Learning Incubator : an instrument to foster entrepreneurship in Nursing

Objective: this study aimed to know the contributions of the Learning Incubator to the process of lifelong education in health. Method: this is a qualitative fi eld research whose data was collected from August to December 2014 by the focus group technique. The research had 34 employees of a Teaching Hospital in the central region of the state of Rio Grande do Sul that participated previously in the incubation process. Results: from the data encoded by content analysis, three themes were selected: Learning Incubator – welcoming and integrating space; An instigating instrument that enhances possibilities; Continuous and lifelong education strategy. Conclusion: the Learning Incubator is an important instrument to foster entrepreneurship in nursing and other health areas due to its capacity of rethinking mechanized practices, to the possibility of instigating new ways of being and acting, and to the ability of creating and developing new ideas based on individual and institutional needs.


INTRODUCTION
The term incubator emerged for the first time in the 1970's in the United States, associated with the incubation of companies.Its use was directed to recent undergraduates as stimulus to entrepreneurship, characterized as an innovative and transformative technology due to the (re)creation of processes, products, services, and others.Thus, this instrument gradually translated into opportunity for young people to start and grow their businesses, by fostering partnerships with physical structures that offered advice pertaining to management, as well as to legal, technology, and communication matters (1) .
In Brazil, the first Incubators emerged in the 1980's when, by initiative of the then President of the National Council for Scientific and Technological Development -CNPq, technology foundations were introduced in several states of the country.Important in this implementation process, the São Carlos High-Tech Facility Foundation (Fundação Parque de Alta Tecnologia de São Carlos -ParqTec) was created in December 1984, being considered the first Brazilian Business Incubator (2) .
In the health area and especially in the Nursing area, this instrument is still incipient, yet promising.In addition to the low level of utilization in this area, Incubators need practicaltheoretical references that validate them as innovative technologies.It is noteworthy, in the Nursing area, the creation of the virtual learning laboratory of the School of Nursing at the University of São Paulo (EEUSP) (3) .Another study, more specifically, discusses the Incubator as a possibility for generating and disseminating new knowledge, as well as of instigating entrepreneurial ideas for Nursing, namely Learning Incubators (4) .
In the current political, economic and technological scenario, professionals are required to innovate, (re)create and transform professional practices through the development of innovative technologies in the different areas of knowledge.In this context, the area of Nursing has an important articulating and integrating role, due to the possibility of investing in health and care technologies, motivated by interactive and associative processes of teaching-learning, in practice (1) .
Based on the aforementioned, in 2012, the University Extension Project called Learning Incubator was created, with the aim of adding technologies to the process of health and Nursing care.This project started with a dual purpose: to instigate the innovative and entrepreneurial potential of Nursing students, fostering the welcoming integration of new staff; and to promote the lifelong education of professionals already in the service, by means of a welcoming reception and new learning methodologies.The Learning Incubator is located in an area of 230 m 2 of a teaching hospital in the central region of the state of Rio Grande do Sul, Brazil.
In the Learning Incubator, activities are carried out by Nursing students, in groups of up to twelve collaborators, under the supervision of nurses.The learning units, conducted creatively and interactively, comprise themes ranging from the welcoming reception to the humanized care, in practice.
Therefore, the innovative and transformative potential of Learning Incubators in the areas of Nursing and health is evident.Thus, this study aimed to know the contributions of the Learning Incubator to the process of lifelong education in health, in the perspective of professionals who previously participated in the incubation process.

METHOD
This is a descriptive-exploratory study, based on the qualitative approach, considering the essential role of this methodology within the context of social and health research (5) .
The data were collected through the focal group technique, with 34 health and hospital support professionals, from August to December 2014.Activities in the Learning Incubator were systematized and conducted by Nursing students, as previously described.
The incubation process, more specifically of newly-hired staff from different areas, was conducted on a monthly basis, during five days in sequence, and each session lasted five hours.With this purpose, the following learning units were creatively and interactively systematized: 1 st day: Individual and collective welcoming reception, in addition to the presentation of the hospital's history and Strategic Planning; 2 nd day: Ethics, attitude, and professional and institutional marketing; 3 rd day: Dynamic (re)construction of the history of the Brazilian Unified Health System (SUS); 4 th day: Main institutional protocols related to the different areas; 5 th day: Visit to the Museum of the Funding Institution (Museu da Mantenedora) and a mixer in a strategic location in the city.
All staff that had participated in the process of incubation were invited to participate in the study.Of the 37 staff members from different areas of the hospital who had participated in the incubation, 34 met the inclusion criteria, which were: having participated in the incubation process and being a staff member, at the institution, for two to six months.The participants were divided into five focus groups.The data were collected at the Incubator and each session lasted about one hour.The focus groups had a researcher and a moderator and the discussions were recorded.The themes discussed were: Contributions of the Learning Incubator; The Learning Incubator and its relation to Lifelong Education; Potential and weaknesses of the incubation process and suggestions for the enhancement of the incubation process.
Subsequently, the data were transcribed and the material was submitted to content analysis.This analysis consisted in discovering the nuclei of meaning that made up communication, whose presence or frequency added significant perspectives to the object of the study.The notion of theme was associated with the statements concerning the subject, presented by words, phrases or ideas, and their operationalization.
The three steps required by this analysis technique were followed (6) .In the first step, called pre-analysis, the data was read exhaustively, followed by organization of the material, and formulation of hypotheses.Next, the material was explored, i.e., the raw data were coded.In the third and final step, the data were interpreted and defined in thematic categories according to the understanding of the meanings (6) .
The recommendations of the National Health Council resolution No. 466/2012, which address research with human beings, were followed (7) .The project was submitted to and approved by the Research Ethics Committee under No. 162.980/2012.To maintain the anonymity of participants, the statements were identified in the text with the letter "P" followed by an Arabic numeral, corresponding to the order of the statements.

RESULTS
From data analysis, three themes were selected: Learning Incubator -welcoming and integrating space; An instigating instrument that enhances possibilities; Continuous and lifelong education strategy.

Learning Incubator -welcoming and integrating space
In the interviews, the participants of the study claimed that the Learning Incubator meets the objectives initially proposed to be a welcoming space that promotes sharing and sociability, especially for new employees.Even with no previous understanding of the meaning of the term Incubator and/or of the Incubation Process, all individuals were motivated to participate in the proposed program.

When they told me \ i should participate in the Incubator, I thought, Wow! What is an
Incubator, how will it be?Is this the word?... for people who are coming in now, premature, it was very important, and also by the fact that every day we have to learn new things.(P3) In addition to being a welcoming space for the newly-hired in the institution, the Incubator enabled exchange of experiences, clarification of doubts and concerns, and opportunities to meet colleagues from different sectors.In the statements of two participants, the importance of being recognized and called by name was evident, not only by team members, but also by colleagues from other sectors and functions: With the Incubator I felt better because I saw that I was not the only new one in the hospital … I felt relieved and could work better.I liked it because there were not just technicians or nurses involved, it was an integration of all sectors.This way we get to know the name... because when you hear your name in the hall 'good morning' and they call you by your name it is like music to our ears.I feel super good.(P9) I appreciate the opportunity to meet the new colleagues.Today I realized that I got into a team that I can rely on... we won't work together, but I'm sure we'll meet in the halls and we will remember the names of each other.To get into a company, like this, I say to my husband, is very good, because I felt embraced by the colleagues and by the institution.I'm in a wonderful environment.(P32) The Learning Incubator also represented the possibility to go beyond structured spaces and/or traditional methodologies, such as formal and specific training.The professionals felt welcomed as colleagues and collaborators, being able to think, opine and contribute actively to the achievement of institutional objectives and goals:

In fact, you don't feel like a mere employee, as in other companies that you're almost asleep on top of polygraphs, learning all the rules ... It wasn't that stressful and boring meeting where only one person speaks and the others listen ... (P21)
The Learning Incubator enabled, especially, the welcoming reception and integration of employees of different areas.This distinguished space allowed for the employees to feel recognized and valued as human beings and not mere employees, subject to a given activity or function.

An instigating instrument that enhances possibilities
For the participants, the Learning Incubator meant the possibility of being and making the difference, regardless of their professional practice scope.They recognized that many professionals, with ease, get used to a single mindset and mode of action and, consequently, develop vices and start acting mechanically.The Incubator, however, instigated and motivated them to transcend the narrow vision and avoid the sameness, that is, doing things routinely, mechanically, and in a dehumanized manner.

This Incubator is very important because it ends up motivating us to escape the sameness and to do better or differently ... we end up getting used, creating vices and doing things mechanically. (U23)
For many participants, the incubation process meant the awakening of dreams or the possibility to keep dreaming.
They understood that, at the institution, their role is not limited to routine work, but that it is possible to continue believing on and pursuing personal dreams.In two statements, more specifically, it was evident that the work had become an end in itself or just a means to support their children, the family.The incubation process represented an awakening and a warning that life is not limited to work or children, but that, through work, it is possible to transcend and broaden both personal and collective possibilities.

Continuous and lifelong education strategy
The Incubator has transcended the traditional meetings or trainings, in which knowledge and practices were presented with little interaction and reflection.The participants recognize and reassess their attitude and practice, in a critical-reflexive manner, and engage in continuous and lifelong learning: I started to reflect and observe things more.By the way, yesterday something happened and I recalled the Incubator... even regarding the way of talking to people.(U3) When I was taking notes, yesterday, someone called me and I had a rude reaction, but then it hit home and our discussions in the Incubator made sense.(P9) In addition to the welcoming reception and the integration between different professionals and sectors, the Learning Incubator allowed for rethinking, reevaluating, renewing and expanding the theoretical and practical knowledge.In some cases, more specifically, the incubation experience transcended the space of the Incubator itself and enabled the multiplication of knowledge to other sectors, as well as to family members.As a continuous and lifelong education strategy, the Learning Incubator proved to be an effective and transformative strategy, especially due to its methodology of intervention: ... this Incubator, I saw it as a pleasant meeting, as if it were a bunch of friends talking and learning together.(P33) The previous statement denotes that the traditional methodologies for continuous and lifelong education must be transcended, and that instruments that are meaningful to the members of the institution must be used.

DISCUSSION
The results of this study allow for the argument that the Incubator, while a concrete space of meaningful learning, can be considered a technology that fosters entrepreneurship, due to the capacity of (re)creating and enhancing the health care relational, interactive, and assistance processes.In the field of Nursing, the Incubator can be considered an innovative learning technology, due to the possibility of generating and integrating innovation, technology, and continuous or lifelong education into the professionals' concrete reality, as evidenced in another study (4) .
The Incubator fosters proactive and entrepreneurial initiatives, insofar as it encourages the need to transcend the sameness and the desire to be and make a difference, by rekindling dreams and making possible the idea of going beyond being a good employee, as expressed by the participants of the study.On that understanding, entrepreneurship translates into the ability to create something new or different, through dedication, personal and collective effort, and through the ability to reevaluate and transcend established practices (8) .
As a learning technology, the Incubator allows for the recreation of the traditional meetings, lectures and or vertical interventions, enabling continuous and lifelong education, through methodologies that promote interactions, associations, and dialogical relations (9) .Therefore, it is noteworthy that health care organizations are complex and dynamic environments that need to keep up with the continuous and growing social, economic and environmental transformations.Thus, as technology or as teachinglearning instruments, incubators appear as bold responses that foster new modes of being and acting.These productive complex learning environments are spaces that generate and foster new ideas, being able to articulate and promote continuous and lifelong education in health, through welcoming reception, recognition and valuation of human-interactive skills and competencies necessary to enhance and humanize health care.
Unlike Business, Technology or Computer Science Incubators, in the fields of Nursing and health, Learning Incubators are characterized as living laboratories, in which humanized and transformative care is experienced in practice (10) .As demonstrated by the participants, much more than creating, testing, and launching new products or services to the market, the Learning Incubator seeks to rescue the human essence by promoting systemic relations and interactions, which are consolidated in and by integrating and articulating care (4) .
The Nursing field has, therefore, several reasons and possibilities to engage in entrepreneurship.First, because it is a profession that has a broader understanding of reality, i.e., of the needs of the human being in its different dimensions.Second, because of the possibility of exploring new spaces, regardless of context or social conditions.Third, because it is a profession of care and for care, therefore the profession of the future (11) .This was confirmed in other studies in which the authors pointed out that innovations are a reality in Nursing and health care practice, even if strongly associated with virtual, information or systematization technologies of nursing care (9,(11)(12) .Thus, fostering entrepreneurship through the Learning Incubator implies changes in the way of understanding and conducting continuous and lifelong education in health.It also implies surpassing conventional interventions devoid of critical reflection and encouraging proactive attitudes capable of enhancing the actual opportunities of human beings as thinking and autonomous individuals (13) .

I
joined in thinking I knew everything and that I would ace it ... but I found a lot of new things.It was like a little seed that changed a lot in me.(P16)This experience I'm taking as a life lesson ... you taught us that we have to be strong-willed, dream and renew ourselves all the time ... I'm going to take these experiences to my colleagues and into my house.(P30)