Teaching nursing: what path is Brazilian nursing research on?

Pétala Tuani Candido de Oliveira Salvador^I; Kisna Yasmin Andrade Alves^II; Cláudia Cristiane Filgueira Martins Rodrigues^III; Theo Duarte da Costa^IV; Yole Matias Silveira de Assis^V; Viviane Euzébia Pereira Santos^VI

^I Nurse. PhD in Nursing. Professor at the School of Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil. E-mail: petalatuani@hotmail.com
^II Nurse. PhD in Nursing. Professor at the School of Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil. E-mail: kisnayasmin@hotmail.com
^III Nurse. PhD in Nursing. Professor at the School of Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil. E-mail: claudiacrisfm@yahoo.com.br
^IV Nurse. PhD in Nursing. Professor at the School of Health, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil. E-mail: theodcj@hotmail.com
^V Nurse. Master in Nursing. Professor at the Federal Institute of Education, Science and Technology of Pernambuco, Recife, Pernambuco, Brazil. E-mail: yole_matias@hotmail.com
^VI Nurse. PhD in Nursing. Professor of the Department of Nursing, Federal University of Rio Grande do Norte, Natal, Brazil. E-mail: vivianeepsantos@gmail.com

DOI: http://dx.doi.org/10.12957/reuerj.2017.21469

ABSTRACT

Objective: to examine the dissertations and theses addressing nursing education available in the theses and dissertations catalog of the Brazilian Nursing Association (ABEn). Method: documentary research, whose data were collected from April to May 2015 from Volumes XIX to XXXII of the theses and dissertations catalog. Results: of 7,141 dissertations and theses, the final sample totaled 627 (8.8%) studies addressing the teaching of nursing, predominantly academic master's studies produced in the Southeast Brazil, and descriptive and qualitative in approach. The study objects and recommendations made indicate the research path trodden by the nursing research as regards education. Conclusion: nursing teaching needs to be further explored by nursing research, which can contribute to critical and scientific thinking about the process of educating nurses as educators.

Keywords: Education, nursing; teaching; nursing; nursing research.

INTRODUCTION

Brazilian nursing education had its first investments as a vocational education in the 1940s, about two decades after the creation of the Brazilian Nursing Association (ABEn) in 1926, when the training of human resources for the sector became a priority of the category fights¹.

Along with the educational context experienced at the time, the understanding of education as a decisive element for economic development, focusing on the work necessary to supply the demand for capital, prevailed at this stage. In the meantime, the curricula were focused on the hospital-centered and specialized model, based on a process of educating and learning technicist and, therefore, traditional¹.

Historically, however, there have been new demands on both the educational and health aspects. The current scenario of health care, thus, evolves to a complex environment of practices that requires high levels of ability of the nursing professionals².

The nursing professors, in this perspective, have as their primary challenge to promote education strategies that integrate the clinical ability of the apprentices with the strengthening of their clinical reasoning and reflexive thinking abilities^2,3.

In the face of such a challenge, the role of scientific research in subsidizing the changes required in the process of educating and learning is highlighted. It is known that the development of research focuses on sustaining and improving the panorama experienced since it has a direct relationship with the daily life and is oriented to the most immediate demands and to the search for answers to universal questions⁴.

Graduate programs, therefore, integrate such assumptions, being responsible for promoting research with the social return, incorporating and responding to the issues in which they are inserted. Thus, the importance of such study is justified in the perspective of understanding the path the researches Brazilian graduate nursing programs have takenin terms of nursing education.

For that, the guiding questions were delineated: what are the characteristics of the dissertations and theses available in ABEn's Catalog of Theses and Dissertations (CEPEn) that approach nursing education? What is the path taken by nursing research in education?

The objective wasto analyze the dissertations and theses available in the CEPEn of the ABEn that approach nursing education.

LITERATURE REVIEW

The education of thinking and doing is integrated and, in addition to this, a new generation of students incites changes in educators: in the world of high technology and of students with different learning preferences, there is a need to recognize and provide innovative education strategies³.

Thus, education seeks the axis in active educating and learning, guided by the construction of strategies on what should be known, what the person has already experienced and setting goals that result in an expansion of the initial knowledge. In this way, a reorganization of the way of educating is required: to decompose the traditional model and consolidate a transformer, decentralized and integrated one⁵.

The health professor, thus, in reviewing the paradigms usually adopted, moves towards a reconstruction of their pedagogical practice, in search of a process of educating and learning that is significant for the subjects involved in it⁶.

In this scenario, a particularity of the nurse educator is added: in several settings, nurses are responsible for the education of patients, families, employees and nursing students⁷.

Thus, nursing education surpasses the academic environment. Nursing educators, therefore, integrate their pedagogical actions into three axes: health education - with patients, families, and community; continuing education, permanent and in service - as part of the team inserted in the work environment; and the training of nursing professionals - at both undergraduate and graduate levels⁷.

METHODOLOGY

This is a documentary research, with a quantitative approach, which consists in the use of documents as a source of study, aiming to extract information from appropriate techniques for their handling and analysis, according to scientific principles⁸.

The present study was carried out at the CEPEn of ABEn, a collection that integrates dissertations and theses produced by graduate nursing programs in Brazil, chosen, therefore, to facilitate access to nursing research, the focus of the research.

To unify the language of the collectors, was elaborated an instrument, entitled Protocol of the Documentary Research, composed of the following items: study objective, guiding questions; search strategies; study selection criteria; strategies for critical evaluation and data synthesis. The data collection was carried out from April to May 2015.

The catalogs of theses and dissertations available on ABEn's website, from Volume XIX to Volume XXXII, were used as data collection sources. The inclusion criterion was: dissertations and theses, components of the CEPEn of ABEn, which had as object of study aspects related to nursing education. Theses and dissertations that were not produced by nurses were excluded.

The studies were selected, initially, from the abstracts available in the catalogs, according to established inclusion criteria. Then, the critical evaluation of the selected studies proceeded, through a spreadsheet built in Microsoft Excel 2010, from the collection indicators: academic level; educational institution; year of publication; place of study development; study object; goal; methodological design (if experimental, descriptive, exploratory or bibliographic research)⁹and approach (qualitative, quantitative or mixed); implications and recommendations.

The data were analyzed by means of simple descriptive statistics, from absolute and relative frequency.

It should be noted that approval was not required in the Ethics and Research Committee, since the selected data are inserted in public domain documents.

RESULTS

The catalogs of dissertations and theses analyzed comprised a total of 7,141 abstracts of dissertations and theses produced by nurses. Of this amount, the final sample of this research totaled 627 studies, which corresponds to 8.8% of the nursing research published in CEPEn. See Figure 1.

FIGURE 1: Quantitative population and sample of the survey, in absolute numbers. Natal, RN, Brazil, 2016. (n=627)

The researches related to nursing education, the focus of this study, were classified in the three thematic areas that compose the educational interfaces of the nurse educator: training of health professionals (466;74.3%); health education (101; 16.1%); and continuing/permanent/in service education (60; 9.6%).

As for the academic level, the results of academic graduates (445, 71.0%), followed by those coming from a doctorate degree (182, 29%) predominated. There were no studies in the sample resulting from a professional graduate's degree.

The researches were developed in 32 universities, as shown in Figure 2. They are distributed in the Brazilian regions as follows: Southeast (11; 34.4%); South (8; 25.0%); Northeast (7; 21.9%); Midwest (5; 15.6%); and North (1; 3.1%).

FIGURE 2: Universities in which the studies were developed, in absolute numbers. Natal, RN, Brazil, 2016. (n=627)

In accordance with the geographic distribution of higher education institutions in which the studies were developed, they predominated as federative units, in which the data collection of the researches was carried out: São Paulo (155; 24,8%) and Rio de Janeiro (78; 12,4%). It is noteworthy that 4 (0.6%) researches were configured as multicenter studies and 2 (0.3%) studies were international, conducted in Peru.

The temporal dimension of the dissertations and theses ranged from 1994 to 2014, with little variation in the number of studies over the years, demonstrating a permanent effect of research on the nursing education. See Figure 3.

FIGURE 3: Year when the surveys were defended, in absolute numbers. Natal, RN, Brazil, 2016. (n=627)

It is worth highlighting the year 2012, when 121 (19.4%) dissertations and theses were defended, with emphasis on studies on the incorporation of technological resources in the nursing education.

As for the type of study, the descriptive research (483; 77%) was predominant, followed by the exploratory (109, 17.4%), bibliographical (24, 3.8%) and experimental (11.8%). Regarding the studies approach, 431 (68.7%) were qualitative, 139 (22.2%) quantitative and 57 (9.1%) used a mixed approach.

Regarding the objects of study of the analyzed researches, the following were elucidated: use and development of educational technologies; profile of graduates; profile of educators; professionalization of the nursing team; continuing/in-service education; health education; factors that interfere with student learning; implementation and evaluation of problematic education proposal; education-service relationship; and implementation of a new curriculum.

Implications and final recommendations of dissertations and theses were cited: the need to incorporate technological resources into education; the rethinking of the training process of health professionals, surpassing crystallized thoughts and knowledge; the improvement of the education-service relationship; the incentive to the policy of continuous and permanent education adapted to the needs of the professionals; the importance of the professionalization of the nursing team; the stimulus to the educational practice based on a liberating and problematizing pedagogy; the relevance of the educational process that facilitates interpersonal relationships; the need to promote a safe learning environment; and the consonance of education with the labor market.

DISCUSSION

The fact that the research sample represents only 8.8% of the total dissertations and theses components of the CEPEn of ABEn reveals that nursing education still needs to be further explored in nursing research, which may contribute to critical reflection and educational processes of the nurse educator, focusing on improvements in this process.

It should be noted, however, that the analyzed catalogs do not represent the totality of the nursing researches developed in the Brazilian situation, gathering the abstracts of dissertations and theses only from universities and researchers that authorize their publication. Thus, the results should not be generalized, but understood from this context.

The predominance of dissertations resulting from academic graduate's degrees coincides with the reality of Brazilian graduate studies, in which the academic graduate's degree, following a historical trend, is the type of graduate course that holds the highest number of degrees in the country, this aspect is also revealed in other documentary researches^10,11.

In addition to this, the academic graduates have, as well as providing a deeper formation, to prepare educators to educate at the higher education and to promote research activities¹². Thus, it is believed that the focus of such modality in the academic environment may have contributed to highlight, in the scope of nursing research, the phenomenon of education.

As for the geographic distribution of the 32 universities, in which the researches analyzed were developed, as well as the federative units in which the data collection was carried out, the South and Southeast Regions of Brazil were highlighted, with emphasis on the States of São Paulo and Rio de Janeiro, an aspect that is also evident in other studies ^10,11,13-15, which is mainly due to the quantitative aspects of the distribution of graduate programs in the country¹⁵and to lines of research aimed at educating.

Regarding the methodological design of the researches analyzed, a greater number of qualitative-based investigations were revealed, an aspect that is highlighted in the literature and which may arise from the possibility of reaching the answers to concerns that involve nursing care and assistance, that is, by the adequacy to the objects of study of nursing research ^16,17.

The predominance of the descriptive research in nursing was also elucidated by another study¹⁰. It is distinguished, besides the imperativeness of the descriptive research, the necessity to balance such numbers, stimulating the promotion of experimental research of quality ¹⁰.

It is understood that the representativeness of the exploratory studies in the analyzed sample constitutes the first step to this process of changes and, in general, an adequacy of the research designs to the objects studied, as well as to the outlined objectives was observed.

The objects of study and the recommendations of the surveys analyzed denote the path taken by nursing research regarding education, as well as indicate where the Brazilian nursing walks in such area.

Thus, the rethinking of the training process of health professionals, overcoming crystallized thoughts and knowledge, stimulating educational practice based on a liberating and problematizing pedagogy and the relevance of the educational process that facilitates interpersonal relations, shows the way forward in search of participatory education.

It should be emphasized that education has experienced a historical moment of transition, in keeping with changes and discoveries characteristic of the information age, marked by the absence of absolute and definitive knowledge, which reflects in the work processes and requires the development of skills and problematizing skills in future health professionals⁶.

The nurse educator, therefore, is inserted in a panorama of development of pedagogical practices based on active methodologies, in the light of an andragogic approach, which scope is to promote the student's participation, favoring the exchange of experiences, leading them to the realization of an active role in one's own learning^6,7,18.

The professor, in this sense, is seen as a facilitator and must constantly evaluate the determinants of the learning of the target audience that they are responsible for educating - patients, professionals or students -, whatsoever: the needs of the learner; the state of readiness to learn; and the preferred learning styles for information processing⁷.

The nurse educator, in this context, has two significant responsibilities: to accept the diversity of styles to create an atmosphere for learning that offers encouraging experiences for each individual to reach their full potential; and to combine different approaches from a critical analysis of its foundations, considering that a curriculum of nursing based on only one approach can restrict the educational development of the students ¹⁸.

In the meantime, another element that reflects the path of nursing that concerns educating is the need to incorporate technological resources into the pedagogical process. This is evident from the emergence of the Internet, which redefined the social and educational scenario, providing innovations and new forms of interaction and communication ¹⁹.

The possibility of a motivating, reflexive, multisensory, dynamic, flexible education regarding timetables and geographic spaces, collaborative and that promotes the socialization of knowledge are highlighted benefits in the literature regarding the incorporation of technological resources in nursing education, in its various learning environments^2,3,19.

Using technological resources in education, the possibility of promoting a safe learning environment, through simulations of practical situations ^2,3, an aspect that was revealed by the dissertations and theses analyzed and that needs to be explored are also highlighted as a benefit provided.

Since 2003, the National League for Nursing has emphasized that nursing educators must create teaching environments to facilitate critical thinking and self-reflection of students and prepare them to practice in a complex and dynamic health care setting. Thus, the importance of the development of clinical skills through education experiences with controlled and safe environments is emphasized, which can be provided using simulations².

In addition, it should be noted that the incorporation of technological resources into educating should not be understood as a purpose, capable of modifying a traditional pedagogical scenario. It is argued, therefore, that pedagogical theories are essential to ensure the maximization of the potential benefits of different education strategies, which requires knowledge and competence of educators^20,21.

Finally, the need to improve the education-service relationship and the consonance of education with the job market was emphasized. In this process, it should be highlighted that the educational practice must be related to critical and reflexive formation, in which the learner learns to inquire, to investigate and to problematize, developing autonomy to act in the practical scenario¹⁹.

Educating according to the job market and the effective education-service relationship, therefore, involve the promotion of the cognitive maturity of apprentices, which presupposes critical thinking skills, clinical judgment, as well as the fundamental affective dimension in the learning process ²².

CONCLUSION

It was concluded that nursing education still needs to be further explored in the Brazilian nursing research, because only 8.8% of the total number of dissertations and theses were part of this thematic area.

In studies resulting from academic graduates, carried out in the Southeastern Region, descriptive and qualitative approach prevailed.

As a way to be traced in nursing education, these were listed as important challenges: the need to incorporate technological resources in education; rethinking the training process of health professionals; the improvement of the education-service relationship; the incentive to the policy of continuous and permanent education adapted to the needs of the professionals; the importance of the professionalization of the nursing team; the stimulus to the educational practice based on a liberating and problematizing pedagogy; the relevance of the educational process that facilitates interpersonal relationships; the need to promote a safe learning environment; and the consonance of education with the job market.

As a limitation of the study, it is worth noting that the findings do not reflect the totality of nursing research carried out in Brazil.

It is expected that the present text will stimulate the discussion about the importance of developing researches that can subsidize improvements in the teaching and learning process, as well as raising educators' reflections regarding the challenges and possibilities of the educational panorama, in their diverse environments to consolidate a qualified teaching education practice.

REFERENCES

1.Kobayashi RM, Leite MMJ. História da educação profissional em enfermagem. In: Prado C. Práticas pedagógicas em enfermagem: processo de reconstrução permanente. São Caetano do Sul(SP): Difusão Editora; 2013. p. 21-41.

2.Onda EL. Situated cognition: its relationship to simulation in nursing education. Clinical simulation in nursing. 2012; 8: 273-80.

3.Boctor L. Active-learning strategies: the use of a game to reinforce learning in nursing education. A case study. Nurse education in practice. 2013; 13:96-100.

4.Rocha Neto I. Prospectiva da pós-graduação no Brasil (2008- 2022). RBPG. 2010; 7: 58-79.

5.Mendoza IYQ, Peniche ACG. Intervenção educativa sobre hipotermia: uma estratégia de ensino para aprendizagem em Centro Cirúrgico. Rev. Esc. Enferm. USP. 2012; 46:851-7.

6.Prado C, Afonso VPM, Almeida DM, Vaz DR. Andragogia: o desafio de ensinar e aprender com adultos na era contemporânea. In: Prado C. Práticas pedagógicas em enfermagem: processo de reconstrução permanente. São Caetano do Sul(SP): Difusão Editora; 2013. p. 75-85.

7.Kitchie S. Determinantes da aprendizagem. In: Bastable SB. O enfermeiro como educador. 3ª ed. São Paulo: Artmed; 2010. p. 115-67.

8.Sá-Silva JR, Almeida CD, Guindani JF. Pesquisa documental: pistas teóricas e metodológicas. Rev. bras. hist. ciênc. soc. 2009; 1: 1-15.

9.Cervo AL, Bervian PA, Silva R. Metodologia científica. 6ª ed. São Paulo: 2007.

10.Pizzani L, Lopes JF, Manzini MG, Martinez MCS. Bibliometric analysis of theses and dissertations on prematurity in the Capes database. J. pediatr. 2012; 88: 479-82.

11.Salvador PTCO, Alves KYA, Martins CCF, Santos VEP, Tourinho FSV. Perfil das dissertações e teses brasileiras acerca do trauma: uma pesquisa documental. Rev. col. Bras. cir. 2012; 39: 328-34.

12.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior. Mestrado profissional, mestrado acadêmico e doutorado [Internet] 2015 [cited in 2016 Mar 23]. Available from: https://www.capes.gov.br/images/stories/download/artigos/Artigo_30_08_07.pdf

13.Rodrigues DC, Backes DS, Freitas HMB, Zamberlan C, Gelhen MH, Colomé JS. Conhecimentos produzidos acerca do crack: uma incursão nas dissertações e teses brasileiras. Ciênc saúde coletiva. (Online) 2012; 17: 1247-58.

14.Santos, LMA. Panorama das pesquisas sobre TDIC e formação de professores de língua inglesa em LA: um levantamento bibliográfico a partir da base de dissertações/teses da CAPES. RBLA. 2013; 13: 15-36.

15.Lino MM, Backes VMS, Canever BP, Ferraz F, Prado ML. Perfil da produção científica e tecnológica dos grupos de pesquisa em educação em enfermagem da Região Sul do Brasil. Rev latino-am enferm. (Online) 2010; 18: 165-72.

16.Prado C, Casteli CPM, Lopes TO, Kobayashi RM, Peres HHC, Leite MMJ. Espaço virtual de um grupo de pesquisa: o olhar dos tutores. Rev. esc. enferm. USP. 2012; 46: 246-51.

17.Erdmann AL, Pagliuca LMF. O conhecimento em enfermagem: da Representação de Área ao Comitê assessor de enfermagem no CNPq. Rev. bras. Enferm. (Online) 2013; 66: 51-9.

18.Bastable SB, Dart MA. Estágios de desenvolvimento do aprendiz. In: Bastable SB. O enfermeiro como educador. 3ª ed. São Paulo: Artmed; 2010. p. 169-220.

19.Fernandes MFP, Vaz DR. Processo ensino/aprendizagem – ensinagem. In: Prado C. Práticas pedagógicas em enfermagem: processo de reconstrução permanente. São Caetano do Sul (SP): Difusão Editora; 2013. p. 63-74.

20.Parker BC, Myrick F. A critical examination of high-fidelity human patient simulation within the context of nursing pedagogy. Nurse education today. 2009; 29: 322-9.

21.Braungart MM, Braungart RG. Aplicando teorias da aprendizagem à prática do cuidado em saúde. In: Bastable SB. O enfermeiro como educador. 3ª ed. São Paulo: Artmed; 2010. p. 73-111.

22.Nickerson CJ, Thurkettle MA. Cognitive maturity and readiness for evidence-based nursing practice. Journal of nursing education. 2013; 52: 17:23.