Management competence level on nursing of a private university graduates

Abstracts

Este estudo, do tipo exploratório descritivo, de caráter quantitativo, teve como objetivos identificar e analisar a percepção dos graduandos quanto ao grau de competência desenvolvido na disciplina Estágio Supervisionado em Enfermagem do Curso de Graduação em Enfermagem de uma universidade privada. A análise dos resultados permite identificar que o grupo de graduandos alcançou em sua maioria o grau de competência gerencial em enfermagem integral. Entretanto, as questões que apresentaram maior número de respostas com o grau mínimo foram: Reconhecer o planejamento como método da administração da assistência de enfermagem; Relacionar o processo de trabalho em enfermagem com a teoria geral da Administração; Conhecer métodos de cálculo para dimensionamento de pessoal de enfermagem e Reconhecer a área de atuação prática e sua inserção na instituição e desta no sistema de saúde.

Educação em enfermagem; Educação baseada em competências; Pesquisa em Administração de Enfermagem

ORIGINAL ARTICLE

Management competence level on nursing of a private university graduates^*

Grado de competencias en la gerencia de enfermería en vista de los graduandos en una universidad privada

José Carlos de Oliveira^I; Cláudia Prado^II; Heloisa Helena Ciqueto Peres^III; Maria de Fátima Prado Fernandes^IV; Maria Madalena Januário Leite^V

^INurse. Ph.D. Professor at Pontifical Catholic University of Campinas. Campinas, SP, Brazil. [e-mail]

^IINurse. Ph.D. Professor. Department of Professional Guidance at School of Nursing, University of São Paulo. São Paulo, SP, [e-mail]

^IIINurse. Ph.D. Professor. Department of Professional Guidance at School of Nursing, University of São Paulo. São Paulo, SP, Brazil. [e-mail]

^IVNurse. Ph.D. Professor. Department of Professional Guidance at School of Nursing, University of São Paulo. São Paulo, SP, Brazil. [e-mail]

^VNurse. Associate Professor. Department of Professional Guidance at School of Nursing, University of São Paulo. São Paulo, SP, [e-mail]

Correspondence addressed to

ABSTRACT

This exploratory-descriptive study, structured from a quantitative approach, aimed at identifying and analyzing the perception of graduation students over the competencies developed during the Supervised Internship in Nursing of the Nursing Graduation Course of a private university. The results analysis allows identifying that the group has reached, on its majority, the managing competence on integral nursing. However, the questions which has presented more often the minimal score level questions were: Recognize the planning as a method of administration of nursing assistance; Make a connection between the nursing work process and the general Administration theory; Comprehend the calculation methods to nursing staff dimensioning and Recognize the practical performance and its insertion at the institute as well this one in the healthcare system.

Key words: Education, nursing. Competency-Based education. Nursing Administration Research.

RESUMEN

Este estudio, exploratorio- descriptivo, de carácter cuantitativo, tuvo como objetivo identificar y analizar la percepción de los graduandos acerca de su grado de competencia desarrollado durante el curso de aprendizaje Práctico Supervisionado en Enfermería del Curso de Graduación en Enfermería de una universidad particular. El análisis de los resultados nos permite identificar que el grupo de graduandos logró, en su mayor parte, el grado de competencia gerencial en enfermería integral. Sin embargo, las cuestiones que presentaron mayor número de respuestas con el grado mínimo fueron: Reconocer el planeamiento como método de la administración de la asistencia en enfermería; Relacionar el proceso de trabajo en enfermería con la teoría general de la Administración; Conocer los métodos de cálculo para cuantificar el equipo de enfermería; y Reconocer el área de actuación práctica y su inserción en la institución, así como la misma en el sistema de salud.

Descriptores: Educación en enfermería. Educación basada en competencias. Investigación en Administración de Enfermería.

INTRODUCTION

Both public and private institutions emphasize the management capacity of the nurses in their careers. However, performing management functions has always been a controversial issue for nurses in Brazil, since the National Curriculum Guidelines for the Nursing Undergraduate Courses ⁽¹⁾ often require a profile and competencies to be reached by nursing undergraduates that are often different to the daily routine observed in healthcare institutions. When a nurse becomes part of a healthcare organization, he or she faces mechanized and bureaucracy-ridden work, with pre-established routines, having to follow norms and regulations, where creative, critical and thoughtful actions are not highly valued.

The Guidelines establish the professional profile of generalist, humanist and critical-reflective nurses. The ability to diagnose and solve healthcare problems, communicating, making decisions, managing and intervening in the process of working, coordinating teamwork and facing situations in constant change are especially outlined in the management competencies⁽¹⁾.

Nowadays, it is considered that there is no single-definition about competence, which is currently understood as the capacity of using several types of resources in creative and innovative ways, not in the static use of learned rules⁽²⁾. Therefore, competence implies in the mobilization of acquired knowledge in order to develop efficient responses for contemporary problems that involve several schemes of perception, thought, evaluation and action.

The following proposals for grouping or rating competences are found in literature: technical, intellectual, cognitive, relational, social, political, entrepreneurial and organizational⁽³⁾.

Technical or specific competencies are the domain of certain specialists only; cognitive competencies are those present in all actions, aiding in the mobilization of personal capacities; relational competencies group practical abilities of relationships and interactions; intellectual competencies are related to the application of mental aptitudes, such as the abilities of perception and reasoning in certain situations; social and political competencies involve social relations and participation, and entrepreneurial and organizational competencies are those focused on company management and organization⁽³⁾.

The management working process has four dimensions: technical, political, communicative and the development of citizenship⁽⁴⁾. The technical dimension focuses on professional instruments such as planning, coordination, supervision, control and assessment of human, physical and material resources; the political dimension covers the different types of power and relates management work to the projects to be developed, where the political-ideological and economical determinations, healthcare policies, different healthcare service users and social policies are present; the communicative dimension is related with the professional negotiations with the healthcare staff and the relations with the community; and the dimension of developing citizenship is based on the management exercise, which is focused on the developing the autonomy of the social subjects, i.e., the agents that are present in the working process, or the clients that use the healthcare services^(5-7).

Therefore, with the innovations in healthcare management, the theory of complexity⁽⁸⁾ that shows that reality is non-linear, chaotic, fractal, catastrophic and must be seen not only quantitatively, but especially qualitatively, a study with the purpose of investigating whether the nursing management courses aid in the developed of the aforementioned competences in the nurses' professional practice is deemed important.

OBJECTIVES

To identify and analyze the perception of undergraduate students regarding the level of management competence, developed in their Supervised Nursing Internship during last semester of their Undergraduate Course.

METHOD

This is a quantitative, exploratory and descriptive study, developed in Faculdade de Enfermagem (FE) do Centro de Ciências da Vida (CCV) (Faculty of Nursing at the Center of Life Sciences) at Pontifical Catholic University of Campinas (PUC-Campinas).

The population consisted of 77 full-time undergraduate nursing students in a 4-year program, and also of 56 night-time students in a 5-year program. The requirements for inclusion in this study were: being regularly enrolled and attending the Supervised Nursing Internship program and accepting to take part in the study by providing written consent. As such, 121 undergraduates took part in the study, being 71 from the full-time program and 50 from the night-time program, representing 58.7% and 41.3% of the sample, respectively.

The data collection technique used in this study consisted of a two-part questionnaire; one named Respondent's Characterization and the other Identification of the Level of Competence. The purpose of the first part of the questionnaire was to allow for the distribution of the respondents regarding age, gender, professional activity and workplace. The second consisted of a questionnaire focused on the identification of the level of competence that the undergraduate student believes to have reached regarding the proposed objectives and curricular content in the discipline, with 54 questions grouped in the four dimensions: technical, political, communicative and development of citizenship.

Four progressive grading levels were used to identify the perception of the level of competence, with the following configuration: level 1 would be the lower end of competence, being named none, and level 4 being the upper end of competence, named full. The intermediate levels 2 and 3 are named minimum and partial, respectively ⁽⁶⁾.

The study was approved by the Review Board of Centro de Ciências da Vida at PUC-Campinas on December 20, 2006, register number 634/06.

RESULTS

Regarding the age variable, the study subjects varied from a maximum of 45 years and a minimum of 20, with a median age of 25. However, when the group was analyzed considering the study period variable, maximum age in the full-time program was 42 years and a minimum of 20, with a median age of 24. In the night-time program, the maximum student age was 45 years and the minimum was 22, with a median age of 27. Student's t test showed that the night-time group is significantly older than the full-time group.

The gender variable showed a distribution of 16 male subjects and 105 female subjects, with a percentile representation of 13.2% and 86.6%, respectively.

Undergraduate students who also hold jobs amounted to 86. Of these, 46 are in the full-time program and 46 are in the night-time program; 62.7% of them work in public institutions and 37.3% work in private institutions. Among them, 22 were nursing auxiliaries, 47 were nursing technicians and 17 held other types of jobs. The application of Fisher's exact test showed that the full-time program group has a higher percentage of nursing technicians, while the night-time program group has a higher percentage of nursing auxiliaries. Regarding the workplace, the result of the chi-square test shows that the night-time program group has a higher percentage of students who work in public institutions.

There were 6534 (100%) responses to the questionnaire about the undergraduates' perception of the level of competence developed in the Supervised Nursing Internship program. The results found in the questionnaire answers were 13 occurrences of the none level, 165 (3%) of the minimal level, 1909 (29%) of the partial level and 4447 (68%) occurrences of the level full, as shown in Figure 1.

The analysis and the distribution of the obtained responses, due to the occurrence or absence of the four aforementioned possibilities, showed that results of the full-time and the night-time groups were different. This set of responses is shown in Figure 2:

In question 9: Understanding nursing care management in functional unit of healthcare establishments, the night-time group had a higher percentage of minimal and partial responses than the full-time group, while the full response had a higher percentage for the full-time group.

Questions 24: Understanding the Continuing Education Sector of a Nursing Service, 41: Recognizing healthcare quality assessment as inherent to the process of continuous improvement of the healthcare provided, 44: Developing nursing practices while working in healthcare institutions in the hospital network, and 48: Identifying the organizational structure of the Nursing Service and the Institution, related to the healthcare system, showed that the night-time group had a higher percentage of full responses than the full-time group, while the full-time grouphad a higher percentage of minimal and partial responses.

Question 45: Developing the nursing management process in the practical field, with knowledge, skills and attitudes obtained in the different programs of the undergraduate course showed that the night-time group had a higher percentage of none and partial responses than the full-time group, while the full-time grouphad a higher percentage of full responses.

Question 52: Performing the nursing healthcare process in the practical field, with educational aspects showed that the night-time group had a higher percentage of none and full responses than the full-time group, while the full-time grouphad a higher percentage of partial responses.

DISCUSSION

The results of this study yielded relevant information regarding the characterization of the subjects and groups studied (full-time and night-time). Variables such as age and occupation are associated to the study period, showing significant differences between both groups.

Regarding the variable students who have jobs and workplace, a higher number of undergraduates without jobs was observed in the full-time program. When the distribution of students who have jobs was analyzed in relation to the professional activities developed, a higher percentage of nursing technicians was found in the full-time program, while a higher percentage of nursing auxiliaries was found in the night-time program.

Regarding the perception of the undergraduate students of the Nursing Course of PUC-Campinas regarding the level of competence developed in the course, the analysis of the results of the subjects' responses indicated that the group had reached mostly the full level of competence, followed by the partial level of competence. The occurrence of the levels of competence minimal and none did not present a numeric significance.

However, the results of the set of responses in the questionnaire of competences allowed for the identification of the questions with higher amounts of answers with the minimal level of competence: Recognizing planning as a method of the administration of nursing care; Making a connection between the nursing working process and the general theory of administration; Comprehending the methods to calculate the size of the nursing staff and Recognizing the field of professional practice and its place in the institution, and the institution's place in the health system.

These findings indicate that the basic instruments of the technical dimension of the management process, such as planning, consider the propeller of transforming social practices⁽⁸⁾, the sizing of the nursing staff as necessary for providing quality healthcare, despite the nurses having several difficulties to plan, adapt and justify the quantitative needs of human resources⁽⁹⁾, the importance of the professors in charge of the Management course and identifying the variable(s) that intervene in this process.

Still, the professors will have to reflect on the political dimension of the management process in this course, in order to provide the student with instruments for critical-reflexive actions in real professional situations. Relating the management theories with the nurses' working process. The nurses' activity within a given context means that the student has to comprehend the political ideological and economic determinations of the organization and society, as well as the public healthcare and educational policies.

The management dimension of the nursing work occurs in healthcare institutions within a society, subject to social forces, which in turn are the reflex of the working relations that exist within the productive process. Therefore, it is subject to the stimuli and limits determined by said forces, requiring the nurse to be technically and politically competent to coordinate the Nursing activities, both in individual and collective healthcare.

As such, we can infer that the management activities performed by the nurse are not due only to personal choice, but to a social determination. Management competence is a modern requirement that demands innovation in administration, as well as institutional results, and, in addition, is also a historical requirement of the profession⁽¹⁰⁾.

The relevance of the occupation of the managerial spaces as one of the professional activities of the nurse is highly important in the development of social skills and critical action as means to overcome the technicism and the conception of healthcare management as a dysfunction of the healthcare process. It should also be noted that, for the future intervention of the undergraduate students on society, as future nurses, the role of the university is to provide them with the instruments that they need to perceive reality and the working process in healthcare practice as something that could be transformed⁽⁷⁾.

FINAL CONSIDERATIONS

The analysis of the results of the respondents' answers regarding their perception of the level of competence achieved in the course shows that the most of the group achieved the full level of competence.

Considering that the students are potentially prepared to work in the nursing management process is important, since the nursing staff, and especially the nurse, is responsible for leading the nursing team, managing physical, material, human and information resources to providing nursing care and actions related directly with the client. These professionals are required to be competent, i.e., to know what they do, to be skilled to do it correctly and to have ethical-political attitudes to play their role in order to achieve the expected results. This requires an in-depth analysis of the academic education of the nurse, focusing on the profile of the professional, the job market and the social meaning of the work developed by this professional, so that this professional can perform according to what was planned and expected for them and by them.

In conclusion, with this study, and as nursing professors, it is indispensable to perform an in-depth reflection and self-assessment of the teachers regarding their educational practice, considering that the competence for the nursing management process implies in educating students that are capable of changing, facing uncertainties, asking questions, questioning what is already known, develop creativity and reflection and being able to promote, invent or reinvent the culture of a world that is constantly changing⁽¹¹⁾.

REFERENCES

• 1. Brasil. Ministério da Educação. Diretrizes curriculares para os cursos de graduação superior. [texto na Internet]. Brasília; 1999. [citado 2009 maio 17]. Disponível em: http://www.mec.gov.br/sesu/diretriz/diretriz
• 2. Perrenoud F. Dez novas competências para ensinar. Trad. de Patrícia Chitoni Ramos. Porto Alegre: Artes Médicas; 2000.
• 3. Resende E. O livro das competências: desenvolvimento das competências: a melhor auto ajuda para pessoas, organizações e sociedade. Rio de Janeiro: Qualitymark; 2000.
• 4. Felli VEA, Peduzzi M. O trabalho gerencial em enfermagem. In: Kurcgant P, coordenadora. Gerenciamento em enfermagem. Rio de Janeiro: Guanabara Koogan; 2005. p.1-13.
• 5. Mishima, SM. Constituição do gerenciamento local na rede básica de saúde em Ribeirão Preto [tese]. Ribeirão Preto: Escola de Enfermagem de Ribeirão Preto, Universidade de São Paulo; 1995.
• 6. Mishima SM, Villa TCS, Silva EM, Ribas-Gomes EL, Anselmi ML, Pinto MC, et al. Organização do processo gerencial no trabalho em saúde pública. In: Almeida, MCP; Rocha SMM, organizadores. O trabalho de enfermagem. São Paulo: Cortez; 1997. p. 251-96.
• 7. Munné F. Las teorías de la complexidad y sus implicaciones en las ciencias del comportamiento. Rev Interam Psicol. 1995;29(1):1-12.
• 8. Ciampone MHT, Melleiro MM. O planejamento e o processo decisório como instrumentos do processo de trabalho gerencial. In: Kurcgant P, coordenadora. Gerenciamento em enfermagem. Rio de Janeiro: Guanabara Koogan; 2005. p. 165-71.
• 9. Gaidzinski RR, Fugulin FMT, Castilho V. Dimensionamento de pessoal de enfermagem em instituições de saúde. In: Kurcgant P, coordenadora. Gerenciamento em enfermagem. Rio de Janeiro: Guanabara Koogan; 2005. p. 125-37.
• 10. Azevedo SC. Processo de gerenciamento e a gestão no trabalho do enfermeiro [dissertação]. Natal: Universidade Federal do Rio Grande do Norte; 2007.
• 11. Japiassu H. Um desafio àeducação: repensar a pedagogia científica. São Paulo: Letras & Letras; 1998.

Correspondência:

José Carlos de Oliveira

Av. Dr. Enéas de Carvalho Aguiar, 419 - Cerqueira César

CEP 05403-000 - São Paulo, SP, Brasil

*

Extraído da tese "Competência gerencial em enfermagem: identificação do grau de competência desenvolvido por graduandos em uma universidade privada", Escola de Enfermagem da Universidade de São Paulo, 2009.

Publication Dates

• Publication in this collection
  07 Apr 2010
• Date of issue
  Dec 2009

History

• Accepted
  16 Dec 2009
• Received
  15 Sept 2009