Teaching implications in the pedagogical training of a technical school

Objective: to analyze the teaching implications with the pedagogical training in a Technical School of SUS. Method: a qualitative study that has the Institutional Analysis as theoretical and methodological framework, Institutional Socio-Clinical modality, whose data were collected from July 2017 to August 2018, with 07 health professionals. Results: they were presented from two themes: implicat ions of teachers with training: the old Technical School ; New directions are evidenced in the implied behavior of teachers: a new Technical School? Final considerations: knowing the factors that hinder and facilitate the pedagogical training in health, and especially to clarify how the behaviors instituted opened loopholes for instituting movements present in that setting, revealing the nuances of a new institutionalization, contributed to the collective construction of strategies related to the training of new teachers.


INTRODUCTION
Nursing education in Brazil underwent changes, following the Diretrizes Curriculares Nacionais do Curso de Graduação em Enfermagem (freely translated as Undergraduate Nursing Course Brazilian Curricular Guidelines), which reinforce the need for articulation with the Brazilian Unified Health System (SUS -Sistema Único de Saúde). Nursing has been changing since its institution, influenced by social, political and economic changes that seek, among other principles, humanization and comprehensiveness in health care. As a result of the struggles of the Sanitary Reform Movement, promulgation of the current Federal Constitution and implementation of SUS, the techno-health care model incorporated the expansion of the concept of health, requiring training schools of health professionals to reformulate their pedagogical projects (1) .
With regard to technical training, since the 1970s, educational reforms have taken place in health education, with the aim of increasing the education of health workers (2) . In the 80's, based on an agreement between the Ministry of Health, the Ministry of Social Security and the Ministry of Education, instituted by the Ordinance of March 11, 1980, as amended by the Ministerial Ordinance of April 27, 1984, ratified by the Resolution of the Comissão Interministerial de Planejamento e Coordenação (CIPLAN -Interministerial Commission for Planning and Coordination) 15 of November 11, 1985, the project known as the Large Scale Project (Projeto Larg Escala) (3) . This project had the objective of promoting and improving training of elementary and secondary level workers, associating supplementary education with in-service training, being carried out by some health organizations. The idealizer was the nurse Izabel dos Santos, also collaborator of the Pan American Health Organization (PAHO). At the time, it was estimated, in Brazil, that there were approximately 300 thousand workers working in health services, without specific qualification, performing various functions, including direct assistance to users of health facilities. In 2000, based on technical cooperation between the United Nations Educational, Scientific and Cultural Organization (UNESCO), the Ministry of Health, the Inter-American Development Bank (IDB), the National Treasury and the Fundo de Amparo ao Trabalhador (FAT -freely translated as Workers' Assistance Fund), the Profissionalização dos Trabalhadores da Área de Enfermagem (PROFAE -Professional Qualification Project of Workers) was created. This joint action enabled the mobilization of individuals and training institutions to develop a critical reference for changes and strengthening of SUS (3) . The PROFAE was created and directed to the workers from health services that carried out their own nursing actions, without professional technical qualification for the exercise of these actions. It was also directed at an expressive number of workers in the nursing activities, with no basic schooling, which caused impairment in the quality of health services offered to the population, implying a situation of irregularity and illegality of these people in the labor market (4) . In Brazil, PROFAE trained, from 2000 to 2006, 13,161 nurses specialized in Professional Education in Health, in the professional qualification courses that, at the time, were lato sensu postgraduate courses, called Specialization in Pedagogical Training in Professional Education in Health. The total workload was 660 hours. The requirements for enrollment were: to be a graduate in Nursing, to be a teacher of the Professionalization Program for Nursing Workers/PROFAE and be indicated by the Project. The objective was to offer specialization, so that the teacher, after graduating, was a multiplier of this process in schools (5) . In the 1980s, when SUS was created in 1988, there was a movement of reorientation of strategies and models of care to achieve individual and collective health, seeking to change the formation and development in health, through several programs. Health Technical Schools then started to be called ETSUS ( (6)(7) . The school's Political-Pedagogical Project (PPP) has as a mission: "to develop professional health education to consolidate the Brazilian Unified Health System, aiming to contribute to the quality of life of the population". The document highlights as ethical-political foundations: transformative practices, giving a new meaning to the concept of inclusion, taking into account the human competence to care for, valuing workers' autonomy, their everyday knowledge and experiences, and their capacity to transform work and life situation. It punctuates Problematic Education as a characteristic of the school and the active participation of learners in teaching-learning (8) . This methodology used in a Technical Training School is considered an active methodology by using teaching-learning strategies based on reality, for the training of instructors, professionals already working in health services and students. The problematization methodology allows us to observe reality (problem), to highlight what is relevant, to theorize the problem, to confront reality with its theorization, to formulate solution hypotheses by applying reality in practice (9)(10) . The active method of critical and reflexive learning, supported by the Brazilian educational legislation and teacher training, sought to break with the traditional model, seeking the training of an emancipated professional in relation to teaching-learning, being prepared to meet the demands of the different settings of SUS (11) .
In  November 28, 2000, in order to comply with SUS principles to promote and carry out courses (12)(13) . Implementation of the courses, in a decentralized way, was justified due to the needs of the municipalities and the technical conditions of the place. This performance made access of workers to qualification or training easier, avoiding displacement to places distant from work and, consequently, reducing the length of service. This training is an important tool for understanding work, with a perspective of a collective construction of knowledge and strategies for a comprehensive health care with quality, promoting integration between teaching-service and community. However, since 2008, the school has suffered an unprecedented precariousness, which began with a lack of autonomy to manage resources and hire a financial manager who managed the funds from the Ministry of Health for the implementation and implementation of courses, affecting the whole dynamics of the school and work. Currently, workshops for pedagogical training that until then were composed of five meetings lasting 8 hours each, totaling 40 hours depend on the availability of human and material resources of the municipalities. These changes not only interfered in the potential of creativity and commitment of teachers with pedagogical training for SUS, but also led to changes in pedagogical workshops, professional practice of teachers, favoring intra and extra institutional conflicts and difficulties in communication and interpersonal relationships. Furthermore, this article seeks to make an approximation of experiences of teachers in Technical Schools based on collective analyzes of their practices in pedagogical training and in their work, from the following questioning: In what way has the pedagogical training been taking place in Technical Schools? Although this study brings the results of pedagogical training in only one setting, the political and social context that affected this Technical School in the 2000s may have had similar repercussions in other technical schools, which justifies a study that brings pedagogical training to debates in an adverse period in education and health policies (14) .

OBJECTIVE
This study aims to analyze the pedagogical training from teaching implications in a Technical School of SUS. This proposition seeks to approximate the experiences of teachers with pedagogical training comprised between 2008 and 2018, which were crossed by political changes in institutional health and education, interfering with work, pedagogical training and qualification of professionals for SUS.

Ethical aspects
This project was submitted to and approved by the Research Ethics Committee of the University Hospital. In order to guarantee anonymity, the teachers' statements were identified by the letter T followed by a sequential number (T1 to T7).

Type of study
This is an intervention research with a qualitative approach, outlined by the theoretical and methodological framework of the Institutional Analysis, Institutional Socio-Clinical modality (15)(16) . The researcher maintains direct contact with people and with the context, making possible to modify by the experience produced by the intervention, being related as the researcher is implied with and in the research (15,17) . It is up to the researcher, during intervention, to think of a device that is the most effective to make the different institutions present speak, allowing to analyze collectively a collective situation (18) . The Institutional Socio-Clinical intervention seeks to understand the social dynamics, bringing discussions as close as possible to the situations lived by participants, analyzing their implications with the institutions that cross them (15) . During the Institutional Socio-Clinical intervention, different moments can be experienced, where the eight characteristics proposed by Gilles Monceau can be evidenced, but not constituting in steps to be followed. The Institutional Socio-Clinical characteristics proposed by Monceau are: Analysis of the order and demands; Participation of subjects in the devices; Work of analyzers; Analysis of transformations as work progresses; Application of refund arrangements; Work of primary and secondary implications; Intention of the production of knowledge; Attention to contexts and institutional interference (15,19) .

Methodological procedures for data collection
This study included 7 health professionals, including only those who worked as teachers at the school, with employment and who were present during the period of data collection. The data were collected from a script with 05 questions. In this article, we will stick to the introduction. The devices used were: a diary of the researcher to analyze its implications and meetings in the framework of the Institutional Socio-Clinical intervention. The device is a type of assembly of heterogeneous elements, created for specific situations, constituting an intervention operator (20)(21)(22) . Regarding the diary, it was used as a writing device capable of leading the researcher to carry out the analysis of their belongings and their implications with the pedagogical training (23)(24) . It is important to consider the attitude of the researcher, his implications for the problem and, especially, his role as a participant in every context in which the research is developed. The conduction of intervention meets the demands put by the group itself, and in this way, aspects related to the study are placed in the debates (25) .
Meetings were held between April 2017 and March 2018, the first three of which contemplated the preparation of the context for the research, when the Technical School's management presented the methodology, the objectives, the approval by the REC (Research Ethics Committee) and the individual invitations to participants. The fourth meeting took place with the group of teachers, according to the Institutional Socio-Clinical intervention, where the pedagogical training in the Technical School was debated. The fifth meeting was the moment of restitution, which is not only a devolution for the participants' lecture, but it is a methodological element to be considered in Socio-Clinical work. In the restitution, partial results of the research can be presented, allowing participants to remain active in intervention, giving opportunity to deepen or question the analyzes or even consider the orientation of the working device itself (15,19) .

Study setting
This study was developed in a Technical School of the Brazilian Unified Health System, which is a public institution linked to the network of SUS's Technical Schools, located in the state of Rio de Janeiro.

Data production
The transcribed speeches, as well as the content of the researcher's diary, went through different readings, where it was sought to evidence the characteristics of Institutional Socio-Clinical. In this exercise, it was found that the same speech can be included in more than one characteristic because it is understood that in this methodological proposal the characteristics intertwine and merge during intervention, being able to be perceived in different phases of the intervention. They are part of an analytical work that is put into reflection by participants and researcher (15) . In the case of an intervention research, the data were produced by the different devices and research strategies that by collectively problematizing a given fact provided a more critical and reflexive positioning of participants (17) .
In response to the questioning, analysis of the testimonies and reports of the diary were manifested more clearly in two themes: implications of teachers with training: the old Technical School; New directions are evidenced in the implied behavior of teachers: a new Technical School?

RESULTS
Before presenting the results, it is important to know the participants of the study. All were female teachers, ranging in age from 44 to 64, with four nurses, a social worker, a biologist and a sociologist. With regard to qualification, two have Master's degree, three are studying Professional Master's degree, one is studying Doctorate and one is a Specialist. Working time at the Technical School ranged from two years to thirty years.

1-Implications of tea,chers with training: the old Technical School
During intervention in collective debates, it was possible to identify different implications related to work in the Technical School and to pedagogical training. Teachers who started their activities before 2008 had the perception that the changes that occurred after 2008 caused a "dismantling" in the Technical School, resulting from other forms of relationship of professionals with higher organs in the offer of courses for pedagogical training, lack of autonomy in the management of financial resources, political interference with education and health, with repercussions on the pedagogical training for SUS.
With regard to the changes that led to the dismantling of the Technical School, they refer that: From 2008 to the present time, the school has suffered a major dismantling. In fact, so our work has been permeated with a lot of resistance, a lot of resilience and also a lot of pain, is not it? Cause this has sickened us all. (T6) We all go through sadness, frustration of knowing our potential, of seeing the potential that this school has already executed in the state of Rio de Janeiro. Now, it's been 10 years since I joined this school with a struggle for survival and this demands of us many strategies because institutionally we are very fragile. (T5) All the management ... they have fought and they have fought, in order to make this school work in some way, but we do not find legal framework and political will to make it happen. (T7) It was possible to perceive the difficulty of some teachers in experiencing changes in the physical, financial and personal structure and, mainly, how professional training courses were carried out. The feelings were of loss, the feeling that they were not working the way they were trained, the words that occurred the most during the first encounter were: struggle, resilience and resistance.
Regarding courses funding, participants revealed that changes caused the loss of the autonomy to manage the resources for their execution and implantation. This negatively affected all the dynamics of the school due to the difficulties of negotiating with the management about the courses to be offered and the lack of transparency regarding the allocation of resources, as reported below: It should be noted that with the decentralization of resources to the municipalities, another way of teaching was related to the Ministry of Health and the State Health Department. Negotiations began to be held with the Municipal Health Department, which brought its own demands for courses and also other ways of relating to the Technical School. These changes were perceived negatively by some teachers.
The follow-up of the debates brings up the question of the pedagogical teacher training, where political interference with Education and also in implied positions of older patients are very visible: Teachers understood as losses the fact that training was no longer conducted in 40 hours and also in relation to being taught in other spaces, which determined when they would be performed, in which place and their workload. By being placed in debates as participants perceived themselves as teachers before 2008 and in the present moment, they reveal the suffering expressed by the failures facing the reality at work, collaborating with the institutional, professional and personal emptiness. The testimonies reveal these feelings: The researcher's diary complements the situation brought by participants: I was very anxious and apprehensive about the meeting. I was expecting a bit of confusion or disagreement. But we find professionals extremely involved with work, crossed by several institutions. During the meetings, they expressed diverse feelings such as exclusion, lack of belonging, much suffering with the processes of what they called the dismantling of Technical School. I was very affected and impacted by the reports, mainly because I did not perceive the feelings of the colleagues in these years of work… The statements allowed to identify issues that were not previously verbalized and that, when they were put into collective debates, made it possible to analyze the implications of teachers with "dismantling" of the Technical School and, above all, with pedagogical training.

2-New directions are evidenced in the implied behavior of teachers: a new Technical School?
Starting from the assumption that everything is in constant movement, the transformations that occurred throughout intervention, could be perceived in the meeting of restitution, when teachers, carrying out an analysis of their implications with pedagogical training, began to have another understanding about work and problematization: This different way of perceiving reality began to reveal a new Technical School where participants sought alternatives to continue working and develop their training as teachers, bringing other experiences in this training. It was interesting to analyze the implications of older teachers still attached to the norms and rules of the institution of pedagogical training before 2008, and teachers who had another perception regarding these changes.
In this space of collective debates, all participants could perceive these two movements: more established and crystallized positions in the practice of some participants; and positions that sought strategies in that context, in more institutional movements. The testimonies of new teachers after 2008, and even of some older ones, surprised by the diversity of activities related to pedagogical training and personal qualification, as can be seen below: With regard to the researcher, the changes in teachers' attitude were well portrayed in her diary, on the restitution meeting: Initially, only three people had confirmed their presence. On the day to my surprise, three more people attended. Four teachers exchanged the work day and time to participate. I consider this moment very important, because we have difficulties to gather people in the school, and the team appeared in a spontaneous and joyful way. It was a pleasant surprise.
These reports reveal new positions of the researcher and of participants and it was verified that the collective reflections carried out during the interventions according to the Institutional Socio-Clinical made possible self-knowledge, perception of the suffering of the other, a rethinking about work and pedagogical training when analyzing its affective, personal and ideological implications.

DISCUSSION
In this article, there were references to health, education and pedagogical training institutions. The concept of an institution is polysemous, and it is not possible to conceive it as a social formation, but rather as the intertwining of different instances, such as economic, political and ideological (18,21) . Every institution has three moments: universality, particularity and singularity (18) . In the reports, it was possible to identify the moment of universality, when teachers made reflections regarding the losses of their old practices before 2008, which correspond to what had been established in its rules, norms values, in pedagogical training. The second moment, particularity, could be perceived when teachers began to reflect on their new role as teachers and in the strategies sought in training, producing conditions of action of instituting forces (26) . These refer to the set of material and social determinations that deny the first moment. Finally, the third moment, singularity, resulting from the negation of the old institutional norms and the acceptance by all or only by some of them of new rules, norms and ideologies that remain in constant movement in search of reaching a certain objective, leading to a new institutionalization (18) .
The results point to the nuances of a permanent institutionalization of pedagogical training. This new institution appears permeated by disputes between the instituted forces and the instituting (27) . In the case of this research, they are still charged with feelings of recognition of the other, of individual differences and of possibilities of expanding interpersonal relations. The institution finds itself somewhere among the revolutionary forces of the institute and those more conservative of the instituted. In this struggle, institutionalization seeks the instituted, its forms more stable and, at the same time, seeks to break from instituting forces, this permanence, from innovative changes, this movement is continually sustained by dialectical forces that remain permanently permeable, fluid and elastic (18,26,28) .
With regard to professional involvement, this arose with the institutionalists, in denying scientific neutrality in their interventions, since they understood that every researcher is emotionally and professionally involved with its object (20,29) . The professional implication is the set of relations that the subject establishes with the profession (thought like institution with its own dynamics) to which it belongs, and with the other institutions in which, or in connection with which, he exercises his profession, and this according to the libidinal, professional and ideological dimensions. As for professional practice, it consists of the set of professional implications of a subject, including ways of relating to the other members of the profession (and, or with other institutions involved in the profession) to think about those relations and to give them meaning and values (15,19) . This concept makes sense, when, in the testimonies, personal implications can be perceived when referring to the suffering caused by "dismantling"; professional implications, when they emphasize the need to have a lot of resistance, resilience and struggle to keep the Technical School in operation; and ideological implications, when referring as health and education institutions interfere with their work as trainers for SUS. It could be said that the professional teaching practice of this study was constituted through the set of professional implications of all participants, including ways to relate to co-workers, other institutions, to think about relationships and to assign them some meaning and value. Through this daily and reflexive contact, "as in a mirror -the professional recognizes himself by looking and being with the other, at the same time that he is also forming from the other" (22).
It can be seen in the testimonies how the Technical School appears crossed by education and health institutions and how the political interferences lead each participant to have a kind of implication with these institutions and with the institutions that cross them.
The discourses reveal that the decentralization of power, the lack of pedagogical and financial autonomy of the school, provoke conflicting situations at work, interfering with the professional and personal life of participants. Some Technical Schools experience bureaucratic obstacles and are influenced by local political issues, in a negative way, in this process, since the majority do not have administrative, financial and decision-making autonomy, increasing the precariousness of the formation and the qualification of the workers (30)(31) . They also point out that the lack of autonomy of some technical schools for the management and execution of resources does not contribute to the changes that are necessary and increases the precariousness of training and qualification of workers (1,30) .
With regard to the implications of participants with the use of the methodologies of the problem, different studies about training in technical schools, point this methodology as teaching, learning and evaluation strategy in the active methodology, by anchoring itself in the pedagogical conception that encourages the student's participation, developing autonomy and understanding of individual and collective responsibility in learning (30)(31) . They point out that the difficulties in the pedagogical dimension refer to the turnover of professionals, the lack of mastery in the application of the methodology, the lack of didactic material and often to the lack of financial resources to make feasible the projects similar to the results of this study (11,(30)(31) .
The specificity of this study is the way in which professionals experienced the "dismantling" in Technical Schools and how they looked for strategies to continue training even in a context permeated by conflicts and by political and institutional interferences in Health and Education. The study revealed that participants were able to leave their established spaces to seek and experience new instituting experiences in pedagogical training, such as the search for stricto and lato sensu post-graduation courses; offer of courses using platforms from the Ministry of Health; production of didactic material; participation in different professional qualification projects for SUS, among others. These actions have led to reflections that pedagogical training can be thought of in a much more comprehensive way, besides the space of the Technical School.
The main result of this study was the ability of teachers to understand their ability to act through a better understanding of the emotional, professional and ideological dimensions inherent in any practice based on the analysis of their implications (32) . Accepting and analyzing these dimensions can contribute to give more power and legitimacy to the teaching work, building a space for dialogue and reflective analysis with the institutions that pass through us, which can bring benefits to the pedagogical training of the Technical School (32) . A process of training understood as the constitution of subjects, lived in an interactive process and, therefore, intersubjective, where the senses were given a new meaning by all participants, mainly by the researcher, confirming that from the dialogue and the unveiling of previously unacknowledged situations that caused suffering in all, one can face the condition of heterogeneity of the daily life of the pedagogical teacher training (2) .
The devices used to analyze professional practices in pedagogical training and the use of the methodological proposal of the Institutional Socio-Clinical allowed the analysis of the participants' implications, bringing them closer to their weaknesses and potentialities, allowing them to strengthen as a group.

Study limitations
It is highlighted as a limitation of the study, the fact that the results highlight pedagogical teacher training in only one reality. Similar studies using this methodological proposal would be interesting in the sense of knowing how other teachers experienced the pedagogical training in adverse contexts.

Contributions to the fields of Nursing, Health or Public Policy
This study contributed to the debate and reflections on pedagogical training of a Technical School teachers and professional quality training for SUS.

FINAL CONSIDERATIONS
This study made it possible to know the factors that hinder and facilitate pedagogical training; to identify how teachers perceive themselves in training; and mainly to clarify how the established behaviors opened loopholes for instituting movements present in that setting, revealing the nuances of a new institutionalization. It has contributed, above all, to the collective construction of strategies related to the training of professionals, aiming at improving the quality of education offered to workers and society.
The use of the Institutional Analysis and, specifically, Institutional Socio-Clinical methodology, produced deep reflections in the group of school teachers, making them rethink their own pedagogical practices and work, giving a new meaning to these processes and challenging them to overcome.
Reflections brought by this research demonstrate the relevance of future research in this field, since it can serve as a theoretical and methodological contribution in other areas, in order to ratify the impressions recorded here. New studies are recommended in order to contribute to the pedagogical training of new teachers and the strengthening of SUS.