REVIEW ARTICLE

Political pedagogical project and critical thinking-based education: facilitators and hindrances

Karolyne Marotto Vila^I, Roberto Henrique dos Santos Teva ^II, Helena Maria Scherlowski Leal David^III, Ronilson Gonçalves Rocha^IV, Elizabeth Teixeira^V, Cristiano Bertolossi Marta^VI

^I Nurse. Cardiology Resident at Pedro Ernesto University Hospital. Rio de Janeiro State University. Brazil. E-mail: karu.lynemarotto@gmail.com
^II Nurse. Nursing Student at the School of Nursing of the Rio de Janeiro State University. Rio de Janeiro, Brazil. E-mail: robertoteva@gmail.com
^III Nurse. PhD. Associate professor, Rio de Janeiro State University. Brazil. E-mail: helenalealdavid@gmail.com
^IV Nurse. PhD. Associate professor, Rio de Janeiro State University, Brazil E-mail: ronilsonprof@gmail.com
^V Nurse. PhD. Associate professor, Rio de Janeiro State University. Brazil. E-mail: etfelipe@hotmail.com
^VI Nurse. Post-PhD. Associate professor, Rio de Janeiro State University. Brazil. E-mail: cristianobertol@gmail.com

DOI: http://dx.doi.org/10.12957/reuerj.2016.21111

ABSTRACT

Objective: to identify, in the nursing scientific literature, elements that facilitate and impede the construction of a political pedagogical project and nurse training based on critical thinking. Method: this integrative review was guided by the questions: What does the literature say about constructing a political pedagogical project and critical thinking-based training? What elements facilitate and hinder these processes? Articles from 2001 to 2013 were searched in the SciELO virtual database, using the descriptors: nursing training, pedagogical political projects, comprehensive care, thoughtful practice in nursing, nursing education, nursing leadership, higher education and graduation. Results: the 12 articles selected were analyzed in terms of facilitating elements and hindrances. Conclusion: the process of constructing projects and of training nurses on the basis of critical thinking requires a collective endeavor engaging, directly and indirectly, the students, teachers and other professionals involved in teaching. In part, the challenges were found to be in this process of collective construction and participation.

Keywords: Education' nursing; education higher; education; nursing baccalaureate.

INTRODUCTION

The critical reflective process is guided by critical pedagogy, for which Paulo Freire is the main reference in Brazil. It is based on the assumption that a critical education leads to the development of citizens in such a way that they are able to analyze social, historical, and cultural realities and create new possibilities that may transform them, resulting in greater autonomy and emancipation of students and teachers¹.

The broad vision of a nurse which results from a critical-reflexive education allows for comprehensive performance that meets the general needs of society and also allows for a precise and effective diagnosis of the social determinants in the health-disease process².

Projects of critical-reflexive education in undergraduate programs require planning, and that is why they need to be conceived by the whole academic community and be based on a political pedagogical project (PPP). It is agreed that the implementation of such projects must be collective and democratic. Many issues arise in this process that can make changes more difficult or easier³.

PPP clarifies the objectives of a course program and guides the strategies to be used. More than a document to be filed, PPP must be a means of integration, of coordination of actions of the different subjects involved in the educational process³.

Following the approval of Resolution CNE/CES number 3, which addresses the Brazilian National Curriculum Guidelines of Nursing Undergraduate Courses ⁴, the construction of PPPs from a critical-reflexive approach has expanded. In view of this fact, the answers to these guiding questions are sought. What does the literature say about the construction of the political pedagogical project and critical-reflexive education? What are the enabling and hindering elements of these processes?

The objective of this study was to identify the enabling and hindering elements in the construction of the political pedagogical project and in the critical-reflexive education of nurses in the scientific literature.

METHOD

In order to carry out the study, an integrative review of the literature was conducted, which aimed to provide a broad analysis of publications in a particular field of study⁵. The methodological approach was developed from a systematic step-by-step process⁶. The object of the study and the situation and problems were identified. Guiding questions were defined and the objective of the review was established. The sample was selected and articles extracted from scientific journals in the field of nursing were chosen. The search was carried out on the Scientific Electronic Library Online (SciELO), by means of the following descriptors: nursing graduation, political pedagogical projects, comprehensiveness of care, reflexive practice of nursing, education in nursing, nursing leadership, higher education and graduation.

Data collection was performed between March and September 2014. The inclusion criteria were: articles that addressed nursing training, elaboration of political pedagogical projects, critical-reflexive nursing practice, nursing social-political competence, articles written by nurses, published between 2001 and 2013 in Portuguese, and fully available online. The exclusion criteria were: any article that did not meet at least one of the inclusion criteria.

A total of 36 articles were identified after reading their abstracts. Twelve of them were selected as they met the inclusion criteria and were relevant to the guiding questions and objective. An exhaustive and analytical reading of the 12 articles was undertaken.

An instrument for data collection was used (IDC)⁶. In this IDC, the following information were identified: title, year of publication, journal name, state (UF), keywords/descriptors, authors, methodology used; main idea/proposal, main results/discussion.

A text analysis was performed based on the idea that "is a way of deepening and immersing in discursive processes in order to acquire knowledge by means of reconstructed readings of speeches" ^6:496. The results were organized and grouped according to: enabling elements and hindering elements. After interpretation and discussion, the final discursive-reflexive text was written with considerations, inferences and conclusions.

RESULTS AND DISCUSSION

Considering the adopted inclusion criteria, 12 texts were published between 2002 and 2012.

The distribution of publications by year was as follows: three articles from 2003; two articles from 2007, 2008 and 2009; and one article in 2002, 2004 and 2012. The distribution of articles by state was as shown in Figure 1: four from São Paulo, two from Santa Catarina and Rio de Janeiro; one from the Federal District, Minas Gerais, Paraná and Rio Grande do Sul.

FIGURE 1: Description of studies included in the integrative review, by title, author(s), year of publication and State. 2002-2012.

Enabling Elements

Concerning the enabling elements, it is worth mentioning that collective work and communication, with the involvement of the academic community in the construction of PPPs, are essential factors that were mentioned in eight articles^7-14. In two of them ^9,13, not only was the participation of all players directly or indirectly involved in the teaching process mentioned, but it was also observed that a horizontal dialogue between them was necessary so that training projects could be implemented democratically.

Regarding the contents that require critical-reflexive approaches, five articles^9,15-18 reported that PPPs must addresscomprehensiveness of care. Of these, three articles ^9,16,18 highlighted enhanced training focused on the user, including: biological, psychological, social and familial aspects, as enabling factors for a critical-reflexive education.

In two other articles^12,14, the history of the profession, and of the Unified Health System (SUS) were mentioned as possibilities that could enhance such approaches and give rise to discussions about democratization and citizenship. They also mention the work process¹⁵, and the ethical aspects of professional practice¹⁷as enabling mechanisms of critical-reflexive thinking.

The construction of PPPs for a critical-reflexive education has communication as the main enabling factor, and consequently, the need for collective and democratic participation in this process. Because students and professionals are also a part of the development of teaching, collaboration is essential if changes are to be introduced "There is consensus with regard to the need for the participation of the greatest number of teachers possible in the construction of PPP, as this ensures that it reflects the group's convictions and proposals"^3:24.

The participation of students at the academic center and/or class representatives is important in supporting this construction and also to create spaces where they do not feel compelled.³. Communication, dialogue and democratic participation give rise to two conceptions. The first consists of using dialogue as a basic method in a horizontal relationship¹⁹. Secondly, dialogue is an existential requirement ¹.

Interdisciplinarity , mentioned in two articles^{8, 11}, is referred to as an enabling mechanism. They state that critical-reflexive education must be comprehensive and interdisciplinary, since this allows for the acquisition of knowledge and for the ability to act with human beings in their subjectivity²⁰. However, its purpose is to educate citizens, as well as professionals who reproduce techniques and/or content. This contributes to decision-making and to the adoption of positions regarding the world and life, which is at the core of social responsibility.

Understanding the environment, the epidemiological profile of a population and the biological-psychosocial and spiritual complexity of a population allows for a broader look at the health-disease process. It also facilitates comprehensiveness of care in the structuring of nursing professionals' education²¹.

There is an attempt to transform professional practices and work organization based on the principles of the Brazilian Unified Health System (SUS, as per its acronym in Portuguese), which is at the heart of reflexive practice. It is "closely linked to rules, values, justice and power, giving rise to sensitivity and decentralization as methods of dealing with ethical aspects of practice"^20:401.

Nursing training needs to "go beyond the walls of schools and services and go towards an understanding of the country, its history, development and potential"^2:191.

There is a convergence with the Brazilian National Curriculum Guidelines¹⁸ and problem-solving education¹⁵. The principles ofstudent-centered learning^12,17, theteacher as facilitator and the actual involvement with the SUS are the real issues of nursing education as well as the active methodologies which function as enabling elements.

Educational practice focuses on the interactive process and the different subjects of the knowledge improvement process, resulting in both co-responsibility and the participation of all parties involved ²².

PPP is a construction that emphasizes collective effort in order to be legitimate and for coexistence with the contradictions of the process itself. Proper qualifications have the potential to add a set of strategies for a training policy of SUS workers and to change health practices ^{23, 24}.

Hindering elements

All articles present PPP as an essential instrument and highlight the difficulties that are inherent to its construction, implementation and content^7-18. In six publications^7-13 the results show diverging proposals, ego-based disputes and a lack of dialogue between professors and students, which are presented as hindering elements in debates and in the construction of PPPs itself.

In one of the texts^18, the lack of regularly employed professors and the prevalence of shorter-term contracts (less than five years) was mentioned. This hindered the continuity of proposals constructed and agreed upon for PPPs. Another hindering element was the difference between PPPs in public and private institutions of higher education; the former included an enhanced critical and reflexive education while the latter generally adapted them to the neoliberal economy. They supported a short-sighted, mechanical and hospital-centered education as a basis for the healing process, occasionally with a preventive, social or pedagogical approach to training.

The lack of participation from the academic community in the construction process of PPPs is a hindering element since this results in only meeting the needs of a minority interest and reflects the hierarchical nature of education projects. This fact could be explained by several reasons, among which were: a lack of dialogue between professors and students; a lack of interest from students in participating in debates concerning their education in universities; the fragmentation of student representative bodies into academic centers and academic administration; professors who were permanently busy with their commitments and who later complained about the decisions made during their absence, claiming that the process was "anti-democratic".

Debates about training, which precede a PPP need to be reflexive and focused on problem solving. For this, representatives from all positions must be included, such as educators and students, and they should be allowed to present proposals to change old education models.

All understandings, points of view and experiences must be taken into account so as to problem solve and consequently create projects that meet the needs of all parties involved. This will contribute to the improvement of the quality of life in society. Only by means of a horizontal dialogue is it possible to produce knowledge that favors the majority of people ¹.

Another point refers to the implementation of proposals decided for other PPPs and regularly employed staff¹⁰. "There are few professors who belong to the permanent staff, and temporary professors stay no longer than four years in graduation courses and this makes it difficult to keep decisions made and approved for PPP as well as their continuity." ^24:405.

Another factor that hinders the implementation is resistance from both students and professors in accepting the proposals made in PPPs. Although they have a project which focuses on ideal education, some professors insist on traditional teaching practices. Moreover, students show no interest in the social, pedagogical and philosophical proposals provided by the educational project in their universities²².

With regard to the content of educational projects, a significant number of articles pointed to the lack of interdisciplinarity between subjects as a hindering factor for a critical-reflexive education^9,11 Historically, nursing principles are supported by an interdisciplinary focus on the construction of a body of knowledge which changes as it comes into communication with any new facts in science, whether these changes are made in research, teaching or healthcare²⁵.

Limited input from researchers and consequently a lack of scientific studies hinder quality training of specialized professors in different subjects in nursing courses, especially biomedical, social and human sciences. What eventually happens is the fragmentation of teaching into compartments, in which each specialist/professor, not necessarily a nurse, teach their content without any association with other subjects. "The educational project needs to adapt to this, and make sure interdisciplinarity is not doomed to failure"^26:579. "Critical education requires correspondence and the crossing over of content that favor problem-solving and a broadening of the vision of educators and students" ^27:21.

A dialogue between subjects is essential to broadening an understanding of a certain subject or fact, since such dialogue is linked to this understanding. "The choice of a curriculum that is included in this project requires the adoption of a dialectic vision of the indissoluble unity between theory and practice. This is ensured by a simultaneous and mutual relationship of autonomy and dependence upon each other." ^28:53.

As highlighted by the authors, interdisciplinarity favors the broadening of knowledge taught in classrooms, since it provides new applications and new visions of reality. In nursing, this idea can be explained by the concept of disease, which, if only understood in its biological dimension, becomes restrictive and limited in its understanding of the causes and effects on individuals and society as a whole. Consequently, concepts and behaviors about a particular topic are not fully reproduced.

All the content taught in classrooms is connected to other fields of knowledge, as stated by the authors. In the example of disease, its concepts can be studied from different points of view and from different fields of knowledge. As such, they characterize the determinants of a process. All knowledge is complex and linked, to understand this link is to promote the critical process of learning^29-30.

The difficulties discussed here are extremely important for a broader education that aims to be critical and reflexive about learning, being and doing Nursing. There are many problems concerning these difficulties, and due to their complexity, it was not possible to execute a thorough analysis on the topic. However, it all begins with PPP, and that is why it is necessary to make an extremely careful analysis of choices made.

CONCLUSIONS

In a systemic and integrative analysis, the literature indicates that critical-reflexive education changes reality. The importance of the construction of PPPs that encourages broad learning in different fields of knowledge is worth mentioning. Interdisciplinarity and the absence of ranking between professors and students which promotes a dialectic of participation and democracy was also found to be significant...

Results suggest that the process of construction of PPPs and a critical-reflexive education in nursing requires collective effort that include, directly and indirectly, professors, students and all professionals involved in teaching. The challenges remaining in this process of collective construction and professor participation was the issue most highlighted.

Critical-reflexive education is based on the premise of encouraging students and teachers to discuss topics in classrooms with the purpose of attaining knowledge, enabling future professionals to change realities and broaden their approach to thinking, doing and being.

Broadening this vision is urgent, so that nurses take care not only of sick people, but of human beings in all their aspects - biological, social, psychological, philosophical and spiritual. To do so, an education that enables professionals not only to master techniques and content but also to apply them in their lives is necessary, so they can understand any event or reality presented to them as the result of a process.

A project of critical-reflexive education must foresee elements, skills and behaviors nursing students and future professionals must have in order to be able, as individuals who are part of history, to transform or promote changes in society that result in a higher quality of life for everyone.

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