The principle of integrality of care in the political-pedagogical projects of nursing programs

Objective: to identify the political-pedagogical projects of the undergraduate nursing programs in Santa Catarina, Brazil according to the guidelines of the Ministries of Health and Education, considering the education of professionals under the principle of integrality. Method: documentary study with a qualitative approach. Nine projects were analyzed. Results: the colleges from the Southern region of Brazil are gradually incorporating the theoretical framework of the Brazilian health system and curricular guidelines, which includes the principle of integrality of care, into their political-pedagogical projects of undergraduate nursing programs. Some institutions strictly follow the curricular guidelines, while others make their own interpretation. Conclusion: most teaching institutions do not provide pedagogical support to students.


Introduction
The creation of the Brazilian National Education It guides policies and programmatic actions to meet the demands and needs of the population (1) , promoting defragmented care in which the human being is seen as a complex being immersed in different socio-cultural contexts. This principle guides the reorientation of curricular changes (2) in nursing programs in order to comply with new teaching and care paradigms. In this situation of changes in the health and teaching contexts, this study's aim was to identify the political-pedagogical

Method
This is a documentary study with a qualitative approach. Documentary research is a valuable source for understanding the object of study through the historical and socio-cultural contextualization it provides (4) . websites. The programs' coordinators attested how recent the documents were. Data collection was guided by a form created based on the general topics of the curricular guidelines. Thematic Content Analysis (5) was used to categorize the data. The following categories emerged from grouping the curricular guidelines according to their convergence: Adherence of Political-Pedagogical Projects to the guidelines in regard to integrality of care; and Critical knots faced in education from the perspective of Integrality. These two categories were discussed on the basis of the theoretical framework of Donald Alan Schön (3) and the principle of integrality, seen as a "battle flag" of the health movement, playing the "image-objective" role, that is, serving as an indicator to signal the desirable characteristics of the health system and its practices (6) , as well as a health training process in the health field. In regard to the curricular matrix, the programs present two remarkable characteristics:

Seeking
in five PPP, the matrices are organized by course, while four programs organize the matrices into modules, or have an integrative core, characterizing integrated content.
Note that even though most of the curricula is characterized as a statement of good practices within the health system that refers to a set of values that is worth fighting for, because they are related to an ideal of greater justice and solidarity (6) . It is also linked to learning that enables students to focus on the reality and health needs of the population. in the educational process (7) , considering that when education is thought of with the respective theoretical frameworks that ground integrality, it is transformed into an element that produces collective knowledge intended to promote the autonomy and emancipation of individuals for the care that is found in the different fields of nursing practice (8) .
The diversity of contexts in which practice is with an exchange of knowledge and real experiences (3) .
The professional profile under study meets the provisions of Art. 3 of the Curricular Guidelines (11) .
Some institutions followed the guidelines, closely while others tie these guidelines to indicators such as democracy, interdisciplinary, and autonomy. There is a tendency among the programs to mention the text of the curricular guidelines together with their commitment to such content, often limiting the text itself when it not renewed/revised (12) .
We note that the development of competencies and abilities needs opportunities in the curriculum to be made concrete and individuals in nursing need the encouragement to act focused on integral care, with opportunities to reflect upon actions performed by the nursing professionals both within academia and when providing care.
These opportunities should be taken into account in the curricular matrix to enable flexible, reflective and non-linear teaching; sufficient time needs to be supplied to students for them to come to know reality of practices and health actions, reflect upon them and reflect upon them again. It also requires that programs work closely with practice and service, facilitating autonomous and continuous intellectual and professional development (11) .
The development of curricular structures with an interdisciplinary nature is seen as a strategy to handle complex issues that involve the health-disease continuum and to respond in such a way as to broaden issues, particularly in the case of the principle of integrality, in addition to the other curricular guidelines (13) , such as acclimating students to the practice of service early on from the program's first semester, and the mandatory curricular traineeship concentrated in the last two phases of the programs, according to the workload proposed by the curricular guidelines.
Accustoming students to the practice of service early on enables a process of reflection and learning about various experiences in which students become involved with the context of service, so they can make sense of information and interpret it in accordance with the relationship (14) they establish with experiences. We note that the "difficulty in teaching integrality is not in conceptualizing it, but in putting it into practice, and in this respect, professionals and professors share the same anxieties and perplexity in regard to both students and patients" (15) , which is perhaps the biggest shortcoming of integrality. Therefore, the richness of practical experience is unlikely to be obtained in lectures, no matter how sophisticated the technologies and pedagogical proposals used, because when teaching is provided in these conventional spaces, the patient is often seen as an abstraction The curricular guidelines also signalize the ability to develop care focused on prevention, promotion and rehabilitation (16) .
Despite adherence of the programs to these In this context, understanding assessment tests as procedural and formative, inseparable from the teaching-learning process, and intended to lead to reflection and autonomy, is to enable and encourage the development of an "artistic talent" in students.
The assessments are also intended to produce selfcritiques, in the sense that students are able to identify their own progress and resistance so to define their subsequent deliberations.
To ensure change in the educational process, however, mobilization, participation, and interest on the part of the faculty members and students is required to ensure the development of a curricular design (and of a pedagogical practice) that permits learning oriented to the propositions of the Brazilian Health System, as indicated by the curricular guidelines (11) .
Note that the programs are integrating applied/ vocational sciences and basic sciences into their curricular traineeships. Is education based on the belief that answers to the users' problems can be found in science and technique, considering the truth to be objective and unique? Considering that the programs adhered to the curricular guidelines from the perspective of integrality, we believe the answer to this question is 'no', however, one must go to the field where practice is implemented, and learn how traineeships and theoretical-practical activities are being performed and how professors perceive such practices, that is, research in practice.
Shön does not deny the importance of teaching applied science, however, the author regards it as valid only if integrated into professional practice implemented in an environment of practical education that integrates action and reflection upon action. Considering that this process occurs in the action (20) itself, in which students feel free to learn through action, they need an opportunity to turn to competent professionals who initiate them into the profession, which implies: "know how to ask for help, find the right word, see for yourselves and from your own perspective what a professional needs to be able to see" (20) .  This study was limited to the analysis of documents, thus it is necessary to verify whether data presented here are in fact a reality, such as the practical application of curricula, the integration of teaching and service, and the perceptions of professors, students and managers concerning teaching.