ORIGINAL RESEARCH

Learning environment: the school area of professional education in nursing technicians

Rosangela Andrade Aukar de Camargo^I; Ariana Januário Araújo^II; Gabriela Rodrigues Bragagnollo^III; Fernanda dos Santos Nogueira de Goes^IV; Renata Silva Appolinário^V

DOI: http://dx.doi.org/10.12957/reuerj.2016.10543

ABSTRACT

Objective: to characterize teaching space and infrastructure of middle schools providing vocational education to nursing technicians. Method: this descriptive study (research ethics approval protocol CAAE: 01433012.8.0000.5393) was conducted at four schools in São Paulo State, where data were collected, between August and October 2012, by non-participant observation and a questionnaire answered by four coordinators, and analyzed against a frame of reference. Results: three schools were private (766 students enrolled) and one was public (53 students); at three, infrastructure was adapted to the school function. Environmental comfort and hygiene were contemplated. They had multimedia equipment. Nursing laboratories had limited space, materials and mannequins for simulations were outdated, libraries collections were small and outdated, and there were no video libraries or anatomy and physiology laboratories. Conclusion: at most of the schools, infrastructure and teaching space were improvised and did not meet minimum requirements, which may possibly sacrifice quality in the profile of professional to be trained.

Keywords: Nursing education; professional education; infrastructure; teaching materials.

INTRODUCTION

The quality of vocational training of mid-level nursing, whose professional activity is regulated¹ by Law No. 7,498 / 1986 directly impacts health actions, which mostly depend on nursing technicians. This quality requires spaces that allow the learning of cognitive skills / techniques, ethics and aesthetics by the student, where the focus is essential nursing care, conscious and responsible in the context of primary health care of the Unified Health System^2.3. However, studies assessing this relationship in the formation of professionals do not exist.

The school learning environment is a place that is socially constructed by students, teachers, administrators and community from the interactions they establish with each other, curriculum, knowledge, physical space, among others, and may be on a path with multiple playback options or social change^4.5. It is a dynamic process and reveals the importance of infrastructure as in schools that have worse infrastructure the Education Development Index is lower⁶.

The school space, or its infrastructure, is a dimension of the educational environment and linked to the Pedagogical Course Project (PCP), constructed from National Curriculum Guidelines (NCGs)⁷. The availability, quality of spaces or equipment and its pedagogical use constitutes the first challenge, and can exert significant influence on the formation⁸. Thus, the school building and facilities should consider environmental conditions as noise, temperature, sunlight and ventilation and light, which determine the performance of students. And the existence library with digital access, outdoor spaces, laboratories, textbooks and reading materials and teaching^9-11.

The character of previously built and organized educational environment, expresses the intention of promoting learning opportunities, but also political commitment to cultural and social emancipation. The educational environment is characterized by grouping elements, which gathered a careful organization must meet the objectives of the learning process ^4,9,11.

For the Nursing Technical Course, the minimum required infrastructure are library and video library with updated collections on health; computer lab, nursing (semiotics and semiotics), anatomy and physiology. Since the completion profile, the formation of a professional to assist in the promotion, prevention, recovery and rehabilitation in the health-disease; preparing the patient for health procedures; provide nursing care for medical patients, surgical and critically ill; perform dressings, administer medicines and vaccines, sprays, bed bath, make anthropometric measurement; check vital signs and apply standards for the prevention of bio-hazards¹².

parallel is by drawing, a study on the training of nurses showed that how is this process can have (positive or negative) consequences¹³ for training, for professional work and especially for nursing care. The question then is: How is the real space and materialized of technical vocational education schools for the training of nursing staff constituted today?

Given the above, this study aimed to characterize the school environment and infrastructure of secondary education schools in nursing, with a view to the development of the teaching and learning process.

LITERATURE REVIEW

Literature review was conducted on a Brazilian base (considering the national aspect of the training of nursing personnel) and has not found specific studies on vocational education average level in nursing and space / school environment and / or school infrastructure published in the last 10 years, corroborating the relevance of this proposal. Therefore we will analyze some studies addressing the professional education in a broad sense.

The study of infrastructure of educational institutions is growing, especially in basic education. They seek to understand the historical context and the specific circumstances of creation and school facility; its evolutionary process; school life and the school building ^14,15.

Study comparing the buildings of schools that house the university, high school and vocational education, a city of São Paulo, showed the materialized distinction of facing education for intellectual work that aimed to manual labor¹⁶.

With regard to nursing, the quality of these courses promotes discussions of Brazilian leaders, such as the need to define specific parameters and indicators for the evaluation of secondary education institutions, including school infrastructure¹⁷.

The literature points to several challenges to be overcome to form professional high level critical and reflective. Among them were highlighted the lack of teaching materials, audiovisual, library, laboratories, as well as updating the faculty and adequate training field^6,8,10,11,14.

The lack of studies assessing this infrastructure in the mid-level nursing education reflects an important gap to contextualize it at the moment, considering the importance of vocational education in Brazil.

METHODOLOGY

This is a descriptive study, covering six schools in a municipality of São Paulo, registered in the National System of Vocational Education and Technological Information¹⁸, offering Technical Nursing Courses in 2012. Of the six schools, one did not reply to the invitation and another, although registered, had ended its activities.

The municipality had in 2012, 1,404 health facilities, totaling 1,896 hospital beds and 332 additional beds. In primary care were 128,624 people registered and 66,941 families¹⁹. The city is considered a reference in high complexity service highlighting also in the area of ​​research and training in health.

The participants were four coordinators of nursing courses, all with a minimum experience of 3 years in office.

Data collection was performed using a structured questionnaire and non-participant observation in two consecutive visits to schools during the period of operation, performed by two different investigators at different times between the months of August and September 2012.

The questionnaire consisted of 36 closed questions: general data; building infrastructure and facilities; human resource. Treating organizational school characteristics, this study parts from a classification already suggested by other research²⁰.

For analysis, the data were released in the table Excel®, while information of the observations was organized according to similarities and differences.

The study met the national and international recommendations and has been approved by Research Ethics Committee - CAAE Protocol: 01433012.8.0000.5393.

RESULTS

Of the four schools participating in the study, three were private and one was a public school, alying to the state government hospital school.

School A, private, established in the late 90s of last century, keeps building rented three floors with 1.000m² adapted for this function. The facade stands out for its vibrant painting, front staircase, flanked by ramp. It is located on avenue with high car flow. It should be noted that on the same avenue, are three mid-level technical schools. The presentation of the school and of course the website It features pictures of the facilities, information about requirements, documents needed for registration, workload of each module and objective of the course. PPC is not presented to the public.

School B, private, occupies the ground floor building, renovated, opened in 2005, with 250m². Located on Avenue neighborhood, it has a facade with white paint and barely visible identification . The website provides information managers, photos facilities, information on agreements with health institutions. PPC is not presented to the public.

School C, private, was built on 3,000m², the Professional Education Expansion Program, a partnership between the Ministry of Education, Inter-American Development Bank, the Fund for Worker and Federal Government, with the Health Union. The building has two floors provided with ramps, with over 2,000m² of built area. Located in the peripheral area of ​​the city, is next to another municipal school and in front of a square. The architecture differs from the others because it was designed to accommodate professional mid-level courses. The website provides information about the school, physical structure, material resources and each laboratory equipment. Data on the PPC were restricted to the goal and workload of each module.

School D is public, the oldest of the city. It has no building of its own. It was created attached to public hospital in the 70s of the last century, it had its facilities demolished in the late 90s. It currently holds the top floor of a rented building, which resembles a barn, adapted to function, located in a peripheral residential district, with an area of ​​approximately 500m². The facade is worn and the external identification is barely visible. The website is allocated within the website Hospital and displays in two paragraphs the school goal.

The dependencies found in the schools surveyed are shown in Figure 1.

FIGURE 1: Dependencies of the building infrastruture of mid-lever nursing schools. Ribeirão Preto (SP): 2014.

Schools B and D have separate bathrooms for men and women, lack access ramps for people with disabilities and a computer lab. None of the surveyed schools have laboratory anatomy and physiology.

The activities of B and D schools occur exclusively during the night, while A and C in the morning and evening. The School has 12 rooms in functioning, while the other only one, with an average of 32 students.

Of the 819 students enrolled in these schools, 766 are in private institutions and 53 public.

With regard to teaching materials and equipment, School A has multimedia access Internet in all classrooms. The nursing laboratory contains beds, created, basic mannequins, torso, scales, cabinets for the storage of materials, sink with cupboard and chairs that take up half the room. It is estimated an outdated collection of 380 books and booklets, but the library remains locked. In the computer lab, there are 16 outdated computers. All rooms have air conditioning.

School B has two multimedia devices. The laboratory has a closet for the storage of material, sink, bed and has no dummy. The library has 276 books and booklets also outdated. Students have no access to computers or the Internet. The rooms have ceiling fans.

School C has multimedia equipment in five rooms. The nursing laboratory of 75 m² is air-conditioned, equipped with sinks, beds, modern mannequins and various equipment listed in website from school. It boasts a mobile laboratory for practical classes - Ambulance intensive care unit equipped. The library has collection of 1,245 books and study aids for consultation and computers with access to Internet.

School D has a multimedia without access to the Internet. In the library, there are three cabinets with 297 books and handouts. The lab has basic materials for demonstration of nursing procedures, has no dummies and sink. All rooms have fans.

It was observed in visits to the schools that most teachers used the media as a teaching resource, students were sitting lined up.

DISCUSSION

The study unveiled learning environment characteristics that contribute to the discussions and determine the process of teaching and learning for the training of nursing technicians, which are analyzed on two topics: the identity of the school building; school space and the learning process.

The identity of the school building

To analyze educational institutions implies paying attention to the environment in which the school is inserted: streets and other buildings, neighborhood, district, city, other schools, city citizens ¹⁶.

As revealed in this study, one of the schools is located in the central area of ​​the city, next to others that are references in the training of workers for industry and trade. In less then 700m from the main street, young people and adults who wish to professionalize and enter the labor market visualize buildings that can identify the vocational courses options and realize their choices. The proximity of these schools and their compartmentalization in the city strengthen its social function, where learning manual labor.

Another observation is that if the idea is to create opportunities for a greater chance of schooling, this falls apart because it is a private school. Which probably explains the small number of students (comparing them to the municipality size). Except for the only public school in the study.

Adaptations of most schools symbolize the lack of investment in infrastructure marked by improvisation and the devaluation materialized towards this training. Current data show the hegemony of private schools, which account for 90% of all students enrolled in the schools. Numbers that contradict the census of education of mid-level nursing of 2012, where out of the total of 154,359 registrations carried out in Brazil, 46.4% belong to the private network while the rest is divided among federal, state and local intuitions²¹. It was observed in this study that there was the closure of five schools, as in the 90s, the city studied was 11 in total²².

The prevalence of private schools in this study stems from an educational policy, which has its origins in the implementation of the liberal state from the 90s, which greatly favored the opening of private schools in technical education. This situation persists in the twenty-first century, with public-private partnerships at the national and state level through the transfer of public funds to private schools, such as the National Program for Access to Technical Education and Employment (Pronatec) and Vence (state level)^23,24. Government proposals to expand the state and federal network of vocational and technological education, ongoing show their duality and the need for the democratization of education, but such initiatives are still barely visible to the area of ​​health.

Schools should build or adapt their spaces to meet the minimum requirements of comfort, hygiene, safety, lighting and ventilation of the environment, observing the principles of public health to social welfare ²⁵. Historically, these issues arise in the late nineteenth century. In the first half of the twentieth century, the institutions have adapted to the hygienic trends and school buildings now have generous areas, large rooms, ventilated, sewage and treated water ^26,27,28.

Schools studied partially meet those needs. The lack of bathroom and limited accessibility show that the adjustments are related. The sound is hampered by the loud noise of the external transit or the classroom next door with damage to the educational activity to decentralize students and teachers.

School environment and learning process

The structures observed in schools can directly interfere with the ability to teach the teacher and the student learning as well as in social relations that are established^9,10. Reflecting the importance of, among other factors, consider that education requires an environment with conditions so that learning can take place, that is a physical environment that encourages and makes possible learning, in addition to promoting human interactions.

In this scenario also the constant changes add up in society which require the formation of a qualified health care professional and able to think critically, requiring part of the educational institutions to overcome the dichotomy between theory and practice¹³. A study evaluating the training of nurses from the hospital area nursing technicians indicates the need for changes in the teaching-learning process for 90% of respondents²⁹.

It was found that the studied schools do not meet all the minimum infrastructure for its operation¹². According to NCGs ⁷, educational institutions must prove the existence of the necessary facilities and equipment that are not reducible to the classroom; however, the NCG does not identify what they are, although they must necessarily be described in the course plan^30,31.

It was observed in this study that the simplicity of school infrastructure and learning environments, it seems prepared with the resources that were possible in some schools, attends a tolerant legal request, but is far a teaching proposal that articulates the NCGs. It showed a contrast between the school that was built for this purpose, which planned its internal spaces and those that have been adapted or improvisations.

This precarious scenario, found in most schools studied, can limit student learning opportunities, with risks of a superficial training and short of the required competence for nursing care.

It is teaching resources essential to the learning process to support the inclusion of students in the scenarios of professional practice to support nursing care, especially the introductory character.

Literature review evaluated the North American educational system, it indicates the need for strategies to improve the transition from nursing student to the world of work. The advances are essential to monitor the health needs, and equip schools with laboratories and technologies that can play a significant reality to be faced ³².

Studies point to the need for simulation learning laboratory, considering that health care has changed in the last 20 years; It became more complex with chronic diseases and longevity of people, which adds up to a technological expansion of high impact. Situation that is focused on patient safety and quality of care, based on evidence presented by research, it is essential critical thinking^33-35.

This question is in addition to a teaching-learning proposal that outlines a new relationship in a space designed so that students can work in groups and individually; although a different arrangement of portfolios does not guarantee a change in teaching concept, which can be said to reveal / express an ideology, an educational design and interferes with the practice to be exercised²⁵.

In the schools surveyed portfolios remain queued and reinforce the idea of ​​a passive learning, the teacher must show students what you want them to learn and that students should reproduce / copy, but do not exchange ideas, focus on content^36,37.

If put under review, the list of teaching materials is greatly reduced for the teacher to develop an active and creative work with the students in the schools. Here we highlight the importance given to the media, it seems an evolved playing the blackboard and overhead projector, and Internet access that offers dynamism. However, the traditional method gains value with images and movements, but may limit critics and student reflection.

A study evaluating the pedagogical practice of teachers of vocational education in nursing pointed out that it is devoid of reflection and meaning, because the lesson plan is carried out partially and evaluation is still the written test, 27% use the traditional method, 23% the active / questioning, and 40% did not answer the question³⁸.

However, advances in research and proven teaching demonstrate that it is necessary to value a problematical educational process, and encourages the formation of guided students on a holistic view of the human being¹³.

With regard to training in laboratories, the culture that the practice should prevail in the educational process, was responsible for the initial construction of the identity of the professional nursing technicians in schools attached to hospitals, which met the demand for this professional, due the welfare pension model³⁹.

The resources in schools were reduced, since the patients were over there and the student should train in locum Possibly in their future workplace strategy that was also seen as a way to overcome the gaps and shortcomings in the work schedules. With a view to task directed and reductionist nature, educational practices did little for reflection and criticism of the health-disease process, as it were limited to that hospital space^5.32.

It was found in this study that the educational role of libraries is compromised by the absence of librarians, the staleness of the collection and lack of network computers.

Libraries are spaces with educational functions that are part of the cultural and scientific training of students. A study identifies three aspects that make up their educational role: reading, scholarly research and cultural preservation. In this sense, it is expected that the student acquires, gradually, competence and informational skills required to locate, select, interpret and use information⁴⁰.

CONCLUSION

It is concluded that the conditions of the infrastructure of the educational environment of high schools of nursing in the context studied partially meet the required by the Ministry of Education. The buildings need reform and increments so that they are appropriate to the learning process, without which can possibly sacrificing the quality of the professional profile to be formed, with deep gaps in their theoretical and practical knowledge and later in their professional practice.

This research also identified a reduction in the total number of schools in the studied scenario, the sector's privatization and the regression of the public sector, considering that it is a large city with complex health needs.

Among the limitations of the research, there is the small analyzed scenario, which requires extended studies to the world of the average nursing education; however, the findings confirm and suggest the urgent link between qualified vocational training and the organization of the health system.

Although the sustainability of mid-level professional courses in nursing needs to be researched, because they rely on costly logistics, such as simulation and anatomy and physiology laboratories, given that the impact on teaching and learning are unquestionable for the sector Cheers.

Conclusion is also that the results of this study can contribute to rethink the professional education policies to support future studies on the impact of the material conditions of schools in the quality of education.

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