ORIGINAL RESEARCH

Rethinking nursing care on the basis of undergraduates' artistic and cultural experience

Estela Maria Leite Meirelles Monteiro^I; Cynthia Angélica Ramos de Oliveira Dourado^II; Waldemar Brandão Neto ^III; Andrea Rosane Sousa Silva^IV; Ana Virginia Rodrigues Veríssimo^V; Ihkaro Gutemberg Brandão de Azevedo ^VI

^I Nurse. PhD. Adjunct Professor, Federal University of Pernambuco. Recife, Brazil. E-mail: estelameirellesufpe@gmail.com
^II Nurse. Master. PhD Student in Nursing, State University of Pernambuco. Recife, Brazil. E-mail: cynthiaaro@gmail.com
^III Nurse. Master. Assistant Professor, State University of Pernambuco. Recife, Brazil. E-mail: waldemar.neto@upe.br
^IV Nurse. Master. PhD Student in Nursing, Federal University of Pernambuco. Recife, Brazil. E-mail: andreafacipe@gmail.com
^V Nurse. Master. Assistant Professor, State University of Pernambuco. Recife, Brazil. E-mail: virginia.verissimo@upe.br
^VI Nurse. Specialist. State University of Pernambuco. Recife, Brazil. E-mail: ihkarogutemberg@hotmail.com

DOI: http://dx.doi.org/10.12957/reuerj.2017.18238

ABSTRACT

Objective: to identify the contributions of artistic and cultural activities to undergraduates' education and to understand the relationship between these activities and ways of caring. Method: qualitative, descriptive study of a purposive sample, involving 17 undergraduate nursing students from Pernambuco State University, who engaged in artistic and cultural movements. Data were collected from March to April 2011, in scripted interviews, which were recorded. The transcriptions were then subjected to collective subject discourse analysis. This study was approved by the Research Ethics Committee (CAAE No. 0296.0.097.00010). Results: the main finding was that the undergraduates perceived cultural involvement to be important to nursing care, as a strategy for advancing health promotion, prevention and recovery. Conclusion: undergraduates' inclusion in artistic and cultural activities proved to be an important educational strategy directed towards practicing holistic care.

Keywords: Education, nursing; nursing care; cultural competency; holistic nursing.

INTRODUCTION

Nursing consists of a science that encompasses knowledge necessary for praxis in human care and contributes to overcome the reductionist and disease-centered health care model¹. In this context, caring should maintain a close relationship with human values, such as emotions and cultural aspects that need to be taken into account when the nurse meets the subject to be cared for^1,2.

The search for knowledge production about care promotes a new look at nurses' performance in their daily lives. This action requires exploration, from the professional's training phase, of strategies capable of reconstructing the nursing performance scenarios to stimulate the student to develop their ability, potentiality, talent and creativity. This intentionality in the educational action constitutes a valuable, communicative and integrative movement in face of the health needs, desires and expectations of the actors involved in the caring process, namely, the nurse and user/family³.

Therefore, rethinking nurses' training under renewed and dynamic ways of acting in health involves developing a critical and creative human capacity to intertwine art and education, allowing reflection on nursing paradigms, concept of care, professional competence and interventions based on intersubjective aspects and cultural values pertaining to people's lives ^4,5. Thus, it is expected that this work will foster reflections and subsidize discussions, giving visibility to the experiences of nursing undergraduates, participants in artistic and cultural activities, on the possibilities of innovation and/or renewal of nursing performance that articulate science, culture, art and education.

In view of the above, the present research had as objectives to identify the contributions of the artistic-cultural activities in the formation of the undergraduate and to apprehend the relation between these activities and the ways of caring.

LITERATURE REVIEW

University policies in the current scenario have been recognizing and valuing the performance of the academy in extension and cultural activities, envisaging an articulated formation in the teaching, research and extension pillars, in order to guarantee a comprehensive, contextualized and resolute training⁶. In the case of nursing, the increase in artistic, cultural and scientific activities in curricular-pedagogical projects can contribute to the development of sociopolitical, ethical and humanistic competences aimed at the practice of holistic care, as well as the construction of a professional profile articulated to the care demands of people.

The art of caring through enjoyable activities can establish between the nurse and the subject of care a relationship that is expressed in joy, play, relaxation, emotion, sensitivity to provide comfort and well-being, breaking with the rigidity of the norms instituted and the neutrality demanded to the professionals by institutions⁷. In this direction, it is necessary to trace new perspectives to nursing education, articulated to the context of the Unified Health System (SUS), and offered in the different care settings, so that critical-reflexive learning can emerge⁸.

The National Curricular Guidelines for Undergraduate Nursing Courses have broadened the discussion about the qualification of nursing education in order to prepare nurses with the technical-scientific and political capacity to intervene creatively and resolutely in the reality of professional practice. And for this purpose, innovations in pedagogical strategies, in curricular changes and in institutional relations between health services and universities must be promoted⁹.

METHODOLOGY

This is a descriptive research, with a qualitative approach, carried out with students from a nursing school of a public university in the Brazilian Northeast. The sampling process was intentional, through the inclusion of all the students enrolled in the undergraduate nursing course, members of the artistic-cultural movements present in the institution, including the theater group, Enfearte, the musical group called Discípulos de Nightingale (Disciples of Nightingale), and the cultural group of a Brazilian rhythm, Maracatu, called Maracafensg . These movements are characterized as extension actions and are supported by the sectorial coordination of extension and culture.

The data collection was carried out during the months of March and April of 2011, through the application of a previously tested interview script, divided in two parts: the first containing characterization data and the second with open questions about the reason for the participant's insertion in the artistic-cultural activities and the relations they perceive between their insertion in artistic-cultural movements and the ways of caring in nursing. The interviews were conducted individually with the help of a recording resource, in a private room and in a time previously scheduled with the students. At the time, the participants were guided about the objectives and procedures for data collection, and formal consent was requested for their participation by signing the Informed Consent Form.

The treatment of the data was carried out based on the Discourse of the Collective Subject (DCS)¹⁰. This technique helps organizing and analyzing verbal data of qualitative research, extracting the central idea (CI) and/or anchor from each of the statements, and their corresponding key expressions, continuous or discontinuous fragments of the discourse that reveal the main discursive content. In the end, synthesized speeches were built, written in the first person singular, in which the thought of a group appears as if it was an individual discourse. The interpretation of the data occurred in the light of the scientific literature in a critical and dialectical manner.

From the DCS, the CIs emerged, namely, CI 1-reason for students' insertion in artistic and cultural activities and CI 2 - artistic-cultural activities and nursing care modes.

In all stages of the research, ethical precepts were respected, and the project was approved by the Ethics and Research Committee of the University of Pernambuco, under Protocol no. 302/2010 and CAAE Registry 0296.0.097.000-10.

RESULTS AND DISCUSSION

Characterization of participants

A total of 17 nursing students participated in the study, of whom 10 were female and seven were male. They all participated of some artistic-cultural movement of the referred institution, corresponding to the totality of the sample.

Of the students interviewed, five were in the second semester, three in the third, one in the fourth, four in the fifth semester, one in the seventh semester and three in the ninth semester. The higher education institution has a curriculum composed of ten semesters, named modules, thus, one can perceive a distribution of the participants in almost all the semesters of the course.

Regarding the age group, the following variations were identified: from 18 to 20 years, six participants; from 21 to 23 years old, nine; one participant aged 27 and another aged 28. It is noticed that participants are in the young adult age group under training for a future professional life in nursing area.

Among the 17 students participating in the study, five participated in the theater group Enfeart, seven participated in theMaracafensg group, of whom five played the instrumentAlfaia, one student played Agbê (xerequê) and one the Agogô. The Music Band Discípulos de Nightingale, this was composed of five students: two in the singing, one on the guitar, one on the keyboard and one on the drums. It is noteworthy that all theatrical productions were original.

As for the students' participation time in each movement, eleven undergraduates had 6 months to 1 year of experience time; 4 students, 2 years; and 2 students had 3 years of participation. It is thus perceived that, over time, they began to interact and create an interest in being involved in cultural spaces, as well as in participating in socio-political movements.

Central idea 1: insertion reason

It was mostly by my own interest; I find it perfect, to learn more about culture, [...] express and combine this artistic aspect with the educational process [...] good opportunity to have a movement and try to connect it with the environment in which I live, [...] to carry out other activities outside the nursing environment and the means of academic training, an escape from everyday learning. I used to be an admirer of arts, I have never imagined acting. I thought I was not going to have that opportunity [...] Having an academic scholarship that inserted me into a project geared towards the arts [...]dancing maracatu and use it as a tool to get closer to the community, [...] an instrument of integration between the community, schools and the academic environment itself. The experience was very positive. Initially, I did not know what I could do with the theater [...] we had the support of the extension sector. (Discourse of the collective subject)

The students' speeches revealed a concern for a more sensitive and humanistic professional training, which favors overcoming the limitations imposed to the decontextualized teaching, and promoting articulation between scientific knowledge and the cultural reality in which it is inserted.

The possibility of getting involved in artistic and cultural activities within the university space is in line with the prerogatives to think about nurses' performance in an autonomous, conscientious and creative way, which is consistent with the development of holistic care practices. This movement, therefore, requires investment in students' abilities and potentialities in the exercise of sensitivity and integration with other areas of knowledge.

Thus, this emerges the challenge of health and education units in working with university students to develop sensitivity, since the bases of the caring process involve the understanding of human complexity and the meaning of the web of relationships/interactions marked by attitudes of collaboration, solidarity, solicitude and compassion¹¹.

Another aspect that deserves attention in the discourse of the subject was the possibility of using the knowledge of arts and culture as an instrument of playful communication and expression in health education activities in the community, thus supporting the role of the nursing professional as an educator, based on a participatory, dialogic, creative approach ¹² , which will promote autonomy and critical awareness and popular mobilization in defense of community health and of a care citizenship.

The importance of support from the extension sector was also pointed out by the students when referring to the implementation of the Academic Scholarship, whose purpose is to support students coming from the public school system to be included in projects that aim at broadening the teaching/learning process during their training. This emphasized the importance of making funding available for cultural and artistic projects that promote the comprehensive development of students and the possibilities of expression and communication of health actions⁶ .

Central idea 2: artistic-cultural activities and nursing care modes

[...] artistic-cultural movements enhance in nursing care a good part of this comprehensiveness of the individual, that humanitarian side of the professionals [...] lead my way of thinking about care ... in a way we seek to perceive and understand the other [ ...] dialoguing and creating an approximation [...] using a popular language so that the patient knows what we are talking about ... [...] so, it makes us changes and it changes that audience that is with us by creating awareness-raising actions ... bringing music to the patient; this would bring them joy... calm [...] a more pleasant and welcoming place [...] using the cultural movement in a dynamic, creative and participative way ... as an instrument of education that is a way of caring ... it is a diversified way of catching the population's attention [...] which will be in their minds, it will not be something that will pass [...] using art as a playful expression [...]. (Discourse of the collective subject)

This discourse highlighted the contribution of the student's insertion in the artistic-cultural movements for their professional training and for the understanding and valorization of the nursing practices through a humanized look and committed to the comprehensive perception of the other. It is worth mentioning that the experience of playful activities and artistic and cultural expressions is a strategic tool in health actions, in a creative and participative proposal, allowing extending the possibilities of caring ¹³.

Playful activity encompasses the human need that provides interaction of people with the environment in which they live, being considered as a means of expression and learning and functioning as a bridge between health professionals and people who need care¹⁴. Leisure activities favor the introduction of values, cultural and social development and the construction of affection networks. They are also useful in the care scenario by promoting physical and mental balance of the professionals who provide care.

The use of art therapy, another way of caring in nursing, encompasses artistic expressions such as dance, theater and music, which can be used in the production of health knowledge through the representation of reality integrated with the imaginary of students. Literature has already evidenced the benefits of these artistic expressions, such as therapeutic interventions, which can give nurses a new way of conceiving and thinking about care, in a humanized, creative and sensitive manner, with positive changes in relationships between people^7,15,16. In addition, it provides a resource for students to develop skills and abilities at work with human emotions, feelings of joy, sadness, fear, pain and appreciation of relaxation and leisure environments.

In this context, artistic and cultural insertion in nurses' training is a strategy for the development of skills considered fundamental for the consolidation of a professional profile aimed at meeting not only the needs of primary care, in the context of health promotion, but also for the development of skills that meet the expectations of medium and high complexity levels of care¹⁷.

In recent years, nursing education has undergone transformations based on participatory and integrative pedagogical trends of intersubjective, historical and socio-cultural aspects as inherent in the production of health care. In this way, the results of this research show that the impact of artistic-cultural activities in teaching can envisage the acquisition of socio-political, ethical and humanistic competences and overcome the dichotomy between theory and practice. In addition, it will allow teachers and educational institutions to reflect on contemporary nursing paradigms, seeking innovative pedagogical practices that enable students' humanizing attitudes towards the experience of caring for people³.

CONCLUSION

The present study enabled understanding the relationship that nursing undergraduates establish about the contributions of being inserted into artistic and cultural movements to personal life, professional training and nursing care modes. It was noticed that the involvement in artistic-cultural activities contributes to the development of skills and knowledge relevant in personal and professional formation. The activity also made possible to discover new perspectives of the nurses' work, associated to playful activities and cultural aspects of individuals and communities, as well as the emergence of talents and creative/communicative ways in the process of popular education in health.

The relationship between these artistic activities and the reinforcement of the nurse's autonomy, the qualification of health care through the articulation of feelings of joy, peace and warmth was highlighted. In addition, the greater the engagement in this type of activity, the greater will be the students' perception about the different ways of conceiving and thinking health.

Finally, the construction of a new knowledge in health, given the complexity of human relations, requires that the concepts of comprehensiveness and interdisciplinarity be integrated and made present in the professional training world.

This study had as a limitation the small sample size, which involved a specific group of nursing students, with low power of generalization of the results. However, due to its qualitative nature, it ensures a deep analysis of the studied phenomena.

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