Nursing teaching on HIV/AIDS in the perspective of citizenship

Abstracts

O objetivo foi verificar a percepção de docentes de Enfermagem sobre sua responsabilidade na prática pedagógica em HIV/Aids e se valorizam a construção do conhecimento sobre a temática do HIV/Aids centrado nos parâmetros voltados à cidadania. Estudo qualitativo, cujo referencial teórico foi o Pensamento Complexo de Morin. Participaram sete docentes de cinco instituições de ensino superior de São Paulo, no perído de janeiro a julho de 2010. Os dados foram coletados através do Grupo Focal e trabalhados por meio de Análise de Conteúdo. As categorias resultantes foram: A importância da reflexão e da criticidade do professor no ensino do HIV/Aids; O exercício da cidadania por meio do ensino de HIV/ Aids e A compreensão do humano no ensino a partir da vivência com o indivíduo com HIV/Aids. O estudo mostra que o papel do professor no ensino do HIV/Aids é essencial para um posicionamento ético e cidadão do futuro enfermeiro.

Aids; Educação em enfermagem; Filosofia em enfermagem; Educação superior

ORIGINAL ARTICLE

Nursing teaching on HIV/AIDS in the perspective of citizenship

La enseñanza de enfermería sobre el VIH / SIDA en la perspectiva de la ciudadanía

^INurse. Ph.D. in Sciences, Graduate Program in Infections and Public Health from the Coordination of Research Institutes of the State Department of Health. Professor of Nursing undergraduation, ABC Foundation Faculty of Medicine, Santo Andre - Sao Paulo, Brazil

^IIPsychologist. Masters in Communication and Semiotics, Pontifical Catholic University of Sao Paulo and Ph.D. student in Philosophy of Education, University of Sao Paulo (USP). Professor of Ethics at the Psychology course at Paulista University of Sao Paulo, Sao Paulo, Brazil

^IIINurse. Ph.D. in Sciences, Graduate Program in ABC Foundation Faculty of Medicine. Professor of Nursing undergraduation, ABC Foundation Faculty of Medicine, Santo Andre - Sao Paulo, Brazil

Author's address

ABSTRACT

The aim was to investigate the perception of nursing faculty about their responsibility in teaching practice on HIV/AIDS and if they value the construction of knowledge on the subject of HIV/AIDS focused on parameters aimed to citizenship. This qualitative study had its theoretical framework on Morin Complex Thought. Seven professors from five institutions of higher education in Sao Paulo participated of the study in the period from January to July 2010. Data were collected through focus group and analysed through content analysis. The semantic categories were: The importance of reflection and criticality of the professor in teaching HIV/AIDS; the exercise of citizenship through education of HIV/AIDS and; the understanding of the human in learning from the experience of a person with HIV/AIDS. The study shows that the role of the professor when teaching HIV/AIDS is essential to an ethical and a citizen development for the future nurse.

Descriptors: AIDS. Education, nursing. Philosophy, nursing. Education, higher.

RESUMEN

El objetivo fue investigar la percepción de los docentes de enfermería sobre su responsabilidad en la enseñanza de prácticas sobre el VIH / SIDA y el valor de la construcción del conocimiento en el tema de VIH / SIDA centrado en parámetros orientados a la ciudadanía. Este estudio cualitativo fue el Pensamiento Teórico Complejo de Morin. Los participantes fueron siete docentes de cinco instituciones de educación superior en São Paulo, en el plazo de enero a julio de 2010. Los datos fueron recolectados a través de grupos de enfoque y trabajaron a través del análisis de contenido. Las categorías resultantes fueron: La importancia de la reflexión y criticidad del maestro en la enseñanza del VIH / SIDA, el ejercicio de la ciudadanía a través de la educación sobre el VIH / SIDA y la comprensión del aprendizaje humano de la experiencia con una persona con VIH / SIDA. El estudio muestra que el papel del profesor en la enseñanza de VIH / SIDA es esencial para una ética y ciudadana de la enfermera futuro.

Descriptores: SIDA. Educación en enfermería. Filosofía en enfermería. Educación superior.

INTRODUCTION

Since the beginning of the discovery of HIV/AIDS in the mid-twentieth century to the present day, several areas of knowledge are showing different concerns, from care to facing the problem of prejudice to the individuals infected by the virus^(1-3). Among these approaches, we found issues related to nursing care in two dimensions: daily care with these people in hospitals, and also, how could we train professionals so that they are capable of understanding the complexity of this disease, in its psychosocial dimension.

Therefore, it is imperative that Nursing invest in fulfilling a citizen education, advocated in curriculum guidelines, which adopts as a profile, a professional with generalist, humanist, critical and reflective view. As also, they should be able to know and intervene with health/disease problems/conditions on more prevalent national epidemiological profiles, identifying the determinants of bio-psycho-social dimensions, in order to act with a sense of social responsibility and commitment to citizenship⁽⁴⁾.

In order to accomplish this ambitious educational project, we search for support on a theoretical epistemic background, relevant to this time of social readjustments, the Morin Complex Thought. Educating for citizenship implies an empathic teaching posture, ie, to be able to put yourself in the place of other thorough identification and projection. It also involves the adoption of a comprehensive educational acts, teaching each other that we participate in the same co existential environment, with equitable rights and duties^(5-6).

With this existential and ethics concern, the authors of this article, go towards a central question: does the teaching-learning process in nursing on the theme of HIV/AIDS appears to be based in care aimed at citizenship, in order to contribute to the extinction of stigma and discrimination against people with HIV/AIDS?

Consequently, we assume that the teaching-learning process on HIV/AIDS should be accomplished through careful planning, which involves safe and punctual attitudes about the disease, requiring an understanding of its stigmas and psychosocial interpretation. Thus, we focus on the role of the professor as a person in the strategic allocation for meanings making and appreciation of all aspects related to the topic studied.

Therefore, the social relevance of this research is located in the educational field, in order to promote reflection to construct new possibilities for teaching to be nurse by the dynamic and complex reality of the HIV/AIDS issue, whose relevance favours an ethical care that values ​​aspects concerning citizenship.

Faced with these considerations, the present study aimed to reach and verify the perception of nursing faculty members about their social responsibility in the educational practice of HIV/AIDS. As if the value of construction of knowledge on the subject of HIV/AIDS focused on the parameters listed here by the Complex Thought aimed at citizenship (such as being empathic, clarify social rights, build relevant knowledge as demands of our reality).

METHODS

This is a qualitative study guided by the theoretical and methodological framework of Complex Thought, studied and advocated by Edgar Morin^(5-6). The Complex Thought emerge to challenge the fragmentation and disintegration of knowledge, and is defined as a system of open thought, comprehensive and flexible that does not reduce the multidimensionality to simplistic explanations or ideas of closed schemes⁽⁶⁾.

Consistent with the above, the research was conducted in July 2010, with seven professors of Nursing from five Higher Education Institutions in Sao Paulo city. To participate in this study (inclusion criteria), the professors from chosen institutions should have: nursing qualification and teach contents on HIV/AIDS.

In two of the five investigated institutions, there were two professors in each of them, who met the inclusion criteria. In the other three institutions, there was only one professor in each, who met these criteria. Thus, we had a total of seven participants. Â

We obtained authorization of those responsible for the educational institutions and in the sequence, the approval of the Ethics Committee on Human Research (protocol CEP/Coordinator of Health Services - Institute of Infectious Diseases Emilio Ribas, registered under the number 197/2008) opened the way so that professors could be oriented on the Consent Form. Hence, participants were also informed that their names and institutions of higher education in which they work, would not be revealed in the socialization of research data. Consistent with Resolution No. 196/96, each participant was called “Professor” (Professor 1, Professor 2, and so on) so that, his/her identity would be preserved.

For data collection, the technique used was the focus group, which was led by two guiding questions: How do you define the responsibility of the professor regarding teaching HIV/AIDS? What are the understandings that you have about the educational process regarding the construction of knowledge in a centered education that encourages citizenship?

The use of focus group technique was performed in only one meeting of two hours. We judged one meeting as sufficient, due to the rich interactions among the group. It is known that the number of meetings is not rigidly determined by mathematical formulas, but the saturation of topics, not holding, thus, probability sample characteristics⁽⁷⁾.Â

Content Analysis Technique was used to process empirical data, which was separated in four steps for building consistent categories: 1^st - After the full transcript of the focus group product, we read the text in floating attention; 2^nd - Through new re-reading, we underlined words and phrases from original texts, identifying convergences and divergences; 3^rd - Once convergences and divergences, words and phrases were identified and underlined, they were cut from the text document, for the preparation of categories; 4^th - After the construction of the categories, we proceeded to the discussion of the data⁽⁸⁾.

RESULTS AND DISCUSSION

The themes highlighted originated the categories called: The importance of reflection and criticality of the professor when teaching HIV/AIDS; the exercise of citizenship through HIV/AIDS education on collective destiny in health and; The comprehension of the human being in learning from the experience with a person with HIV/AIDS.

The importance of reflection and criticality of the professor when teaching HIV/AIDS

Self-criticism, self-evaluation and commitment as a person are practices that professors may adopt to conduct the teaching-learning process in a responsible way, to promote the construction of knowledge, human comprehension and, therefore, improving the professor-student relationship⁽⁹⁾.

Accordingly, professors may be able to analyse their own values​​, perceptions and attitudes regarding the issues aimed at HIV/AIDS. The importance of this act is crucial, because it contributes to an education, filled with meaning, not only for the professor, but also for the student. Furthermore, the critic and consequently reflective professor, from his/her self-analysis may be able to work better with the values​​, perceptions and attitudes of their students, as reflected about himself in relation to the theme⁽¹⁰⁾.

For that reason, we cannot deny that professors are important for the individual formation, especially if you are motivated to contribute to education on HIV/AIDS in a critical and reflective manner, which implies awareness and education of graduate students about essential values of a more humane care for individuals with HIV/AIDS. These values ​​are related to solidarity, non-discrimination and respect for others^(1-3).

The following excerpets from statements demonstrate these ideas, ie, the concern of the professor in deconstructing prejudices and enhance solidarity, respect and empathy for others with HIV/AIDS, basic elements for human comprehension⁽⁵⁾:

[...] I understand that my practice favors deconstruction of prejudice and the student's own reflection, when I talk about prevention and condom use. I understand my pedagogical practice as an opportunity to discuss ethical values [...] (Professor 5).

[...]sometimes the person has prejudice of something and they don't even know why ... Treat the person with AIDS badly, for example, they don't even know why they are treating the person like that [...] I think that the deconstruction of common sense is important [...] it is essential to change this mindset ... deconstruction of prejudice [...] (Professor 7).

It can be said that one of the major responsibilities of professors is to prepare young people, not only for a confident future, but to build in an ethical and responsible manner for a better world. The professor should permanently represent critic, reflective and participatory citizens, requiring constantly nourish for the production process itself.

Therefore, the professor's responsibility is not simply to transmit information, but to participate in the construction of contextualized, globalized and multidimensioned knowledge(6), so that future nurses may cope with the complex reality of HIV/AIDS. Furthermore, professors contribute to build the capacity of critical reflective discernment of students in order to establish individual and collective responsibility.

Consequently, a concise education in relation to the issue of HIV/AIDS in the Institutions of Higher Education in Nursing can lead not only to preventing infection among students, but also serve as a multiplier agent in the construction of knowledge in which future nurses will be prepared to advise this population to have a healthy life and care for in a sensitive and ethical way of the person with HIV/AIDS.

The exercise of citizenship through HIV/AIDS education in collective destiny in health

The teaching-learning process in Undergraduate Nursing in Brazil, as well as other undergraduate courses in the health area, are realizing that education focusing on a biomedical view has not been enough. Thus, the Brazilian response to the AIDS epidemic is based on the structural assumptions of the Unified Health System (UHS) actions, ie, within the concept of health as a right for all. This notion is grounded in human rights provided by the UHS and the permanent mobilization of civil society for its effective implementation, allowing the structure of a program of universal access to antiretroviral treatment⁽¹¹⁾.

Since 1988, the National Program Sexually Transmitted Diseases and AIDS began free distribution, within the UHS, of drugs allowed by each time of change in therapeutic treatment, providing drugs to all patients in need. The demands posed by the AIDS control forced the health system to improve, and thus, we can consider that the control of AIDS was a relevant opportunity to strengthen and make work a political project that had been built earlier as a possibility of social participation and innovation^(11-12).

Therefore, over approximately twenty-five years of the Unified Health System, one can realize the greatest adoption of health practices in order to promote health, not only disease prevention. There have been and are currently several programs involving health education, and among them lies the National Program of Sexually Transmitted Diseases and AIDS⁽¹¹⁾. In the National Program on Sexually Transmitted Diseases and AIDS is perceived prioritization of education for citizenship in health, transversality on human rights theme, continuing education, training of health professionals and education⁽¹²⁾.

In this sense, the role of the professor in undergraduate nursing courses on the HIV/AIDS teaching-learning process, must present an ethical stance in defense of life, the promotion of citizenship, autonomy, emancipation of the human person, respect for knowledge, search of dignidity and equal living conditions among people. The professor should participate in the teaching-learning process on HIV/AIDS, keeping in mind, the colective construction with students with knowledge about the citizenship basing themselves in interaction with others and respecting differences^(3,9).

The following excerpts from statements demonstrate the importance of the theme HIV/AIDS in education as a way to exercise citizenship, since there is a clear concern of professors to think of a process that fosters the health of the collective:

[...] nursing responsibility is to guide the people and provide clarification [...] So, I try to discuss all this information in class, because it extends much students' views on this subject ... their responsibility to the population [...] (Professor 2).

[...] I try to show students early on how important it is to take responsibility for the health of the entire Brazilian population. Guide, inform and care for the individual with HIV, AIDS ... that is what I try to discuss with students [...] (Professor 3).

Being a professor is a big responsibility, especially when it comes to HIV/AIDS. We need to focus on citizenship to take care of people [...] (Professor 7).

A critical view of the professor as moderator of a citizen teaching on HIV/AIDS, must also be aware of the ethical matter⁽¹⁾. AIDS brought up essential ethical issues, baring a variety of legal challenges(2). On stigma and discrimination, for example, the Nursing Professor working with the student care to others, continues to discuss the notion of ethics and respect for others, essential for the construction of citizenship⁽¹³⁾.

As stated earlier, people living with HIV/AIDS are often discriminated against and stigmatized. Therefore, we need to rethink how to educate, so that human care is implemented, especially for those who are experiencing a process of morbidity, value, awareness, sensibility and ethics are necessary^(1,10). Â The selected excerpt demonstrates that the professor is concerned with the notion of ethic of care to individuals with HIV/AIDS, discussing human rights to build together with the student the process of citizenship in relation to the complex topic of HIV/AIDS:

[...]Professors must have their minds focused on ethics, and there is no point in teaching or explaining ethics to the student if you are rude with the patient or the student himself [...]One of the responsibilities of the professor is to train students who will care for the person with AIDS, for example, from our own example. So, we would be able to work around the notion of citizenship and human rights [...] (Professor 6)

A critical view of the professor as moderator of a citizen teaching on HIV/AIDS, must include the construction of solidarity, which is key to combating the epidemic of HIV/AIDS. As discussed earlier, for the professor to be able to discuss with the student notions of social responsibility and citizenship when facing the individual with HIV/AIDS, it is essential that he/she is self-critical, self-reflective, self-evaluative, and build knowledge along with students⁽⁹⁾.

The comprehension of the human being in learning from the experience with a person with HIV/AIDS

Understanding the human condition necessarily includes a process of empathy, identification and projection. Always subjective, understanding asks for openness, friendliness and generosity^(5,13-14). The excerpts of selected statements below highlight how the professors try to help students see the other (the person with HIV/AIDS), as he/she (the student) would like to be seen and treated:

[...] We need to put ourselves in this patients' place and serve them well. Not only hearing their physical complaints, but the person. I try to discuss this with my students so that they can provide and reflect about their practice... To that practice worthy of human beings. It is important to hear them. It is important to welcome them, pay attention. I need to know the context of this patient and the fact that he/she lives so that I can actually care with dignity and so he/she will have more chance of adhering to HIV treatment [...] (Professor 5).

[...] Every time we make them (students) see themselves in the situations, it is interesting [...] this responsibility to bring the experience a little closer to reality is important [...] I'm going to talk and understand the story of that person's life with HIV/AIDS, and the students themselves build their own, and to see to what extent the patient's history is similar to him/her, that is a chance that the student will not ever forget [...] (Professor 1).

The other person is important for us to get to know ourselves, but it does not release us from self-analysis, which allows us to integrate the other's gaze in our effort of self-comprehension. The contestant exercise of self-observation leads us to an awareness of ourselves, making us recognize our self-centeredness and measure the degree of our shortcomings, gaps, weaknesses⁽⁶⁾.

Thus, the exercise of empathy also promotes the encouragement of self-care. The excerpts below demonstrate these ideas. Consider

[...]My main intention is to make the student able to exercise sufficient care for the patient with HIV, the nurse student must be aware of the disease in their profession, but in particular, he/she must be aware of their self-care. So that, he/she is so vulnerable to HIV/AIDS as any other [...] (Professor 4).

[...] as time passes by, the student begins to see that the patient who has HIV, that person that he is listening, is part of his/her world [...] they are people who walk, who go to the club. Things that the student also does [...] then they realize and think about preserving themselves [...] (Professor 6).

Thus, as the professor works with the theme of HIV/AIDS with the student thorough experience with a person with HIV/AIDS, it helps them to understand the human condition of the individual, at the same time, he/she recognizes in himself/herself their own human condition^(5,13).

It is noticed that professors participating in this research use from the experience with the person with HIV/AIDS, the exercise of empathy as a trigger for self-care, because it allows students to put themselves in the shoes of the person with HIV/AIDS. From there, it is possible to propose interactive activities, individual or collective, through debates, plays or dynamic, which help in the construction of knowledge in relation to this issue, and therefore, allows reflection to self-examination, self-criticism, introspection and self-care.

Insight analysis needs to be completed by the other (self-hetero-analysis) and also continuously practiced. The self-analysis is a prime requirement of psychic culture that should be taught from early school in order to become a regular activity. Self-criticism is also essential in order not to deceive ourselves with our self-centeredness, and open ourselves to the other⁽¹³⁾.Â

Therefore, the understanding of human diversity through respect and openness to the individual with HIV/AIDS are also part of a learning process grounded in ethics, solidarity in the notions of citizenship and education for human complexity^(1,15).

The teaching-learning process on HIV/AIDS that values ​​the importance of understanding the human experience through the experience of individuas with HIV/AIDS, can provide students the opportunity to analyze and discuss situations they are close to, requiring him/her to be opened to the new, for reflection, for the questioning of themselves and to search for new meanings.

FINAL CONSIDERATIONS

Initially, it is important to recover the propellant spring for the accomplishment of this study. It was the necessity to verify the perceptions of Nursing faculty members about their responsibility in pedagogical practice on HIV/AIDS and value the construction of knowledge on the person with HIV/AIDS focused on parameters aimed at citizenship.

After its completion, the study responds to our objectives, showing that professors have the perception of the importance of being reflective and critical of the teaching-learning process on HIV/AIDS, since they become able to analyze from their own values, perceptions and attitudes towards the person. The importance of this act is crucial, because it contributes to an education full of meaning for both the professor and for the student.

Professors realize the importance of their role in the education and training of future nurses, since they favor the exercise of citizenship through the teaching-learning process of HIV/AIDS in collective destiny of health. When they present an ethical and citizen position in defense of life and seek to reflect the students' comprehension of the human experience from the person with HIV/AIDS.

Thus, professors realize that when working the theme of HIV/AIDS with students by experiencing with a person with HIV/AIDS, it helps us not only to understand the human condition, but at the same time, it encourages students to self-care, through empathy.

We realize with the discussion of the categories that the professors were concerned with the notion of ethic care to people with HIV/AIDS, discussing and clarifying the human rights to build together with the student the citizenship process in relation to the complex topic of HIV/AIDS. We note that our professors have a significant concern with respect to clarify the equity value of social rights in the health field when teaching.

We also noted that the process of discussion of moral and social values ​​involved in the care of the person with HIV/AIDS among professors and students, served as a stimulant for the construction of a more active and academic knowledge related to issues around this scenario.

We clearly see that this issue requires reflection and it does not end with this work. Thus it would be interesting to study the perception of students regarding this issue, in the sense of knowing what actually has been significant in their learning, in order to deepen the results presented in this research.

Finally, we believe that the results of this research are not generalizable. The reality of the fields of study in question is unique, with its own characteristics in the teaching-learning process on the issue of HIV/AIDS, so, that is a limitation of this study.

REFERENCES

• 1 Kawagoe J, Chaves LC, Fonseca FLA, Filipini R, Blake M DT, Camillo SO. As dificuldades de adaptação do convívio social de pacientes portadores de HIV/AIDS. Rev. bras. crescimento desenvolv. Hum. 2012;22(1):93-97.
• 2 Gomes, AMT; Silva, EMP; Oliveira, DC. Representações sociais da AIDS para pessoas que vivem com HIV e suas interfaces cotidianas. Rev Latinoam Enferm. 2011;19(3):1-8.
• 3 Caillods F, Kelly MJ, Tournier B. HIV e SIDA: desafios e abordagens do setor da educação. guia sumário do IIPE para os planificadores [Internet]. 2009 [citado 2008 Dez 1];1(1):4-46. Disponível em: http://unesdoc.unesco.org/images/0018/001804/180406por.pdf
• 4 Ministério da Educação (BR). Diretrizes Curriculares Nacionais do Curso de Graduação em Enfermagem. Resolução CNE/CES n. 3, de 7 de novembro de 2001 [Internet]. Brasília (DF); 2001 [citado 2013 Jul 16]. Disponível em: http://portal.mec.gov.br/cne/arquivos/pdf/CES03.pdf
• 5 Morin, E. O método 5: a humanidade da humanidade. 5ÂŞ ed.Porto Alegre: Sulina; 2009.
• 6 Morin E. Os sete saberes necessários a educação do futuro. 2ÂŞ ed. São Paulo: Cortez; 2011.
• 7 Barbour, R. Grupos focais. Porto Alegre: Artmed; 2009.
• 8 Bardin, L. Análise de conteúdo. 7ÂŞ Ed. Lisboa: Edições 70; 2010.
• 9 Camillo SO. Compreensão do ensino da Síndrome de Imunodeficiência Adquirida na perspectiva dos docentes de graduação em enfermagem sob o olhar do pensamento complexo [tese]. São Paulo (SP): Programa de Pós-Graduação em Ciências, Coordenadoria de Controle de Doenças, Secretaria de Estado da Saúde de São Paulo; 2012.
• 10 UNESCO, Oficina Internacional de Educação/ IBE-UNESCO. Manual para a integracão da educacão sobre VIH e SIDA nos currículos oficiais [Internet]. Genebra; 2009 [citado 2009 Dez 1]. Disponível em: http://www.ibe.unesco.org/fileadmin/user_upload/ HIV_and_AIDS/Manual/manual_por_v1_2009.pdf
• 11 Guedes HHS, Stephan-Souza AI. A educação em saúde como aporte estratégico nas práticas de saúde voltadas ao HIV/ Aids: o papel da equipe de saúde. Rev APS. 2009;12(4):388-397.
• 12 Ministério da Saúde (BR), Departamento de DST, Aids e Hepatites Virais. Acesso universal no Brasil: cenário atual, conquistas, desafios e perspectivas [Internet]. Brasília; 2010 [citado 2010 Out 30]. Disponível em: http://www.aids.gov.br/publicacao/ acesso-universal-no-brasil
• 13 Morin E. O método 6: ética. 4ÂŞ ed. Porto Alegre: Sulina; 2009.
• 14 Camillo SO, Nóbrega MPSS, Théo NC. Percepções do graduando de enfermagem sobre a importância do ato de ouvir na prática assistencial. Rev Esc Enferm USP. 2010;44(1):99-106.
• 15 Seidl EMF, RibeiroTRA, Galinkin AL.Opiniões de jovens universitários sobre pessoas com HIV/AIDS: um estudo exploratório sobre preconceito. Psico USF. 2010;15(1):103-112.

a

Simone de Oliveira Camillo^I; Fabiana Tavolaro Maiorino^II; Loide Corina Chaves^III

Publication Dates

• Publication in this collection
  02 Dec 2013
• Date of issue
  Sept 2013

History

• Received
  14 Apr 2013
• Accepted
  12 Sept 2013