Reflections on nursing teaching in the post-modernity era and the metaphor of a theory-practice gap

Abstracts

Se presenta una reflexión sobre la enseñanza de enfermería. Inicialmente fue realizada una contextualización con relación al mundo globalizado y las repercusiones de sus paradigmas sobre el hombre y, en consecuencia, sobre el aprendizaje del estudiante de enfermería. Seguidamente se enfoca la laguna entre la teoría y la práctica durante el aprendizaje de enfermería. De los profesores se espera que muestren la importancia de la integración de los diversos conocimientos para los alumnos. Así como, que sea la base de un proceso que permita a los estudiantes aplicar el conocimiento teórico en situaciones prácticas, reduciendo la diferencia entre lo ideal y lo real en el trabajo. El modelo bio-psico-social-económico-cultural valora el cuidado al individuo en sus diversos contextos organizacionales y fundamenta la práctica. Una otra discusión se suscita cuando cuidamos del otro en su dimensión corporal, mental, espiritual y fenomenológica, además de la atención dada al individuo que cuida.

enfermería; enseñanza; educación en enfermería; aprendizaje

Trata-se de uma reflexão teórica acerca do ensino de enfermagem. Inicialmente é feita uma contextualização em relação ao mundo globalizado e as repercussões de seus paradigmas sobre o homem e, conseqüentemente, sobre o aprendizado do estudante de enfermagem. Em seguida é enfocada a lacuna teórico-prática estabelecida no aprendizado da enfermagem. Dos educadores é esperado que mostrem a relevância da integração destes diferentes saberes aos alunos. Além disto, que sejam o pivô de um processo que ajude os estudantes a aplicar o conhecimento teórico nas situações práticas, reduzindo a diferença entre o que é considerado ideal e o que é real no trabalho. O modelo bio-psico-social-econômico-cultural valoriza o cuidado ao indivíduo nos diferentes contextos das organizações e pode vir a fundamentar a prática. Outro questionamento suscitado é quanto temos cuidado do outro na sua dimensão corporal, mental, espiritual e noética, além da atenção ao indivíduo que cuida.

enfermagem; ensino; educação em enfermagem; aprendizagem

UPDATING ARTICLE

Reflections on nursing teaching in the post-modernity era and the metaphor of a theory-practice gap

Zeyne Alves Pires Scherer^I; Edson Arthur Scherer^II

^IPhD, Professor at the University of São Paulo at Ribeirão Preto College of Nursing Psychiatric and Human Sciences Department, WHO Collaborating Centre for Nursing Research Development, e-mail: [e-mail]

^IIPsychiatrist, Doctoral Student, Assistant at Hospital das Clínicas University of São Paulo at Ribeirão Preto Medical School

ABSTRACT

This article presents a theoretical reflection on nursing teaching. First, we contextualize the topic regarding the globalized world and the repercussions of its paradigms on mankind and, consequently, on nursing students' learning. Next, we focus on the theory-practice gap established in the nursing learning. Educators are expected to show students the relevance of integrating these different types of knowledge. Moreover, to play a pivotal role in a process that helps students to apply theoretical knowledge in practical situations, reducing the difference between what is considered ideal and what is real. The bio-psycho-social-economic-cultural model values the care for the individual in the different organizational contexts and can base the practice. Another inquiry that emerged is about the extent to which we have assisted others in their corporal, mental, spiritual and noetic dimensions, in addition to the attention delivered to the care-giver.

Descriptors: nursing; teaching; nursing education; learning

INTRODUCTION

The current social context has demanded increasingly qualified human resources. Since the end of the twentieth century, education has undergone changes and knowledge has been revolutionized all around the world. Consequently, new information and communication technologies in the pedagogical processes are being demanded from universities, as well as increased qualification, new abilities and competencies and articulation with society ⁽¹⁾.

These are challenging issues to the institutions that educate and produce knowledge and, therefore, demand broad discussions. Today, universities are engaged not only with the unconditional search for the truth, but also with the construction of society⁽¹⁾. We live in a world with advances in sciences and technologies, which values personal abilities and competencies and not only the quantity of acquired information. Universities are demanded to increment alternative and integrated strategies, favorable to the collective construction of a fairer and more humane society.

From this perspective, education must adopt the premises of the "need to consider the flexibility, interdisciplinarity, the contextualization and the unification of the theory-practice relation and respect for ethical, esthetic, and political values"⁽²⁾. According to this view, nursing schools have attempted to adopt proposals that integrate several aspects of health problems, considering the complexity of the human being, the environment where (s)he lives and providing resources that allow for the formation of competent professionals to deal with the challenges of the twenty-first century⁽³⁾.

GLOBALIZATION AND ITS REPERCUSSIONS

Currently, we live in a post modern moment, with its pragmatic unfolding of the globalized world. Certainty and order have been replaced by the culture of uncertainty and indefiniteness, generating changes accompanied by crises and ruptures⁽⁴⁾.

Globalization both divides and unifies. The comprehension of time/space, where time is accelerated and space comprised, the ever more globalized elites are separated from the remainder of the population, even more "localized", opening a gap between those who have and those who have not. The advent of the computer is translated in the decline of truly public space. The human being is more easily found and, consequently, controlled. Who is in control of the situation? Despite the fact that human actions happen on a global scale, events cannot be dictated. We only observe principles, institutions and frontiers changing rapidly and unpredictably. Are the needy being assisted more rapidly and efficiently? Has the poor's situation improved or worsened? Who will have higher access to jobs in this new mobility hierarchy? In this way, we observe people being overloaded with anxiety caused by insecurity and uncertainty, generated by the current existence⁽⁵⁾.

In the face of this reality, the human being becomes vulnerable to crises. Crisis can be understood as a moment of transition in which two opposite models live simultaneously. It is an unstable moment, because the previous order ceases to exist and the new one is not sufficiently clear to provide defined parameters of behavior. The transition not only demands coping with the unknown, but triggers the person's creative capacity. The rigid posture tends to lead the individual to perceive crises as chaos. Therefore, in order to live with new models, one is supposed to have a more flexible view. This moment is expected to be understood as a redefinition for the development to occur.

It is necessary to be attentive in order not to let the phenomena that dehumanize, that mechanize the human being, impregnate this new chapter of humanity's evolution history. The new (post modern) cultural paradigm makes possible the emergence of another style for society through the communitarian desire and the feeling culture. This cultural rebirth presents a friendly relational communication, which has been the essential principle that fundaments nursing practice, although a valuation by rationalist, technical and scientistic logic is acknowledged, causing the dehumanization of the art of taking caring of the other⁽⁶⁾.

The care delivered to the patient tends to be executed in a fragmented way. There is a dichotomy between discourse and action, between theory and practice, in which the expressive aspect of nursing care is little developed in comparison to the instrumental aspect that holds the nurse's attention, leading him(er) away from the human being⁽⁷⁾.

THE METAPHOR OF A THEORY-PRACTICE GAP

In the specific situation of nursing teaching, the metaphor of a gap between theory and practice is firmly established. Some authors argue that it will always exist, because there are different types of knowledge involved. One of them, for instance, refers to theory as a knowledge "know that" acquired in books; and the practice as knowledge "know how" gained through direct experience of a situation⁽⁸⁾. This dichotomy seems to exist because the theoretical concepts are outdated. Thus, it is suggested that nursing theory needs to be re-conceptualized, so that theory and practice exchange information and develop from each other⁽⁹⁾. There are scholars who believe there is no theory-practice gap, but rather a theory-theory gap, because there are two different theoretical nursing perspectives, used by professors and nursing professionals⁽¹⁰⁾. In order to solve the problems caused by such gap, it is expected that educators show the relevance of integration these different kinds of knowledge to students. In addition, they must be the pivot of a process that helps students to apply theoretical knowledge in practical situations, reducing the difference between what is considered ideal and what is ideal in nursing work.

Aiming to solve the theory-practice gap, educators tend to focus their attention on the environmental conditions in which the student learns. The student's cognition, though very real, is not palpable and is inherent to each human being and, therefore, not accessible to the teacher. In addition, it is known that theoretical and practical knowledge are brought by the learners and are not separated experiences from one another⁽¹¹⁾. There is also a lack of systematized studies that include these aspects related to the student's person.

FINAL CONSIDERATIONS

At this time of reflection, the perception emerges that the global and interrelation problems generated by the positivist paradigm, hegemonic until then, and its emphasis on technological development, have distanced humanitarian aspects (involvement and affect). The explicit objectives of technology, under the positivist aegis, are control, mass production and the standardization, sheltering in rationality, technique, organicism, believing in the unlimited growth illusion. In the current educational system, compromised with the valuation of self-affirmation manifested as power, control and domination of others through force (predominating patterns in our society), based on competitive behavior, original ideas and questioning of authority are discourage. Thus, it is clear that competition is promoted to the detriment of cooperation. The action becomes direct, the technical routine is implemented and reflection, thinking and creativity are put aside. Thus, it can be concluded that, while this situation of desegregation of the whole persists, our practice is insufficient and incomplete⁽⁴⁾.

Rethinking these postures will possibly influence the attitudes regarding those who we deliver care to, provided that it is based on the biopsychosocial-economic-cultural model, which values the individual in the different contexts of organizations (health institutions, teaching and other). It is also important to question how much we have taken care of the other in his(er) bodily, mental, spiritual and noetic dimensions. Also, to reflect about the individual who delivers care. Has the caregiver been worried with his(er) human totality?

Recebido em: 10.11.2005

Aprovado em: 13.9.2006

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Publication Dates

• Publication in this collection
  12 July 2007
• Date of issue
  June 2007

History

• Received
  10 Nov 2005
• Accepted
  13 Sept 2006