Critical thinking in nursing training: evaluation in the area of competence Education in Health

Chirelli, Mara Quaglio; Sordi, Mara Regina Lemes de

doi:10.1590/0034-7167-2020-0979

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Revista Brasileira de Enfermagem

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Sumário

ORIGINAL ARTICLE • Rev. Bras. Enferm. 74 (suppl 5) • 2021 • https://doi.org/10.1590/0034-7167-2020-0979 copy

Critical thinking in nursing training: evaluation in the area of competence Education in Health

Pensamiento crítico en la formación del enfermero: la evaluación en el área de competencia Educación en la Salud

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To analyze the constitution of critical thinking in nursing training in the approach by competence and the integrated curriculum, considering the evaluation process by capturing its challenges, and proposing overcoming strategies.

Methods:

Qualitative. In the first phase of data collection, interviews were conducted with twenty-four professors, nine preceptors, and fifteen students to reconstruct the profile of competence, and in the second phase, a workshop to validate the profile identified challenges and proposals. The Collective Subject Discourse was used to analyze the interviews and the holistic competence reference in reconstructing the profile.

Results:

The critical thinking is built based on experiences in the world of work, and evaluation is the conductor of reflections towards emancipation.

Final considerations:

It signals the importance of professor training in the learning evaluation and working with the collective construction of subjects to overcome challenges that happen in the changes of training.

Descriptors:
Thinking; Employee Performance Appraisal; Nurses; Professional Competence; Competency-Based Education

Key actions	Performance
Identifies and processes learning needs	Experience the reality of professional practice in real and simulated scenarios promoting learning in successive approaches through reflective narrative and problem situations about work in health and education. Analyzes the individual socio-cultural context, the service, institution, network, or project in which it is involved; presents an ethical and open posture to different points of view, committing and co-responsible with the development of group activities and realizing the impact/mobilization that the situations provoke. Use the exchange of knowledge and experiences to broaden the understanding of reality and promote knowledge construction and new meanings. Show interest, willingness, and openness to identifying and understanding knowledge gaps, the challenges related to emotional aspects and/or the relationships, based on the analysis of experiences in real and simulated scenarios, recognizing these for the production of new knowledge and practices. Identify and articulate problems by representing what was experienced in the practice scenarios and elaborated problem situations, considering the context understanding and data identification in the face of the situation, mobilizing the baseline of skills constituted throughout personal and academic life. Elaborate hypotheses/presupposed and build an explanatory network of problems based on the rational way of understanding the world, identifying learning gaps from recognizing what is known and what is needed to intervene in the problem situation. Elaborate questions to overcome learning requirements to advance the performance. Access databases with scientifically systematized knowledge production and other forms of knowledge production. Critically analyze the sources' quality, the scientifically produced information, and elaborate reflective individual synthesis that sustains the knowledge gap for understanding and explaining the collected problems. Socialize the understanding, analysis, and doubts about the systematized knowledge and how to access the databases; dialogue with the knowledge of other participants in the activity, communicating clearly; present arguments from the perspective of understanding and solving the identified problems; capture the various explanations and possibilities of interventions, relating them to the previously formulated hypotheses, repeating or modifying them. Take up the problems to identify actions/strategies to overcome them in the exercise of the professional practice or problem situation, considering the context, local culture, professional ethics, relationships, and the capacities and challenges to deal with the situations. Elaborate a synthesis of the construction of knowledge revealing the understanding of the construction of knowledge and proposed actions.
Develops and evaluates educational actions	Participate in educational actions based on the identified learning requirements, enabling a significant education and transformation of reality. Encourage the development of the ability to learn from people, team, and community, supported by the learning requirements, valuing previous knowledge, encouraging curiosity, intellectual autonomy of those involved in the production of care and education in health, through interaction and cooperation in groups, listening and respecting different ideas, promoting inter/transdisciplinarity. Cooperate in the creation, dissemination, and sharing of knowledge. Participate in education by example, showing persistence, patience, and respect for the difference in people, teams, and community learning timing in developing their skills. Conduct and receive criticism ethically, and respectfully. Support the production of new skills required for the professional profile, identify learning opportunities in the work process and the places of permanent education, considering them as a formal device to promote the construction, socialization, and updating of knowledge aimed at the management and transformation of health practices, according to the best available evidence. Use hits and mistakes as input for professional and institutional learning. Monitor and evaluate processes, products, and results related to educational actions, through peer, professor, and self-evaluation. Recognizes and analyzes its achievements, potentialities, and challenges, promoting meta-analysis, metacognition, and meta- evaluation, proposing a plan for monitoring the performances to be (re)built.
Performs knowledge production and dissemination	Identify the need for new knowledge based on reality and the challenges of working in health and education. Promote usage of adequate resources for production and recording of new knowledge based on practice. Develop and/or participate in the scientific production in the area of operation through research guided by ethical-scientific principles and focused on the generation and dissemination of knowledge relevant to health and education production, directed to people and society's quality of life. Participate in internal and external events as a way to improve, develop professionals, and share information. Participate in elaborating and/or disseminating guidelines involving care and organization of protocols, educational materials, and promoting a culture oriented towards excellence.

Central idea

Collective Subject Discourse

Development of transversal capacities in the construction of critical thinking, with focus on evaluation

[...] Evaluation is one last capability that I think is important and transversalizes the entire teaching-learning movement, which the constructivist spiral has realized to be a method that favors competence-oriented curriculum training in the dialogical approach. Besides evaluation peers, the lived process, and the professor, it has an aspect that is the self-evaluation. So, the critical capability of how much they manage to capture what they already have conquered, the power and what challenges they still have to develop, so that in the future we can make a meta-analysis, metacognition, a meta-evaluation of themselves. So, in every moment that we do some activity, they expect feedback. This evaluation of the process, how the people interacted [...]. This is very strong in graduation because from that they can also see themselves within a context. The proposition is that we can do this daily evaluation during the meetings, while the work in a group, and do it in a specific way with those you get closer that day and make a process comparison. But it's not a done issue, although making a comparison with the traditional, we have much more significant possibilities to understand, to get closer to this student, to get closer to previous knowledge and then see the process of knowledge construction both in terms of the cognitive issue, and in terms of attitude, mainly because we get closer to this student in the group meeting or by following the visits. [...] So, it may have many aspects, but I think the main one is that students can do self-criticism to see where they could have a different performance. I think they could look at this as a whole, but they look much more at themselves, how much they could advance, [...]. They can keep the service in check, and they can put themselves in a way that it would not seem like an unethical thing, a question that can suddenly hurt the people who are there. I think, in this sense, the evaluation helps this process of creating critical thinking.

Central idea

Collective Subject Discourse

Building criticism through the evaluation process

Always at the end of the day, we perform an evaluation, leaving it available for them to expose what has to change that day, not only about the elaboration of the cycle in college but in practice. We make it very clear that there will be no punishment for expressing opinions [...] Moreover, the fear of exposing does not exist anymore because, since the beginning, they learn that the important thing is to expose an independent opinion, which can be favorable or not at that moment, but always making clear right from the start how they should expose the opinion [...]. However, some students from other schools, each one originated from a different place, can carry out the criticism in an offensive way. We also begin to work with them from the beginning because there are ways of exposing opinions without offending or hurting people next to us [...].

Central idea

Collective Subject Discourse

Evaluation process as part of the training process

At all times, we need to make a group evaluation at the end of every activity because it is part of the methodology. We evaluate the group, evaluate ourselves, and evaluate the facilitator, the preceptor, and the attending psychologist. It is not that it is difficult, it is very complex, and we can realize that it is necessary to be always self-evaluated, self-critical, and always showing respect. We can expose insecurity or expose something that did not please everyone, make constructive criticism, expose a favorable issue of the group, and feel this horizontality. [...] So, it is a constant evaluation, and in a way conveys security, because, since it is an active method, many people can feel insecure [...] But, this issue of evaluation always trying with everybody else, which also makes part of the process of knowledge construction, to assess and bring up their feelings; all of that could bring up security to the method which can be perceived, many times, as something fluid and insecure [...].

Challenges	Causes	Overcoming Proposals
Difficulty in carrying out the evaluation process proposed in the Pedagogical Political Project	- Some professors leave to present the gaps in the students learning only in the periods of registration of formats at UPP and tutoring, which generates incomprehension and non-acceptance by students in that situation, including the criticism made by the professor, having had little dialogue. - Evaluations are still more focused on the outcome than on the process. - The student had difficulty in receiving criticism from the professor and was unable to dialogue about the causes of the problem highlighted.	Resume discussion about evaluation during the activities of Permanent Education (PE); constitute a place to debate and understand the proposal of evaluation with students, which should be part of the pedagogical activities; train the professor/preceptor and the student about the skills to make and receive criticism, through a workshop, considering ethical, dialogical, respectful and empathetic approaches; build strategies since the first year on how to evaluate and be evaluated; how to build changes of "behavior"/attitude; compose evaluation in the group contract, to enable it to occur in a constructive, fair, democratic and human way, focusing on the process and product.

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[1] Corresponding author: Mara Quaglio Chirelli. E-mail: marachirelli@gmail.com