Teaching in health: perceptions of graduates of a Nursing specialization course

Abstracts

This study is about the graduates’ perception of the teachers’ work on nursing specialization, and is part of a research completed in 2013, with 29 graduates. It is a qualitative study with two stages of data collection: a questionnaire with open and closedended questions and a semi-structured interview. Data analysis was performed by content analysis in thematic mode, identifying the both contextual and registration units to build analytical categories. The results reveal the importance of the professors’ pedagogical training to understand their role as learning mediators. There is still much to investigate about teaching training and practice in higher education, exploring trajectories, identifying gaps and proposing ways of training that will prepare them to meet the needs and interests of the twenty-first century students.

Teaching; Nursing education; Higher education

Trata-se da percepção de egressos acerca do trabalho docente na especialização em Enfermagem, e é parte de pesquisa, finalizada em 2013, com 29 egressos. Estudo de abordagem qualitativa com coleta de dados em duas etapas: aplicação de questionário com perguntas abertas e fechadas, e entrevista semiestruturada. A análise dos dados foi realizada pela técnica da análise de conteúdo na modalidade temática, com identificação das Unidades de Contexto e de Registro para construção de categorias analíticas. Os resultados revelam a importância da formação pedagógica do professor universitário para compreender a relevância de seu papel de mediador de aprendizagens. Ainda há muito a se investigar sobre a formação e a prática docente no Ensino Superior, explorando trajetórias percorridas na formação, identificando lacunas e propondo caminhos de formação docente que os preparem para atender às necessidades e interesses dos estudantes do século XXI.

Trabalho docente; Educação em Enfermagem; Educação Superior

El presente artículo trata de la percepción de los estudiantes egresados de la especialización en Enfermería acerca del trabajo docente. El mismo es parte de una investigación finalizada en 2013, realizada con 29 estudiantes egresados. Este estudio es de abordaje cualitativo con recolección de datos en dos etapas: primero, la aplicación de un cuestionario con preguntas abiertas y cerradas, así como la elaboración de entrevistas semi-estructuradas. En segundo lugar, el análisis de los datos fue realizado por la técnica de análisis de contenido (modalidad temática), con identificación de las Unidades de Contexto y Registro para la construcción de las categorías analíticas. Los resultados revelan la importancia de la formación pedagógica del profesor universitario para comprender la relevanci de su papel de mediador de aprendizajes. Se sostiene que también hay mucho material a ser investigado en las áreas de formación y práctica docente en la enseñanza superior, explorando trayectorias recorridas en la formación, identificando lagunas, proponiendo caminos de formación docente que prepare a los profesionales para atender a las necesidades e intereses de los estudiantes del siglo XXI.

Trabajo docente; Educación en Enfermería; Educación superior

Introduction

The beginning of the 21^st century is being marked by numerous discussions about Higher Education, especially in the area of health. One of these discussions, which has been recurrent, concerns the need for teachers’ professionalization. Investing in their permanent education is a way of reflecting on the countless challenges that these professionals have to face continuously in this teaching segment.

Among these challenges, it is possible to highlight the increasing need to deal with large classes and with students distracted due to different reasons – here, digital technology has a strong influence. Helping students to transform information into knowledge means investing in active teaching methodologies to direct them towards a type of learning that is significant, long-lasting and transformative.

Another important aspect that deserves to be considered by Higher Education teachers is that they should understand the evaluation of learning as a process and value procedures that enable the analysis of students’ progresses regarding the development of knowledge, skills and attitudes.

Understanding what being a Higher Education teacher means, especially in the area of health, demands constant reflections on how to transform pedagogic practices that, today, do not meet students’ needs and interests anymore. Nowadays, accessing information is a very quick process. Therefore, giving classes that are merely expository lectures, in which the student is not the subject of the process, is no longer sufficient to educate the critical and reflective professional that society requires. The teacher must act as a mediator, helping students to construct their knowledge in a critical way.

Transforming information into knowledge and, more specifically, knowledge that has meaning and, therefore, transforms practices, has been a great challenge for teachers and students. Today, learning by repetition and reproduction of previously transmitted models is no longer seen as a good practice. When students merely memorize concepts, they do not appropriate this information and do not know what to do with it.

Striving for students to learn significantly demands reflecting on the essence of Significant Learning and helping these students to perform the necessary mental interactions between what they already know and the new knowledge that is presented to them. Thus, they can recover previous knowledge that has been dormant or is not much used in the learning process and, due to this, does not make sense to them¹.

According to Ausubel, Novak and Hanesian¹, the student is not a passive receptor – far from it. In order to learn, students must use the meanings they have already internalized. Previous knowledge plays an important role in the learning process because, when new information is incorporated into the subject’s cognitive structure and he already has some knowledge of a certain matter, the subsumers or anchoring ideas gradually acquire new meanings and become differentiated and more stable^2,3-5.

However, Ausubel, Novak and Hanesian¹ argue that the occurrence of interactions between new and old knowledge does not guarantee that significant learning will take place. It is necessary that, in this process, the learning subject is predisposed to learn significantly. The learner must want to relate new knowledge to that which already exists, assigning meaning to this incoming knowledge. In addition, the material to be learned must be potentially significant, and the teacher is responsible for selecting and organizing this material^4,6.

Today, there is no space for automatic repetition or mechanical learning that is not significant. Students need to learn in such a way that new knowledge or reconstructed knowledge makes sense, as intervening in reality is the ultimate purpose of learning, and this is not an activity that the student performs by himself. The teacher plays a fundamental role in learning and must be the mediator of this process^2,7.

Teaching within these presuppositions, especially to Higher Education students, requires that teachers understand that, today, we cannot teach as we used to do in the 20^th century. It is important to highlight that the majority of teachers still employs the pedagogy of transmission, replicating the models in which they were educated. Pedagogic knowledge is a gap in these teachers’ practice.

Thus, transmitting to students information that is knowledge constructed by teachers, when its meanings have not been the object of reflection, and have been neither understood nor incorporated by the learning subjects, requires the understanding that the “university adult has greater capacity for reflection on knowledge and on his own learning processes.” ⁸ (p.89-90).

In view of the transformations that education has been undergoing and in light of studies that have demonstrated how subjects learn, it has become necessary to transform the educational models that are still supported by the traditional teaching paradigm, which adopts educational strategies of large-scale teaching in a fragmented, reductionist and reproductive way.

This view of fragmentation can be understood through Behrens⁹ words, when the author explains that: [...] knowledge fragmentation has been viewed as the greatest challenge to be overcome in order to be on a par with the complexity paradigm and the challenges imposed by Knowledge Society⁹(p.25).

The innovative or emerging paradigm^10-12 challenges universities and teachers to adopt an innovative methodology, taking into account students’ previous knowledge, as well as their social, political, professional and cultural reality. Therefore, “it is essential to propose new educational models that study the complex phenomena that predominate today and meet human needs in a dialogic and collaborative way”.¹³ (p. 3).

Today, the professionals who go to universities to improve their practices certainly evaluate the profile and the form in which teachers prepare and develop their classes, and criticize them when, grounded on the traditional teaching paradigm, they transmit information without considering that those students want knowledge beyond simple information.

This article aims to present the graduates’ perception of the teaching that is developed in a Continuing Education and Specialization Course in Nursing.

Methodology

The study was developed through the qualitative approach and involved 29 professionals who graduated between 2007 and 2011 from a Continuing Education and Specialization Course in Nursing that took place at a Federal Public University located in the Southeastern Region of Brazil.

Data were collected in two stages: in the first, a questionnaire¹⁴ with open⁽¹⁾ and closed⁽²⁾ questions was administered. The closed questions enabled to outline the subjects’ profile and the open questions were based on the following guiding questions: When you started the course, what were your expectations? What is teaching and learning for you? How do you see the teachers’ participation in the course? In your perspective, what is Significant Learning? Did you identify, during the course, Significant Learning experiences? If you did, why did you consider them as significant learning and what were the characteristics of this kind of learning? Of the 29 questionnaires sent in the first stage, 20 (69%) instruments fully answered by the graduates were obtained.

In the second stage of the study, aiming to clarify the data collected in the first stage, a script for a semi-structured interview¹⁵ was developed based on three thematic nuclei that emerged from the answers to the questionnaire’s open questions: Teaching-Learning Process, Significant Learning, and Teachers’ Participation in the Continuing Education and Specialization Course in Nursing.

After the interview script was developed, the 20 graduates that had fully answered the questionnaire were consulted about the possibility of participating in this second moment of data collection. Of the 20 consulted graduates, 10 (50%) participated in the interviews. The other 10 did not manifest themselves, not even to indicate that they did not want to participate in the second stage of the study.

The data were analyzed in light of the Content Analysis framework¹⁶, thematic modality, which encompassed the pre-analysis of the collected material by the performance of a free-floating reading, the constitution of the research corpus, and an in-depth reading to determine the Units of Context (UC) and the Units of Register (UR). Then, the material was explored through the apprehension and construction of analytical categories, in the perspective of the understanding of the investigated object.

The ethical aspects were respected as determined by the Resolution in force when data were collected: Resolution 196/1996 of the National Health Council. The study was approved by the Research Ethics Committee of the institution under number 1365/11. The research participants signed a consent document, which assured the right of free participation, as well as the freedom to withdraw their consent at any stage of the study.

To preserve the participants’ anonymity, the answers to the questionnaire are identified in the text by the configuration (E_xx) and the interviews by (S_x:UC_xx/UR_xx).

Construction of Results

Based on the questionnaires and interviews, and considering the scope of this article, we present here the data and the analyses concerning the thematic nucleus Teachers’ Participation, which originated two categories of analysis: Mediatory Teacher Participation and Transmissive Teacher Participation.

The categories of analysis were constructed through apprehensions of meaning nuclei expressed in the graduates’ answers when they described teachers’ participation in the course. Thus, content analysis, in the thematic modality, encompassed work performed with words, textual formulations (the questionnaire’s open questions) and verbal constructions (interviews), in the search for meanings according to the research participants¹⁶.

Mediatory Teacher Participation

This category of analysis is grounded on the testimonies that appraised the participation of teachers as aggregative, committed, engaged, hardworking, dynamic, transformative, up-to-date, respectful, mediators, and experts.

The course’s teachers are proactive, have a broad knowledge and a good didactics. Because of this, I could realize the importance of stimulating students to participate in the classes, as they are knowledge exchanges, that is, the students brought their experience and the teacher also acquired knowledge. E₁

The teacher was very dynamic; all the time, she brought experiences from practice, connecting them to theory. So, you were able to see clearly how you would put that knowledge into practice, how this would modify your values. This made all the difference to me: joining theory and practice. S₄(UC₁₁₆/UR₂₂₃)

The teacher teaches the way, but you’re the one who will really build this learning. S₄(UC₁₈/UR₄₄)

The teachers are committed to the students in knowledge construction and apprehension. E₅

It is believed that being a mediator of the learning process permeates the teachers’ practice, as “in the great majority of situations, we still find the teacher playing the role of information transmitter, giving only expository lectures”¹⁷(p.23), projecting many slides that will be only read, without the students’ participation in this exposition of the teacher’s knowledge.

However, being a mediator of the learning process implies the understanding, which can be complex - mainly to those who have not received pedagogic education -, of what teaching is in this century, in which students have access to information very quickly, and this is a great challenge to the teacher.

Having a broader view, understanding that teaching is not “transmission of information and experiences”¹⁷ (p.19), and aiming to develop the students’ learning must be a goal for Higher Education teachers, in a collaborative exercise so that students learn how to select information and are able to transform it in knowledge that can be applied to their professional practice.

However, sometimes, this is not an easy task. Some teachers and even students still remain in their comfort zones concerning the teaching and learning process: the teacher prepares slides, explains the subject and the student must copy and memorize the contents to do the tests which, in the majority of times, contain only multiple choice questions.

Mediating the teaching-learning process is much broader than transmitting information to the students in the classroom, with an education targeted only at the cognitive aspect. The teacher must view the student as the subject of this process, making him realize his importance for an effective construction of knowledge.

Thus, if the student does not see himself as the subject of this process and leaves the responsibility for learning or not to the teacher, it is necessary to reflect on it. Nowadays, this model is outdated, both to teachers and to students, and the latter recognize the efforts of teachers who try to withdraw this traditional model of giving classes.

The new context of access to information “has emptied the meaning of the teacher’s function as knowledge transmitter”¹⁸ (p.72), either in the classroom or in any other academic space. It is not possible to work merely as an information transmitter anymore. In this paradigm, “[...] the student’s experience is not taken into account and activities involving creation are hardly ever developed. This pedagogic practice leads the student to characterize himself as a being who is subservient, obedient and devoid of any form of expression”⁹(p.181).

Therefore, in the 21^st century, “the teacher’s pedagogic practice needs to be projected in different methodologies”⁹ (p.181), helping the student to select, organize and understand the learning material, aiming at knowledge production.

Thus, it is important that teachers approach, with the students, the knowledge from their professional area and, in addition, they should help them to develop the competencies (knowledge, skills and attitudes) that are expected from a professional and, above all, from a responsible citizen. As teachers, they need to promote students’ learning with the effective participation of each one of them in this process.

According to Masetto¹⁷(p.14), “[...] in higher education, teachers already recognize that they have ceased to be the only knowledge owners; rather, they are one of the partners who is responsible for sharing their knowledge with the others, including their own students”, so that they feel they are the subjects of the learning process and see the teacher as an ally in their education, not an obstacle.

Thus, this posture of partnership will certainly produce positive results, both to the student, who will feel he is valued and will understand that the learning process also depends on him, and to the teacher who, as a partner, can perceive, in the students, a growth that is not only professional, but also personal. Both of them must realize that “a new attitude, a new perspective in the relationship between teacher and student in higher education”¹⁷ (p.14) is needed.

However, it cannot be denied that there are still students who do not want to abandon their secondary role in the process and remain on the sidelines of the teachers’ mediation initiative, sometimes ignoring what happens around them, sometimes participating to accomplish the task. This is a challenge to the teachers who work (or would like to work) as learning mediators. Unfortunately, to some students, teaching and the classroom are still the place of massive speech. They do not value learning in the sense of constructing their knowledge, “waiting to be passively conducted”¹⁹ (p.15) by teachers, whom they expect to give them everything ready to use.

Transmissive Teacher Participation

This category of analysis emerged from the frequency with which words like authoritarian, lack of charisma, lack of commitment, lack of qualification, impolite, not dedicated and unmotivated were used in the graduates’ testimonies.

I don’t see much dedication, as I feel a lack of motivation in the sense that it is not simply entering the classroom and speaking; rather, it is demonstrating that what you will teach is important and necessary, having pleasure in that. And I didn’t feel this in the majority of the teachers, as they simply focus on attendance and grades, and not on the students’ teaching-learning process. E₆

[...] It seemed to me that the majority of the classes was a monologue, in which I could experience banking education: the student as an empty container and the teacher as the knowledge owner [...]. The student’s experience was also not relevant and, many times, I felt that I was being treated like a High School student […]. E₁₄

It was always the same. Except for you, who were the most different one, they were all very similar: slides, speaking, speaking, speaking, we note things down, one tells a life experience, the other speaks, but there was not much dynamism. S₁(UC₉₉/UR₁₉₆)

[...] One of the teachers stayed there during the whole discipline. She stayed there from the beginning to the end of the class; the slides were gradually projected and she didn’t move. She just spoke into the microphone all the time and this was very tiring. It was the traditional method, she just read the slides. Yes, we had this difficulty: teachers who didn’t care much, who used the traditional method and didn’t care much if the student was paying attention or not. They stayed there, in the backstage, reading the slides all the time, and didn’t even change their tone of voice, increasing or decreasing it, to call our attention [...].S₅(UC₁₁₇/UR₂₂₅)

The strategies were as classic as possible and always induced us to sleep: one talks and all the others listen; the teacher gives his opinion and no one has the courage nor feels free to disagree […].S₇(UC₁₂₁/UR₂₃₇)

The testimonies above stimulate the reflection on how these teachers have constructed their trajectories in the paths of teaching. Conceiving university education as something that aims to “develop in the individual the capacity and initiative of searching, by himself, for new knowledge, intellectual autonomy, freedom of thought and expression”²⁰ (p.36) indicates that teaching by transmitting knowledge is no longer possible and, sometimes, it upsets students.

Changing the logic that has perpetuated the teachers’ action in teaching institutions at all levels, in which the conservative and mechanistic paradigm still prevails, demands the will of the actors involved in this process. According to Behrens⁹: “[...] teaching in its traditional approach needs to be rethought, as students attend school in order to learn, and not simply to hear, read, memorize and repeat the contents presented by the teacher”⁹ (p. 180).

A study carried out by Castanho²¹ (p. 55) with eleven teachers from the area of health revealed that some of them had started teaching “due to financial need, unemployment, because they gave classes in courses that prepared students for taking exams to be admitted into universities or in monitoring activities”, and some “had become teachers all of a sudden”.

However, teaching cannot be the second option in the career of a professional who has not been successful in his area or to complement his income. In fact, the individual chooses to be a teacher and builds his career in the daily routine of the classroom, in the contact with his students, when he is planning his classes, defining strategies and constructing evaluations that enable him to know the student beyond the learned content.

The teaching profession needs to be valued and recognized. In public universities, teachers choose this profession and are evaluated by committees that certify that their performance is adequate for this profession, based on the candidates’ previous experiences and on knowledge productions which, in the majority of times, are prioritized, to the detriment of students’ education.

When they start teaching at University, they seem to forget their true function and, without a minimum didactic-pedagogic education to sustain their teaching practice, they replicate models grounded in their experiences and approached in the study conducted by Castanho²¹: they believe that the subjects to whom they will teach do not need planned classes, reflected strategies and evaluations of processes. These teachers have: “[...] fear of losing contents they master, fear of the new, fear of losing space in the disciplines, difficulty in working with active teaching methodologies and in implementing interdisciplinarity in knowledge construction”²². (p. 29)

Due to this, they perform this academic activity based on models experienced during their education. Their teachers, authoritarian and transmitters of information, used to believe that “knowledge belongs to the teacher and the student is the one who knows nothing; therefore, the teacher must transmit all forms of knowledge to the student”²³ (p. 14).

Changing practices entrenched in years of a teaching career that has never been questioned by students is not an easy task. According to Guimarães, Martin and Rabel²² (p. 29), “the incorporation of pedagogic concepts that stimulate the development of the students’ critical conscience and active participation” is a great challenge to teachers. However, they must be open to it and, thus, they can envisage the possibility of growth not only of the students, but of their own development, with the possibility of exchanges that this contact allows. In the education of future professionals, it is necessary to work in an integrated, dialogic and participatory way that is significant to the adult student.

Knowles, Holton and Swanson²⁴ argue that “the intellectual model that the teacher has of the student is that of a dependent being, and the adult student’s psychological need, no matter if it is conscious or not, is to direct himself” (p. 70-1). Therefore, considering the experiences that the subjects bring with them as the point-of-departure for learning is good in order to view students as learning subjects in the construction of their own knowledge. This implies the teacher’s recognition that “his pedagogic authority must not, under any circumstance, be transformed into authoritarianism; rather, it must be connected with the students’ cultural and critical enhancement”²⁵ (p. 165-166).

It is important that the teacher is aware that the maxim according to which “the one who knows automatically knows how to teach” ²⁰ (p. 36) is no longer sufficient and does not function in the current context of education. This is especially true in higher education, as students get tired of extensive lectures which, at the end of the class, represented nothing but a boring exposition of knowledge “that was discovered and developed by other people”¹⁷ (p. 13) and is extremely far from their reality. The adult student must recognize the utility of that knowledge to his professional life.

Changing the way of teaching implies that the teacher must reflect constantly on his performance, on what he expects from his students. Above all, teachers must reflect on the importance of changing this way of teaching in order to think about how they can make their students “develop methods to acquire, discover and construct knowledge”²⁰ (p. 36), assigning meanings to the new learning or re-signifying and redeveloping previous knowledge.

Today, the teacher who has not understood yet that his role is no longer that of transmitter and that he has become a knowledge mediator, must be attentive to a new order that has been ruling the teaching and learning processes. “Transmitting knowledge makes sense in an immutable environment”²⁶ (p.110) and people are not immutable; likewise, knowledge is not finite and the teacher is not the only source of knowledge.

Knowles, Holton and Swanson²⁴ state that “a teacher’s learning theory will influence his theory of teaching” (p.76). Therefore, reflecting on which learning theory or theories will guide his teaching practice is fundamental for him to understand that transmitting knowledge is no longer the only way to teach, especially in Higher Education, with adults.

Final Remarks

The analysis of the graduates’ perceptions of teaching in the Continuing Education and Specialization Course in Nursing showed that it was transformative in some moments, allowing students’ active participation, collaborating to their growth, with proactive and committed teachers, dynamic classes and differentiated strategies, motivating and stimulating students to search for knowledge construction.

In the perspective of mediatory teaching, the act of teaching was perceived by the graduates as a movement full of uneasiness, discoveries, transformations and intentionality, in which mutual trust and respect also contributed to the students’ growth.

However, according to some graduates, transmissive teaching also had its place in the course and emerged in a negative way, indicating uncommitted teachers who did not explain the importance of what they did to the students and acted in an authoritarian and transmissive way, with classes centered on their knowledge and almost no dynamism to teach. It was interesting to notice that the students identified, in the transmissive teachers, lack of charisma, which, in the case of the teacher, can be a source of inspiration and enthusiasm to the student in the learning process.

The analysis of teaching in the Continuing Education and Specialization Course in Nursing revealed that the university teacher needs permanent pedagogic education, especially the teacher that works with adult students. Thus, teachers will be able to overcome the place of knowledge owners and will assume the mediations of the teaching and learning process, explaining to studentsthe importance ofmaking the class instead of attending the class, so that students can be active subjects of the learning process.

Therefore, university teachers need knowledge and education because, when they understand that, instead of playing the role of knowledge transmitter, they must become the mediators of the learning process, they can envisage new ways of teaching, in a more critical, reflective and transformative way, paying attention to the complex teaching and learning process.

We believe that further research is needed into the education and practice of Higher Education teachers in the area of health. It is necessary to explore the paths they took in their education, identifying the existing gaps and proposing teacher education programs that prepare them to meet the real needs and interests of 21^st century students.

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• e
  Open questions: also called free or non-limited questions, as they give subjects the opportunity to express themselves freely on the matter.
• f
  Closed questions: also called limited questions or questions with fixed choices, in which subjects choose one answer among a list of options.

Publication Dates

• Publication in this collection
  16 Feb 2016
• Date of issue
  Apr-Jun 2016

History

• Received
  28 May 2015
• Accepted
  01 Oct 2015