nursing education; higher education; teaching; curriculum.

INTRODUCTION

The Law of Guidelines and Bases of National Education (LGB) provides to schools scientific, philosophic, politics and methodological bases to guide the development of educational projects, in order to contribute to the education of a professional as critic, reflexive, active, dynamic, willing to learn, understand and satisfy the society needs. Thus, the schools, are responsible for the education of a professional profile that meets the needs of the labor market, as they have autonomy to build their curriculum¹.

In front of this situation, on November, 07th, 2001, the Resolution CNE/CES nº 03 was approved, which implanted the National Curriculum Guidelines for Nursing Graduation Course (DCENF). With the appearing of DCENF, there was a change in the educational paradigm of nursing of Brazil, establishing as egress/professional profile, a nurse with generalist, humanist, critic and reflexive education².

The Higher Education Institutions (HEI) play a fundamental role in the education of critic-creative professionals and reflexives when assuming the responsibility for the preparation of pedagogical politics projects, implementation of active methodologies and proposals of academic participation in teaching activities, research and extension, in order to stimulate the critical thinking and transforming praxis of the professional future.

Thus, teaching, research and extension are understood as an inseparable process and very important to the educational process of a critic, creative and reflexive professional, allowing to the academic experiences that go beyond the classroom barriers and obligatory activities proposed by the course, inserting it to the political and social reality of the country, stimulating the reflection and the creativity of the student, in order to be able to meet the population's real needs, to solve problems creatively and be inserted in the labor market.

In this context, this study aimed to analyze how the graduate of a Nursing Graduation Course realizes the contribution of the non-obligatory activities in their educational process and insertion in the labor market.

LITERATURE REVIEW

Knowledge of how nursing graduation, at different levels, has contributed to the insertion in the labor market; it has been a growing concern for educators and researchers of the area^3-6.

The exercise of research during the graduation has been stimulated by development organs through scientific initiation (SI), modality of graduation and incentive to research at graduation that aim at the initiation of scientific graduation of nursing professionals since the beginning of the course. The activities developed by SI constitute an important stage of education because it enables the student's contact with different scientific methods and instrument, participation in scientific projects and events and propagation of works in events and journals, besides the increase and production of knowledge in a particular thematic area of nursing⁷.

At the meeting of the educational, research and extension triad, the extension projects provide distinguished experiences and very important to the academic and professional development, as this projects insert students in everyday practice with health teams, bringing them closer to the socio-cultural context, developing interaction and interpersonal communication skills and application of theoretical knowledge in practice⁸.

METHODOLOGY

This study represents a cut of the course conclusion work9 of Nursing Graduation performed and approved by the Federal University of Santa Catarina (UFSC), entitle Contribution of critical-creative education of the insertion in the labor market: view of nursing graduates⁹. It is an exploratory, descriptive study of qualitative approach, whereas the methodological referential adopted to qualitative approach was proposed by Minayo ¹⁰. The research was conducted with graduates of the Nursing Graduation Course of the Federal University of Santa Catarina (Brazil), who were graduated in 2009 and 2010 and who are included in the labor market.

The studied university registers 114 graduates of the Nursing Graduate Course graduated in 2009 and 2010. The invitation to the participants was done through email and social networks, whose addresses were informed by the educational institution. The exclusion criteria were not being inserted in the labor market. The choice of participants was for convenience, that is, those who responded to the invitation until data saturation.

The present study included 15 graduates of the Nursing Graduation Course, aged between 22 and 31 years old, 14 females and only one male. Participants were, at data collection time, inserted in different areas of nursing practice, as: hospital care, family health strategy, telemedicine service, home care, public health service management, pre-hospital care service, esthetics clinic and teaching (graduation and technical course). Only four participants reported prior experience in a different place than at current work.

Data were collected in August and September 2011, trough semi-structured interviews, conducted by the researchers at place and date chosen by the interviewee.

The instrument for data collection was structured in two stages. In the first one, graduates were asked about their personal data – age, years and semester of graduation, current workplace, professional area, previous experiences and if they were performing or performed postgraduate courses, to characterize the profile of interviewed professionals. In the second stage, semi-structured interviews were conducted with the elaborate script, especially for the study and validated by researchers; this instrument addressed issues related to the graduation process and contribution to the insertion into the labor market, as an early professional career, met expectations, significant aspects of education and plans for professional career.

After the instrument elaboration, interviews were initiated, without a previous pilot test, a fact that did not interfere with the operation of data collection.

The interviews were recorded in a digital file, later transcribed into a text file in the computer, by the researchers, and stored in a personal computer, with restricted access. Interviews took the minimum of 13 and maximum of 42 minutes and the amount of participants defined by data saturation technique ¹¹.

Data analysis was performed according to the following steps: ordering of data, where the transcripts of the interviews were conducted, with re-reading of the material and organization of the reports; data classification and final analysis, with exhaustive and repeated reading of the texts, seizure of the relevant structures of the central ideas, formation of the categories themes, cross- reading of the material and compared with the theoretical framework, seeking to answer the question of the study¹⁰. Through data emerged the category: Expanding horizons: the possibilities of the route, with two subcategories: A trip to the territories of the research and Extension: extending the territories.

The research was approved by the Ethics Committee in Research with Human Beings of UFSC, registered under number 1942/11, as recommended by Resolution 196/96 of the National Health Council¹².

Acceptance of graduates to the research participation was achieved through the signing of the Informed Consent (IC). Anonymity was maintained used for the identification of subjects the letter I (interviewee), followed by a numeric order of 1 to 15.

RESULTS AND DISCUSSION

The category Expanding horizons: the possibilities of the route are non-mandatory activities that were sought and performed by the graduated during their education journey. Includes reports about the activities developed in research (scientific initiation scholarship, participation in research groups and research project) and extension (not mandatory internships, participation in extension projects, conducting courses/training and monitoring activity).

A trip to research territories

Among the activities performed during the education, the graduates highlighted the articulation research, teaching and extension, which was mentioned as a facilitator in the learning process, as shown in the testimony:

Positive [on graduation course] was the research, extension and teaching. These three things together, I think are very important. The experience of the other nurses who are there [in the workplace], who have graduated in other universities, they may not have this same registration vision chart that I have, I always try to register a lot of things, make queries in the form of SOAP [...] it was very positive, this methodology at the University [...] (I2)

The articulation research, teaching, and extension consist of the university teaching tripod, which is regarded as inseparable. Its implementation provides an academic education of better quality, as it allows the student to recognize the three-dimensionality of education¹³. Such articulation promotes the integration of theoretical knowledge seized in academic education, allied with scientific knowledge, acting as a facilitator in the practical field.

The participation in a research project and research groups was something evidenced highlighted in the reports of the interviewed subjects. Mentioned affirmed that the opportunity of this experience contributed positively to the insertion in the labor market, as well as for the development of critical thinking and a different professional education, as evidenced by the following extracts:

So I think that helped me a lot [the stock SI] to critical thinking, thinking in academic life, scientific articles, the importance of this part of it is also not only work, you have to think of research too and this relationship to see how the reality of University Hospital is quite different from the nursing reality. (I6)

Helped [initiation research scholarship] acquiring knowledge through the research groups as seeking knowledge, databases, articles, to have this form of updated knowledge, not only the books. Having reflection and interpret an article properly. Even we have it a little, very little in graduation, but this on the participation in research groups help students [...] (I15)

To meet these last two statements, initiation to research, during graduation, was considered important strategy concerning the development of differentiated abilities and more effective preparation of the academic to the labor market by allowing the interaction between research and professional practice¹⁴.

Another aspect observed in the interviews was that the labor market enhances the practical experience at the expense of experience with research. The research is still perceived as something divorced from practice by certain graduates, and stressed the importance of participation in groups and research projects as fundamental, only for the inclusion in the academic strict sense trajectory (master degree and doctorate), with little impact on the transformation of professional practice and entry into the labor market. This was explained in the following statement:

So I could not see much of this [experience as scholarship of scientific initiation] may have helped me in my work practice, today, but as I want to do master degree and doctorate, and I think to do at UFSC, so I think it was well important I have participated in research groups, even to the TCC, to have an idea about research helps a lot. (I13)

In my work area, I did not see much [contribution of participation in the research group], but for those who want a career and for anyone who wants to follow this research career is quite valid. I do not enjoy much, because when you are in the university you are concerned about all you have to do [...] and not giving much importance. I think if I went now and participated in a research group would be much more valid. (I9)

When living the research activities during graduation, the student builds skills that help to base their professional practice, develop the oral and written expression, learn to check for updated references, and read them critically. These assignments are essential to the best performance of the student in the selections for entrance into postgraduate programs, but cannot be limited to research activities as something only for scientist's education. By opting to exercise care, the student also will enjoy greater critical analysis, intellectual maturity, creative and transforming capacity; and greater ability to deal with problems¹⁵.

Another important aspect is the encouragement of participation in research projects, during graduation course, as shown in the following statement:

Nursing tries to take the student to the research, I think the course and emphasize the important of research that nurses always have to search. During the course I participated in the research group [...] understand how research happens and to be more attentive to what is emerging in scientific journals and that research groups enable this, bringing new articles. (I11)

Encouraging participation in projects and research groups demonstrates the concern of researchers and educational institutions in the consolidation of science. The nursing as a historically empirical profession faces difficulties in living the new values espoused by the scientific community, being extremely important to build investigative productions that contributed to the resolution of welfare issues and the development of the profession.

It is worth noting that one of the graduates emphasized his experience with the research groups, highlighting that the production of knowledge is more easily developed by students when existing the possibility of scientific initiation fellowships. Noteworthy, a gap in academic education since this experience is the privilege of the few.

Encourage more students to research; I think we stay too far from the research unless those who become scholars of the research groups even after or at the time to make the TCC. And also, later, for those who want to pursue a master's degree, it is very complicated [not having such an experience]. We go out with a very fragile base about research and is something that is growing more and is very important. (I4)

In a study about the meaning of scientific initiation (SI), ex-SI scholars highlighted such activity as a differential for professional and scientific education. Although this contribution is highly valued by students and teachers and proven in scientific studies, the number of SI scholars transferred to nursing is still insufficient, considering the need to prioritize this ability for the education of a critically inserted professional in the production of knowledge^{11, 14}.

Extension: extending the territories

The interviewed professionals expressed as positive the activities of non-obligatory internships for insertion in the labor market, stressing in their speeches the importance of practical and technical experience during the formation process.

What contributed to my education were the extra internships I did [...] I think if you want to graduate, if you do not have the technical nursing and you do not have a lot of skill it is good to make an extracurricular internship and in the nursing area, in the hospital part or even health centers, but more with the practice to acquire more skills, because there are 20 hours per week in which you are there, in direct contact with the patient, can see its evolution, that sometimes on the university internship can not see it, but it is up to the student. (I1)

One thing that I see that is very fundamental, they observe in your resume is the question [...] internships, things like that, dedicated to practice [...] so one thing that stands out in the curriculum is your quest for knowledge beyond what the graduation offers you. Extracurricular opportunities are very important [...] To see in the resume of a recent graduate who has enough practical experience is something [...] (I15)

The non-obligatory internship, during the academic trajectory, depends on the student and identify their need to develop skills related to the construction of knowledge, professional experience, autonomy, taking the initiative, the improvement of technical knowledge and understanding of the dynamics in different scenarios of practice. This experience, which transcends the academic curriculum, allows an approach to the labor market; as the subject is inserted in a professional context in which perform with greater autonomy and responsibility¹⁶.

Valuing non-obligatory internships in professional education, there were reports about the importance of these activities in leadership development and improvement of interpersonal relationships among professionals.

I think it helped me to learn how to deal with a team [...] What contributed most to me, as a professional, was the question of the team, to learn leadership [...]. (I6)

All these internships [...] are very productive, very valid. Curricular, extracurricular internship, these that we have here at the university, it is very valid, because first of all we learn to live together with people; second, it is a practice, you have practice. (I9)

As mentioned, the graduates reported about their interpersonal relationships with professionals in the field of practice. Teamwork favors the professional growth of all involved members. The exchange of experience and information acts as a facilitator in the learning process, reflecting on the assistance in the practice field. The opportunities offered by the education process related to practical experiences and good interpersonal relationship allow to the academic developing leadership skill, as it takes on greater security and autonomy to be inserted in a professional context ^17,18.

It was highlighted in the subjects speeches, issues related to autonomy, glimpsed during the performance of the non-obligatory internships. Such autonomy was attributed to the absence of the teacher in the training field, the feeling of insertion in the team and to direct and constant contact with the nurse and their respective activities.

Internship [non-obligatory] is very important to do to have a different notion. There you are without a teacher, sometimes the teacher intimidates you, you stay kind of stuck because of it. It is good to do because there are practice professionals, as much as the teacher knows, is different from a person who is there every day. [...]. (I10)

It was very good, especially because we had no teacher and was just you and the nurse of the unit. So you were inserted in the unit, in the nurse work, following all the time, so you could see what nurses do in practice [...] (I13)

The testimonies demonstrate the influence of vertical and authoritarian teaching posture exercises in the training process of the students, intimidating them. This relationship will reflect the lack of dialogue between the teacher and the student, which damage the incentive to search for learning, interfering with curiosity and autonomy. It is important that the teacher respects the autonomy and identity of the student to the educational process take place in a pleasant way, and there is the involvement of both to build a common knowledge¹⁹. Also, the teacher should still use new strategies and teaching methods, providing opportunities to graduating the development of critical thinking and a qualified professional education²⁰.

Suit also to highlight the direct link between academic and nurse of the unit, which reflects in great learning moments, as the professional is inserted into the practice field, acting as a facilitator of the teaching-learning process and bringing the students to the reality of local practice.

CONCLUSION

From this study, it became clear that not only the scientific community but also graduates participants of this research, consider as an important point in education the linking of teaching, research and extension to enable this triad as a fundamental condition for the formation of self-employed professionals and committed to the desired changes in the health field. As is known about the real situation of graduates in the labor market and their views about the contributions of the training in this insertion, there is the need for curriculum integration, better use of experiences of clinical practice, the appreciation of the academic approach to research, as well as the importance of training in guided dialogue between students and teachers. Thus promoting the liberating teaching practice with loveliness and humanization, allowing freedom of expression and opinion during the learning process, so without oppression.

The fact that the research was performed in only an educational institution is a limiting aspect because we need to consider the great diversity of contexts and realities of the country, influencing directly on issues prioritized by the institutions during professional education.

Finally, the deepening is suggested in future studies about an evaluation of graduates from different universities to identify the true potential of IES in the formation of critical and creative professionals, and provide a reflection aiming at transforming the reality of these institutions.

REFERENCES

1.Ministério da Educação (Br). Lei nº 9.394, de 20 de dezembro de 1996. Lei de Diretrizes e Bases da Educação Nacional. Estabelece as diretrizes e bases da educação nacional. Brasília (DF): Senado Federal; 1996.

2.Conselho Nacional de Educação (Br). Resolução CNE/CES nº 3, de 07 de novembro de 2001. Institui Diretrizes Curriculares Nacionais do Curso de Graduação em Enfermagem. Brasília (DF): CNE; 2001.

3.Pereira ALF, Nicácio MC. Formação e inserção profissional das egressas do curso de residência em enfermagem obstétrica. Rev enferm UERJ. 2014; 22:50-6.

4.Colenci R, Berti HW. Formação profissional e inserção no mercado de trabalho: percepções de egressos de graduação em enfermagem. Rev esc enferm USP. 2012; 46: 158-66.

5.Püschel VAA, Inácio MP, Pucci PPA. Inserção dos egressos da Escola de Enfermagem da USP no mercado de trabalho: facilidades e dificuldades. Rev esc enferm USP. 2009; 43: 535-42.

6.Jesus BH, Gomes DC, Spillere LBB, Prado ML do, Canever BP. Inserção no mercado de trabalho: trajetória de egressos de um curso de graduação em enfermagem. Esc Anna Nery. 2013; 17: 336-45.

7.Erdmann AL, Leite JL, Nascimento KCd, Lanzoni GMM. Vislumbrando o significado da iniciação científica a partir do graduando de enfermagem. Esc Anna Nery. 2010; 14: 26-32.

8.Tavares DM dos S, Simões AL de A, Poggetto MTD, Silva SR. Interface ensino, pesquisa, extensão nos cursos de graduação da saúde na Universidade Federal do Triângulo Mineiro. Rev Latino-Am Enfermagem. 2007; 15: 1080-5.

9.Jesus BH, Gomes DC, Spillere LBB. Contribuição da formação crítico- criativa na inserção no mercado de trabalho: visão de egressos de enfermagem [monografia]. Florianópolis (SC): Universidade do Sul de Santa Catarina, 2011.

10.Minayo MCS. O desafio do conhecimento: pesquisa qualitativa em saúde. 8ª ed. São Paulo: HUCITEC; 2010.

11.Fontanella BJB, Ricas J, Turato ER. Amostragem por saturação em pesquisas qualitativas em saúde: contribuições teóricas. Cad Saúde Pública. 2008; 24: 17-27.

12.Conselho Nacional de Saúde (Br). Resolução n^o 196/96 de 10 de outubro de 1996. Institui as Diretrizes e Normas Regulamentadoras de Pesquisas envolvendo Seres Humanos. Brasília (DF): CNS; 1996.

13.Moita FMGSC, Andrade FCB. Ensino, pesquisa e extensão: um exercício de indissociabilidade na pós-graduação. Rev Bras Educação. 2009; 14: 269-80.

14.Reis LA. Programa Institucional de Bolsas de Iniciação Científica do IBAMA: uma política de pesquisa [dissertação de mestrado]. Brasília (DF): Universidade Católica de Brasília; 2007.

15.Fava-de-Moraes F, Fava M. A iniciação científica: muitas vantagens e poucos riscos. São Paulo: Perspec. 2000; 14: 73-7.

16.Paiva KCM, Martins VLV. Contribuições do estágio extracurricular para as competências profissionais: percepções de enfermeiros de um hospital público. Rev Eletr Enf. 2011; 13: 227-38.

17.Pires RP. Formação de competências na interface estágio extracurricular e início da atuação profissional como enfermeiro. [dissertação de mestrado]. São Paulo: Universidade de São Paulo; 2006.

18.Ramos VM, Freitas CASLF, Silva MJ. Aprendizagem da liderança: contribuições do internato em enfermagem para a formação do estudante. Esc Anna Nery. 2011; 15: 157-61.

19.Freire P. Pedagogia da autonomia: saberes necessários à prática educativa. 37ª ed. São Paulo: Paz e Terra; 2011.

20.Nazik MAS, Handi YH, Olfat S. Developing an understanding of research-based nursing pedagogy among clinical instructors: a qualitative study. Nurse Education Today. 2014; 34: 1352-6.