Projections and expectations of students enrolled in a teaching qualification in a technical health professional education course

Abstracts

O presente estudo propõe analisar as projeções e expectativas dos ingressantes em um curso de formação docente, que visa superar a fragmentação disciplinar e criar maior aproximação com o mundo do trabalho. Trata-se de estudo qualitativo realizado a partir de entrevistas com 33 ingressantes do curso. Para a análise dos dados, pautou-se na técnica de análise de conteúdo, modalidade temática. Os resultados do estudo permitiram elencar as seguintes categorias temáticas: possibilidade de ensinar-aprender; necessidade de capacitação pedagógica e de constante busca de aprendizagem; possibilidade de mudança da realidade. Conclui-se que os ingressantes vislumbram a transformação da realidade social na qual estão inseridos, considerando a necessidade de aquisição de novas habilidades e competências profissionais, com intuito de exercer eficazmente o trabalho e ocupar um espaço competitivo no mercado.

Educação em enfermagem; Capacitação profissional; Formação de recursos humanos

ORIGINAL ARTICLE

Maria José Sanches Marin^I; Silvia Franco da Rocha Tonhom^II; Adriana Paula Congro Michelone^III; Elza de Fátima Ribeiro Higa^IV; Mário do Carmo Martini Bernardo^V; Cláudia Mara de Melo Tavares^VI

^INurse. Post-Doctorate in Health Science, Paulista State University. Professor of Collective Health, Nursing Course, School of Medicine of Marilia, Marilia, SP, Brazil. [e-mail]

^IINurse. Doctor in Education, State University of Campinas. Professor of Nursing in Collective Health, School of Medicine of Marilia. Tutor of CFDEPTAS/EAD-FIOCRUZ. Marília, SP, Brazil. [e-mail]

^IIINurse. Master in Nursing, University of São Paulo. Professor of Clinical Nursing, Nursing Course, School of Medicine of Marilia. Coordinator of the Teaching Support Nucleus, CFDEPTAS/EAD-FIOCRUZ. Marília, SP, Brazil. [e-mail]

IV Nurse. Doctor in Fundamental Nursing, Nursing School of Ribeirão Preto. Professor of Health Sciences Education, School of Medicine of Marilia – Famema. Doctor in Fundamental Nursing, Nursing School of Ribeirão Preto. Tutor, CFDEPTAS/EAD-FIOCRUZ. Marília, SP, Brazil. [e-mail]

^VPhysician. Master in Pediatrics, Paulista State University. Professor of Pediatrics, School of Medicine of Marília, SP, Brazil. [e-mail] in Nursing. Professor of the Nursing School, Federal Fluminense University. Learning Leader, CFDEPTAS/EAD-FIOCRUZ. Niterói, RJ, Brazil. [e-mail]

Correspondence addressed to

ABSTRACT

This research aims at analyzing the projections and expectations of students enrolled in a teaching qualification in technical health professional education course, aiming at overcoming disciplinary fragmentation and further approaching the working world. This was a qualitative study that included interviews with 33 students enrolled in the course, and the data analysis was performed using a content analysis technique. The following categories were identified among the results: the possibility of teaching-learning; the need for pedagogical qualification and the constant search for learning; and the possibility of changing reality. We conclude that students enrolled in this course foresee the transformation of their social reality, taking into account the need to acquire new skills and professional competences to effectively perform their job and compete within the working world.

Descriptors: Human resources qualification. Nursing education. Professional qualification.

RESUMEN

El estudio propone analizar las proyecciones y expectativas de los ingresantes a un curso de formación docente que apunta a superar la fragmentación disciplinaria y a conseguir una aproximación mayor con el mundo laboral. Estudio cualitativo realizado mediante entrevistas con 33 ingresantes al curso. Datos analizados según técnica de análisis de contenido, modalidad temática. Los resultados del estudio permitieron enumerar las siguientes categorías temáticas: posibilidad de enseñar-aprender; necesidad de capacitación pedagógica y de constante búsqueda de aprendizaje, y la posibilidad de cambiar la realidad. Se concluye en que los ingresantes vislumbran la transformación de la realidad social en la cual están insertos, considerando la necesidad de adquisición de nuevas habilidades y competencias profesionales, con vistas a ejercer eficazmente su trabajo y ocupar un espacio competitivo en el ámbito laboral.

Descriptores: Educación en enfermería. Capacitación profesional. Formación de recursos humanos.

INTRODUCTION

Since the 1980s, the Brazilian Constitution has proposed a Unified Health System (SUS) that includes deep changes to the organization of the healthcare model. The SUS aims at implementing a health surveillance model that allows different structuring spaces and incorporating the concept of health promotion and integrality in an attempt to overcome fragmented sanitation practices⁽¹⁾. This proposal stresses the need for transforming teamwork relations and incorporating the community of health professionals based on the understanding that an organized population enhances the views related to the social aspects of the health/disease process⁽²⁾.

In this context, there is a need to improve the technical, ethical and political knowledge of health professionals in order to transform working processes and eliminate inconsistent assistance principles, which is a major challenge for public SUS-oriented policies.

Therefore, new teaching / learning methods are proposed to achieve the qualification of critical public professionals, preparing them to learn, create, propose and build a new health care model⁽³⁾.

Proposals to improve the level of education and qualification among health professionals must emphasize innovative models; the qualification process is currently highly cultural organizations influenced by traditional teaching trends through which they centered on the professor as the knowled-may participate inge owner and on the contents of a course without considering the social reality and qualifications of the subjects.

In addition to this problem, it must also be noted that the technicist thinking in the health area is hegemonic. This is a concept that emphasizes the use of technology in the learning process. The activities are mechanical and entirely programmed, and the professor is merely a specialist who applies the manuals. This is in line with the fragmented, biologicist and overspecialized assistance model, making professional qualification even more removed from the social and political context of the people⁽⁴⁾.

The dichotomy between education and work is reinforced by the industrialization process, which has questioned the separation between instruction and productive work, providing an origin to the

division of men in two major fields: those with manual professions, for whom a practical qualification limited to performing the tasks is required; and those with intellectual professions, where a broad theoretical mastery is required to prepare the elites...⁽⁵⁾.

The intention, however, is that workers will have cultural organizations through which they may participate in ensuring the equality of conditions and in discussions of the problems that affect society. We are talking, then, about preventing the working class from falling into intellectual passiveness and, at the same time, preventing university students from falling into academicism⁽⁵⁾.

In the context of criticizing traditional schools, the New School ideas were formulated with the basic principle of valuing the individual as a free, active and social being. The center of school activities should not be the professor or the disciplinary content, but rather the focus should be on students as active and curious beings. Such a concept, due to its advanced and consistent ideas, continues to guide the reformulation of the school system⁽⁶⁾.

In the 1970s and 1980s, with the proposal of school activities based on the immediate social reality, social problems and their determining factors were analyzed and actions were structured to transform the social and political reality. This pedagogic line has as a theoretical-methodological reference the Dialectic Historical Materialism, formulated by Karl Marx and Friedrich Engel⁽⁷⁾.

The critical theory advocates the idea that the school is the place to address social contradictions and to question reality, that the decision about what to know and what to do depends on lived social needs, in addition to overcoming the intellectual vs. manual work dichotomy as a proposal to qualify men by and for work⁽⁸⁾.

According to the principle of education for work, there are two types of learning that should be expected from students: knowledge of how to strive and knowledge of how to build, which are based on the school's relationship to the current reality and on self-organization among students'. Students need ideological and political soundness as well as the autonomy and creativity to help recreate practices and social organizations⁽⁹⁾.

In this context, the relationship between work and science is intrinsic, and the two cannot be separated; that is, practice should be based on theoretical laws. Therefore, praxis means action-reflection-action, as from scientific knowledge with an aim at transforming reality⁽⁸⁾. It is understood that the basis for the social Pedagogy of the School of work is the current reality in a social plane that determines the choice of themes, having as a reference the dialectic method where interdisciplinarity, transversality and transdisciplinarity are integrated to convert sense and social and historical meaning into knowledge and reality^(10-11).

It is observed, then, that the principles of critical education and education for work, based on the dialectic historical materialism, are a major reference of the pedagogic project of the Teaching Qualification in Technical Health Professional Education Course, which was developed under the national coordination of the Osvaldo Cruz Foundation (FIOCRUZ) and directly influences the development of educational ideals.

It is important to consider that nursing technician qualification is being transformed as a result of the National Curriculum Guidelines for professional education via competence-oriented concepts that seek to promote the development of skills that are relevant to the working world⁽¹²⁾.

The distant learning (DL) modality is becoming increasingly prevalent in Brazilian society and may be particularly useful considering the demand for strategies that will enable professional qualification in ways that are congruent with the SUS proposals and that can be implemented quickly and with the possibility of involving a large number of people. Therefore, the proposal is to follow an innovative and challenging pathway while seeking to merge the working world with education, knowing that most professionals have technical qualifications in their area of activity that are not based on pedagogic principles. Very often, professionals lack a critical awareness of their potential as subjects within the working world.

The Teaching Qualification in Technical Health Professional Education Course was developed in the State of São Paulo via partnerships with five public universities that provide physical space for classroom activities as well as IT and library resources. These institutions are referred to as Professor Support Nuclei (PSN). One of these nuclei is located in the School of Medicine of Marília (Famema), which serves the Regional Health Department (RHD) IX and XI macro-regions. The process of the selection and qualification of tutors, both for the proposed content and the DL tools, is underway.

During the tutorial qualification process, the issue of who would be intended to attend the course is of particular concern. Discussions are ongoing to address the following questions: What should be the course participants previous experiences? What pedagogic process ideas would the participants have? What does being a professor mean for their lives? Given this, tutors as mediators of the teaching process have also questioned whether they would be able to maintain the motivation and interest of the students.

Although there are many questions, the certainty is that all will be included in the health professional qualification process, and it is believed that by rescuing their experiences and encouraging them to question reality through a review of the history of working processes, educational processes and the organization of the health system, it would be possible to cope with any difficulties.

Given a proposal for changes in the teaching methods and in the conceptual structure, which will involve more critical and less technical qualification, this study aimed to analyze the expectations of students/professors participating in the Teaching Qualification in Technical Health Professional Education Course and their projections for the development of a teaching work.

METHODS

This is a qualitative study to analyze the projections and expectations of students of the Teaching Qualification in Technical Health Professional Education Course according to their level of specialization and regarding their experiences with the distant learning modality with some classroom time, as promoted by the National Public Health School Sergio Arouca (ENSP/FIOCRUZ) in partnership with universities of the State of São Paulo, to qualify SUS workers⁽¹³⁾.

Through the Government School of Health, ENSP / FIOCRUZ has recently begun configuring a professional qualification model for SUS in agreement with the essential demands of such configuration. The goal of the course is to complement the educational pathway of professionals who have graduated in different health sub-areas to assess a set of initiatives that will bring about inter-sectorial and interdisciplinary relationships between health and education, which are essential to promote both the quality of life and Unified Health System assistance⁽¹⁴⁾.

Selected universities serve as Interdisciplinary Professor Support Nuclei – IPSN, which carry out the course in the hinterland of the State, with local coordination and teaching as well as academic and administrative support.

Famema hosts an IPSN serving the region of DRS IX and XI and currently counts on seven accredited schools to qualify nursing technicians, with a total of 40 professionals attending the first course.

The subjects of this research are students and professors, and they are part of the first group to attend the Teaching Qualification in Technical Health Professional Education Course, in specialization level, from IPSN at Famema. Among 40 enrolled students, 33 participated in the study. To assure confidentiality, the interviews were alphanumerically coded as F for female and M for male, followed by a number related to the participants' age.

A semi-structured questionnaire was developed for data collection, with identifying data such as gender, age and family income, as well as information about the participants' professional qualifications and working conditions. Open questions addressed the participants' reasons for entering the teaching field, the positive aspects and difficulties associated with teaching and their expectations for the course to be developed.

After enrolling students in the course and making their data available to Marília's IPSN, an e-mail was sent with the data collection tool and the Free and Informed Consent Term requesting their participating in the study. This e-mail was sent the week before the students were first contacted with the proposal of the course. We requested that the completed questionnaires be returned to the research coordinator on the first classroom day.

The data were analyzed using the content, thematic modality analysis technique⁽¹⁵⁾. Initially we comprehensively read the material to obtain an overview, to find nuclei or axes around which the testimonials could be structured and common features could be grouped. Next, we identified themes around which data could be discussed.

It has to be stressed that, in compliance with Resolution 196/96 of the National Health Council, the research was conducted after receiving the approval of the Research Ethics Committee, School of Medicine of Marília under n. 394/10. Based on this resolution, the subjects could only participate if they agreed with the Free and Informed Consent Term (FICT), which must be read by the researcher and understood, accepted and signed, reassuring the participants of the confidentiality and anonymity of their answers.

RESULTS

Table 1 shows the data related to the demographics, professional qualifications and working conditions of the participants of the Teaching Qualification in Technical Health Professional Education Course. With regard to gender, 30 (90%) were females. The age varied from 24 to 60 years, and the family income of most of the participants was up to five minimum wages. With regard to professional qualification, almost all of the participants were nurses, and one was a dentist. We observed that 27.3% of the respondents did not have specialization level course, with 30.9% having less than one year of experience working as professors. With regard to the time dedicated to teaching, 33.3% of the participants reported that they work from 11 to 20 hours weekly, and the majority (75.8%) participate in activities beyond teaching; 45.5% of the participants reported that they have temporary working agreements.

The participants' expectations and projections with regard to the course revealed three thematic categories: the possibility of teaching and learning; the need for pedagogic qualification and the continuous search for learning; and the possibility of changing reality.

Possibility of teaching and learning

Given the possibility of teaching and learning, according to the enrolled students, the idea of exchanging and sharing among subjects is an important aspect of the teaching and learning process.

The power of sharing experiences among group members. Educators are not only information and knowledge spreaders; they are also information receivers (F, 27 years old).

I consider the educator/student relationship to be extremely positive, with the sharing of experiences and cultures and the possibility of enhancing knowledge and action in a very synergistic way (F, 54 years old).

It is clear that, by enrolling in the course, the participants had already discarded in some sense the traditional role of the professor as an individual who transmits knowledge, as the complexity and increasing knowledge place the professor in a more flexible position and promote a dialogic shift.

Need for pedagogic qualification and the continuous search for learning

The participants in the course were aware of their weaknesses in the teaching field and anticipate that the course would contribute to their qualifications.

The requirement of the Council associated with the perceived need for specific qualification for the teaching function was also what led the participants to become interested in the course, as indicated by the statements below.

Be pedagogically prepared for professional education (F, 39 years old).

... the course will provide (...) possibilities of reviewing concepts and theories, postures and strategies to build/ deconstruct in the classroom (F, 54 years old).

... requirement of the Regional Council of Nursing and of the demands of technical schools and courses, which are increasing in the nursing area, and the opportunity to teach... (M, 24 years old).

Improve interpersonal and intergroup relations skills, enhance planning... (M, 25 years old).

The statements of the students also reflect the concern with continuous learning and professional improvement, which for them represents a reason for overcoming teaching barriers and for updating their professional skills. Such concern demonstrates the participants' commitment to their profession and suggests a way to maintain their involvement in teaching and help them to cope with the low compensation imposed on health professionals.

...to improve myself, qualify myself, because we should always look for new knowledge, especially because there are always discoveries in our area (F, 26 years old).

admiration for teaching, improvement and overcoming my barriers, because I really want to know how to teach (F, 25 years old).

My first interest was to increase income... (F, 31 years old).

Teaching courses has become mandatory and I ended up losing classes. Without classes, I could not pay because my income has decreased. As soon as this opportunity appeared, I decided to attend the course and return to teaching (F, 31 years old).

Possibility of changing reality

From the perspective of the students, it was also observed that by attending the course, they would have the possibility of integrally changing the reality of health assistance, aiming at achieving the SUS principles and guidelines.

I believe that the course will enable numerous possibilities for philosophical, pedagogic and ludic reflections, with endless opportunities for reviewing concepts and theories, postures and strategies for building and rebuilding knowledge (F, 54 years old).

... I always wanted to teach beyond the school curriculum; I wanted them to notice how all that (with a broader view) would be important for their lives, a life of values and ethics within a society (F, 45 years old).

... understanding SUS will be a step forward to qualify SUS workers (F, 35 years old).

The position of the students corresponds to the principle of educating for work, considering that scientific knowledge has transforming reality as its single goal. The statements related to teaching work and taking SUS workers into consideration reveal the understanding of the need to acquire skills that are different from the traditional basis of the teaching model, which has qualified the majority of professionals.

DISCUSSION

The predominance of females in our study reflects a socio-historical condition that persists in nursing, which relates the profession to its origin based on the sacred order, on the European influence of the 19^th Century and on the image of females associated with the provision of domestic assistance to children and older adults ⁽¹⁶⁾.

Most respondents reported some latu sensu post-graduation level; however, the investment in technical qualification and increasing the level of nursing experience, at the expenses of the teaching qualification, must be stressed.

The respondents' duration of academic experience varied from 10 years to less than one year, and approximately one third of the participants had less than one year of experience in this area. These data, when associated with the age of the respondents, lead to the conclusion that they entered the professional pedagogic process soon after graduating and, as a consequence, had little experience in either the professional technical aspects of the field or in the academic area.

Our findings also call the attention to the large number of respondents who, in addition to their academic activity, have other activities,whether in primary care or in hospital. As a consequence, the participants report that they dedicate little of their time to teaching, and their working agreements with teaching institutions are temporary. One may consider that although the contact with different professional practices may give more legitimacy to the doing of the profession, it is possible that the limited period of time dedicated to teaching prevents further involvement with the pedagogic project, resulting in general inconsistencies.

These data are similar to those of a study analyzing working conditions of new nursing professors in which more than half of the participants reported that they would teach up to 10 weekly classes as a way to supplement their income. The activity was performed during their free time, implying that the professors would be tired and have no time to prepare their teaching activities. In addition, the respondents did not receive adequate preparation for satisfactory teaching development during their qualification process⁽¹⁷⁾.

Therefore, upon enrolling in the course, the participants expected that the professor would be more flexible and that the learning would be dialogic, representing an advancement in the understanding that it is necessary to move beyond the traditional teaching concept where the professor is in charge of transmitting knowledge that is very often out of context.

The dialogic concept is implied in the historical-critical pedagogy where education is understood as the act to produce, directly and intentionally, in every single individual, the humanity which is historically and collectively produced by all men. Therefore, it is understood that social practice is the starting point and the end point, while education is a form of mediation. Professors and students, each with their role, are committed to finding solutions problems encountered in the social sphere⁽⁵⁾.

Although this perspective already pervades the desires of the students, it is necessary to understand the theoretical bases that permeate the role of professors in different pedagogic areas and to provide tools for the desired and necessary qualification, given the current social demands.

Imbued with the desire to make changes in the teaching process through interventions based on incorporating the knowledge of people and including the possibility of confronting different realities, one foresees changes in the teaching process and its role in the transformation of health assistance.

However, based on the statements from the students, it has to be stressed that to make this desire concrete, it is necessary to consider the teaching and health practices that we are in place today as well as those that we wish to see supported by principles and guidelines directed at meeting the needs of society.

The lack of qualification for teaching in the field of professional health is a significant barrier to the changes that are needed in the teaching and learning process. Due to the lack of qualification, professors end up repeating old models that are not in line with the current social needs, which involve an overt process of globalization and democracy consolidation⁽¹⁸⁾.

Aiming at the pedagogic qualification of professors, the Regional Council of Nursing of the State of São Paulo, by its directive COREN-SP/DIR/26/2007, has made it mandatory that nursing professionals demonstrate their pedagogic qualification⁽¹⁹⁾.

It is shown that they foresee a qualification process that will supersede the traditional view, pointing to the need for new concepts, postures and strategies to help build/ deconstruct the pedagogic practice. They also show the need for interpersonal and intergroup skills, leading to the idea of participative and collective knowledge building.

The desire for advancement in professional development is due to the increasing availability of knowledge and the process of globalization, which are bringing about changes in the dynamics of human relationships, which now require greater proximity, sharing and articulation of information. To consider all of these conditions, it is necessary to change the ways in which we act, interact and view other people to truly change the relationships among health team professionals.

Adaptation to this new way of acting and interacting within the health team has to be initiated by changes in the professional qualification process, which should be organized to provide tools in the technical, ethical and political aspects of the field through innovative pathways, assuming that the current level of knowledge transmission is not enough. The need for the qualification of critical and citizen professionals who are prepared to learn, create, propose and build a new model of intervention on reality is reinforced⁽³⁾.

It is understood that the need for the continuous search for knowledge and professional enhancement is related to the need to be prepared for competitiveness in the work market⁽²⁰⁾.

There is also a need to understand the area of SUS, as understanding the proposed principles and guidelines for coping with the demands of the current model is important for this process.

The students' projections are in line with the proposal of the course. For the development of the course, three axes were considered to be relevant for creating a learning process that aims to change professional health practice. The organization of such axes involves work, health and education. The SUS and health work processes and the pedagogic approaches to teaching health care professionals aim at overcoming, above all, the gaps between theory/ practice and teaching/service.

However, to move in this direction, it is important to consider statements such as the following:

In the former, work is transformed in teaching object, since the objective of the school is to prepare students for a certain type of job and so does not meet modern society needs. In the latter, work is a teaching method or means to provide students with the learning of other disciplines since it is not the object of teaching⁽²¹⁾.

It is noticeable that such education-by-work approaches are only a means of repeating and copying already known lessons⁽²¹⁾; such approaches are alienating and unable to promote the necessary transformation demanded by current situation. In this context, work should be the raw material, or the starting point. As an exercise in critical reflection on reality, one returns to the starting point with new formulations and innovative and transforming proposals.

In this way, a pedagogic proposal is conceived, which is different from the traditional teaching practice, and which centers its function around the intellectual qualification and knowledge transmission, with consequent assimilation of the contents by the students⁽⁵⁾.

The need for new professional qualification profiles driven by productive world changes, that is, the working world, requires the ability to solve problems, to lead, to make decisions and to adapt to new situations. Education proposes to prepare students to engage in social citizenship and competitiveness⁽¹⁸⁾.

CONCLUSION

In analyzing the projections and expectations of the students enrolled in the Teaching Qualification Course, values, projects and meanings were exposed, revealing the real sense of investment in such qualifications: preparing professionals to act in compliance with the SUS principles and guidelines, aiming at implementing a new health attention model.

However, it is necessary to pay attention to the working conditions of such people, and especially to understand the conditions under which they will attend the course; although they are willing and aware of the importance of the course for their professional achievement and maintenance in the working market, attending the course will be one additional task that they must undertake within the complex context of multiple working shifts. The socio-demographic data and working conditions of the participants indicate that the participants undertake two working shifts and receive low wages, in addition to their teaching activities, which require daily preparation.

The statements of the participants reveal that they foresee changes in the working process, considering the need for new skills and competences to effectively perform their work and occupy a space in the competitive working world.

When projecting professional qualifications according to the current concepts, one may conclude that the respondents are concerned with the development of citizenship and ethical and humanistic principles, in addition to the means for permanent learning.

A political discussion involving technical health qualification is necessary, and we believe that the expectations and projections of the respondents may be clues for the development of proposals to meet their needs. However, additional studies are also needed, especially to investigate those who have completed the Teaching Qualification Course with the aim of understanding its results.

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Projections and expectations of students enrolled in a teaching qualification in a technical health professional education course

Proyecciones y expectativas de ingresantes al curso de formación docente en educación profesional técnica de salud

Publication Dates

• Publication in this collection
  15 Mar 2013
• Date of issue
  Feb 2013

History

• Received
  04 July 2012
• Accepted
  05 Sept 2012