REVIEW ARTICLES

Critical nursing education: repercussions on State University of Rio de Janeiro

ABSTRACT: This is a integrative literature review whose object was the political-pedagogic Project of the Nursing Education Curriculum of State University of Rio de Janeiro (UERJ). Objectives were identify and discuss knowledge areas and themes and political-pedagogics’ principles published by the Faculty`s teachers and other authors in scientific journals. Integrative review was carried on from online scientific databases about Nursing, using the keywords nursing and UERJ. Exclusion criteria were applied, and 17 papers were analyzed, based on thematic content analysis methodology. Results were organized in themes, and the most relevant principles were interdisciplinary integration, theory-practice relationship and professional education as a social practice. We conclude that this pedagogic proposal preserve original principles defined on it`s implementation.

Keywords: Nursing; political pedagogic project; curriculum; nursing education.

INTRODUCTION

As participant teachers in the implementation of the proposed changes in the process of nursing education at the Faculty of Nursing at the State University of Rio de Janeiro (FENF / UERJ) followed several papers being presented at scientific meetings about the repercussions of the institutional political-pedagogical project (PPP). In the 16 years of its implementation, the curiosity about these effects made ​​us seek scientific literature on the PPP FENF / UERJ disclosed in scientific publications, making it the object of this research. This curiosity arose and became the guiding question for this study: What aspects of the PPP the institution have been reported in published studies? We set as our aims: identify areas of knowledge, themes and political-pedagogical principles related to the PPP FENF UERJ disclosed in scientific publications. The relevance of this study expressed the need to diagnose the effects of the implementation of the PPP FENF / UERJ to subsidize adjustments in the educational process.

THEORETICAL FRAMEWORK

FENF / UERJ in 1996 implemented its current PPP, based on the proposed profile of nurse elaborated in collective discussion between professional bodies and educational institutions in nursing, from which the company proposed changes in political, social and economic contexts, which impacted the health field.
This debate promoted the internal repercussions FENF / UERJ, considering the many dimensions that make up a political education for nursing education. It involved an inflection on the role of the University in the training of teachers and students, the expansion and deepening of cultural horizons and humans, training them in the culture of reflection and criticism in various aspects of society¹.

In addition to this role of the University, we also considered inherent aspects of the work in health and nursing, of multidisciplinary nature, involving various forms of organization. With regards to work, nursing has been marked by a Taylorist organization, with a technical division in three categories and specific conditions of varied work, in public health and hospital care, including the provision of services in the public and private sector, between the regions of the country².

In the PPP FENF / UERJ, the mission set by the social body includes the concepts of man, society, health and nursing expressing the commitment to training nurses citizens, levels of undergraduate and graduate programs through teaching, research and extension. This training not only considers the technical aspect, but the social, political aspects as well, among others, so that it adopts positions on life and the world³.

From this mission, and considering proposals for change in nursing education and the perspective of the social production of health, the collective staff and students defined the nurse to be formed. One hopes that the graduates of the college is committed to life, from ethical principles present in the technical and political dimensions of their action, respecting human rights, tolerance in dealing with differences. Furthermore, it should be able to intervene in the process generating health / illness, with proposal of actions covering the dimensions of its performance (technical, educational, management, policy and knowledge production), resulting in improving the well being of people and preserve the survival of the planet in search for quality of life³.

To meet such a training perspective, the FENF / UERJ elected as one of the conceptual framework of the PPP, a conception of democratic education, to recover the concept and practice of citizenship and allow reflection and criticism on issues involving the quality of life⁴.

In the field of Critical Theory, the categories of totality, critical, dialectical theory and practice is its main fundamentals⁵. These fundamentals are related to education and are reflected in the conceptions of curriculum and pedagogy chosen. From this emancipatory educational process, it is expected that future nurses develop critical reading relating to the conditions and relations of production of its existence, the people who will care and the profession itself⁶.

Having this perspective of education as a foundation, the FENF / UERJ curriculum considered as a historical and social construction, with space for expression of relationships with social structure, culture, power and ideology. We chose to structure it in an integrated way, which tries to overcome the dichotomy between basic cycle and professional looking and interdisciplinary approach between theory and practice of content that support the action of the nurse in order to articulate the school to work and the community⁷. The curriculum is presented in three areas. The Assistance is divided into five subareas, which presents the theoretical and practical content related to nursing in direct care health. The Core is subdivided into four sub areas where the expertise offered structured the exercise of nursing care. The third area called Biological and Social Bases of Nursing is composed of materials that made up the old basic cycle. The key areas and biological and social bases are distributed across curriculum as the demand for knowledge of the attendance area.

The Emancipatory Education was the choice of a path to achieving a critical, dialectical and dialogical education. This design seeks the approximation theory with historical reality and encourages students to reflect on the problems and needs, with a critical reading of issues that relate to the practice of nursing and health³.

METODOLOGY

It is an exploratory study in which we seek the expertise of various situations and relationships involving social, political, economic and other aspects of human behavior, both individual and in groups and more complex communities, as is the case of university. This training area is imbued with meanings and intencionationalities⁸ which justifies the qualitative approach.

Considering the object of research, we chose to use an integrative review, since it is possible to compile the current knowledge regarding a specific topic, which is held on the identification, analysis and systematization of results^9-11. This study was done from published references and databases available online.

The survey data was made in the Virtual Health Library (VHL) in its various components, such as search in space electronics, in September 2011, in two stages. Because it is a Brazilian institution, the first time we decided to search for articles written in Portuguese, considering the descriptors curriculum AND college AND nursing AND UERJ. 10 articles have appeared in online databases: Database of Nursing (BDENF), Scientific Electronic Library Online (SciELO) and Latin American and Caribbean Health Sciences (LILACS). After analysis, we delimited a set of seven articles.

In a second step, we extended the search using only the descriptors college AND nursing AND UERJ in databases described above and also in VHL salud + Google scholar, totaling 187 articles. Reading the abstracts, we noticed that most articles were related to curriculum and nursing, but not the FENF / UERJ or published in the Journal of Nursing UERJ without being related to the theme. Of these, 23 articles were read in full. We selected 17 directly related to the object of study^4,12-27.

A thematic analysis was conducted on articles, with a search of themes, from the meanings contained in the texts examined. After the selection and arrangement thereof on the pre-analysis, we performed an analytical description, emphasizing the content based on the theoretical references. In this step, the themes emerged, which were coded, classified and grouped into categories such as: knowledge areas / themes and political principles and pedagogical PPP. Finally, the referential interpretation led to the relationship between the object of analysis and the broader context, producing reflections and / or new knowledge⁸.

RESULTS AND DISCUSSION

The choice of a pedagogical approach based on critical education - expressed in the integrated curriculum, teaching methodology and problem-learning diagnostic assessment - requires a constant analysis and evaluation on the development of this project, which is important in identifying evidence of consistency between what was planned and implemented - the dialectical relationship between theory and practice⁷.

The scientific production examined was organized in descending order of publication, noting the time frame between 1997 and 2011, as shown in Figure 1.

The results of the impact of the implementation of the PPP FENF / UERJ were considered on the basis of human development and technical proposal in accordance with the social practice that the nurse develops in society. The reports were made by teachers and scholars from graduation, post graduation and advisors, as well as board members, coordinating graduation and internship and monitoring committee curriculum.

Knowledge areas and most discussed topics with emphasized aspects

In this first theme category, certain aspects stand out among areas and subjects as shown in Figure 2.

The construction of the institution^4,12-14 of the PPP was the biggest single issue. No description from the initial movements outside the college that supported the development of a national proposal for the training of nurses to the internal movement with changes made ​​based on the principles and concepts that underpin the critical perspective of Education. Internal to this, there is an emphasis on redesigning the curriculum, presenting advantages and difficulties in the change process.

From the implementation of the PPP, reflections on teaching methodology were frequently presented^15-18. A study analyzes the convergence-care education from extension project through problem-shop for tickets in the various courses of the UERJ Academic Initiation Program (PROINICIAR). We sought to reflect on healthy habits, based on the concepts of vulnerability and resilience. For these students, the workshop reflected the expansion of knowledge and experience on healthy living and development of skills to take care of one, knowing one better. Students evaluated the methodology as a facilitator in the learning process¹⁵.

The project Living Experiences aims to broaden students' interpersonal skills in order to cope with healthier life events and daily life and their professional self and contribute to the understanding of nursing care as a human act. The methodology developed in it has been evaluated by students at boarding school (final two periods of the course). They claim that by participating in the activities of the project enabled the development of self-knowledge, the behavior of care, recognition of limits, of attitudes of self-acceptance, behavior and empathic listening sensitively¹⁶.

A research conducted with the students during the internship interpersonal characterized relationships as follows: student / teacher, student and individual served; students and multidisciplinary team. It was observed that through the training process, the students develop ethical relationships and mutual respect, from the expansion of the capacity for dialogue, differences of perception and positioning of critical and reflective of their action in a more mature way, enabled by methodology, featuring the same time as the profession¹⁷.

The recognition of the educational dimension of nursing work as an expression of living labor, which occurs in the relations between subjects - professional and individual or community to be served, presents the popular education and health (EPS) as a field of ideas that supports overcoming asymmetry in the relationship between health professionals and individual or collective. Educational activities, using the theoretical and methodological EPS - the same as the PPP FENF / UERJ - also stand as a space in which the nursing staff can perform deeper analysis on the conditions and ways of living and health production . It expands the vision of their own work process, overcoming a one-sided view of domestication and health services. This methodology has been implemented through an extension project¹⁸.

The teachers of women's health have the option of de-medicalization of women health care in nursing education^19-21 from the medicalization of teachers, curriculum (by changing the content and practices) and the students themselves. This option for overcoming the biomedical model of care of women, resonated with the implementation of extension project in midwifery prenatal care to low risk development of educational and charitable services. The change resulted in technical and political partnership with the Municipal Health Secretariat of Rio de Janeiro (SMS / RJ), with development of specialized course for nurses working in maternity services and basic health units, as well as advice for creating and implementation of the Birth Center. These services have been practice fields for students to date, as well as research and continuing education.

The reorganization of the subarea Research with content expansion and workload, became a research tool applicable in training and professional life. Teachers report greater student interest in participating in research groups, extension projects, as well as events that may disclose the results of these studies, not limited to the preparation of the thesis course²². This purpose is confirmed in the participation of scholars extension projects in research activity as subjects of the project after developing other research on educational activities implemented by them. For these students, it was an opportunity to expand the development of the skills acquired by research and educational activities, such as dimensions of the action of the nurse²³.

The decision to organize as an area of ​​expertise in mental health, rather than psychiatric nursing, demonstrates the option of teachers by paradigm shift²⁴. This option has consolidated the integration of theoretical and practical content of this subarea care in seven of the nine periods that make up the structure of the curriculum FENF / UERJ, taking as its starting point the theoretical and practical contents of the other four sub-areas that make up the Area Assistance. There insertion of drugs in this subarea theme throughout its length, relating to the content it contains, with specific strategies approach.

A research conducted on teachers' conceptions of the FENF / UERJ on the topic held in masters degree, identified that they have no specific training in drug phenomenon, and their knowledge acquired throughout their career. As for the design, they perceive concepts in macro and micro determinants of the use / abuse of drugs, strongly influenced by political and socioeconomic contexts²⁵.

In assessing the relationship between training of graduates and the working world, it appeared the following categories: employment, monthly income, course of post graduation, area of acting, way of acting in the professional world of work and achievement or no development of work as a nurse. The graduates evaluated that training has allowed to be agents of change in the labor room, despite that the conditions of work and wages are not very satisfactory. The graduates showed capacity for reflection and critical analysis of the context^26,27.

Political and pedagogical principles of PPP

In the second thematic category, the studies reflect on the implementation of the principles that underpin the institution of PPP. The collective construction of this project resulted in understanding the entire curriculum built from the analysis of the social, health and nursing reality^4,12-17,19.

The organization of the curriculum and content conform the interdisciplinarity perceived by academics. Studies confirm the integration of theory and practice with teaching strategies that articulate with the service through agreements with SMS / RJ and inclusion in health units UERJ, as well as the creation of extension projects bringing together the academic community with seeking care in these services, promoting the integration of knowledge and practice^{4,12-18,20-27}.

Understanding Emancipatory Education for teachers and students has enabled developing skills for critical analysis of reality and reflections on the determinations of the disease process, with proposals for intervention accompanied by ethical attitudes and empathic in relational processes^{4,15-19,21,22,24}.

The quest to overcome the dichotomy between thinking and doing in health has been the purpose of the PPP FENF / UERJ, through the integration of the teaching, research and extension. The coherence between the participatory process experienced in the preparation of this project with the principles described in the PPP itself reinforces the purpose in developing a critical pedagogical praxis³. This option demands from the group a process of change that is gradual and has doubts, resistance, conflicts, perceived procedural evaluation performed by the monitoring committee curriculum that develops this work to the present day. Published studies indicate understanding of teachers on the principles of the PPP and its implementation in everyday classroom and curriculum, advocated in view of a proposal dialectical view of the training process. Reflect the institution's responsibility to prepare people in a precaution which is relevant socially speaking - health²⁸.

The political dimension of the PPP is also perceived in teacher participation in open debate on the role of nurses in the field of obstetrics and mental health in relation to alcohol and other drugs, as a result of partnership with the Inter for the Control of Drug Abuse of the Organization of American States (CICAD / OAS) 29.

These results are compatible with the profile of nurse offered by the institution, meeting the national curriculum guidelines for nursing, regarding the SUS as context and learning scenario, the paradigm of health promotion as a model of attention and the development of skills and attitudes in the relationship of care³⁰. The institution's mission is strengthened by showing that the choice made ​​by the social body's FENF / UERJ for training in critical perspective has reached its purpose3 affecting the world of work^26,27.

CONCLUSION

The results allowed us to identify areas of knowledge, themes and political-pedagogical principles related to the PPP FENF UERJ disclosed in scientific publications, such as designing training and education, mental health, research, women's health, and work and egress care. In all these relations were established with the principles of wholeness, interdisciplinarity and dialectics, which support the PPP.

The results reported in this study describe a particular reality of PPP's FENF / UERJ, which indicates its limit, it is not possible to generalize the findings to other projects of educational institutions, due to different interpretations of the DCN institutional nursing. However, this review subsidizes the evaluation process of the impact of curriculum performed.

Recognizing that several subareas have not released experiences or assessment on the impact of the PPP FENF / UERJ or relationship-job training, we recommend the continuation of analyzes and assessments for critical reflection on the vitality of it.

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