Supervised Curricular Internship and the development of management skills: a perception of graduates, undergraduates, and professors Práctica Curricular Supervisada y desarrollo de competencias gerenciales: visión de egresados, estudiantes de pregrado y docentes

Objective: Analyze the perception of graduates, undergraduates and professors about the teaching-learning process of the Supervised Curricular Internship (SCI) of Nursing Undergraduate Courses and in light of the development of management competencies. Method: Qualitative study based on the Mayan content analysis from a questionnaire of objective and discursive questions that evaluated the perception of 87 undergraduates, 280 graduates, and 48 professors from two universities in the state of São Paulo. Results: Four thematic categories emerged from this process and the development of management skills, highlighting the fundamental role of the supervising nurse in SCI and the need for greater presence of professors. Regarding management skills, the subjects emphasized leadership, resource management and performance of bureaucratic functions as essential skills. Final considerations: SCI is an environment that favors learning the profession and developing managerial skills; however, better coordination is required between educational institutions and SCI practice sites.


INTRODUCTION
Internship is the period in which the student has a chance to achieve personal and professional growth by performing actions in real practice critically and reflexively, providing greater security to the student at the end of the undergraduate course and beginning of the professional career. 1,2Besides, the training of a professional for practice should not be restricted only to theory; it should also include the student's knowledge of their future place of practice.This way, the supervised curricular internship allows students to expand their knowledge, associating theory with practice. 3ontextually, the Supervised Curricular Internship (SCI) is a relatively new teaching approach in health courses, officially implemented in nursing undergraduate courses through Resolution 3/2001 of the National Curricular Guidelines (NCGs) for Undergraduate Nursing Courses (UNCs).Such resolution defines that the UNCs should include a list of general disciplines from biological and human fields, as well as specific ones from health and nursing.In addition, according to the curriculum, supervised internship is mandatory in the last two semesters of the course, and the minimum SCI hours should correspond to 20% of the total hours of the proposed UNCS. 4 The Higher Education Board of the National Education Council, through report no.213/2008, approved on October 9, 2008, and Resolution no. 4 of April 6, 2009, defined the minimum hours for the UNCs of 4,000 hours. 5,6Then, based on the percentage of 20% of the total hours of the course, the SCI should have 800 hours.
In view of this legal aspect, the SCI can be seen as a critical tool for the training of nursing professionals, since during this period the student will use the theoretical knowledge acquired during the course, seeking to find oneself as a professional, through self-analysis of personal experiences and performance. 3esides this perspective, the students' experience with the SCI gives an identity to their work, in a natural process, making them perform with more and more proficiency, while handling different scenarios and situations, thus facing the demands and challenges of the labor market. 7It also brings more opportunities for development and improvement of skills, including management, through nursing practices with individuals, families, groups and communities, experiencing real work-related situations linked with the demands of the population and the challenges and possibilities of health services. 8t should be noted that internship or clinical clerkship should not be seen as a simple instrument that provides a student with classroom theory applied to practice, but as a moment for students, through theoretical knowledge, to use practice in attempt to change the reality of the place the internship is conducted and of the students themselves, thus becoming praxis and breaking with the dichotomy between practice and theory, to build the profile of a critical and reflective professional in search of a fairer society.
Work-based learning encourages the development of knowledge, skills and attitudes in an autonomous, responsible, free, creative, and committed manner to master practice and its social role, deepening and contextualizing knowledge, then assuming a transformative practice. 7,8n this sense, the experience in SCI helps the nursing student in the development of different skills (managerial and related to the care) required for their training. 7,8It is important to highlight the relevance of the coordination between higher education institutions (HEIs) and institutions that provide conditions to conduct internship programs, since in the curricular internship there may be a greater interaction between teaching and service, through which different knowledge is coherent and responsible for the benefit of learning and well-being of the population. 9,10anagerial skills in the NCGs are: leadership, decision making, communication, and administration and management of health services. 4,7,8In the latter, the idea is strengthened that, for its development in the SCI, the knowledge of both macro-and micro-organizational contexts is critical to have the resources required to manage human, material, physical and financial resources and create strategies for planning, decision making, interaction and resources. 4,7iven the importance of the SCI in the development of skills, especially those related to management, it is important to emphasize that the work underexplores this specific universe of the SCI, that is, managerial skills have been either cited or only constituted the thematic categories of qualitative studies. 1,7,81][12][13][14] In addition, it should be mentioned that such studies present the perception of only one or two actors involved in the process -undergraduates, 1,3,12,14 professors, 8,10 health professionals, 10,11 or graduates. 13t reinforces the importance of new studies on the subject from the perspective of the various agents involved in the SCI to support strategies of more assertive interventions in the activities conducted, in the elimination of possible failures, and in promoting new discussions.
Considering the above, this study aims to answer the following question: What is the perception of graduates, undergraduates, and professors of two HEIs in the state of Supervised internship and management skills Rigobello JL, Bernardes A, Moura AA, Zanetti ACB, Spiri WC, Gabriel CS São Paulo regarding the teaching-learning process of the SCI of Undergraduate Nursing Courses and for the development of managerial skills described in the National Curricular Guidelines?

METHOD
This is a qualitative exploratory study whose purpose is to understand the perception of three actors involved in the teaching-learning process -graduates, undergraduates, and professors -regarding both the SCI discipline and the development of managerial skills proposed by the NCG for UNCs.
The study included two higher education institutions of the UNCs with active and accredited registration with the Ministry of Education, located in the countryside of São Paulo.One is a state institution and the other is a private nonprofit institution.Although there is a difference between the legal nature of the two universities, they were selected due to the similarity of factors concerning the SCI discipline, such as similarity between the political-pedagogical projects and the syllabus of the discipline; the staff of qualified professors; the implementation of SCI both in basic care and hospital environments; and finally, the fact that the SCI is based on the NCG in both institutions.
During data collection, the UNCs of public and private HEIs had 591/158 undergraduate students, 3,250/484 graduates and 90/30 professors, respectively, who constituted the study group.Considering this population, the inclusion criteria in the study were graduates who attended the SCI course and graduated in 2013, 2014 and 2015; undergraduates of the nursing bachelor course who attended the first semester of the SCI course in 2016; and professors who had been working in the SCI discipline for at least six months.According to the inclusion criteria, the following subjects were eligible for the study: 87 students who completed the SCI discipline in the first half of 2016 (63 students from the state HEI and 24 from the private HEI); 280 graduates who finished their courses in 2013, 2014 and 2015 (195 graduates from the state HEI and 85 from the private HEI); and 48 professors who worked for at least one semester in the SCI discipline, 42 from the state HEI and 6 from the private HEI, totaling 415 possible respondents.The search for subjects took place in HEIs to which these subjects were linked, through a letter asking for their contact (telephone and email address) of possible participants -graduates and professors.After the contact, the questionnaire was sent to participants via Google Docs ® platform.For undergraduates, the date of the SCI conclusion meeting was checked and, after the consent of the students, the questionnaire was applied.
This questionnaire was applied to the study participants from April to June 2016.This instrument had objective questions and a discursive question to analyze the perception of undergraduates, graduates and professors in relation to the discipline of the SCI and the development of management skills, based on the experiences of the actors.Also regarding the dissertation question, proposals of SCI discipline improvements were also requested.In addition, the instrument presented items that sought to identify sociodemographic aspects.In this study, data correspond to the data obtained through the dissertation question.
The analysis of sociodemographic data used absolute frequencies, relative frequencies and the mean on the SAS ® (Statistical Analysis System), version 9.3.For the dissertation question, the latent content analysis described by Mayan 15 was used.According to this framework, the latent content analysis comprises a process of data identification, coding and categorization, since the researcher examines the content meanings and determines proper categories. 15At the end of the analysis, the researcher finds the conclusions and performs interpretations, interrelating them with the theoretical framework initially outlined or builds new paths around new theoretical and interpretative dimensions suggested after reading the material, aiming to qualify the subject's experiences and perceptions of a particular object and its phenomena. 16,17ased on the framework mentioned above and with the purpose to identify meanings and obtain inferences about the material collected from the study subjects (professors, graduates and undergraduates), the following steps were performed: 1) Data coding, in which the researcher familiarizes with data and begins to organize them; 2) Data categorization, where each category should be judged on the basis of two criteria: external homogeneity (referring to the relationship between the different categories) and internal homogeneity (concerning individual categories); and 3) Definition of themes and conclusions. 15ata coding started from the identification of excerpts of the discursive question, according to the order of the questionnaires and the categories of respondents.In the course of multiple readings of the material, excerpts of the texts were highlighted, and interpretations, observations and questions about such fragments were recorded for data organization.Then, through the categorization resulting from coding, four categories were created: actors' view of the supervising nurse's role in the SCI, nurses' relationship with the educational institution and undergraduate students; professors' role in the SCI in the perspective of graduates, undergraduates and professors; coherence of information provided to students by SCI supervising nurses and professors; and perception of graduates, undergraduates and professors on the development of management skills in the SCI.
Finally, the relationship between the resulting categories was defined, leading to the formulation of two themes that allowed the conclusions of this study: the general perception of the actors on the SCI and the actors' view of the development of management skills in the SCI.

Supervised internship and management skills
Rigobello JL, Bernardes A, Moura AA, Zanetti ACB, Spiri WC, Gabriel CS The identification of study subjects had a two-letter combination, ensuring anonymity.The first letter refers to graduate (G), professor (P), and undergraduate (U), whereas the second letter refers to the HEI of the participants: private university (P) and state public university (S).The project was approved by a research ethics committee in December 2015, under CAAE protocol no.49697415.0.0000.5393,and all the requirements of Resolution 466/12 of the National Health Council were fulfilled.

RESULTS AND DISCUSSION
Of 415 eligible subjects, 197 (47.5%) participated in the study.Of the 87 undergraduates of the HEIs analyzed, 59 (67.81%) answered the questionnaire.Of these, 35 students were from the state HEI (55.55%) and 24 from the private HEI (100%), their mean age was 24 years and three months.The final students of HEI were identified as four (6.78%) male and 55 (93.22%) female students.Of the 280 graduates, 85 were from the private HEI.Of these, 42 (50.58%)answered the questionnaire and, among the 195 graduates from the state HEI, 69 (35.38%) answered the questionnaire.Of the 111 students who actually answered the survey, nine (8.11%) were male and 102 (91.89%) were female, their mean age was 26 years and nine months.
In relation to the 48 professors who worked in the SCI discipline, 27 (56.25%)answered the questionnaire.Among the 42 professors from the state HEI, 22 (52.38%)participated in the study, whereas among the six professors from the private HEI, five (83.33%) participated in the study.Among the 27 professionals, two (7.4%) were male and 25 (92.59%) were female.The mean age of the respondents was 48 years and 9 months.
The four categories that synthesize the general perceptions of the SCI of the actors from both institutions are presented, along with their view of the development of management skills in SCI.It should be noted that the singular aspects of the institutions were not evidenced in the answers of the study participants, showing similar perception of these actors.This fact can be observed through the eyes of at least one of the actors from each of the institutions in all categories.

The actors' view of the supervising nurse's role in the SCI, and the nurse's relationship with the educational institution and the undergraduates
In this category, the aspects of the supervising nurse's role in the SCI and the nurse's interaction with the HEI and undergraduates are identified in the records of the following study subjects: graduates, professors, and undergraduates.

Nurses for supervision are required, who are really willing to stay with the student and guide them, giving us confidence to develop care activities and improve our team-interpersonal relationship (UP24).
It is necessary to place the supervising nurses closer to the educational institutions so the activities are conducted with more egalitarian and effective partnerships (PS12).

The supervising nurse must effectively participate in the activities [at the school] (PS8).
Ensuring the professional of the site is trained, in addition to having technical training, to meet the needs of undergraduates and their normal functions at the site.Psychological preparation of the professional is essential for good progress and use of the SCI (GP14).
Based on the above excerpts from three actors involved in the study, nurses assume an important role in SCI, representing, therefore, the link between the university and the place of internship.It requires a closer contact with educational institutions; willingness to guide and teach students; and being technically trained and psychologically prepared to meet their needs.
They highlight the supervising nurse is considered, or idealized, as a standard to be followed by students in their practice, a professional model to be achieved.This way, nurses should be aware of their importance and reference role for graduates, and the responsibility attributed to their position, requiring professional knowledge review and update. 1 Given the singular characteristic of the SCI, nurses have become notable professionals.This professional should be prepared to convey experience, which will allow the student to incorporate classroom theory into the practice experienced in the internship. 16In addition, nurses are essential for the introduction of managerial activities and to conduct the work process at the internship site. 1 In addition, when observing the attitudes and behaviors adopted by nurses, interns think and relate the knowledge to the situations experienced.The performance and supervision of nurses in internship still guide students to quality nursing work, using scenarios of problematization, leading to knowledge consolidation and collective use of intellectual instruments. 7

Performance of professors in the SCI from the perspective of graduates, undergraduates and professors
Regarding the work performed by professors in the SCI, some graduates and undergraduates reported that if the professor was more present and closer, several challenges of Supervised internship and management skills Rigobello JL, Bernardes A, Moura AA, Zanetti ACB, Spiri WC, Gabriel CS the SCI could have been mitigated and/or avoided, since their presence would bring more confidence and tranquility, as doubts could be clarified faster.In addition, there is the question of a greater presence of the professor, the aspect of professor training to perform in the SCI, as described in the speech of a professor from the state public institution.These findings appear in the excerpts transcribed below:

I believe professors have to be closer to students in the internship program, with more meetings or field visits, since the professor usually appears only in the presentation of papers and final evaluation (GP9).
A more frequent presence of the supervisor in the internship site to support the connection between theory and practice, which diverge greatly (GP2).

Commitment of professors to actually supervise students with politeness and support (GP39).
I think the supervising professor could track us more closely, more often (US42).

[...] there is a lack of better professor training to supervise the SCI (PS4).
The requested presence of professors in the internship site was also highlighted by students who participated in a study conducted at a public university in the interior of the state of São Paulo.In this study, such desire of the students may indicate a poor coordination between teaching and service, or even be the result of the discomfort caused by the rupture of the direct supervision and tutoring process, through distant monitoring, whose intention is to build student autonomy. 12n this sense, the teaching role is to set the link between the actors involved in the discipline (student, nurse and service professionals), with an impact on the success or failure of the student's learning in the internship. 18The SCI professor contributes to the management training of the future nurse, so professors have to rethink their role in a critical-reflexive manner. 19he strategies to be adopted by teachers, in order to fulfill their real role as educators, should allow a close relationship with the students, since such proximity will lead to the knowledge of the individualities of students and will contribute to improvements in the teaching-learning process.
Also regarding the aspects related to the professor performance, graduates from both HEIs indicated the need for greater attention from professors to the individualities of the students, so they would feel more embraced when sharing their doubts, as the following excerpts show:

Greater attention of supervising professors to the needs of students [...] (GS52).
Professors should open up and listen to the student's doubts and not punish them for simply not knowing things, but give them tools and tips so that they can seek and find the knowledge they need (GP31).

Each student has a different view and different affinities. The professors should be more attentive to different affinities and develop this situation (GP19).
Considering the interviews with the study participants, it should be noted that it is up to professors and students -in this form of curricular organization for nursing training -to face the challenge of teaching and learning in an active and contextualized way.Professors are expected to plan the resources, guide and supervise activities that allow meaningful and critical-reflexive learning; students are expected to be active and critical, responsible for building their own knowledge, which will allow the development of skills to solve problems in their area of practice and, thus, exercise citizenship and assume their role in the construction of their own reality. 20ikewise, professors are responsible for the pedagogical act; it is up to this actor to seek training for their own development with competence, thereby committing to their own learning and encouraging students to dedicate to the learning process.In this perspective, the introduction of innovative pedagogical strategies that break traditional paradigms can promote a greater involvement of the student in the teaching-learning process. 21hus, professors can be considered supporters of the teaching-learning process, and they should know it deeply, besides having experience, willingness, and appreciation regarding what they do.Likewise, they should know how to teach, approach, listen, respect, interact and dialogue with the student.This new role would require professors to become, in the teaching-learning process, a mediator of active student learning, transforming the school into an environment of interand transdisciplinary practices integrated into everyday life, knowing and applying active teaching-learning strategies and methodologies to think, learn, evaluate and care for. 22rom this perspective, internship supervising professors could be defined as mediators of the teaching-learning process, since they offer theoretical, emotional and psychological support to future professionals. 13In parallel, if the UNCs professors are actually focused on the real needs of undergraduates and their Supervised internship and management skills Rigobello JL, Bernardes A, Moura AA, Zanetti ACB, Spiri WC, Gabriel CS training as critical-reflexive individuals, the commitment of these professors to students is essential. 23

Coherence of information given to students by SCI supervising nurses and professors
This category was created for study participants to identify the need for a closer relationship between professors and nurses, in order to clarify the SCI actions.In addition, these two groups of professionals should be involved in internship activities, especially those related to discipline planning, since at that moment standards and guidelines for the SCI development will be defined, as illustrated in the excerpts below:

[...] better coordination with the nurse in charge of the practice site (GS103).
A greater integration of the educational institution (not only professors) and health services (PS7).

[...] nurses should participate more in the discipline planning so there is no dissonance between what professors demand and what they require of students [...]; if there was more interaction among the disciplines, professors, and practice nurses, some problems seen during the internship involving the students would not happen (PS5).
In agreement with the study on SCI in Brazilian higher education, the excerpts show the importance of the coordination between the educational institutions and internship institutions, 9 foreseen in the NCGs of the UNCs 4 and Law 11.788/2008, 5 which explain the need for the participation of organizations in the program development and in the supervision process of students, an essential arrangement for the goal to be achieved.However, it has not been always fully performed.
The discussion on the training of health professionals is the responsibility of both education and health sectors, requiring an intersectoral partnership, leading to a meaningful creative teaching-learning process, committed to local needs of health, besides encouraging autonomy and self-management of learning itself.As for the health system, it is responsible for providing the practice environment, whose organization of health services, activities, management and formulation/ implementation of policies are fundamental for the processes of training and continuing education of nursing professionals. 24he participation of nurses is foreseen in the NCGs for the UNCs, but is not always observed.This fact impairs the teachingservice interaction, since nurses and professors are considered as agents that drive the contact between care and teaching projects. 10Also, there is a lack of strategies that seek teacher/ student-service-community integration as an essential condition to support the process of change in the nurse academic training, even with the insertion of the student in the reality of services and communities. 25n addition, the teacher-nurse-student partnership is very rich, since it allows the contact of students with experienced professionals in different areas of nursing practice and lead to individual and group critical reflection. 7Non-compliance with this interaction may harm students, since it can lead to deficient academic training and thus compromise the profile of the future health professional.Such deficient integration is a great challenge for subjects involved in the SCI.

Perception of graduates, undergraduates, and professors on the development of management skill in the SCI
The relevance of teaching management skills is described in the NCGs. 4 Based on this, the perceptions of graduates, undergraduates, and professors associated with the development of management skills in the SCI were also reported, as highlighted in the statements below: [...] the SCI time should be longer, because it is during this period that we learn how to be and act as professionals; we gain confidence, more technical skills and learn how to deal with human and material resources, and learn how to lead a team (GS73).
It is important for the student to have an experience in care practice with all ages and learn the bureaucratic aspects of nursing as well, and thus the student will end the course more prepared for the job market (GS92).
In some cases, the student will assume the whole shift with the nurse, including shift reporting (GP37).
There should be a management internship in basic care.And not just in the hospital (GS52).

[...] I think the students should present a clinical case study but also a more comprehensive study of a problem identified in the service [...] so the student can seek, plan, implement and evaluate the results of evidence-based interventions to address this problem [...] in order to promote deeper discussions (PS3).
Based on the excerpts above, with the insertion of students in the SCI, it is possible to create links with the population and the continuous development of activities that help strengthen the autonomy and the development of knowledge, skills, Supervised internship and management skills Rigobello JL, Bernardes A, Moura AA, Zanetti ACB, Spiri WC, Gabriel CS and attitudes of the future professional. 26Although one of the graduates described that the SCI period should be longer, as in the excerpt of GS73, both institutions fulfill the hours defined in the NCGs. 4 This observation of the graduate is justified by the fact that this actor is aware that the internship period provides the student with an opportunity to resolve ethical, political, technical and cognitive issues, and promote the development of their skills and qualities, mainly administrative and managerial skills. 26he excerpt of GS73 also shows the need to develop management skills, especially, leadership skills.Such skills, present in the NCGs, 4 have been increasingly demanded, since the current and globalized labor market, characterized by the adoption of technological innovations, new management models, and continuous marketing demands, involves the need to learn new roles and the development of skills, among them, leadership. 27o strengthen this aspect, a study conducted with teachers in the southern region of the country showed the relevance of teaching this skill, although some educators report challenges in providing this experience to students.However, it emphasizes that leadership is linked to permanent incentive of undergraduate, in order to keep them motivated and, thus, able to conduct actions with creativity and innovation.In addition, it emphasizes that leadership is related to communication skills, understanding that it permeates all other skills. 28he excerpts presented by graduates GS92 and GP37 and professor PS3 discuss learning of administrative actions performed by nurses -bureaucratic tasks, shift reporting and planning, implementation and evaluation of strategic actionsthat correspond to management skills, as well as the perceptions described in the categories called 'description of administrative activities related to the nursing team' and 'criticism of students to care provided (bureaucratized care)', both present in a study conducted in the interior of the state of São Paulo. 1 The essential teaching of management skills is highlighted in an integrative review that concludes teaching of nursing management is fundamental for the training and development of students as future nurses.29 The excerpt of GS73 highlights the management of human and material resources.About this aspect, a study conducted at a university in the south region of the country reported that through the SCI, the student is able to develop management skills such as decision making, management of human resources, materials, medicines and inputs, consequently qualifying their work process and training committed to the other ones and nursing care.14 In addition, the excerpt of GS52 shows the need to develop management skills in basic care, in agreement with a study conducted with professors in the state of Paraná, which shows management skills should be developed both in hospitals and in basic care.The same study shows SCI should involve care and management issues, as mentioned in the excerpt of PS3.28 Finally, training of nursing students can have a positive or negative impact on the construction of management knowledge required in their professional performance.Therefore, the four excerpts show that the curricular internship is significant in the construction of management skills, but with some special conditions, such as the need for greater emphasis on primary care internship, identification of site deficiencies, and definition of a management diagnosis, allowing the proposal of strategies for improvements in the care provision.

FINAL CONSIDERATIONS
In the perspective of the three actors involved in this study, four categories were identified, three of which present the general perception of the participants about the SCI and one refers to the development of management skills through the SCI.In this sense, the actors highlighted that the internship supervising nurse plays a critical role in the teaching-learning process of professional practice.However, supervising nurses have no ability to develop this role; and they also pointed out the need for a more active participation and close contact with educational institutions.
Regarding the presence of the professors in internship, graduates and undergraduates reported that several obstacles found in the SCI could be mitigated with the presence of the educator, a figure that would enable undergraduates to have a resolute and persevering education.Also, the need for coordination between nurses (representatives of the internship institution) and professors (representatives of the educational institution) was also highlighted for an agreement between these two groups of professionals and for students' better learning.Regarding the development of management skills in the SCI, the perception of some subjects of this study emphasized leadership, resource management, and performance of bureaucratic tasks as essential management skills to be developed in the SCI.Other needs identified were improvement of these skills in the scope of basic care, not restricted to hospital environments; and involving improvements in care skills.
This study has a great relevance in studies on nursing education, considering that it shows the view of three actors involved in this process: undergraduates, professors and graduates of UNCs at two HEIs.However, regarding the study limitation, it is important to present the perspective of SCI supervising nurses, given their importance in this context.
According to the results of this study and considering the uniqueness of the teaching-learning process in the SCI, it is fundamental to strengthen the link between educational and health institutions where this discipline is taught and, at the