RESEARCH ARTICLES

Program of Education through Work (PET) in Healthcare: linkage between qualification and integration of teaching and work

Jaime Everardo Platner Cezario^I; Donizete Vago Daher^II; Marja Ferreira Soares Nolasco^III

^I Nurse. Master degree in Pedagogical Qualification in Health by the Professional Master in Health Education of Aurora de Afonso Costa Nursing School, Federal University Fluminense. Niterói, Rio de Janeiro, Brazil. E-mail: shovegan@yahoo.com.br
^II Nurse. Associate Professor at Aurora de Afonso Costa Nursing School, Federal University Fluminense. Niterói, Rio de Janeiro, Brazil. E-mail: donizete@predialnet.com.br
^III Nurse. Master degree student of the Academic Program Health Care Science at Aurora de Afonso Costa Nursing School. Federal University Fluminense. Niterói, Rio de Janeiro, Brazil. E-mail: marjafs@hotmail.com

DOI: http://dx.doi.org/10.12957/reuerj.2015.7979

ABSTRACT

The aim of this qualitative, descriptive study was to identify how scholarship students and tutors of the Program of Education through Work (PET) in Health perceived the integration between teaching and work (IES) in the training process, and to examine how this program contributed to the health professionals' training. Data were collected between 2010 and 2012 by observation and interviews of the 16 participating tutors and scholarship students at healthcare facilities in Niterói. Our thematic analysis generated two categories: IES is essential to training in healthcare; and training in healthcare and the challenging process of building IES. Matches and mismatches between practice and theory were reported as if the dissociation formed part of an established culture. It was concluded that the program activities offered opportunities for building and rebuilding knowledge and practices.

Keywords: Training; PET-health; teaching-healthcare integration services; nursing.

INTRODUCTION

Studies about the process of health professional training are having significant space in debates, especially after the implementation of the Unified Health System (SUS), of the National Curricular Guidelines (DCN) and after the implementation of the Family Health Strategy (ESF). These investments of the Ministries of Education and Health have been instituted to redirect the care model to the current health and reorient health education practices. Thus, when addressing reflections promoted by health care courses, it was noticed that it is normal by teachers as by students the disconnect posture with the environment in which they are performing the practical training.

It seems that the primary health unit (UPS), the support network of SUS, is understood as a space for presentation and observed no interconnection required the teaching-learning process. At the same time, there is also resistance by the service professional, denying to be part of this training process.

In this sense, there are distances detected of all involved, contributing to the election of the object of teaching-service integration (IES) in the health professional training through the Education Program through Work for Health (PET-Health).

This study provides subsidies both for teaching, as to stop health services; calling on all involved the reorientation of their knowledge and practices.

The question elected was: What is the perception of scholarship students and tutors, participants of PET-Health, on the training process and the possibilities of IES?

The objectives of the study are: To identify the perceptions of scholarship students and tutors of PET-Health Project of the IES in the training process; and analyze the PET-Health´s contribution in the health professionals training.

LITERATURE REVIEW

The disarticulation between theory and practice in health education processes is a reality in Brazil and could be mitigated by effective IES; uniting teachers, students and health professionals with the central focus on the patient, and also investment in raising awareness of the participants entered in scenarios where they develop care and the teaching and learning process^1:358.

The theme of IES indicates that, despite innovative proposals to promote oriented training for the implementation of the principles and guidelines of SUS, we experienced ways to train health professionals generators decontextualized practices, guided by fragmentation of knowledge and practices^1-3.

The partnership between teaching and service must consist of a facilitator process between work, education and health, seeking to reflect on the continuing dichotomy between thinking and doing, between general and specific, integrating actions and theoretical and practical skills^4:378.

In 2007, the Secretary of Labor Management and Health Education (SGTES) established the PET-Health. It was created as a bridge of opportunity between teaching-service-community, PET-Health aims to train teaching-learning groups guided by tutors and allocated in areas considered of special attention to SUS, being a tool for the approximation of public health policies and practice services.

Debates in Brazil have produced efforts to changes in professional training processes, politically embodied in the emergence of several initiatives, highlighting the articulation carried out by the Ministries of Health and Education, manifested in the development of actions such as Incentive Program Curriculum Changes in Medical Schools (PROMED) and the National Program for Reorientation of Vocational Training in Health (PROSAÚDE) and PET-Health. All actions taken by those involved in the programs should result in a professional profile with skills to identify, reduce and/or solve health problems^5-7.

The Federal University Fluminense (UFF) and the Municipal Health Foundation (FMS-Niterói) reaffirmed the partnership aiming

[...] to strengthen mechanisms for cooperation between managers of the local network of health and UFF, expanding learning scenarios; intensifying in training, comprehensive approach to health-disease process and health promotion [...]^8:436.

Thus, it is important to understand how health vocational training is being developed to new demands and theoretical discussions and practices within SUS. The search for overcoming the dichotomy between theory and practice, between thinking and doing in health, has been the subject of reflection of many studies seeking to integrate the perspective of moving towards a more efficient and decisive SUS of the individual and collective needs ^9,10.

In this context, the PET-Health seeks the discussion of IES training and the possibility of approaching training institution with the SUS reality. Its intention is to conduct a study of the new pedagogical training proposals, seeking a balance between technical excellence and social relevance, understood as spaces that contribute to curriculum change movement in more interactive teaching model, in adopting active teaching and learning methods, student-centered as the subject of learning and the teacher as facilitator of knowledge building process¹¹.

METHODOLOGY

The qualitative and descriptive approach was the one best suited to this study. The data collection was carried out through area work carried out in two stages: participant observation and semi-structured individual interview. Participant observation took place at different times, when the researcher was acting in the area, or when he had the opportunity to observe the daily life of the other tutors and fellows in service, during the realization of the PET-Health Project. The interviews after scheduled, took place in spaces chosen by the participants, recorded, transcribed and analyzed separated by themes in three stages: pre-analysis, material exploration and treatment of results, and interpretation¹².

The study subjects chosen randomly were nine graduate students in the health area, from nursing, medicine, nutrition, pharmacy, dentistry and physical education courses; all fellows of PET-Health group/UFF; seven tutors, professionals from different primary care health services in Niterói-RJ, constituting the scenario of this study.

The subjects agreed to participate by signing the Informed Consent Form, ensuring confidentiality regarding the information provided and their identity; meeting in this way, the Resolution 466/2012 of the National Health Council. In this sense, the tutors were identified with the letter P, followed by a number that followed the sequence of respondents and fellows with the letter B, followed by a number and also in interview order, to maintain the anonymity of the participants.

The inclusion criteria established was: Students enrolled in the health graduate courses, students fellows of PET-Health, between 2010 and 2012, who agreed to participate by signing the informed consent from (TCLE); Higher level education professionals in the public health system of the city of Niterói, who participated as tutors/fellows at PET-Health, aware of the purpose of the research and to sign the TCLE. To exclusion criteria, there were: graduate students of health area courses and Niterói municipality professionals who participated in the PET-Health for a period less than three months and those Program´s members who disagreed to participate in the study. Research approved with the number 184,881 by the Ethics Committee of the Faculty of Medicine and the University Hospital Antônio Pedro/UFF.

RESULTS AND DISCUSSION

In order to meet the objectives, the results are presented and analyzed through two core themes outlined below.

The essentiality of IES in health education

When asked about how they understand the IES, participants stressed their essentiality:

The IES is understood as "[...] spaces where there is a dialogue between labor and education and they assume a privileged place to the perception that the student develops about the others in the everyday care" ^1:358. Thus, there are areas of permanent education, construction of professional identity and citizenship, in which service professionals, teachers, members and students are building and establishing their social roles at the confluence of their knowledge, ways of being and seeing the world.

Great credit has been deposited at the IES, as passing instrument of the current design, where "the main consequences of this training model are: the fragmented care production and low capacity for reflection on professional practice"^13:520, for a process who opposes the status quo. Thus, we seek to present a thematic and conceptual approach to the development and strengthening of critical thinking in the training of health professionals.

The PET-Health was defended by participants as an important strategy to work the IES. In this sense, when the possibilities of the program are analyzed, it is emphasized that this can be understood as "an action strategy to contribute to better links between academia and health services"^14:545.

We emphasize that the

[...] practice scenarios for vocational training should be diversified and binders of educational and community facilities, in addition to health facilities, fostering a closer relationship between students and the reality of services^15:41-42.

The formation and construction process of the IES

Encouraged to reflect on the training of health professionals and the experience of this process in their scenarios of practice, study participants expressed in different ways:

Recognizing that there are limitations in the process of training of health professionals, especially the fine participation of services in this process, and that the direction to be taken in the pursuit of scientific and technical excellence means enhancing the perceptions and the knowledge and experience accumulated by professionals services, this living reality in their daily lives, we emphasize that:

[...] The present moment requires adjustments and reinterpretations of professionals and institutions to elect strategies and renewal models consistent with the context. In this sense, [...] the understanding that it is necessary [...] actions in the educational area to enable a breakthrough in the knowledge of work health, recognizing and appreciating the educational potential of the job^16:176.

Each health professional who experience the services, being part of it, and that is heard about his technical knowledge, will print his own conception of IES. By revisiting the process of acquisition of knowledge and that it faces today, the professional can foresee and indicate outputs, even understanding them as challenging.

To intervene in reality,

[...] It is necessary that the sectors of education and health establish close and permanent inter-institutional partnership, aiming to develop joint and coordinated actions for the development and construction of an educational proposal that combines the knowledge produced and accumulated by the two areas. [...]^4:377.

The similarities and differences between theory and practice experienced by the participants, scholars and professionals in their work processes, have been reported with ease and much assurance, as if this dissociation was part of a culture, as formalized as normal, everyday.

Thus, it is necessary to review the training to a new praxis, which transits between the caring, managerial, educator and research of nursing work process, so he can assume his role of articulator in the system, services and health care from the perspective of completeness, the integration of teaching and service¹⁷.

The rapprochement between the different levels of management is one of the tools that favors the IES and the academic, deserving to be constantly stimulated. This attitude contributes to reduce, or perhaps eliminate the strangeness that limit the articulation of integration proposals.

CONCLUSION

This study enabled the recognition of the perception of scholarship students and tutors participating in the PET-Health Program of the IES. The analysis of the reports emerged two thematic categories: The essentiality of IES in health education; and Training in health and construction process of the IES.

The PET-Health is shown as a prime space to work education and IES, in addition to promoting the integration of participants in the community daily, which the project is being developed. Thus, what is constructed, the result of this symbiosis is the possibility of the emergence of a professional in line with the health needs of the population and the implementation of actions that strengthen the health system in Brazil.

A limitation of the study was due to the reduced adherence of the participants of PET-Health in the research, making believe that they see it as timely strategy, whose health activities in partnership cease with the end of the program. We conclude that the IES is an ongoing process that needs programs similar to PET-Health for its effective consolidation.

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