Production of knowledge about the training of nurses in Latin America

Abstracts

Trata-se de uma revisão integrativa de literatura, com abordagem qualitativa, que teve como objetivo conhecer o panorama da produção científica em Educação em Enfermagem latino-americana para compreender como está sendo conduzida a formação dos futuros enfermeiros. A coleta de dados foi feita na base de dados Literatura Latino-Americana e do Caribe em Ciências da Saúde, no período entre 2005 e agosto de 2012. Os descritores utilizados foram: Educação Superior, Currículo, Ensino, todos associados ao descritor "Educação em Enfermagem". Fizeram parte dos resultados desta pesquisa 82 estudos. A partir da leitura completa dos estudos, emergiram as seguintes categorias: "Currículo", "Docentes", "Processo Ensino-Aprendizagem", "Estudantes" e "Avaliação". Os resultados identificaram a preocupação dos autores na formação do enfermeiro com questões relativas à postura crítica e ações de cuidado integral à comunidade. É preciso avançar em relação à adoção de referencial teórico emancipador, que necessita ser incorporado e discutido entre as instâncias formadoras do enfermeiro.

Educação superior; Educação em enfermagem; Enfermagem

REVIEW ARTICLE

Production of knowledge about the training of nurses in Latin America

Producción de conocimiento sobre la formación de enfermeros en América Latina

Bruna Pedroso Canever^I; Marta Lenise do Prado^II; Vânia Marli Schubert Backes^III; Diana Coelho Gomes^IV

^IA nurse. She holds a Master's Degree in Nursing. She is also a doctoral student at the Graduate Program in Nursing of the Federal University of Santa Catarina (UFSC) and a Member of the Research Group in Nursing and Health Education (EDEN). Florianópolis, Santa Catarina, Brazil

^IIA nurse. She holds a Doctorate in Nursing. A CNPq Researcher. She is a professor of the Nursing Department and the Graduate Program in Nursing at the Federal University of Santa Catarina (UFSC). The Vice Leader of the Research Group in Nursing and Health Education (EDEN). Florianópolis, Santa Catarina, Brazil

^IIIA nurse. She holds a Doctorate in Nursing. A CNPq Researcher. She is a professor of the Nursing Department and the Graduate Program in Nursing at the Federal University of Santa Catarina (UFSC). She is also the Leader of the Research Group in Nursing and Health Education (EDEN). Florianópolis, Santa Catarina, Brazil

^IVA nurse. She is also a member of the Research Group in Nursing and Health Education (EDEN). Florianópolis, Santa Catarina, Brazil

Author's address

ABSTRACT

An integrative literature review with a qualitative approach aimed at understanding the landscape of scientific production in Nursing Education in Latin America, made to understand how it is being conducted the training of future nurses. Data collection was done in the database Latin American and Caribbean Health Sciences, between 2005 and August 2012. The descriptors used were: Higher Education, Curriculum, Teaching, all of them associated with the main descriptor: Nursing Education. We included 82 studies to research this topic. From the complete reading of the studies yielded the following categories: "Curriculum", "Teacher", "Teaching-Learning Process", "Students" and "Evaluation". The results identified the authors concern in nursing education with issues of critical, care actions integral to the community. We must move forward in relation to the adoption of theoretical emancipation that needs to be incorporated and discussed forming between instances of the nurse.

Descriptors: Education. Higher. Education in Nursing. Nursing.

RESUMEN

Se trata de una revisión integrativa de literatura con enfoque cualitativo que tuvo como objetivo comprender el panorama de la producción científica en Enfermería y Educación en América Latina para comprender la forma en que se lleva a cabo la formación de los futuros profesionales en enfermería. La recolección de datos se llevó a cabo en la región de América Latina en la base de datos Literatura Latinoamericana y el Caribe en Ciencias de Salud, entre 2005 y agosto de 2012. Los descriptores utilizados fueron: Educación Superior, Currículo, Enseñanza, todos los asociados con el descriptor: Educación en Enfermería. Formaron parte de los resultados de esta encuesta 82 estudios. De la lectura completa de los estudios salieron las siguientes categorías: "Curriculum", "Profesor", "enseñanza-aprendizaje", "Estudiantes" y "Evaluación". Los resultados identificaron la preocupación de los autores en la enseñanza de enfermería con los temas de las acciones críticas, atención integral a la comunidad. Debemos avanzar en relación con la adopción de la emancipación teórica que debe ser incorporada y discutió la formación entre las instancias de la enfermera.

Descriptores: Educación superior. Educación en enfermería. Enfermería.

INTRODUCTION

Nursing education field has been through a moment of challenges and extension of its body of knowledge, which demands even more capacity and prepare from the professionals involved in this process. Along with the evolution of society it is necessary that all sectors alter in a way that they can keep up with the needs imposed by the globalized world. Thereby, the Institutions of Higher Education (IES, in the Brazilian acronym) need renovation in the curriculums and better capacity of their faculty in order to qualify the formation processes with ethical commitment, with ability to join education and practice as it contributes with a more integrated, socially committed interdisciplinary knowledge.

Accordingly, the creation of Guidelines and Basis of National Education Laws (LDB) conduct the construction of specific National Curricular Guidelines (DCN) to each undergraduate course, aiming the development of general and specific skills, cultural technical-scientific improvement and curricular easing, ending up settling Pedagogical Political Projects (PPP) in order to achieve a new curricular setting and consequently a different training for the professionals to be (²).

In this context, the professor plays a major role by being responsible for the conducting of this dynamic, creative and reflexive teaching-learning process, which makes possible for the student to be active part of the construction of their own knowledge(³). Thus, there must be a faculty that is able to transcend the settled traditional pedagogical positioning, refining and motivation new ways to teach and learn, therefore changing the social reality.

From this perspective on, this work has the goal to understand the scenery of Latin-American scientific production when it comes to the education of the nurse between 2005 to August 2012. To steer this research, the following guiding question has been chosen: What are the contents of Latin-American scientific production when it comes to the academic training of the nurse?

METHOD

This is a descriptive-exploratory research with qualitative approach on documental bases, in which the Integrative Revision of Literature was used to recognize the scientific production on nursing education in Latin America.

The Integrative Revision of Literature allows the researcher to have a wide range of published studies on the topic of interest, systematizing it and enabling the development of detailed analysis and, by that means, providing greater accuracy to the analysis of the selected works.

The Integrative Review is guided by the following stages: identification of the subject to be worked on and selection of the research question, choice of criteria for inclusion and exclusion of the studies, definition of data to be extracted, making of a table using Microsoft Excel, with data taken from the scientific articles, analysis and discussion of results ⁽⁴⁾.

For the collecting, the following keywords have been used: Higher Education, Curriculum and Teaching, individually associated to the descriptor Nursing Education. Data collecting happened in August 2012. This search took place in Latin American and Caribbean Literature on Health Sciences (LILIACS) database, due to the fact that it is published in Latin America and Caribbean countries.

As criteria of works selection, it was established that the studies should be original articles, published in English, Spanish and Portuguese between 2005 and August 2012. They should also be available online in their full form, as well as consistent with the subject related to the academic training of the nurse. Editorials, letters, opinion pieces, reviews, summaries of proceedings, trials, duplicate publications, theses, dissertations, final projects, official documents of national and international programs, books, chapters of books, experience reports, reflective studies, theoretical review and studies were excluded. Sample data can be viewed in the graph below:

Data were characterized and organized in forms prepared for this research, using the program Microsoft Excel^TM, in which is included: number, title of article, journal, year of publication, country of study, nature of the research, the study objective, analysis method, thematic classification, keyword.

The publications were classified in the following categories: resume (articles that address issues relating to the structure and curriculum organization, contents, curricular models, curriculum evaluation), professors (studies on the training of teachers of nursing, attitudes and beliefs of teachers, profile), teaching-learning process (studies on educational methodologies, technologies and new models of teaching) and assessment (studies dealing with issues related to the political context of education in nursing, social transformations and their impact on education, the challenges for the education in nursing).

The analysis of the data was performed from the operational proposal of data sorting, sorting the data (horizontal and comprehensive reading of the texts, cross reading, final analysis) and report. To display the categories some excerpts of the studies were used. They were analyzed through textual cut-outs with the number of sequential work and their respective year of publication ^(5).

Since the data provided by the database LILACS are in the public domain, it was not necessary for the study to be submitted and analyzed by the Committee of ethics in research.

Graph 1

RESULTS AND DISCUSSION

185 scientific works have been obtained as results of the search on LILIACS database. Out of those, 103 have been excluded, leaving 82 scientific articles in Nursing field to be analyzed.

From the analyzed total, the year of 2008 was the one that had the highest number of published works, making a total of 16 scientific articles, and that distribution of these 82 articles over time is represented in Chart 2.

Regarding the qualification of the magazines which the Brazilian scientific articles were published, it is noticed that 78% hold Qualis A2 and B1 according to Qualis/CAPES

In relation to the analyzed articles, it has stood out that the majority (82.9%) of the studies has qualitative nature, (12.2%) have qualitative disposition and (4.9%) have both qualitative and quantitative approach.

Among the 82 articles that deal with the academic formation of the nurse, most of them refer to the topic "Curriculum" and only four of them mention Evaluation, as Chart 3 demonstrates.

In order to understand what these works bring as results, and which pedagogical tendencies they are guided by so that they will contribute to the building process of this field knowledge, the following categories were explored: Curriculum, Teaching-Learning Process, Professors.

Curriculum

In the curriculum category, we have included articles that addressed issues relating to the structure and curriculum organization, contents, curricular models, evaluation of curriculum. From the analysis of 31 texts relating to the grade Curriculum, it was found that 22 studies set the following concern what is advocated in the DCN, in order to develop an integrated curriculum and train future professionals in a new perspective.

The need to design a new curriculum emerged from the establishment of these guidelines that are in line with the principles of health reform and Brazilian unified health system (SUS), emphasizing the importance of links between higher education and health, to obtain a professional with generalist, humanist, critical and reflective training with scientific and technical competence, aiming at promotion, the prevention, recovery and rehabilitation of health.

In this sense, the PPP become important instruments in the conducting of strategies for vocational training. In order to obtain a differentiated education, in which the students take a critical, reflexive and proactive stance and promote an awareness of the role of teacher and student co-responsibility empowerment in the teaching-learning process requires the active participation of teachers, students, professionals and community assistance in the implementation process and implementation of new curricula. "[...] the engagement of teachers was difficult because, although we schedule meetings for times when everyone should be free to participate in the meetings, not everyone attended [...]"^(6:684).

The clipping points little participation on the part of teachers, which consequently undermines the effectiveness of the proposals drawn, since the PPP is something dynamic and constant, a commitment built collectively providing understanding and growth of those involved in the pursuit of actions to achieve these proposals.

Another factor to be noted is that the studies that develop evaluative processes revealed and adopted curricula revealed the presence of traditional trend, with the biological approach, the valuation of repetition and memorization, focusing significantly on technical procedures, in which the teaching is centered on the knowledge of the professor, by reinforcing the fragmentary vision of knowledge^{(7,8,9,10,11)}.

Oh the other hand, other studies argue that in order to occur quality leap in formation is of great importance that there is a reorientation of the posture instructor , in which the professor assumes the part of facilitator of the teaching-learning process, rethinking new ways of knowing and do; by encouraging the use of new approaches to teaching-learning, for example, the use of the active methodologies enabling the development of autonomy and critical thinking and reflective of the future professionals ^{(12,13,14,15)}_.

The studies included in this category pointed out the need for greater investment in training process, encouraging teaching improvement and teaching-service integration from the perspective of the SUS. Such measures involve the development of competencies, with a view to the achievement of alterity, creating opportunities for workers to have an environment with permanent learning from the daily work, so as to consider the practical scenarios spaces of real and consistent training.

Nursing as a profession that integrates the health area needs to transcend the current professional training, taking into consideration the educational policy for SUS and the teaching-service-management integration. It is important that the actions around the professional training of nurses be reconsidered and discussed continuously for all subjects involved in this process, emphasizing "competence, quality of education, education geared to the demands of the labor market/integral training, interdisciplinarity, essential knowledge and general training"^(16:13).

Teaching-learning Process

Articles that deal with teaching-learning process bring topics which are related to the way that students consider they learn more significantly, and besides that, the articles bring aspects about: methodology, educational technologies and teaching models that refer to the current learning methodologies. Analysis of the 24 publications in this category shows ways to make teaching-learning process easier, which involve students/professors, such as: group works, case studying, inclusion in practice settings (internships), use of nursing diagnosis through the systematization of nursing assistance, practical simulation using software, videotapes, and distance learning strategies.

It was possible to highlight 5 studies that show what students consider the interchange between theory and professional practice as the most significant way of learning. Visualization and applicability of what is built in classroom is highly important for the students, because this way it favors the comprehension of teach/care process. "The way I learn the subjects the most is when I have to put them into practice, actually, it is when I see and touch it, it has to be more real to me"⁽²⁶⁾.

However, it is important to emphasize that some studies report the traditional pedagogical method still prevails in Nursing undergraduate courses. They evidence that teaching-learning process is still based on vertical learning, on the transmission of informative contents that dissociate theory and practice, on the relation of domination and hierarchy by the professors, on the use of evaluation, only through memorization and copying of knowledge and absence of critical reflection by the students. ^(19,20)

It is relevant that the professors understand the need for changes in their behavior and implement new pedagogies in continuous movements of construction and reconstruction of epistemological bases, which anchor the daily activities because it is not enough to adopt some of the different strategies highlighted in the texts, but, necessarily, incorporate the theoretical emancipation, which is base for the referred strategies, such as clinical case studies, group work, supervised internship, among others ⁽²¹⁾.

In this perspective, some studies highlight the use of active/current methodology, which are essential strategies to arouse interest in searching for acquirements, and stimulate the students' critical-reflexive ability ^(27,28,29). "The active methodology is rather interesting, it leads us to think/reflect about the situations lived in an internship experience [...]"⁽³⁰⁾.Among the strategies two texts explore news such as Integrative Method and Project Method, which consist of strategies to boost the research in order to qualify the future professional performance^(31,22).

Teaching-learning process needs to be dynamic, stimulating and creative; turning the professor into a facilitator/mediator of the process, providing a group discussion, making the students the responsible ones for the knowledge building and changing in their reality⁽²²⁾. Being of utmost importance the collaboration of teacher/facilitator in the teaching-learning process, and so that it becomes effective it is necessary for the professor to have mastery of the content establishing a relation between theory and practice, enabling and stimulating group discussion, Exchange and interpersonal relationship, aiding in the collective construction of knowledge^(31,32).

It also becomes evident in articles that educational technologies are used as facilitators of the teaching-learning process, providing interaction and knowledge construction and thus corroborating with differentiated training of the professional to be. In fact, the educational process must focus on differentiated experiences to strengthen significantly the formation of future professional and reflecting directly on their practice in the most varied fields of activity, developing their ability to work as a team and their leadership spirit, making them able to perform skilled listening.

Educational technologies make the educational process easier, enabling the participation of the learner as an active subject. Thus, it is possible to work with different educational benchmarks, based on the pillars of education, encouraging action and transformation in professional training⁽²³⁾. Stands out, however, the importance of investments in the training of educators/students, as well as resources for infrastructure; promoting the development of new teaching strategies, grounded in differentiated pedagogical practices ⁽²⁴⁾.

However, in the classroom, teaching and learning have qualitatively different determinations and may only happen at the same time and space by the mediation of a didactic method, which will only have significance if it is effective in accomplishing its usage value. It is therefore essential that the didactic method organize teaching and learning in order to enhance differently the workforce that is present in the student body ⁽²⁵⁾.

From the readings of the studies, the importance of theory and practice is noted, the use of active methodologies, the importance of the teacher's role as a facilitator and the use of educational technologies as facilitators of the teaching-learning process. These aspects demonstrate the extension of the students' awareness during training, providing a distinctive outlook; therefore, making the active participation in its academic journey more reflective and engaged.

Professors

The category called Professors gathered studies about trainers, their profiles, attitudes, beliefs that pervade the teaching-learning process. With the analysis of 18 texts related to this category, it was found that eight studies indicate there are flimsy pedagogical training of nursing professionals engaged in teaching.

The texts point out that most teachers enter the academic life without adequate preparation and highlight the importance of continuing education through the support of institutional policies. Therefore, it is necessary that the nursing professor, besides having mastery in their knowledge field, has a specific pedagogical training, together with the experience gained over the course of his professional experience, allow the conduction of educational process, linking theory and practice, favoring his own reflection and making the students aware of their actions.

Another factor that must be mentioned is the strong movement of overcoming in relation to the traditional trend, in which the actions of teachers are concentrated in critical and reflective attitudes about themselves, with which they share and discuss about the teaching-learning process with students, seeking to overcome the traditional pedagogy of transmission of knowledge and stimulating creativity and independence in the learning of students. This can be checked in the following textual clipping: "I try to encourage him to stand out because, in fact, teaching is a learning exchange between student and teacher, then there is no such thing as the professor knows better than the student, both have knowledge" ⁽¹⁷⁾.

In publications that have the participation of professors in training as the main topic highlight the topics related to the process of death and dying, mental health and intensive care unit. To the authors, these themes require specific preparation, because they emphasize the humanization in service and an expanded perception of full care, which implies the overcoming of traditional healthcare paradigm that does not focus such aspects.

The educational process provides that a teacher-student relationship must necessarily involve empathy, dialogue, understanding and concern for each other. It is pointed out that the professor's knowledge also need to be continuously cut among peers through a process of reflection of their own practice, which makes it possible to create innovative actions of construction and reconstruction of pedagogical practice in the various areas of activity (assistance, teaching, research, and extension), including teachers/students in an active process of teaching and learning ⁽¹⁷⁾.

In this sense, reflections about the teaching practice on initial training and on institutional strengthening of continuing education supported by disciplinary and pedagogical content are necessary, since these conditions directly affect the quality of education; reflecting later on the health professional education.

Some texts express concern about the continued training of teaching staff, including the use of new methodologies for teaching-learning, active methodology based on critical-reflective referential is pointed out, which makes the students active in the educational process, facilitating the assimilation of these practices in their professional lives.

Thereby, in order to get success in teacher's training, it is necessary that they get involved and exercise guidelines that the pedagogical political project of each course provides, developing creative and dialogical pedagogical practice, contributing to the training of critical and reflective subjects.

The educational process in the training of nurses with skills and abilities, resulting in larger perspective of the act of caring, teamwork activities and new ways of thinking, doing and causing changes in their own workplace of work must be guided by the principles and guidelines laid down in the National Curriculum Guidelines.

Evaluation

In the category named Evaluation there have been found four publications that address issues related to structural and political context, the challenges for the education in nursing and social transformations and their impact on education.

One of the texts portrays how the evaluation of adhesion of PPP to DCN within higher education institutions (HEIs) both public and private is occuring, revealing that the results fall short of expectations and critical analysis revolves around the defense of advances and breaks. It is highlighted as positive aspects of the public HEIs the working conditions and the qualification of teachers, enabling greater engagement in discussions and collective constructions which favors the teaching-learning process. However, in private INSTITUTIONS of HIGHER EDUCATION, the system of work with temporary hiring is shown as a negative factor in the process of preparation and dedication to the PPP. "With whom must collective PPC be built? How to monitor the implementation of this project that is favored by the meetings of reflection groups if the group can't be together?"⁽³³⁾.

The private INSTITUTIONS of HIGHER EDUCATION, on the other hand, bring good indexes in aspects of appropriateness of the curriculum, adequacy of education to course design and evaluation of the teaching learning process and its procedures. In the same study, however, the authors express another reality, as you can see below: "who embodies the PPC in private courses and on what basis the evaluation concepts strictly hold? What evidence has been used by the evaluators to express membership that must be present in the courses "(33).

The second text promotes the evaluation of courses at different levels in Latin America identifying diversity with respect to knowledge and trends in researches, agencies that fund researchers, methods of analysis, translation and application of researches, contributing this way, with the acquisition of skills for the research, required for the academic preparation of future professionals ⁽³⁴⁾.

The last two texts talk about the importance of accreditation, as a process of recognition of the implementation of activities by the institution with competence and security allowing one to identify strengths and weaknesses in the INSTITUTIONS of HIGHER EDUCATION and contributing to the improval of quality of education. They highlight the need to establish universal criteria and regional standards ensuring minimum levels on the course with the consequent increase of the quality of education in the country. They also point out, though, that all nursing INSTITUTIONS should participate in the process, mainly the private INSTITUTIONS of HIGHER EDUCATION as they are responsible for the largest number of courses and students (35).

It is inferred here that this very important theme to leverage evaluative indicators needs to be built among peers in a dialogical and participative relation.

FINAL CONSIDERATIONS

The results show the "State of art" concerning the Latin American scientific production on training of the nurse through the thematic study, it was also identified the concern of authors who investigate the education of nurses when it comes to critical attitude full care to Community actions. Given this scenario, we need to move forward with regard to the adoption of emancipatory theoretical reference that needs to be incorporated and discussed between the training bodies of the nurse. Thus, it enables the transformation of social reality, not just reproducing institutional charges and/or legal frameworks, as this condition moves apart from practice and undertakes the process of reflection on the transformation perspective.

Even though some publications still show resistance to changes, one notices the manifestation of the need for reform in the process of training for nurses, the continuous update of the faculty, making it engaged and autonomous in this respect. There are also various initiatives taken in the teaching-learning process and the reflective/participatory perception of students in their academic walk.

The considerations developed here suggest critical and creative innovative approaches, participative in the production of knowledge of nursing education, demonstrating that the ethical-reflective and committed process can guide the advances in the area.

At last, it is suggested to conduct studies on critical and reflective training in nursing, which is still little explored in the scientific community, with the aim of bringing different realities closer and showing experiences and innovative projects that contribute to the formation of a critical-reflective professional and transformative capacity.

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¹

(2009) which shows that this subject has nationwide impact. Most of the studies were developed in Brazil (89%), followed by Cuba (4,9%); then, Colombia (3,6%) and finally Chile (2,5%).

Publication Dates

• Publication in this collection
  27 Mar 2013
• Date of issue
  Dec 2012

History

• Received
  19 Jan 2012
• Accepted
  28 Nov 2012