PERCEPTIONS OF THE PEOPLE RECRUITED ABOUT THE STRATEGIC ACTION “O BRASIL CONTA COMIGO” (BRAZIL COUNTS ON ME)

ABSTRACT

Objective:

to analyze the perceptions of academics and supervisors about the strategic action “O Brasil Conta Comigo”(Brazil counts on me).

Method:

cross-sectional study conducted in Mato Grosso do Sul - Brazil, from December 2020 to March 2021, in two stages: 1) Exploratory (quantitative), via analysis of reports of the 33 supervisors and 90 academics convened, application of an online questionnaire; 2) In-depth (qualitative), using the remote focus group technique, with convenience sampling. Descriptive and content analysis was performed.

Results:

the reasons for joining and remaining with the action (scholarship, internship hours, and social responsibility), the pedagogical aspects (training, evaluation, and support from educational institutions, and management), and the contributions of the action (assistance and professional training) were identified.

Conclusion:

the general perceptions of the recruits are positive. Pedagogical aspects related to the evaluation of academics and support from higher education institutions should be reviewed, for more assertive actions in times of health crisis.

DESCRIPTORS:
Higher Education; Unified Health System; COVID-19; Health Human Resource Training; Public Health Systems Research

RESUMO

Objetivo:

analisar as percepções de acadêmicos e supervisores sobre a ação estratégica “O Brasil Conta Comigo”.

Método:

estudo transversal realizado em Mato Grosso do Sul - Brasil, de dezembro de 2020 a março de 2021, em duas etapas: 1) Exploratória (quantitativa), via análise de relatórios dos 33 supervisores e 90 acadêmicos convocados, aplicação de questionário on-line; 2) Profundidade (qualitativa), utilizando a técnica do grupo focal remoto, com amostra por conveniência. Realizada análise descritiva e de conteúdo.

Resultados:

foram identificados os motivos de adesão e permanência à ação (bolsa, horas de estágio e responsabilidade social), os aspectos pedagógicos (capacitação, avaliação e apoio das instituições de ensino e gestão) e as contribuições da ação (assistência e formação profissional).

Conclusão:

as percepções gerais dos recrutados são positivas. Aspectos pedagógicos relacionados à avaliação dos acadêmicos e apoio das instituições de ensino superior devem ser revistos, para ações mais assertivas em momentos de crise sanitária.

DESCRITORES:
Educação Superior; Sistema Único de Saúde; COVID-19; Capacitação de Recursos Humanos em Saúde; Pesquisa em Sistemas de Saúde Pública

RESUMEN

Objetivo:

analizar las percepciones de estudiantes y supervisores sobre la acción estratégica “ El Brasil Cuenta Conmigo”.

Método:

estudio transversal realizado en Mato Grosso do Sul - Brasil, de diciembre de 2020 a marzo de 2021, en dos etapas: 1) Exploratoria (cuantitativa), a través del análisis de los informes de los 33 supervisores y 90 académicos convocados, aplicación de un cuestionario en línea; 2) En profundidad (cualitativa), mediante la técnica de grupo focal a distancia, con muestreo de conveniencia. Se realizó un análisis descriptivo y de contenido.

Resultados:

se identificaron los motivos de adhesión y permanencia a la acción (bolsa, horas de estancia y responsabilidad social), los aspectos pedagógicos (capacitación, aval y apoyo a las instituciones de enseñanza y gestión) y las contribuciones de la acción (asistencia y formación profesional).

Conclusión:

la percepción general de los contratados es positiva. Los aspectos pedagógicos relacionados con la evaluación de los académicos y el apoyo de las instituciones de enseñanza superior deben ser revisados, para que las acciones sean más firmes en momentos de crisis sanitaria.

DESCRIPTORES:
Educación Superior; Sistema Único de Salud; COVID-19; Capacitación de Recursos Humanos en Salud; Investigación em Sistemas de Salud Pública

INTRODUCTION

The pandemic caused by Corona Virus Disease 2019 (COVID-19) started in China, and has spread rapidly around the world, putting pressure on countries to devise strategies to combat the disease.¹ COVID-19 presents itself as a disease of high transmissibility and clinical severity, with different social impacts,² imposing an extra demand on health systems’ structures, inputs, and human resources.³

Around the world, strategies have been developed to optimize the availability of human resources in health services.⁴,⁵ In the UK, for example, more than 65 thousand nurses and 15 thousand doctors who have retired in the last three years have been recruited by the NHS (in English) through the “needs you” campaign. In addition, medical and nursing students in recent years have also been given the opportunity to take on temporary, fully paid roles to further increase the number of active professionals in front of the NHS.⁶

In Brazil, the Brazilian Unified Health System (SUS), even before the emergence of COVID-19, already presented deficiencies in terms of working conditions.⁷ Thus, in view of the pandemic situation, and aiming to ensure care to those affected by the disease, a strategic action called “( Brazil Counts on Me)” was implemented.⁸ This strategic action began in May 2020 and ended in December of the same year and was made operational by the Ministry of Health. More information about this strategy can be found in the notice no. 4, of March 31, 2020, which calls on states, the Federal District, municipalities, and philanthropic health establishments to join the strategic action “(Brazil counts on Me) ⁸”.

This action counted with the exceptional and temporary support of health students aiming to strengthen the fight against the new coronavirus. According to the ordinances that regulated the action, students enrolled in Higher Education Institutions (HEI) attending the fifth and sixth year of medical courses and the last year of undergraduate courses in Nursing, Physiotherapy, and Pharmacy could work, on a voluntary basis, in the services that make up the SUS. Also in this context, the participants were entitled to financial aid, in other words, a scholarship conditioned to a workload, as well as points in residency programs. All students were to be supervised by health professionals in their respective areas.⁸

This measure was criticized by social sectors. ⁹,¹⁰ In an official note, the National Health Council (NHC) stated that the participation of students in training period to act in the front line in the fight against COVID-19 should be the last measure to supply the need for workforce. The entity raised the concern that this action would be a low-cost labor alternative, and without considering the safety of the students to perform in health care settings.¹⁰ Furthermore, the official documents from the Ministry of Health about the action “(Brazil counts on Me)” did not clarify how the action would be conducted, especially regarding the educational-assistance process of the students, to guarantee safe assistance.¹¹

No studies were identified that investigated the vision of the students and supervisors involved in the strategic action mentioned above, and that pointed out, based on this viewpoint, the contribution, and challenges of this proposal during the pandemic. Given this issue, this study sought to analyze the perceptions of academics and supervisors about the strategic action”(Brazil counts on Me)”.

METHOD

Two investigative movements were carried out. The first movement was an exploratory, quantitative stage, to get to know the research universe and its main themes, and the second moment was the qualitative stage with a convenience sample, and in-depth analysis of the themes that emerged.

A descriptive analysis of the quantitative data obtained through the frequency reports and the online questionnaire was performed. The recorded sessions (qualitative stage) were transcribed in full, using the Microsoft Word® program. The material produced by the focus groups was analyzed using the content analysis technique.¹²

The research was conducted in the state of Mato Grosso do Sul (MS), from December 2020 to March 2021. In the state, only two hospitals were qualified by the state management to participate in the strategic action, both of which are public hospitals. In all, 90 students and 32 supervisors were invited, distributed in two hospitals in the state: 45 students and 18 supervisors in a hospital located in the capital city (Campo Grande), and 45 students and 14 supervisors in a hospital in a city in the interior of the state (Três Lagoas). For this study, we considered all the individuals summoned, excluding the academics who dropped out and/or worked for less than one month (n=18).

The exploratory stage was carried out in December 2020. This stage relied on the analysis of attendance reports of the summoned students, and on the application of an online questionnaire. For the students, the questionnaire had general questions, such as: age (in years), gender (female/male), undergraduate course (nursing, medicine, pharmacy, physiotherapy), place of work (hospital in the capital or hospital in the interior of the state). For the supervisors, in addition to the general questions, we investigated their training time (in years), and experience in the field of internship supervision. For both, there were questions regarding the organization of the strategic action on the performance of the participants in the action, on learning, and the evaluation of this process for training.

The second stage of the research was conducted in February 2021, using the focus group technique.¹³ Using the responses from the online questionnaire, a semi-structured script was built for the remote focus group, conducted by the Zoom® application. All respondents to the online questionnaire were invited to participate. Two focus groups were conducted: one with supervisors; and another with the academics. The focus groups were recorded with the authorization of the participants, following the ethical precepts.

The focus groups were initiated with the explanation of the research objective, moment in which was also reiterated the maintenance of anonymity of the participants. The focus groups were conducted in two stages: I) discussion based on the initial question about the trajectory of each participant, how they became internship supervisors or how was the trajectory of the academics during graduation, adherence to the strategic action (what led them to enroll and stay in the action), questions about how the supervision occurred, the dialogue with the university, the students’ evaluation, the general evaluation of the strategic action, and feelings about the end of this measure; II) closing: moment in which a space was opened for comments on issues not addressed.

The study was approved by the Ethics and Human Research Committee of the State University of Mato Grosso do Sul, under opinion number 4,352,540.

RESULTS

Through the reports, it was observed that of the 72 active students, 37 (51.36%) were undergraduate nursing students. Regarding the institutional attachment, 43 (59.72%) were from public HEIs. As for the demographic profile, the majority was female, 58 (80.56%). The hospital located in the capital city received 45 (62.50%) academics throughout the action, while the hospital in the interior city received 27 (37.50%). Among the supervisors, 19 (57.58%) were female, 17 (51.52%) with a nursing degree, and 18 (54.55%) linked to the capital city hospital (Table 1).

Table 1
Description of action participants available in the follow-up reports of the strategic action “(Brazil counts on Me)”. Campo Grande, MS, Brazil, 2020.

Variable	Academics n(%)a	Supervisors n(%)b
Gender
Female	58 (80.56)	19 (57.58)
Male	14 (19.44)	14 (42.42)
Graduation
Nursing	37 (51.36)	17 (51.52)
Medicine	27 (37.50)	11(33.33)
Pharmacy	4 (5.56)	2(6.06)
Physiotherapy	4(5.56)	2(6.06)
Institutional Affiliation
Public	43(59.72)	33 (100)
Private	29 (40.28)	-
Hospital allocated in the strategic action
Interior 27 (37.50)		14 (42.42)
Capital 45 (62.50)		18 (54.55)

• ^a
  n Total=72;
• ^b
  n Total=32 Source: Authors (2020)

Twelve supervisors and 25 academics participated in the online questionnaire. The supervisors had an average age of 39.83 years (±6.23), 10 (83.3%) were female, 10 (83.3%) had a nursing degree, and 19 (76%) were connected to the capital’s hospital. Nine (75%) presented time of training less/equal to 10 years. As for the academic respondents, the average age was 25.82 years (±4.24), 22 (88%) were female and 15 (60%) were linked to public HEI. Of the total, 19 (76%) worked in the strategic action in the capital hospital (Table 2).

Table 2
Description of participants in the action”(Brazil counts on Me)”, respondents of the online questionnaire. Campo Grande, MS, Brazil, 2020.

Variable	Academics n(%)a	Supervisors n(%)b
Age
Mean (Standard Deviation)	25.82(±4.34)	39.83(±6.23)
Gender
Female	22(88)	10(83.33)
Male	3(12)	2(16.67)
Educational Institution
Private	10(40)	-
Public	15(60)	-
Undergraduate
Nursing	19(76)	10(83.3)
Medicine	4(16)	-
Other	2(8)	2(16.67%)
Hospital allocated to strategic action
Interior	6(24)	10(83.33)
Capital	19(76)	2(16.77)
Training time
≤10 years	-	9(75)
>10 years	-	3(25)
Previous experience as a supervisor
Yes	-	11(91.67)
No	-	1(8.33)

• ^a
  n Total=25;
• ^b
  n Total=12
Source: Authors (2020)

Focus Group Breakthroughs

In the Supervisors Focus Group (SFG), five nurses were present, four women and one man. Of the total, four were linked to the hospital located in the capital. In the Academic Focus Group (AFG), four students participated, being three women and one man. As for the composition, three were nursing undergraduates and one was a physical therapy undergraduate, and all of them worked at the hospital in the capital. Of this sample, two were linked to a public university and the others to private universities.

The following themes emerged from the online questionnaire and were deepened in the focus groups: 1) Motivation for joining and remaining in the strategic action; 2) pedagogical aspects; 3) contributions of the strategic action.

Motivation for joining and remaining in the strategic action

The main motivations for joining and remaining with this strategic action, according to the students, were the desire to help, to acquire experience with multi-professional work, the possibility to work in assistance, remuneration through a scholarship, and the use of the strategic action to count hours in the mandatory internship during graduation.

(...)and I felt the need to learn that every day, to know how to deal with a multi-professional team, to deal with situations that you don’t have - how do you say - governance. You can’t solve them. And much less being an academic. As a professional it is already difficult in the service, imagine as an academic. So, this was very challenging for me. It was very positive and that is why I stayed (AFG - participant 4) (…)

(...) what motivated me to do it, to stay, was the financial issue mainly...the course is full time, isn’t it, and at the time I was self-employed, and then with the pandemic, things got stuck, etc., (...) allied to this, there was the issue, the possibility of continuing the internship, and graduate as soon as possible, because it was getting costly to stay year after year in college. (AFG - participant 3)

The supervisors highlighted, as a motivation, the importance of the action in the assistance to patients with COVID-19, an aspect highly valued by them. In addition, this need is compounded by the difficulty in hiring new professionals in the public service.

(...)because we work in a public hospital, we know that SUS has a whole application process, a calling process through a public notice. So, it is a little complex until we can hire people. Certainly, if it wasn’t for the help of the academics there, we would have really succumbed (...) - (SFG - participant 1)

Both groups also emphasized the opportunity that joining this action provides to exercise their social responsibility through cooperative and solidary attitudes and actions with society.

(...) and then I really had this desire to help, to learn. More than learning, for me I wanted to help. (AFG - participant 2)

(...) everyone was involved in this, giving of themselves, really trying to help, to be maybe a differential for our city not to suffer so much with this pandemic. So, this was our goal, I believe, the main one. (SFG - participant 1)

Pedagogical aspects

One of the items highlighted by the students involved the preparation of the participants for the development of the strategic action, who received qualification or training before starting their activities in the hospitals. The supervisors emphasized that they had no training, especially in pedagogical aspects, to supervise the students.

We had continuing education, which was all the training for intubation, how to enter an arrest, resuscitation. They had the training, they gave it to us, there was even one time that it was a month of training (AFG - participant 4)

(...) it was up to us how to conduct... (...) so, I don’t know if we did our part as supervisors, but we really didn’t have this clear instruction on how the role of the supervisor would be at this moment, right? (SFG - participant 3)

A relevant fact to be highlighted by the supervisors was the existence of a direct and an indirect supervision during the development of the action. Thus, these students were under the direct supervision of a professional from the sector who guided them in their daily tasks, and indirectly with the supervisors registered for this function in the action “ Brazil Counts on Me”.

And when they went to the sectors, the supervision was not direct, every day. So they were under my responsibility, we talked, but I wasn’t directly with them. I met with them some... some two or three times a week at the end of their shift so they could tell me how their experience had been, (SFG - participant 2).

Another pedagogical aspect highlighted was the evaluation process of the students, which did not occur in a systematic way among all supervisors. Although, in the perception of the actors involved, there was the adoption of a diversity of aspects to be evaluated, from subjective aspects (autonomy, dedication, attitudes), to the more objective ones (attendance, activities carried out), the criteria on what and how to evaluate do not seem to have been clear or defined, leaving the impression that, for the strategic action, the main evaluation criterion was the presence of the student (measured in a monthly report in the system), even because the attendance/attendance had an impact on the payment of the scholarship.

(...) I think that really the evaluation platform is very simplified, isn’t it? We only evaluated if the professional was really fulfilling the workload correctly or not. So, I think there was an observation field, ok, but really their form of monthly evaluation could be more worked on, right? (SFG - participant 2)

The relationship between supervisors and academics with the educational institutions was not unanimously perceived by the participants. For some academics and supervisors, this relationship was good, with monitoring by the course coordination/teachers in the process. While for others, the HEI coordination and professors did not support the insertion of the academics in the action.

Ah, well, I can say that we had zero support, ((laughter)) at least the people from (name of the HEI), understand? Our coordinator said, “ah, do you want to participate in (Brazil counts on Me?) It was like this, you know. Zero support from the university. (AFG - participant 2)

In fact, not all the universities came to us (...) But at (name of HEI) and (name of HEI)

I didn’t have... I didn’t hear from the coordinators or anything. (SFG - participant 2)

Contributions of the strategic action

For the participants, “(Brazil counts on Me)” guaranteed human resources to help in hospital care and contributed to the training of future health professionals.

So, I say that today I can face anything because of this period that I spent in the emergency room, of really getting my hands dirty. From assisting, going there, helping to give a bath, to working, to doing a cardiac massage. Report, everything, so we went through everything there, at least I went through all the stages that a nurse goes through in an ICU, I went through there in (name of the institution) through”(Brazil counts on Me)”, I am sure that if I had done my internship in college, they would not have given me as much autonomy as “(Brazil counts on Me)” gave me (AFG - participant 2)

According to the supervisors, in terms of professional training, the action enabled not only learning, but also a possible integration between teaching and service, from the perspective of continuing education in health. In the reports, significant changes are observed in the work process, provided by the meeting between supervisors and students.

(...) if I mention all... show all the classes that the girls helped put together, like training the nursing team about notes, about some basic concepts, some updates, they were the ones who helped implement everything. Everything, everything, everything. (SFG- participant 4)

The provision of human resources to assist the health services in care was perceived as a relevant contribution, since there was a shortage of professionals. Furthermore, the students worked in several critical scenarios of the institution.

(...) we had many employees on leave, some nurses had to leave because they were from a risk group and so on, and they came at a very critical moment, when the hospital needed them a lot. They helped us not only in COVID, in the COVID area, which is the ward and ICU, but also in the emergency room, in the maternity ward. (SFG - participant 5)

It was also observed that the supervisors needed the presence of the students, and this, in a way, contributed to a differentiated reception. The students felt that the professionals treated them equally.

When the professional understands that you are there as an academic, an intern, but that you will also contribute to the service, that you have this duty, he gives you different attributions than he would give to an academic (AFG - participant 4).

DISCUSSION

The students and supervisors positively evaluated the contributions of the strategic action “(Brazil counts on Me)”. Most participants highlighted that they lived an innovative experience, which provided the improvement of professional practice and the acquisition of new knowledge, besides having achieved the main objective of the action, which was to reinforce health care to the population during the pandemic of COVID-19.

In response to the pandemic, students in different countries were mobilized to support health systems during the health crisis.⁵,⁶,¹⁴,¹⁵ In order to understand the effects of this movement, a study conducted in Poland, with 580 student volunteers from health courses, who worked for six months since the beginning of the first case in the country, identified that the students performed from triage of cases, follow-up of cases by phone, and even activities in hospitals, inpatient wards, emergency rooms, and diagnostic laboratories. Most volunteers were female (77.6%), from the medical course (62.1%), and reported satisfaction in participating in volunteering, due to the gain in professional experience and the feeling of helping society in a historical moment.¹⁵ Such information corroborates the perceptions found in the present study. However, in general, there is no consensus in the literature about the insertion of students in curricular and extracurricular internship activities in times of pandemic,(¹⁶,¹⁷) because the balance between the benefits and harms still does not seem to be clear. The fact is that, in a pandemic context, possibly, there will always be the need for the health system to increase its contingent of health workers so that they can collaborate in assistance, acting in the front line.

The qualification in the training of future health professionals, provided by a performance in the care, management, and educational dimensions, as well as the feasibility of articulating the theoretical and practical knowledge learned in the academy with the knowledge and practice acquired during the strategic action, was already expected in a

supervised professional internship, to the extent that it is configured as a training space that provides this teaching-service integration.¹⁸ However, the possibility of acting in situations that are not always part of the routine of a mandatory curricular internship, increasing the list of professional competencies is what stood out in this study.

Certainly, the strategic action “(Brazil Counts on Me)” provided the students with experiences that can contribute to the enrichment of their professional lives, being considered a differential in their training, as also pointed out by a report of nursing students in Amazonas.¹⁹ However, even in the face of urgency due to the seriousness of the health situation in which the country found itself at the time of formulation and publication of the mentioned strategic action, it is necessary to reflect on some important points of this experience, which were often not perceived and highlighted by the participants.

The students reported that they had undergone training, especially in correct biosafety, paramentation movements of dressing and disposing, and that they themselves had promoted training on this topic for the hospital health teams. These trainings are important as they ensure physical integrity and individual and collective safety.⁹ Despite this care, however, the official documents of the strategic action do not make explicit the need to purchase accident life insurance for students, which is mandatory in any academic internship.⁸

Even if all the students called to participate in the strategic action were, in theory, competent to join, because they were in their last year of undergraduate studies (except medical students), in other words, able to perform the mandatory internship, the uncontrolled scenario they would have to face could trigger physical and mental health disorders.¹¹ Similarly, academics with comorbidities could have serious compromises if infected by the disease and, therefore, it would not be appropriate to recruit them, as England did, for example, in which students identified as “high risk” by the health system were not allowed to participate as volunteers in facing COVID-19.²⁰

As far as training of supervisors is concerned, it seems to have been foreseen only for clinical protocols, without reference to the need for pedagogical training.(⁸) It is essential that the supervisors who follow the students in internships, whether mandatory or extracurricular, besides having an appropriate profile, receive pedagogical training that subsidizes their practices within what is expected in the students’ training process, especially in relation to this strategic action, since many students took the opportunity to compensate for the hours of mandatory curricular internship.

The evaluation of the students also emerged throughout the research. It is known that the evaluation process, during the supervised internship, has as its principle the mediation of professional training, so it should be based on a critical-reflective dialogical relationship that leads the student to understand his weaknesses and potentialities, so that his learning process is (re)oriented.²¹ In this sense, the internship supervisor plays a relevant role as a mediator of the process. In the present results, the evaluation of the students was perceived as an aspect that needed to be better conducted.

Other points were also identified, such as the absence of a more qualified dialogue between HEIs and health services, especially with the supervisors, in addition to a punctual follow-up of the students when this occurred. Inclusively, the relevant fact to be pointed out was the lack of involvement of HEIs in the definition of the action,(⁹) when analyzing its elaboration.

As a counterpoint, contributions to training were also identified. The possibility of finishing the degree in the allotted time and still obtaining some type of remuneration similarly attracted students from other countries who were motivated to act in health services, in the face of COVID-19.²⁰,²² The remuneration of student volunteers is seen as essential in this type of action and considered by the academics as an important aspect for the recognition of their work in the face of the health crisis.

The sense of social responsibility and the willingness to help others, considered desirable attitudes for a health professional, were also highlighted in other studies that analyzed the perception of student volunteers.²² In Saudi Arabia, for example, of the 1,824 student volunteers who served in public institutions during the 19 COVID pandemic, the major reasons for volunteering were patriotism (21.05%), gaining experience (20.85%), helping others (19.03%), and religious rewards (16.19%).¹⁴

It becomes important to report the strengths and limitations of the study. This is the first quantitative-qualitative study to investigate the perception of academics and supervisors on the contributions of the strategic action “(Brazil counts on Me)”. It is noteworthy that the qualitative methodology does not allow generalizations, and the present results have applicability in the local context. Furthermore, not all participants in the strategic action answered the online questionnaire and took part in the focus group, which may have masked other perceptions and experiences. Studies with a larger number of participants are needed to show the perception of the strategic action “(Brazil counts on Me)” in other regions of the country.

CONCLUSION

The perceptions of those recruited are positive about the strategic action “(Brazil counts on Me)”, highlighting the measures that contributed to the adherence and permanence of those involved, such as: the right to a scholarship for the students, fulfillment of the mandatory internship hours for graduation, exercise of social responsibility, contributions of the action to hospital care and to the improvement of professional training. There are, however, negative perceptions, highlighting the pedagogical aspects of the proposal related to the assessment of the students and the support of higher education institutions for the development of the project, which leads to the inference that the action should be reviewed to be activated in times of health crisis.

ACKNOWLEDGMENTS

To the Foundation for the Support of the Development of Education, Science and Technology of the State of Mato Grosso do Sul (Fundect). Research for SUS: shared management in health (PPSUS) Program, Announcement #08/2020.

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Associate editor: Gilberto Tadeu Reis da Silva

Publication Dates

• Publication in this collection
  19 Sept 2022
• Date of issue
  2022

History

• Received
  25 Jan 2022
• Accepted
  26 Apr 2022