RESEARCH ARTICLES

The meaning of nursing internship to interns at a public university

Simone Domingues Garcia^I; Beatriz Silva Ignotti^II; Carolina Zandonadi Ciciliato^III; Marli Terezinha Oliveira Vannuchi^IV

ABSTRACT: The study aimed to identify the meaning of the nursing medical internship for students in the last semester from a public university in northern Paraná, in 2011. The qualitative methodology was used, to obtain data through semi-structured interviews with 19 students. The guiding question was: what is the meaning of the medical internship for you? This has resulted in the construction of five categories: contextualization of learning; preparation for the job market; skills acquired during the medical internship; the nursing management in the context of the medical internship; and identification of being a nurse. It was concluded that the medical internship was essential for the contextualization of knowledge gained in the graduation. The effectiveness of the internship helped the development of skills and competences to make the inmates prepared for the job market. Finally, the interaction between nurses , teachers and inmates was cited as essential in the discovery of being a nurse in each student.

Keywords: Non-medical internship; nursing; health care education; learning.

INTRODUCTION

In the current social context, nursing schools face real challenges to achieve the incorporation of proposed changes in the professional education. These modifications are established by the National  Curriculum Guidelines for Nursing (DCN/ENF) and are related to the acquisition, development and assessment of skills and abilities, the essential contents, practices, internships and complementary activities¹.

It is stated that there was a significant increase in the number of nursing courses in the country, raising attention to the quality of education of these professionals and the spaces of practice where  they perform the internships².

The supervised internship, denominated of nursing medical internship in some institutions, is a form of compulsory education carried out in the last two semesters of undergraduate nursing. It aims to provide to the academic an overview of the their profession in a broad and concrete way, besides providing technical and scientific experiences, with the development of duties with responsibility, ethics, leadership, communication skills and decision making².

The nursing medical internship is considered by nursing graduates as the most significant academic experience to their professional life, serving as a rich space for discussion, reflection and learning. The knowledge assimilated with the realization of the internship reflects not only in academics, but also in nurses teachers and the involved health services, allowing a greater flow of information between university, health services and the community³.

In the State University of Londrina (UEL), nursing medical insternship boosted the curriculum changes in the  nursing course, presented as one of its main strategies the partnership between teachers, students, service nurses and community in planning and structuring of internship³.

According to the above, it is considered that to understand the perceptions and meanings attributed by students to nursing medical internship, it is possible to contribute to the development of internships in nursing education. Thus, the purpose objective of the study was to identify the meaning of the  nursing medical for students of the Undergraduate Nursing Course of UEL.

THEORETICAL REFERENTIAL

The theoretical framework followed the Problematizing Theory⁴ or Awareness, considered within the scope of education as appropriate for inquiries experienced by students, providing opportunities for reflections about their practice.

The theory defend critical pedagogy as opposed to banking education, fighting in the search for students who create their own education, thus making their own way and not following a previously constructed⁴.

It reflects that freedom related to education is only possible with the real and humanistic generosity, with mutual respect between people and different knowledge, valued within the medical internship with the interaction between students, teachers and nurses in the field. Liberating education only in communication makes sense in human life. The thinking of educators, represented by teachers nurses and the fields of internship, only gains in authenticity on the students thinking, inmates, both in front of the reality of the health system5. The challenge of assigning meaning to the medical internship is represented as being with the world and with the others, building dreams, ideals and points of view from different realities. It is valued the fact that without science, without learning, without teaching, without education ideas, without politicizing it is not possible to live and create⁶.

Throughout the structuring of the nursing medial internship, including the active support of the methodologies used, there was a search for meaningful learning. Thus, emphasis was placed on the student as the main actor of their learning, developing the ability to transform their reality and everyone around them.

METHODOLOGY

This is a descriptive qualitative study conducted in the medical internship of the Undergraduate Nursing, allocated at the Center of Health Sciences, UEL.

Students were contacted in the classroom, being presented the purpose of the study and how it would be done. The participation of all students was voluntary. 19 undergraduates 2011 chose to participate in the study.

Data were collected through semi-structured interviews conducted individually, following the guiding question: What was the significance of the medical internship for you?

For data analysis it was used discourse analysis, that suggests the sequence in the modality of the structure of the located phenomenon, composed of two moments. At first, comprises the ideographic analysis, divided into four steps: reading the description from start to finish without seeking any interpretation or identifying element in the reports; apprehension of the meaning units, interpretation of the same and synthesis of units⁷.

The second moment is the nomothetic analysis, which seeks to reach the general psychological structure, providing a movement of convergence and divergence that are demonstrated in individual cases⁷.

After completion of the two moments, was done the joining of data in order to make them meaningful and relevant to be discussed through the categories.

The categories were named as the meanings that emerged from the discourses of the inmates, covering important characteristics and feelings that permeate the nursing medical internship.

The identification of the interviewee was preserved in the testimonies, and numbered according to the dialogue, 1-19, representing the number of actors and order of participation in the survey. As an example D1, dialogue 1. For research there was no interest in separating by gender, presenting men and women among the participants.

The study was approved by the Ethics Committee in Research at UEL, with CAAE: 0165.0.268.000-11.

RESULTS AND DISCUSSION

The analysis of the interviews enabled the construction of five categories that involve the meaning of nursing medical internship. The first category was called contextualization of learning, representing the opinion of inmates for content assimilated in graduation with the performance in practice.

The second category was denominated preparation for the labor market, identifying the importance of the practical experience of the services to be able to insert themselves in the labor market.

The third category comprises the skills acquired during the medical internship, featuring the student development and overcoming challenges faced with the reality experienced in the internship.

By the fourth grade, titled the nursing management in the context of the medical internship was possible to visualize the scope of the proposed goal by the medical internship in the performance of the inmates management assistance.

Finally, the fifth category was titled identification of being a nurse, demonstrating that the experiences during the medical internship strengthen the identification of the inmate as future nurses, enabling them to work in different health services.

Contextualization of learning

In the first category, the significance of nursing medical internship is represented by the inmate contextualization of learning, as the testimonials show:

It is a moment that we have to put all our practices and begins to review all the assistance part as the management. (D19)

It was to relate everything we learned during the Graduation. (D8)

And the time you put all you have learned in theory and in practice and what are you
learning now in the fourth year with the management classes. (D11)

The reflection on the meaning of nursing medical internship provided to the inmate to contextualize previous knowledge acquired even before the internship, featuring the moment as a summary of their experiences over the four years of the course.

The first report showed that the inmate already have a characterization of their knowledge, denominated of care and management part, which can be interpreted as the contents that come with direct patient care and content related to health management, essential to the practice of nurse.

It is considered that the context of nursing education has undergone changes, since today the student participates as a subject in the construction of their knowledge. The graduating, represented in the context of study of the nursing inmate, has own knowledge, arising from their life history, originated from human contact, reading, internet and common sense².

These experiences nurture the inmate, awakening to the curiosity of scientific knowledge, and still raises group discussions, moments in which the synthesis of their knowledge is built on the experiences of colleagues who spend the same time at the nursing medical internship.

The study took place in an undergraduate course that uses the assessment of learning ability, valuing the course of the academic life of the student in the education process. Thus, qualitative stand on the quantitative aspects, not only estimating results in finals⁸.

The teaching-learning process in nursing is a major challenge in the country and one of the factors more discussed in the education of professionals. The assessment is inserted in this process when looking for the articulation of theory with practice⁹.

In measuring the learning based on competence, we consider the knowledge acquired and the development of skills and attitudes as an expected set in relation to pedagogical proposal. The student growth is wanted from professional acquired skills, not limiting to the performance result. Thus, strategies are projected that favor the development of skills required to work⁹.

It is expected that the inmate when contextualize their knowledge, introduce changes in attitudes, socializing the knowledge built and improving the management of care experienced during the internship practice.

It states that learning has greater significance when constructed in conjunction with the partnership of field nurses, teachers and other inmates.

Preparation for the labor market

The nursing medical internship was also described as an opportunity to experience the process of working in the units, providing autonomy development and serving as a true preparation for entering the labor market, as mentioned below:

Extremely important to prepare for the job market. (D15)
So I can leave more prepared for the job market. (D18)

To become able to enter the labor market one of the fundamental requirements is the development of group work. The interactions between professionals from different fields nurture the exchange of experience and theoretical and practical knowledge among all staff involved in health.

With the existing partnership between inmate, nurse and teacher seeks the share of new discoveries and knowledge in teams, with professionals able to make decisions, willing to learn and attentive to their communication skills. It is expected that the sharing of relevant information and well organized would be able to produce new knowledge, which will be used in future in the work process of the new professional¹⁰.

Is charged to the teacher training students with skills and abilities to cope with the demands of the market, increasingly competitive and high degree of adaptation¹⁰.

Another factor is that the inmate in their own workspace acts as an important tool to update the healthcare team, to maintain the link theory and practice and still be at graduation. Thus, during their practical performance, the inmate is encouraged to participate with the nurse field of educational activities involving the entire health care team, as being part of the improvement of the nursing staff daily.

These actions act as a stimulus to the inmate quest for knowledge, causing it to use more scientific tools, such as articles in various journals of the field, and even the construction of research that creates new items, something increasingly useful in nursing.

Nurses of the internship units of the medical internship play an important role in the formation of the inmate, acting as fundamental components in personal and professional growth of the student. These nurses when viewing potential in the development of the inmate can assist in their integration into the labor market, something commendable and of great responsibility for the professional.

It is noticed that field nurses act as facilitators of the educational process and inclusion in the workplace. Regarding acquired learning between field nurses and inmate, he is considered as one of the most significant, as the subject, represented by the inmate, is perceived as part of reality, as is seen and share the experiences⁴.

To demonstrate to the inmate that he is an important part of the unit's work process is indispensable,  because that innovative forms of education, alone, does not account for the possibility of introducing changes in the educational process. It is only possible to achieve meaning and transformation in the workplace when there is the recognition that all teach and learn. An educational theater can be as much or more authoritative than a traditional lecture, so between nurses and inmates is necessary to favor spaces of mutual learning and growth, where both feel valued¹¹.

It is considered that with the expansion and diversification of legitimate sources of knowledge and the necessary consistency between the know-how and know-be-teaching, something relevant to the question of the preparation of nurses for the job market⁴.

Skills acquired during the medical internship

Acquired skills were cited by the inmates as capabilities identified during the internship, as highlighted in the speeches:

That's when you really find the skills you can develop. (D15)

Gain independence to see to what extent we learned. (D4)

When approaching the moment of the student in direct contact with the reality of services, it is expected that it can demonstrate the association between the theoretical and practical knowledge learned so far.

It states that theory without practice becomes verbalism, as well as practice without theory becomes activism. However, when it joins the practice with the theory, it has been the practice, the creator and modifier action of reality⁴.

It is during the practice that knowledge becomes one of the elements used in the profession of nursing, from the perspective of action through the competence, skill, persistence, patience and willingness to act consciously and intuitively¹².

When the nurse is trained and updated with the understanding of the necessary skills for their actions, it shows consistency between the knowledge acquired and the practice carried out, demonstrating an understanding of the importance of their role on the team. With that, generates beneficial changes in the institution, resulting in improving the quality of nursing care¹³.

It is expected from the nursing inmates active attitudes in search of knowledge, innovations, overcoming challenges and required initiative to perform educational activities that encourage meaningful learning for their staff working¹³.

The achieved overcomes by interviewees demonstrated this feeling of resilience present in the educational process, to describe an individual's ability to deal with problems and overcoming fundamental obstacles to their ripening.

The following stories demonstrate overcoming skills achieved:

I loved, adore, it was very good, even surprised myself, I realized that I was very good, it was a great experience. (D3)

I thought it was essential because we enter so completely lost thinking they will not get anything, but as passes and coming you are going well and you learn how to do it. (D5)

Educational institutions wish to provide to the labor market, a professional with high capacity to adapt, ready to overcome daily challenges posed by the Health System. To occur this, students need to experience diverse and conflicting situations in practice, requiring them decision making and direct actions.

Among the challenging situations arising from practical internships are: conflicts between academic works, moments of personal and interpersonal difficulties, conflicts in romantic relationships, physical and mental fatigue linked to illness and terminally. These situations can trigger stressful situations, making fundamental to find a support within the institution for the learner to develop the skills necessary to find overcome, strengthening the future as a professional¹⁴.

The testimonies of the students demonstrated that challenging situations were essential for their development, and that the feeling of overcoming assisted in its maturity and self-knowledge during walking in the medical internship.

Overcome challenges and feel valued personally and professionally, gives the student time of great reflection of his performance as a future professional. Another important factor achieved with the challenges experienced by the inmates is the change in the practices of health services, linking cognition and affection, reflection and action, oppression and freedom found in the work process⁵.

Thus, just as is recognized the need to increase the number of nurses in the country, it is demanded  fundamental qualities and potential for this professional to correspond the multiple and increasing social and health demands, with attitude, consistency, ethics and as the principles advocated by the current healthcare system. It not enough to grow at any cost, it is important to grow since the criteria of quality and relevance of training is guaranteed¹⁵.

Nursing management in the context of medical internship

During the realization of the medical internship, the management of nursing care is discussed in practical and theoretical moments, contemplating the skills necessary for the formation of the generalist nurse. On the topic was quoted:

That part you learn the management of the unit has been very rich, very
important. (D16)

It get to review all the care and management part, is a managerial time
extremely important. (D19)

The speeches of the students show that understanding the management of nursing care enriches knowledge during the course of the medical internship.

The nurse manager is a professional who assumes the coordination of the nursing team. His work involves actions of direct and indirect care, i.e, it turns to management care, enabling the development of a differentiated professional practice¹⁶.

It is considered that nurses manage the care when plan, delegates or perform, predicts and provides resources, train its staff, educates the user and interacts with other professionals. It is also the responsibility of the managerial nurses to occupy spaces that materialize improvements in care, being fundamental that appropriates the management tools to transform the care process¹⁶.

During the theoretical meetings performed on Friday's, with inmates, are discussed management issues, such as: leadership, decision making, human resources, material resources, health education, conflict management, teamwork and others³.

Searching up to work with these themes to provide the broad understanding of the role of nurses in their various performance fields. The desire of teachers and professionals involved is that when you leave the University, the new nurses associate these issues with their practice, performing a different job with quality and knowledge.

There are constant efforts of nursing faculty and internship units to provide the management assistance teaching in an integrated manner, but it is noticed that the inmates still visualize the management in a fragmented form of the assistance.

The reports reflect the information:

Here we are more like management rather than assistance. (D11)

We imagined that led to all, both the bureaucratic and the care. (D19)

The dichotomy between care and nursing management has an historical context, important to be discussed with the students so that they understand the present developments in nursing history.

At present, it is experienced an emerging paradigm, that refers to management focused on nursing care, in an optic that articulates management and assistance, with centrality the user of the health service and care in an approach that goes beyond the technicality toward comprehensive care¹⁷.

This situation requires nurses knowledge, skills and attitudes for understanding the health-disease process in an enlarged scale, which favors resolving care. It is necessary to mobilize skills beyond the clinical context that enables the nurse to assume the role of managing care. This action should consider the relevance of biological dimension without, however, reducing the user to this, i.e, to consider an approach that favors comprehensive care and care incorporates the psycho-emotional, social and spiritual dimensions¹⁷.

Students have superficiality on current knowledge, by not having a lot of data and experience of reality that are experiencing. With this, they need to obtain knowledge about the addressed topic, through autonomous and independent learning, absenting of naive curiosity to epistemological curiosity⁴.

It is considered that it is possible to achieve effectiveness in the actions performed as the person falls within the educational context, in this case to include the inmate into management of the assistance unit.

Identification of being a nurse

Interviewees determined that for the discovery of being a nurse there must be interaction between teaching and service, that is, through living with other nurses is that the inmate discover which activities are directed to professional in their daily practice. Following the speeches:

Understanding the role of a nurse in a single unit. (D9)

You have more contact with the reality of nurses, where you see even more specific nursing work. (D14)

For the inmate succeeds in forming the concept of what is a nurse, it is necessary to reflect in relation to its construction. To educate nurses nowadays is a great challenge, and there is the training of the professional for the exercise of general and specific skills, in addition to skills guided in the conceptions of students as subjects of their educational process¹⁸.

Thus, the professional education is seen as a process in which transits through different experiences and interacts with various bodies of knowledge and approaches, covering both the period of formal preparation and systematic, as the professional practice¹¹.

The nurse, in their care practice, should be considered an apprentice, as well as the inmates he also visualize care as an activity of health education, not realizing owner of caution, and not having a vertical attitude in the holistic care act. So he can build a liberating practice, critical of customer appreciation⁶.

Within the context of being a nurse is established that all the knowledge from science and daily practice must be disclosed to others in order to lead them to perceive familiar elements in different ways, obtaining new information to construct their identification and understanding¹⁹.

It is emphasized that the assistance continues outside of healthcare settings, as well as the construction of concepts and definitions relating to care. So you must equip themselves in different communication media to achieve greater scientific knowledge, considered an essential tool for the promotion and consolidation of knowledge about the profession and themselves¹⁹.

CONCLUSION

The study identified that the potential of nursing medical internship highlights, making it meaningful to undergraduates.

With the first category, the contextualization of learning was positively identified, emphasizing the unity of theory and practice, and with it, the practice of medical internship, thus forming critical and reflective professionals.

In the second category the inmates demonstrated that, despite the adversities experienced, felt prepared for insertion in the labor market and achieved the development of essential skills to work as nurses.

The third category showed the skills achieved during the medical internship, demonstrating that the overcome displayed by the inmates is relevant. It also demonstrated that the process of maturation and transformation of the student to the health professional is being conducted in an effective and valuable way.

In the fourth category, the nursing management revealed the importance of the discussion of managerial issues with inmates, so that they transform the practice performed in the units and enter on staff as managers of nursing care, decreasing the distance sometimes created between management and assistance.

Finally, the last category reveals the identity of being a nurse, permeated by a process of constant change built within a complex network of knowledge and practice that transforms the inmate into this professional.

It is considered that the involvement of the inmates in the construction of the nursing medical internship process is fundamental and relevant, and therefore, one of the limitations presented by the study was the small number of studies that highlight the opinion of nursing students in relation to internship, since the nursing medical internship is recommended to all institutions of nursing education in the country, following the DCN.

Finally, the study provided an opportunity to identify that the main challenge of nursing is not quantitative but qualitative, with the constant search for training innovative professional, incorporating the market need with the quality of offered education.

Thus, it is expected that this study provides further discussions regarding the education of nurses, as well as the importance of research dealing with the practice of nursing education, addressing the undergraduates as essential actors in the construction process.

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