ORIGINAL RESEARCH

Nursing undergraduates' individual characteristics and self-care behavior: experience in a sociopoetic workshop

Maria das Graças Gazel de Souza^I; Iraci dos Santos ^II; Leandro Andrade da Silva^III; Alexandre Vicente da Silva^IV; Leonor Coelho da Silva^V; Adriana Loureiro da Cunha^VI

^I Nurse. PhD in Nursing, Graduate Program in Nursing, State University of Rio de Janeiro. Brazil. E-mail: mariagazel@hotmail.com
^II Nurse. PhD in Nursing. Full Professor, State University of Rio de Janeiro. E-mail: iraci.s@terra.com.br
^III Nurse. PhD in Nursing, Graduate Program in Nursing, State University of Rio de Janeiro. Brazil. E-mail: proflandrade@gmail.com
^IV Nurse and Professor. PhD student, Graduate Program in Nursing, State University of Rio de Janeiro. Brazil. E-mail: alexvicentesilva@uol.com.br
^V Nurse. Captain-Lieutenant of the Brazilian Marine Health Corps. Master in Nursing. Rio de Janeiro Brazil. E-mail: lecos80@icloud.com
^VI Nurse. Master in Nursing. PhD student, University of the State of Rio de Janeiro. Brazil. E-mail: adrianaloureiro1@gmail.com

DOI: https://doi.org/10.12957/reuerj.2018.19997

ABSTRACT

Objective: ito identify the individual characteristics and self-care behavior of nursing undergraduates in sociopoetic workshops. Methodology: this statistical, descriptive, sociopoetic study was conducted, after approval by the research ethics committee, by applying a form at a group meeting of twenty nursing students from a public university in Rio de Janeiro, Brazil, between April and May 2015. Results: most were female, single and childless, aged 20-25 years, white, Protestant, with family income of four minimum wages and lived with their parents, and only one reported integrated self-care behavior. Conclusion: most did not apply the concept of comprehensiveness to self-care, but favored body hygiene.

Descriptors: Nursing; sociodemographic characteristics; profile of graduates; self-care.

INTRODUCTION

It is believed that nursing academics, i.e. students, are human beings who made the choice to care for and help other human beings to be born and to live in a healthy way, to overcome diseases, to live with limitations, to find a meaning in that experience and help individuals die with dignity. However, situations of suffering are faced in the process of preparing to carry out the various actions involved in the nursing work with technical, dialogical and political competence. Such situations may contribute to the process of humanization, but also to its trivialization¹.

In a bibliographical survey carried out on the sociodemographic profile of nursing students, a lack of studies on the subject was identified. The scientific production pointed out the correlation between the characterization of the students' profile and adequacy of the educational process, whose approach aims to subsidize the elaboration and application of a pedagogical political project coherent with the subject, adapting it to the reality of health needs of each individual².

In addition, the current life standards adopted by the population and stimulated by globalization and the unbridled capitalism in which people live have placed individuals ever closer to the diseases of the modern world. The work and the attitudes adopted before daily problems and stress conditions that are inherent to human beings in their workplaces and schools in association with the unbridled incentive to frenzied consumerism, the eating and consumption habits encouraged by the media, which revolves only around profits, has increasingly exposed individuals to the development of health problems and stimulate disease-triggering factors ³.

In this context, an effective performance requires knowledge and the ability to recognize variables related to self-care. Studies have addressed these issues by investigating variables related to access to information and knowledge, satisfaction with health services, family support, and other relevant psychosocial factors⁴.

Changes in the field of nursing training have followed the transformation of education and health policies with a view to redirect the academic training of nursing students, modifying curricular contents as well as teaching methodologies and teacher training with the aim of training professionals that the contemporary society needs⁵.

In view of these reflections, we defined as a research problem the fact that although nursing students have an idea of the importance of caring for others during their professional training, t there is no course in the curriculum guiding on the importance of self-care as an indispensable practice for the maintenance, appreciation, and valuation in the continuity of life. Thus, the following objective was formulated: to identify the individual characteristics and self-care behaviors of nursing students participating in a self-care course in a socio-poetical workshop.

LITERATURE REVIEW

The Guidelines Law and Bases of the National Education (LDB) establishes the training process in higher education through the development of skills and abilities; through cultural, technical and scientific improvement of citizens; flexibility of curricula; and implementation of innovative pedagogical projects, with a view to changing the vocational training. These assumptions point to new configurations for curricular standards, which have hitherto been in force, indicating the need for restructuring undergraduate courses with paradigmatic changes in the academic context and directing the construction of Curricular Guidelines for each undergraduate course⁶.

The health sector is an area that undergoes constant changes and advances in knowledge through research and constant introduction of new technologies. For this reason, it is essential that future health professionals update and complement their academic training with the objective of offering quality care and a practice based on scientific evidence⁷.

Some studies have shown that the exposure of students to nursing workloads is similar to the exposure of professionals already inserted in the labour market⁸. This similarity indicates that, if interventions are not applied in the academic life of this professional category, the future of this profession will present the same problems that affect health workers today.

This profession plays an important role both in maintaining and promoting health. It is emphasized that the challenges in health care provision are characterized by attention to the complexity of the clinical and emotional situation of others, seeking to learn new ways of living which value life. It is therefore considered that education has the responsibility to transform reality by its potential to provide a reflexive movement, directing the individuals' awareness on behaviors and actions that will affect their health or illness conditions, resulting in a (re)achievement of autonomy. Thus, by perceiving and allowing citizens to be responsible for themselves, for their life, they will tend to exercise self-care for the sake of their own well-being⁹.

This fact reinforces the importance and the coherence of actions that consider self-care as fundamental for the life and survival of human beings, and consequently the insertion of the teaching of self-care actions in the curriculum of undergraduate nursing courses.

Self-care refers to actions that people take in favor of their own health without formal medical supervision. Self-care is defined as a set of practices carried out by individuals and families through which positive health behaviors are promoted in the prevention of illnesses and treatment of symptoms¹⁰.

The ability to perform self-care is developed during the course of daily life, through a spontaneous process of learning, in the maturing of intellectual curiosity, through the instruction and supervision of others, and through the experience of self-care measures¹¹. Thus, throughout the nurses' training process that should be based on caring for others, self-care should be emphasized and considered as promoting the health of caregiver because in order to care for others, individuals must firstly care of themselves.

METHODOLOGY

This is an excerpt of a PhD dissertation. We chose a descriptive and mixed method. The study was developed from April to May 2015 in a socio-poetical workshop on Self-care. The participants were 20 undergraduates from the sixth and ninth academic semesters who met the following inclusion criteria: being a student enrolled in the Nursing School of the University of the State of Rio de Janeiro (FENF/UERJ), and agreeing to participate in the study. Those who did not agree to participate, those who were on medical leave and those who did not sign the Informed Consent Term (ICT) were excluded.

The research strategy included, during the socio-poetical workshop, techniques of relaxation and sensitivity recommended in the method. The following sociodemographic and professional variables were collected through structured interviews: age, sex, self-declared ethnicity, marital status, family constellation, residence type, place of residence, religious belief, family income, employment bond, individual income, graduation in another area, and self-care behaviors. In case of doubts, the researcher would help individually to each student, reread the question and provided the necessary explanations.

The data produced were submitted to descriptive statistics using absolute frequencies represented in tables and figures, as only 20 students shared in the study.

In compliance with the Guidelines and Standards Regulating Research Involving Human Beings, a research protocol and the ICT were presented to the Research Ethics Committee (REC) of the State University of Rio de Janeiro before starting the study, as recommended in Resolution n° 466/2012 of the National Health Council. After the approval by the REC through the Certificate of Presentation for Ethical Appreciation (CAAE) nº 39631714.1.0000.5259, the production of data was started.

RESULTS AND DISCUSSION

Data of the individual sociodemographic and professional characteristics of nursing students are shown in Table 1.

Table 1: Individual characteristics of the research participants (n = 20). Rio de Janeiro, Brazil, 2015.

We observed that, of the total of 20 nursing students participating in the research, only one was male. This is in agreement with a study¹² on the sociodemographic profile of nursing students where a similar percentage was found¹² corroborating the aforementioned result. The data found in this and other studies have emerged to reinforce two trends already found in the literature: the historically constructed relationship between women and care, and the preference of women for nursing courses^1,2,5,7.

An analysis of the history of nursing shows clearly the idea that nursing activities were understood as linked to the female sex, because women have historically been considered as having natural abilities for caring, promoting and helping individuals to develop harmoniously. Such natural conditions have been associated with their physical and biological constitution, conditioning their character and personality, making them milder, docile, and devoted¹².

According to the Federal Nursing Council (COFEN), the majority of nursing professionals in Brazil are female, corresponding to 87.24% of the professionals in the country, while 12.76% are male¹³.

As for the variable age, the participants from the age group 20 to 25 predominated, evidencing the presence of young people entering the nursing courses. This may be explained by the fact that nursing is a still recent profession and with a good range of possibilities of insertion into the labor market¹³.

Data collected by the COFEN show therefore that the work force of nursing professionals in Brazil is mostly young and at the top of their productive and reproductive strength¹⁴.

Regarding self-declared ethnicity, 12 students declared to be white. This corroborates the results of the 2010 census of the Brazilian Institute of Geography and Statistics (IBGE) which presents the self-declared black population as a minority in Brazil.

Other aspects identified in the profile of the students were marital status and the family constellation. In this respect, we observed that the proportion of unmarried students and without children corresponded to 100%, being superior in relation to the other variables. This result resembles that of another study where 91% of the nursing students of a public university in the State of Paraná were unmarried¹⁵.

The significant presence of single and childless young adults in the academic environment indicates that most of the students are not yet in the labor market and do not have family obligations.

As for residence characteristics, the majority declared to live with the parents; five participants lived on their own. Regarding the place of residence, the study showed that there was a predominance of people residing in the North Zone⁽⁸⁾ of Rio de Janeiro. This is explained by the fact that students seek a university closer to their homes for their Higher Education to avoid inconveniences and expenses related to transportation and travel. Among the participants, only one lived in the South Zone and 11 in other locations in the city of Rio de Janeiro.

As for religion, the majority of the participants had religious affiliation; the Protestantism (11) predominated, followed by people declaring no religion (4), Catholic religion (3) and others (1).

The considerable number of students who declared to have no religion and the overlapping of the Protestant and Catholic religions stood out in the data. These traits are dissonant with the Brazilian reality, in which Catholicism remains as predominant among Brazilian religions¹⁶.

The majority of students (15) had a family income of up to four minimum wages per month, followed by those who receive five to eight minimum wages per month (2) and only three had an income above nine minimum wages. On the other hand, 10 students reported having a monthly salary of up to four minimum salaries.

Regarding paid work, a study showed that 57.5% of the nursing students had some kind of paid activity; among these students, 42% worked as nursing technicians or nursing assistants. It is important to point out that the percentage of students with paid work falls dramatically when compared to studies carried out in institutions that offer a Full-time Nursing Courses as a result of the difficulty of exercising regular work activity and the need for family financial support in these cases¹⁷.

A study with the nursing students of the University of Paraná revealed that the need for remuneration and professional experience was the motive that led participants to search for paid works¹⁸.

In another study, it was emphasized that work acts as a determinant of low academic performance due to lack of time to study, difficulty to assimilate the subjects studied, and poor concentration in the classroom. Moreover, conciliating study with work entails a decrease in productivity, increase in susceptibility to diseases, constant medical consultations, and abuse of medications¹⁹.

As for graduation in other areas, only one of the students had a degree in administration. This finding is consistent with another study in which only 4% of nursing students had a university degree, 2.8% were enrolled in universities, and 93.2% did not have a university degree in any other area. Among those who had a university degree, 55.2% had graduated in the health area, including nutrition, psychology and dentistry courses².

In this respect, it is noteworthy that man constructs society and plays roles supported on the knowledge and the domain of language; this may explain the search for more than one higher education course. On the other hand, such search may indicate the immaturity of students who seek profession in increasingly ages, and enter higher education courses with doubts about their professional preferences before so many options, and are often unable to take on work responsibilities².

Regarding the presence of SC behaviors, 14 students showed some forms of self-care behavior and only six did not respond to the question. The behaviors mentioned by undergraduates are summarized in Figure 1.

Figure 1: Self-care behaviors of the researcher group. Rio de Janeiro, Brazil, 2015

Self-care behaviors were identified in the answers of the participants, specially related to leisure activities, body hygiene care, mental hygiene, healthy meals, sleep, contact with nature, spiritual pursuits, family life and social interaction with friends.

In this context, self-care in health is defined as a set of measures that each person, individually, takes to protect his physical, mental and social well-being. Self-care is based on the belief that man is able to take care of his health and comprehends a series of actions to maintain physical and mental health, to prevent illnesses, to satisfy physical and psychological needs, seek medical care or to take medicines on the own initiative¹⁰.

However, a study reports that emotional situations and events interfering with self-care such as stress, negative emotions, work or school pressure, personal problems, depression and anxiety may represent important barriers to the practice of self-care²⁰.

In the case of nursing students, this fact may be related to achieving good grades, attending classes, supervised internships, direct contact with patients, academic evaluations, living away from the family, and uncertainty regarding the future employment.

It is assumed that even individuals who did not report self-care behaviors have some form of self-care, because self-care is an inherent learning to maintenance and preservation of life passed on from parents to children and promoted since birth to end of life.

Self-care is the action that should be perceived as a natural process to be practiced and not as something that the person should build.

The investment in public health policies directed to the population related to prevention of diseases can contribute to health promotion, understood here as self-care, since childhood and adolescence²¹.

Such an investment can be made on the basis of training health professionals and interdisciplinary teams to work with people, aiming at teaching/learning self-care, to live with well-being despite limiting situations caused by illnesses²¹.

Reviewing the unhealthy lifestyles adopted by individuals becomes imperative for public policies and health practices through investments in interventions and actions directed at behavioral factors. Health practices and public policies aim at educational proposals to implement lifestyle changes so that healthy habits may be adopted. Nurses, as care providers, become interveners through provision of guidance on self-care, providing an integrated care to clients, that is, a care associated with education²².

Strategies that promote critical awareness about the importance of developing and incorporating daily actions of self-care should be stimulated among nursing students, seeking to provide better conditions for coping with health/illness situations that may be experienced after leaving the university, both in personal and professional life.

CONCLUSION

The study described the individual characteristics of nursing students from a public university in the State of Rio de Janeiro and also provided elements for understanding the participants' behavioral factors.

In the findings, we observed that all the nursing students of the study, field of research, were single and childless. The majority of the participants was female, aged 20 to 25 years, and self-declared white, living with their parents in the northern zone of the city, of Protestant religions, having a family income of up to four minimum wages, half had an income of up to four minimum wages, and one had a degree in another area. The majority did not apply the concept of integrality to self-care, and gave priority to corporal hygiene.

This study is relevant for nursing to understand that the identification of individual characteristics and self-care needs of nursing students allow a critical examination of these people and provide subsidies for health education, with the purpose of stimulating healthy behaviors, valuing integral self-care and contributing to the improvement of academic life and professional future.

The limitation of the study was the impossibility of describing the results of the initial research on the knowledge of students regarding self-care actions. However, it was verified that one of the students performed all the SC behaviors, from the perspective of integrality of the human being.

Therefore, the university has an important social role in the professional/personal, technical and scientific training of future nurses and their respective implications in academic life. It is necessary to promote strategies that value the teaching of integral self-care in universities as a practice that protects the life and well-being of the individuals.

REFERENCES

1.Saupe R, Nietche EA, Cestari ME, Giorgi MDM, Krahl M. Quality of life of nursing students. Rev latino-am enferm[Online]. 2004 [cited in Dec 08, 2017]; 12(4):636-42. Doi: http://dx.doi.org/10.1590/S0104-11692004000400009

2.Brito AMR, Brito MJM, Silva PAB. Socio-demographic profile of nursing students of higher education institutions in Belo Horizonte. Esc. Anna Nery Rev .Enferm [Online]. 2009 [cited in Dec 10, 2017]; 13(2):328-33. Doi: http://dx.doi.org/10.1590/S1414-81452009000200013

3.Souza MGG, Santos I, Silva LA. Health education and self-care actions as determinants for cancer prevention and control. J. res. Fundam.care [Online]. 2015 [cited in Dec 10, 2017]; 7(4): 3274-91. Doi: http://dx.doi.org/10.9789/2175-5361.2015.v7i4.3274-3291

4.Otero LM, Zanetti ML, Souza CRT. Sociodemographic and clinical characteristics of a diabetic population at a primary level health care center. Rev. latino-am. Enferm [Online]. 2007 [cited in Dec 10, 2017]; 15(nspe). Doi: http://dx.doi.org/10.1590/S0104-11692007000700009

5.Francisco AM, Costa MCG, Hamamoto CG, Hafner MLMB. Nursing training evaluation: the reflection of teaching-learning methods and curricular assumptions in professional practice. Avaliação [Online]. 2016 [cited in Nov 12, 2017]; 21(2): 479-502. Doi: http://dx.doi.org/10.1590/S1414-40772016000200009

6.Ministério Education (Br). Law No. 9,394, December 20, 1996. Establishes the guidelines and bases for national education. Diário Oficial da República Federativa do Brasil. Brasília (DF), December 23, 1996. Section 1, p.833-41 [cited in Dec 12, 2017]. Available from: http://portal.mec.gov.br/seesp/arquivos/pdf/lei9394_ldbn1.pdf

7.Barbera MC, Cecagno D, Seva AM, Siqueira HCH, López MJ, Maciá L. Academic training of nursing professionals and its adequacy to work activities. Rev. Latin-am. Enferm [Online]. 2015 [cited in Dec 15, 2017]; 23 (3): 404-10. Doi: 10.1590/0104-1169.0432.2569.

8.Scudeler LA. Exposition of Nursing Students to Chemical Loads [monograph]. São Paulo: School of Nursing, University of São Paulo; 2006.

9.Xavier BLS, Santos I, Silva FVC. Promoting self-care in hemodialysis clients: application of the Nola Pender diagram. J res fundam care online [Online]. 2017 [cited in Dec 15, 2017]; 9(2): 545-50. Doi: http://dx.doi.org/10.9789/2175-5361.2017.v9i2.545-550.

10. Pan American Health Organization. Strengthening self-care as a strategy for Primary Health Care: the contribution of health institutions in Latin America [text on the Internet]. Santiago, Chile; 2006. [cited in July 31, 2017]. Available from: http://www.biblioteca.cotecnova.edu.co/docentes/Magali/Cartillas/autocuidado.pdf

11.Kickbusch I. Self-care in health promotion. Soc Scienc Med. 1989; 29(2):125-30

12.Passos ES. From angels to women. Ideology and values ​​in the training of nurses. 2^nd ed. Salvador (BA): EDUFBA; 2012 [cited in Jan 06, 2018]. Available from: https://doi.org/10.7476/9788523211752

13. Federal Council of Nursing. Business Intelligence Committee. Output 2: Data analysis of nursing professionals in the Regional Councils. 2011. [cited in Jul 21, 2017]. Available in: http://www.cofen.gov.br/wp-content/uploads/2012/03/esquisa profesionales.pdf.

14.Barreto IS, Krempel MC, Humerez DC. Cofen and nursing in Latin America. Enferm Foco [Online]. 2011 [cited in Jan 06, 2018]; 2(4):251-4. Doi: https://doi.org/10.21675/2357-707X.2011.v2.n4.195

15.Eurich RB, Kluthcovsky ACGC. Evaluation of the quality of life of nursing students in the first and fourth years: influence of socio-demographic variables. Rev. psiquiatr. Rio Gd. Sul [Online]. 2008 [cited in Jan 06, 2018]; 30(3):211-20. Doi: http://dx.doi.org/10.1590/S0101-81082008000400010

16. Brazilian Institute of Geography and Statistics. Census 2010. [cited in Jul 20, 2017]. Available from: http://www.censo2010.ibge.gov.br

17.Oguisso T, Lira OS, Vieira APM, Pereira KCM, Mesquita MMC, Silva PJP. Profile of the student entering the Undergraduate Course of the Nursing School of the University of São Paulo. Rev. paul. enferm. 2006; 25(2):9-16.

18.Magalhães LB, Carzino EP. The profile of students of the first nursing group of the Tuiuti University of Paraná. Cienc. Cult. 2002; 26(3): 109-22.

19.Marques MKE, Souza DAB, Silva MCF, Zago ABS, Costa AL. Profile of nursing students from Univap - São José dos Campos/SP working in the health area. Annals of the 10^th Latin American Meeting of Scientific Initiation. 6^th Latin American Postgraduate Meeting; Oct 19-20, 2006; São José dos Campos (SP): University of Vale do Paraíba; 2006 [cited in Jan 06, 2017]. p. 839-42. Available from: http://www.inicepg.univap.br/cd/INIC_2006/inic/inic/03/INIC0000353_OK.pdf

20.Almeida JSP. Global mental health, depression, anxiety, and risk behaviors in higher education students: prevalence and correlation study [Dissertation]. Lisbon (Pt): New University of Lisbon [cited in Jan 06, 2017]. Available from: https://repositorio.ipcb.pt/bitstream/10400.11/2939/1/tese.pdf

21.Santos I, Guerra RG, Silva LA. Self-care categories among elderly people with diabetes: a socio-poetical study. Rev.enferm. UERJ [Online]. 2015 [cited in Dec 22, 2017]; 23(2): 216-21. Doi: http://dx.doi.org/10.12957/reuerj.2015.16498

22.Santos I, Soares CS, Berardinelli LMM. Promoting self-care of clients with obesity and coronary artery disease: application of the Pender diagram. Rev. enferm. UERJ. 2013; 21(3):301-6.