Evaluation of nursing education according to the perception of ex-students

Abstracts

OBJETIVO: Apreender a percepção de egressos de um curso de graduação em Enfermagem sobre o processo de sua formação, frente às demandas que vivenciamos no cotidiano profissional para subsidiar a reformulação pedagógica do curso. MÉTODOS: Trata-se de uma pesquisa de abordagem qualitativa e o método adotado foi o Estudo de Caso. Foram entrevistados 32 enfermeiros egressos do ano de 2003 e foi utilizada a análise de conteúdo segundo Bardin. RESULTADOS: Resgataram-se cinco categorias, donde se depreende que o programa de ensino deve reforçar o desenvolvimento de competências ético-políticas; contextualizar-se segundo as políticas públicas de saúde; promover pesquisas vinculadas às demandas de saúde da comunidade; considerar a interdisciplinaridade na distribuição de conteúdos e carga horária e reforçar a formação de competências específicas, principalmente, as relacionadas à gestão em enfermagem. CONCLUSÃO: Este estudo permitiu identificar aspectos do processo formativo que interferem no cotidiano de trabalho de enfermeiros e merecem ser considerados na reestruturação dos Projetos Político Pedagógicos.

Educação em enfermagem; Pesquisa em avaliação de enfermagem; Formação profissional

ORIGINAL ARTICLE

Evaluation of nursing education according to the perception of ex-students^*

Evaluación de la formación de enfermeros según la percepción de egresados

Maria Dyrce Dias Meira^I; Paulina Kurcgant^II

^IRN, M.Sc, professor at the Nursing Course at Centro Universitário Adventista de São Paulo - UNASP – São Paulo, (SP), Brazil

^IIFull Professor at the Nursing Graduate Program at Escola de Enfermagem, Universidade de São Paulo - USP - São Paulo, (SP), Brasil

Corresponding Author

ABSTRACT

OBJECTIVE: Apprehending the perception of ex-students from a Nursing undergraduate course about their educational process in view of the demands they experience in daily professional routine, in order to support the pedagogic reformulation of the course.

METHODS: This is a qualitative research, and the Case Study method was adopted. Thirty-two nurses were interviewed, all of them graduated in 2003, and Bardin's content analysis was used.

RESULTS: The interview yielded five categories, from which it is observed that the educational program should reinforce the development of ethical-political competences; contextualizing itself according to public healthcare policies; promoting research linked to the healthcare demands of the community; considering interdisciplinary aspects in the distribution of contents and hour load, and reinforcing the development of specific competences, especially those related to nursing management.

CONCLUSION: This study allowed for the identification of aspects of the educational process that interfere in the professional routine and deserve to be considered in the restructuration of Political-Pedagogical Processes.

Keywords: Education in nursing; Nursing evaluation research; Professional formation

RESUMEN

OBJETIVO: Aprender la percepción de egresados de un curso de pregrado en Enfermería sobre el proceso de su formación, frente a las demandas vivenciadas en el cotidiano profesional, para auxiliar la reformulación pedagógica del curso.

MÉTODOS: Se trata de una investigación de abordaje cualitativo cuyo método adoptado fue el Estudio de Caso. Fueron entrevistados 32 enfermeros egresados en el año 2003, utilizándose el análisis de contenido según Bardin.

RESULTADOS: Se rescataron cinco categorías, concluyéndose que el programa de enseñanza debe reforzar el desarrollo de competencias ético-políticas; contextualizar de acuerdo a las políticas públicas de salud; promover investigaciones vinculadas a las demandas de salud de la comunidad; considerar la interdisciplinaridad en la distribución de contenidos y carga horaria y reforzar la formación de competencias específicas, principalmente, las relacionadas a la gestión en enfermería.

CONCLUSIÓN: Este estudio permitió identificar aspectos del proceso formativo que interfieren en el cotidiano del trabajo de enfermeros y que merecen ser considerados en la reestructuración de los Proyectos Político Pedagógicos.

Descriptores: Educación en enfermería; Investigación en evaluación de enfermería; Formación profesional

INTRODUCTION

The National Curricular Guidelines – Diretrizes Curriculares Nacionais (DCN)⁽¹⁾ for undergraduate nursing courses guide nursing education to cover the acquisition of competences and skills, considering the epidemiological situation of the country/region. As such, education contemplates the DCN⁽¹⁾ when it proposes that nursing education be linked to community demands, which forces higher education institutions – Instituições de Ensino Superior (IES) – to build or reorganize their political-pedagogical projects (PPP) as a permanent process of discussion of educational practices, concerns and assumptions.

Ex-students from nursing undergraduate courses have to face complex situations during their work routine, which leads them to confront the competences developed during the course with those required by professional practice. From this experience, they can assess the adequacy of the pedagogic structure of the course they took, and also suggest changes that can intervene in this process to improve the results of their academic education, and be capable of responding to the professional necessities. Scholars^(2-3) support the pertinence and contribution of such an evaluation.

With the purpose of widening the borders of the educational evaluation, the National System of Higher Education Evaluation – Sistema Nacional de Avaliação da Educação Superior (SINAES) was proposed in 2004. It proposes the evaluation of courses, institutions and student performance. According to the SINAES, evaluation is a structured activity that aims to verify the quality of the institution and its social responsibility⁽⁴⁾.

Among the ten dimensions contemplated by SINAES, the ninth refers to the "policy towards students and ex-students", and the manual that guides the execution of self-evaluation of the IES, regarding this dimension, has professional insertion of ex-students at its core. It also suggests the following questions as facultative topics:

Are there mechanisms to get to know the opinions of ex-students about the education they received, regarding both the curriculum and ethics? Which are those?

What is the situation of the ex-students? What is the occupation rating among them? Are the occupation and education they received related?⁽⁵⁾

Considering the relevance of the aspects presented, this study aimed to apprehend the perception of ex-students from a Nursing undergraduate course about their education, in view of the demands they experience in their daily routine, to support the reformulation of the pedagogic proposal of the course.

METHODS

This is a descriptive-exploratory qualitative research. The Case Study method was used with different purposes in the scope of qualitative research, highlighting the exploration of real-life situations, whose limits or outlines are not clearly perceived⁽⁶⁾.

The research has the educational process of ex-students of the Nursing Course in a private, confessional and philanthropic university as its case-unit, focusing on the class of 2003. In their education, these nurses experienced the curriculum adopted before the one adopted by the new National Curricular Guidelines and, at the moment of data collection for this research, were inserted in the job market in the city of São Paulo or nearby cities.

Thirty-two students, graduated in 2003, took part in the study, contacted from a roster provided by the coordination of the course. The interviews were scheduled at a time and place convenient for the subjects. The project was approved by the Review Board at Escola de Enfermagem da Universidade de São Paulo (file #4872005). Data collection started after the signature of the term of consent. The subjects were identified by codes, from E₁ to E₃₂, in order to preserve their anonymity. A semi-structured interview was used as the data collection instrument, with the purpose of characterizing the subjects, the context related to their professional activity; the perception of their educational process and suggestions for improving the curriculum of the nursing course used as the setting for this study.

The collected data were submitted to content analysis according to Bardin, which yielded five categories with their respective units of meaning extracted from the ex-students' testimonies, presented in Chart 1.

Considering the research goals, the categories were analyzed according to the thematic reference of the pedagogic approaches, the course's DCN and PPP, which confers a singular meaning to each of them.

RESULTS

The purpose of the subjects' characterization was to know the interviewees' profile, so as to contextualize the analysis of the data.

Of the 32 subjects in the study, nine were male, mostly between 27 and 31 years old; 23 were female, mostly between 23 and 30 years old; 18 were nursing technicians or auxiliaries before graduation; 26 were taking "lato sensu" graduate courses and one of them had started a master's degree program. Regarding their professional field, the prevalent characteristic was the insertion of the ex-students in public and private hospital institutions (26), followed by public healthcare services, particularly the Family Health Program (15); teaching in technical courses (14) and university education (2). Most respondents (25) reported having experienced working in more than one workplace and, of these, eight assumed management positions.

The base of the analysis of the interviews was the profile of the ex-student, as recommended by DCN, yielding five categories with their respective units of meaning – Unidades de Significado (US), acquired from the ex-students' testimonies and presented in Chart 1.

DISCUSSION

The ex-students' testimonies (Chart 1), which were considered relevant because they reinforced the trends of teaching significant for professional training and permitted a closer look at this theme, stand out since they allow for the comprehension of reality.

Regarding competency development, the categories allowed for their identification in the technical-scientific, social-educational and ethical-political scopes; the ability to identify and intervene in health-disease situations and the ability to recognize and act in different healthcare settings^**.

In this sense, the theoretical base is considered fundamentally important for the beginning of professional activity, as well as the generalist education, recommended by the DCN, which is also presented as a highly relevant facilitating aspect.

The elements the ex-students considered as difficulties to perform the necessary technical-scientific competences for professional activity are diversified, and point to deficiencies related to the work, care, management and research processes, in the hospital setting and in Public Health, in Basic Healthcare Units – Unidade Básica de Saúde (UBS) and Family Healthcare – Programs Programa de Saúde da Família (PSF).

"Teaching, learning and researching" articulate with the two moments of the gnosiologic cycle: when one teaches and when one learns⁽⁸⁾.

Ex-students are coherent with the current trends of public healthcare policies when they suggest an educational program that prioritizes the development of technical-scientific competences in the public health area, and that the theory/practice relation be given its due importance.

The critical reflection about the practice should become a "demand of the theory/practice relation. Otherwise, theory may become gibberish and practice may become activism"⁽⁸⁾.

On the other hand, teaching social-educational competences involves the ability to act and promote social responsibility and commitment with citizenship; reflecting and promoting reflection and transformation of reality, and encouraging and promoting conditions for continuous learning^**.

The educational program should present the contribution of the course in the development of social-educational competences clearly and consistently. Knowing how to deal with patients is one of the main attributes of a good nurse. Second, and equally important, the ex-students recognize the relation with the multidisciplinary team as fundamental.

The complexity of the human condition cannot be apprehended while dissociated from its constituent elements, which include community involvement. This causes a feeling of belonging and social responsibility in the student. The role of education is to act towards the preservation of the "unit" of the human species, without allowing the idea of "diversity" to fade away and, still, understand that comprehending the "other" is also learning and re-learning incessantly, since comprehension is a means and an end for human communication.

Investments to stimulate the student to seek forms of knowledge advancement through research, supporting and consolidating the development of autonomy, and the consequent performance of social-educational competences should be one of the axes of professional education in the healthcare area.

As for education in ethical-political competences, which assumes the ability to construct the work processes collectively; deciding ethically, valuing solidarity; listening and sharing decisions and managing conflicts, identifying its determiners^**. Ethical education is considered indispensable, because "it is not possible to visualize human beings far from ethics or even outside it"⁽⁸⁾.

Ex-students were also shown to appreciate how the college prioritized the conveying of values, based on "Christian ethics" and supported by the philosophy that orients the pedagogy of confessional schools. Teaching values is the axiology that should permeate the school curriculum and influence a life coherent with the basic principles of Christian ethics, valuating the human being as a community member, with responsibilities and rights towards the environment, family and life⁽⁹⁾.

Ethical-moral competences should guide the educational process and permeate every action in the construction of competences⁽¹⁰⁾.

Although they recognize that the technical, ethical and political dimensions overlap⁽¹¹⁾, the ex-students refer to difficulties essentially related to the "political" aspects of professional exercise, especially regarding knowledge of government and institutional laws about the rights of the professional team. The students often graduate without even knowing their rights, nor their team's rights. According to the ex-students, this should be a prerogative of the college.

The school accomplishes its political mission when it prepares the citizen for life in the "polis" through educational practices, and for the comprehension of the social wholeness one is inserted in⁽¹²⁾.

Regarding the constituent elements of the educational process, which comprehend, a priori, the institution, it is important to observe that the teacher and the student are highlighted as factors that substantially direct the development of college education⁽¹³⁾.

The university is a space for decision-making where several "vectors" influence the results. The existing relations between these vectors and the complexity that permeates these relations are the basic dimensions that determine effective education⁽¹³⁾.

The answers highlight the importance the ex-students attribute to the "good name" attained by the college in the job market and the society in general, and attribute an importance to this "good name" that goes beyond pedagogic influence, as if simply by studying at that institution were an important differential by itself.

"There is an undeniable pedagogic aspect in the materiality of the space destined to education", where the teacher and the student play differentiated and integrated roles in the educational setting. "My fundamental role (as a professor) is to contribute positively for the students to become the crafters of their own education, helped by the educator"⁽⁸⁾.

Regarding the elements that constitute the educational program, it is assumed that college education, in order to be effective, should comprehend the weaving of several factors described as structural axes of educational action, delimited by a double reference space: one internal, known as the university world, formed by the institution, the faculty, the students and the curriculum; and another external, corresponding to the many dynamics affecting the University functioning, such as policies for college education, advances of science, culture and research, and also the demands of the job market⁽¹³⁾.

A predominantly educational evaluation should focus on learning, because "when the student notices the teacher's interest in promoting learning by evaluating, the educational process is established in a Socratic complicity"⁽¹⁴⁾.

The ex-students also suggest, very significantly, the issue of interdisciplinarity, mentioning that the student is not able to establish the necessary links for the comprehension of the whole, which is indispensable for the education of the nurse.

Lack of student autonomy is another aspect that interferes negatively in education, which is aggravated by the conduct of some professors who restrict the opportunities of Clinical Education practice to "basic care", to the detriment of other practices considered essential for nursing education.

Increasing the study hours related to practical education, which should make up 20% of the total hour load of the course assigned to Supervised Curricular Training⁽¹⁾, reinforces the importance of an educational program prioritizing learning that is not dissociated from practice.

The predominance of a hospital-centered education is an aspect that evidences the lack of synchronicity between the educational programs and the context of the Single Health System - Sistema Único de Saúde (SUS), as well as the direction of public healthcare policies. The schools should incorporate the principles of the SUS as a guideline of the educational process, focusing on bringing it closer to professional practice⁽¹⁰⁾.

Research and scientific initiation programs should be encouraged during undergraduate programs, as a full component of the curriculum. Inserting research as a solid curricular component, inseparable from education, is a challenge for undergraduate courses in Brazil. For the student to acquire the research process as a significant learning element, it is necessary that the professors also be researchers and that they "lead their students, as it is done within the professorship, to an atmosphere of investigation, which makes them acquire knowledge and re-elaborate it, aiming at comprehending their social place critically"⁽¹⁵⁾.

An expressive point in the testimonies is the necessity to improve nursing management education in terms of course length and the distribution and furthering of contents.

The importance of better education in this area is supported by the DCN, which, by determining the general competences for nursing education, favor those related to knowledge stemming from the Management sciences, such as decision-making, communication, leadership and management⁽¹⁾.

FINAL CONSIDERATIONS

The analysis of the ex-students' testimonials made it possible to reflect about the theoretical-practical conceptions related to the educational process they experienced due to the demands of their professional nursing routine. These reflections are excerpts from reality, which show the difficulties faced every day by the ex-students and attributed to the deficiencies of the educational proposals.

Among the fragilities noted, the ex-students register the education of a critical-reflective professional as an unaccomplished goal, as opposed to the recommendations of the course PPP. This perception is evident in the testimonies of some ex-students, as well as in the statements of managers who receive nurses from this college, as seen in a previous study⁽¹⁶⁾. This probably happens because of the debility identified in the ex-students and the focus on political and social aspects of the nursing education management.

Regarding the curriculum, the course favors the hospital-centered healthcare model, which is at odds with the recommendations of the DCN. The ex-students suggest strengthening the interdisciplinary practices and they note the necessity to "optimize" the distribution of contents and the hour load of the courses focusing on administrative competences.

In agreement with the significant aspects of the teaching-learning process that are defended by the scholars who study reflexive educational practice, it is perceived that, when the students are brought closer to the professional reality, they are offered conditions that will generate consistent learning, capable of mobilizing them to seek out new knowledge in a contextualized perspective, and to consolidate their undergraduate learning.

Among the contributions this research brought for the revision of the PPP of Nursing Courses, which was the setting of this study, the need for education focused on the development of ethical-political competences is noted; it should be contextualized according to public healthcare policies, planned and executed through research and university extension projects, and it should meet the healthcare demands of the community. Still, as PPP addenda, related to the constructive elements of the educational process, the ex-students' feelings of pride regarding the university and of gratitude and friendship with the teachers, who were the protagonists of the educational process experienced.

As a contribution of this study, the importance of Higher Education Institutions should also be encouraged, with a view to valuing and validating an evaluation policy that would include the participation of ex-students, since educational practice is only consolidated in daily professional reality.

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*

Dissertação apresentada ao Programa de Pós-Graduação em Enfermagem da Escola de Enfermagem da Universidade de São Paulo, (Departamento de Orientação Profissional) em 24/05/2007.

**

Kurcgant P. A profissão Enfermagem. O profissional Enfermeiro. Palestra ministrada no Curso de Enfermagem do Centro Universitário Adventista de São Paulo. São Paulo: 2006.

Publication Dates

• Publication in this collection
  13 Jan 2009
• Date of issue
  2008

History

• Received
  22 Aug 2007
• Accepted
  26 Oct 2007