ORIGINAL RESEARCH

Teaching occupational health and safety in an undergraduate nursing course

Marcela Costa Fernandes^I; Norma Valeria Dantas de Oliveira Souza^II; Iraneide Ferreira Mafra^III; Claudia Regina Menezes da Rocha Pôças^IV; Déborah Machado dos Santos ^V; Bruno Lira da Silva^VI

^IMSc in Nursing. Nurse of the Family Health Program of the Municipality of Rio de Janeiro. Rio de Janeiro, RJ, Brazil. E-mail: marcelacostafernandes@yahoo.com.br
^IIPhD in Nursing. Professor at the School of Nursing of Rio de Janeiro State University. Rio de Janeiro, RJ, Brazil. E-mail: norval_souza@yahoo.com.br
^III Stomal therapist. Nurse of the Family Health Strategy of the Municipality of Rio de Janeiro. Rio de Janeiro, RJ, Brazil. E-mail: neidemafra.l@hotmail.com
^IV PhD student from the School of Nursing of Rio de Janeiro State University; Nurse from HUPE/UERJ; Rio de Janeiro, RJ, Brazil. Email: cmenezespocas@gmail.com
^V PhD student from the School of Nursing of Rio de Janeiro State University; E-mail: debuerj@yahoo.com.br
^VI Nurse. Undergraduate degree from the School of Nursing of Rio de Janeiro State University. Rio de Janeiro, RJ, Brazil. E-mail: brunolirasilva@gmail.com

DOI: http://dx.doi.org/10.12957/reuerj.2017.23052

ABSTRACT

Objective: to identify and analyze the configuration of worker's health education in undergraduate nursing courses at a public institution. Method: in this qualitative study at a public university institution in Rio de Janeiro City, the participants were 12 teachers on the nursing degree course working with content about worker's health. The study was approved by the Research Ethics Committee (Protocol No. 06/2012). Data were collected between May and July 2012 by semi-structured interview and from documents released by the Undergraduate Coordination Office. Results: thematic content analysis of the data resulted in the category "contradictions in content on workers' health". Participants' discourse was observed to differ from the content of teaching documents, confirming contradictions in how the course worked with content relating to workers' health. Conclusion: the articulation between theory and practice should be improved, and there is a need to discuss the relevance of nurses' generalist education.

Keywords: Occupational health; curriculum; nursing bachelor degree; work.

INTRODUCTION

This study aims to address the contradictions that permeate the teaching of occupational health and safety in the nurse's education at a public institution, the curriculum framework of which is distinct, since, upon the creation of its political-pedagogical project, in 1996, it sought to break with the fragmented view of the health-disease process and, in its turn, the teaching.

From this perspective, such institution has created a curricular logic developed through Fields of Knowledge, namely¹: Assistance, Fundamental and Biological and Social Bases of Nursing, which consist of subareas, and each of them "encompasses a set of subjects integrated to one another, making up a curriculum framework that is guided by the understanding of the entire health-disease generating process" ^1:363. The subareas complement each other and enlarge and deepen the building of the student's theoretical-practical knowledge, always from the perspective of totality¹.

Within a context in which the teaching of occupational health and safety is made into an issue in Nursing undergraduate courses, the universities play a major role in this field of knowledge regarding the education of professionals and the conduct of research. This is corroborated by the Brazilian Law that governs the Directives and Bases for Education, which ² determines that the undergraduate courses develop their curriculum frameworks in compliance with the legal directives established. Thus, higher education seeks to educate professionals who are able to take part in the development of society, which implies interfacing with the world of employment and several social contexts.

Considering such contextualization on the subject matter, we have chosen as purposes of this study: to identify and analyze the configuration of the teaching of occupational health and safety in the undergraduate education in nursing courses.

LITERATURE REVIEW

Living in the world of employment may imply processes of becoming ill, as a result of the interaction between the individual and his/her employment condition. Thus, the damages to health due to employment conditions are determined by several factors, from those related to the labor conditions to the incipient knowledge of the professionals concerning the occupational risks, which cause physical and mental illnesses³.

Within such context, an understanding of the relationship between health and labor should be encouraged early on, starting in the professional education, providing the students with the study of the world of employment in its several realities³.

Therefore, the undergraduate nursing courses have the challenge of educating professionals who are technically competent and able to meet the real health needs of the population, and also address the particulars of the world of employment and establish philosophic, conceptual, political, methodological bases that define skills and competences of several areas of knowledge⁴_. In this regard, the future professionals should apprehend the interrelation between health and labor, by acquiring technical and scientific conditions in order to implement actions concerning the worker's health, due to being aware of the influence of the world of employment on the health-disease process⁵.

The National Occupational Health and Safety Policy defines the restructuring of occupational health and safety education and recommends that this issue be included in the higher education curriculum framework - especially in the health professional's careers⁶. Thus, the education of the nurse must encompass the knowledge about protecting their own health and safety⁷; as well as the guidance of the nursing team regarding the protection of individual and collective health ^7,8; the correlation between the user's health and disease aspects and the labor activity they perform^8,9, and about labor as a point of dialectic centrality in people's lives, being able to both promote health and cause a disease^10,11_.

The development of content on occupational health is still incipient in the undergraduate nursing courses in Brazil¹², although the National Curricular Directives (DCN)¹³ determine that those taking such courses must identify and intervene in relevant health-disease situations in the Brazilian epidemiological profile.

The relevance of the study is in evidencing the importance of such theme in the education of the nurse, whose labor tool is the care to the human being, which requires theoretical and practical support so they may understand that their patients' disease may be connected to their labor activity. Furthermore, it is highlighted that the exercise of nursing subjects the professional to numberless occupational risks¹⁴. Therefore, one has to understand the risks to which he/she is exposed ¹⁵ in order to take measures that ensure their good health and that of the members of their team.

METHOD

This is a qualitative and descriptive research, based on an excerpt of a master's degree dissertation¹⁶, defended at the School of Nursing of Rio de Janeiro State University, in 2013.

The participants in this study were professors in the assistance and fundamental areas of the undergraduate curriculum framework being investigated, who specifically worked in 11 subareas, the names of which referred to the content on occupational health. The research had as inclusion criteria: to be a permanent professor at the institution and having worked in the aforementioned subareas for at least two years; and, as exclusion criteria, the professor having no connection with the research, as well as being on leave. Thus, 12 professors have been selected, and 10 of them gave classes in the assistance area, and 2 in the fundamental area, with one professor at least representing the relevant curricular subareas, namely: Health, labor and environment, Adolescent's, adult's, elderly's health and the world of employment.

The data was collected from May to July 2012. The participants were informed on the research details and, after that, they signed the Informed Consent Form (TCLE in the Portuguese acronym). The technique used for collection was the semi-structured interview, which is considered as a primary source. The interviews were recorded with previous consent by each participant and later transcribed. In order to guarantee anonymity, the professors were identified through an alphanumeric code (E1...E12) , due regard being given to the chronological order of the interviews. As secondary sources, pedagogical documents were used, which were made available by the undergraduate education coordination of the institution at issue: political-pedagogical project, syllabi, subarea planning and curricular flowchart.

The interviews were subjected to content thematic analysis, which is a technique that aims to objectively, systematically and quantitatively describe the content taken from the study sources¹⁷. Based on such procedure, 119 registration units (RU) have been captured, which were subsequently grouped into 11 signification units, resulting in the analysis category: contradictions in the teaching of occupational health.

The research project was approved by UERJ Ethics Committee, under protocol, 06/2012, as set forth in Resolution 196/96 of the National Health Council, then in force, which established the rules for research involving human beings.

RESULTS AND DISCUSSION

Contradictions in the teaching of occupational health

This category evidences the participants' view on the teaching of occupational health in an undergraduate course, showing contradictions in the teaching of such theme and its relationship with the correlation between theory and practice, the importance of the given content for the education of the nurse and its organization over the undergraduate studies, as well as recommendations in order to minimize and/or solve the contradictions and dilemmas that may have been found.

The correlation between theory and practice fosters some reflections on professional education and the urgent need of strengthening the association between these two axes of the teaching in a nursing course. Therefore, it is essential that the practice is expressed through actions based on the theory, and that the phenomena produce reflections that renovate the construction of theories^18,19. Some divergences in the understanding of such correlation were captured, since, among the 12 respondents, 6 understood that there was a correlation between theoretical content and practice, 5 deemed it to be weak, and 1 teacher considered that it was nonexistent, according to the testimonials shown below:

I believe so, mainly because I think occupational health is very strong in the curriculum and it is very well worked on, very well structured and this is very clear. The students are able to bring into practice what they have learned in theory regarding such content. (E3)

There is no such correlation and there is no formal content in writing. We cannot count on a way to make such correlation. (E6)

I think it exists in a very fragile manner; I think this is something we have to qualify to a greater extent. (E9 )

The speeches show different ways of understanding of the content development, as many times such connection happens only within certain education contexts. Thus, it is presumed that the contradictions that permeate such content may be related to how it is structured in the course and how it has been developed in different periods and subareas.

Considering the centrality of labor in people's lives²⁰, and nursing as a social practice²¹, the content on occupational health allows educating nurses that are able to perform their activities within the complex context of the current world of employment²². In this regard, some interviews evidenced that the content on occupational health is adequate to the generalist education of the nurse², has a link between theory and practice and also meets the variability of the themes involving such area of knowledge.

Thus, such course curriculum addresses essential contents on occupational health for the nurse's education, dealing with health promotion, protection, prevention and recovery, as well as labor-related concepts and policies²³.

Regarding the content systematization, we have characterized the working hours that are sufficient to their adequate development, and the students' interest in developing course completion works (TCC) on such theme, reflecting a systematic approach to occupational health.

The working time is good and very well developed. If we make a survey of the TCC's, occupational health is way ahead. So, we can see how much this justifies the systematized approach to occupational health over the course. (E7)

On the contrary, there were reports by those that did not consider the content to be appropriate nor taught on a systematized basis; according to some respondents, the students did not show awareness of the relevance of such theme for their professional performance. Moreover, it was apprehended that the development of such content did not take place in a correlated and coherent manner over the undergraduate course; furthermore, this approach was made by a few teachers who specializes in such area.

In my opinion, the manner in which they are given depends a lot on the professor who is conducting the subarea at that time. So, depending on the professor, if he/she is a professor with a degree in occupational health, he/she will address such theme. Otherwise, this is not even mentioned at all. (E9)

Other apprehended aspect is that the occupational health content was given with a plenty of themes addressed, albeit not always developed in a systematized manner, which makes difficult for the student to understand and incorporate such knowledge.

It is a very wide field, as it is a conceptual basis that has many interfaces: the biosafety, care, safety itself, professional education, public policy, citizenship, right to employment. (...) The curriculum encompasses all these themes; however, the contents need to be better designed and correlated so the student may apprehend them better. (E7)

In disagreement with that, some professors considered the development of such theme to be organized and systematized in an increasing learning; however, they said that the content is not sufficient.

The manner of development is systematized. They are addressed in the periods, they come in an increasing learning. Now, can they be deemed to be appropriate? I think that the generalist issue is not an answer for you to have only approached contents in the occupational health area. Although they are generalist, they are beneath the expectations of the market. (E5)

The curriculum must clearly show the pedagogical and political options of the professional's education^24,25. Under this perspective, a permanent discussion and review contribute to minimize any eventual contradictions in the development of the curricular proposal. In this regard, we make an emphasis on the professor's recommendations on changes and adjustments to the curricular operationalization and/or review, for improving the teaching-learning process with a focus on occupational health, as reported below:

The job market wants you to minimally know more about everything. So, one cannot have that too much generic view anymore. Today, you have to be a specialist in almost everything. (E5)

We have to better characterize the theoretical content so it does not get too "loose". Because, today, I know what I do and how I do it; but, tomorrow, I can't tell who will be in my place, and, then, I just don't know how this will be addressed in the curriculum. (E6)

Thus, a reflection must be made on the importance of such content being made formal and systematized in syllabi, in curricular planning of the subareas and in teaching methods. This minimizes the chances of its development depending only on the teachers' and/or students' initiatives, and also of it not being developed or being lost over time. The report below makes such analysis clear:

Occupational health is not restricted only to the workers in the health area (...). I think the students should see other spaces, I think this is necessary in the education focus (...). And this is a little outside the context of such theoretical-practice correlation. (E10)

Within the scope of the discussion on what one expects to be addressed, this last statement is consistent with the meanings attributed to the generalist education and recommends taking a deeper look into such theme, so they go beyond the contents in the undergraduate course curriculum frameworks, evidencing a view that encourages approaching a specific content focused on different work spaces, yet such theme is the goal of a graduate course in the occupational health area.

Pedagogically, we have to discuss some issues at the curriculum committee. Review the directives that caused the curriculum to be prepared like that in order to see whether they are still relevant or not. (E4)

The following statement, although it depicts a professor's understanding of the relevance of the transversal approach to occupational health, it reveals a mistaken sense regarding the focus of teaching in an undergraduate nursing course, which is the care to the human being:

Occupational health should be the backbone of the curriculum, (...) the focus that is going to guide all that have been discussed so far. (...) but I can't see, I don't think that this transversality addressed [in the curriculum] is going to be actually accomplished. ( E4)

The strengthening of the correlation between the theoretical and practical contents on occupational health, as well as the correlation between education and knowledge produced in the undergraduate and graduate courses, were highlighted as important aspects to be assessed by the institution being studied. In this regard, the education programs and, mainly the teachers, play an essential role in such recommendations, as one can infer from the following statements:

I feel some difficult when I arrive at the Boarding School, for instance, that we decide to outline the professional's profile. The students fall behind in certain concepts that got lost on the way. In some period. So, we have to better correlate theory and practice. (E2)

The main correlation we have to do with the teaching of occupational health is the correlation with specialization, in the master's and doctor's degree. (E10)

The results showed some divergences of perceptions among the participants, which leads to a reflection regarding the several forms of understanding reality, the teacher-student interaction, the understanding of the teaching-learning process and the philosophy of the curriculum at issue. The perception of reality is mingled with objective (professional qualification and education) and subjective (values, cultures, life histories) data. Thus, the understanding of a research phenomenon, which is correlated with subjective aspects, may be permeated by contradictions. However, we highlight that it is by analyzing such contradictions that better qualitative results are developed in a given investigation ²⁶.

One cannot disregard the fact that the work is dynamic and dialectic, which incorporates in the subjective dimension of the workers⁸, because, in a teacher's work there is, paradoxically, informal and variable elements that show themselves as possibilities the teachers have for handling the task of teaching²⁶.

In teaching, the daily work is marked by a great amount of autonomy, in which the activities are developed according to representations, making the worker's personality a part of the labor process²⁶. Therefore, capturing the teachers' views allows one to follow up the dynamicity of reality and production of knowledge/teaching²⁶.

Regarding the relevance and importance of the occupational health content developed in the undergraduate course, and the manner in which it has been organized in the curriculum, we have identified some contradictory aspects. Among the 12 participating teachers, two of them considered the content to be adequate and given in a systematized manner in the curriculum; five reported that they did not consider it adequate or systematized; one said it is not adequate for the generalist education, although it is systematized in the curriculum; and four of them said it is adequate, even though it is not systematized.

Higher education has been challenged to break with paradigms towards an education with social relevance. We point out to the use of active teaching-learning methods considering the work in the health area as an axis supporting the activities; as well as to the integration between teaching and the health services, in order to improve comprehensive health care²⁷.

Higher education should be concerned about the global education of the professional, by integrating and fostering a relationship between the parts and the whole, and vice-versa, providing the development of skills that allow one to assess and discern for them to understand or change the reality in which they are inserted. Therefore, is not up to the undergraduate course educating specialized nurses²⁸.

Based on the statements by the teachers, some recommendations have arisen, such as: improved operationalization of the school curriculum aiming to strengthen, consolidate and systematize the teaching of occupational health; however, without the intention of educating a specialist in the area.

We highlight the dynamism that involves the curriculum frameworks of higher education institutions (IES), which is connected to the characteristics of the world in which we live, marked by constant political, economic, cultural and religious changes that have effects on education, breaking with paradigms that are rooted in the educational contexts²⁹. In this regard, the emphasis made by the teacher on the need of the curriculum being constantly reviewed and reassessed is relevant.

At the school at issue, there was a curriculum follow-up committee that held biweekly meetings in order to assess the operationalization of the curriculum and promote pedagogical qualification workshops. By analyzing the documents from such meetings, one can infer the issue of not leaving it to "crystallize", associated to the view of the group of teachers on the issue of the increasingly changing "live curriculum", which evidences that their statements, the investigated documents and the related literature are quite similar to one another^1,3,12.

Other suggestions were made, such as the need of a transversal content in the curriculum and deeper discussion on the theme, from the theoretical and practical point of view. Thus, the transversality of the occupational health field was considered as an excellent strategy for conducting such content, fostering the integration of the knowledge of the different areas with the aspects of the world of employment and contributing to the continued approach of such theme over the undergraduate course, as well as allowing for systematic development.

Considering that the transversal themes are educational contents that, even when they are not directly related to the courses, they show particulars that are common among all of them³⁰, the theme occupational health in the undergraduate nursing course can be apprehended as a transversal curricular content, ensuring the relevance in permeating the entire curriculum, assisting the professional actions, irrespective of the specialty of nursing care¹². Thus, it is indispensable to give thought to the limit existing between the generalist and specialist education in this field of knowledge.

Corroborating the foregoing, the directives and bases of the nurse curriculum framework determine that the undergraduate course structure must guarantee the correlation among teaching, research and extension, ensuring a critical, thoughtful and creative education³¹.

CONCLUSION

Contradictions permeate the development of the teaching of occupational health in undergraduate nursing courses, and represent distinct views of the teaching-learning process, showing that the professional's education process is impregnated with subjective and objective conceptions of the teachers, resulting in dialectic views on a same phenomenon. Such dialectics is relevant, as it induces changes that may result in achieving better quality education for a certain historic and social time.

In the view of the participants, a contradictory point regarding the subject matter of this study was determining whether the teaching of occupational health is systematized over the undergraduate course or it takes place in a manner that is little connected to the political-pedagogical project, due regard being given to the education theory upon which it is based, the mission of the institution, the nurse profile expected to be achieved, the teaching method adopted and the logic of developing the curriculum into area and subareas.

The contradictory views on such matter recommend that the teachers discuss the curriculum philosophy, reviewing some points that need to be changed or strengthened in this project, seeking to organize and adjust the content to the epidemiologic and social requirements, as well as educating a professional who critically assesses the health and labor context in which they are inserted.

The content about occupational health is valued and deemed as necessary to the nurse's education; however, there are different views of it, which requires some discussion among the teachers on the nurse's generalist and specialist education. Considering the generalist education, the proposal of such content being made transversal in the curriculum framework was evidenced, as it contributes to wider and interdisciplinary view on the individual and his/her health.

Such recommendations seek to elect contents that are more appropriate to educate the nurse on the knowledge related to occupational health, considering, above all, the political-pedagogical project of the course and the National Curricular Directives (DCN) for nursing. Thus, it is necessary to collectively discuss the correlation between knowledge and practices and the increased presence of the undergraduate student in the health services.

As a limiting aspect of this study, we call attention to the fact that such curriculum is distinct from most undergraduate nursing courses existing in Brazil; hence, the results shown here have some vulnerabilities to be generalized in other pedagogical realities.

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