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Revista Brasileira de Enfermagem

versión impresa ISSN 0034-7167versión On-line ISSN 1984-0446

Rev. Bras. Enferm. vol.71  supl.4 Brasília  2018

http://dx.doi.org/10.1590/0034-7167-2017-0340 

REVIEW

Supervised internship in undergraduate education in nursing: integrative review

La etapa curricular supervisada en la graduación en enfermería: revisión integrativa

Larissa Sapucaia Ferreira EstevesI 

Isabel Cristina Kowal Own CunhaI 

Elena BohomolI 

Elaine Cristina NegriII 

IUniversidade Federal de São Paulo, São Paulo School of Nursing. São Paulo, Brazil.

IIUniversidade de São Paulo, School of Nursing of Ribeirão Preto. Ribeirão Preto, São Paulo, Brazil.

ABSTRACT

Objective:

to analyze the evidence available in the literature on the contributions of the Supervised Internship in nursing training in Brazil and the teaching-learning methods employed.

Method:

integrative review of the literature, with search of articles published between 2002 and 2016, in PubMed, LILACS, SciELO and Eric databases.

Results:

Of the 4,699 articles consulted, 14 met the inclusion criteria. The analysis of these studies revealed three thematic categories: the understanding about the role of Supervised Internship; the teaching-learning processes employed; and their contributions to the training of nurses.

Final considerations:

this is a fundamental element in the academic training, since, depending on the didactic-pedagogical organization, it makes possible the (re) signification of the acquired knowledge throughout the course and realizes the professional competences. The teaching-learning methods are structured by the critical pedagogy, being the active methodologies the main choices of the authors.

Descriptors: Teaching; Learning; Nursing Education; Internships; Higher Education

RESUMEN

Objetivo:

analizar las evidencias disponibles en la literatura sobre las contribuciones de la Etapa Curricular Supervisionado en la formación en Enfermería en Brasil, y los métodos de enseñanza-aprendizaje empleados.

Método:

la revisión integrativa de la literatura, con búsqueda de artículos publicados entre los años 2002 a 2016, en las bases de datos PubMed, LILACS, SciELO y Eric.

Resultados:

De los 4.699 artículos consultados, 14 atendieron a los criterios de inclusión. El análisis de estos estudios reveló tres categorías temáticas: la comprensión acerca del papel de la Etapa Curricular Supervisada; los procesos de enseñanza-aprendizaje empleados; y sus contribuciones a la formación del enfermero.

Consideraciones finales:

es un elemento fundamental en la formación académica, pues, dependiendo de la organización didáctica pedagógica, posibilita la resignificación de los conocimientos adquiridos a lo largo del curso y concreta las competencias profesionales. Los métodos de enseñanza-aprendizaje están estructurados por la pedagogía crítica, siendo las metodologías activas las principales opciones de los autores.

Descriptores: La Educación; El Aprendizaje; Educación en Enfermería; Etapas; Enseñanza Superior

INTRODUCTION

Nursing education has been the focus of many studies and debates, mainly after the establishment of the National Curriculum Guidelines (DCN- Diretrizes Curriculares Nacionais) in 2001(1), generating a series of restructurings in professional training, such as not reducing the professional training of nurses development of technical and instrumental skills, incorporation of active learning methodologies, promotion of professional edification guided by the principles of integral care, considering the Brazilian Unified Health System (SUS) as the structuring axis of the training process(2), in addition to the incorporation of Supervised Internship (SI). All the restructuring proposed since 1996, the year of the promulgation of the Law of Directives and Bases of National Education (Lei de Diretrizes e Bases para a Educação Nacional- LDB) has contributed to the teaching of nursing to move towards the development of complex thinking, aiming to train more critical and reflexive professionals capable of acting in the different situations, proposing solutions to the problems encountered(3).

The Brazilian Nursing Association (ABEn- Associação Brasileira de Enfermagem) has been a protagonist about the technical, scientific, ethical and political development of the profession and, in 1994, through the 1st National Seminar on Guidelines for Nursing Education (SENADEn- Seminário Nacional de Diretrizes para Educação em Enfermagem), inaugurates one of the main structuring spaces in relation to nursing education in Brazil(4). The debates that took place in the 13th SENADEn, was held in the capital of Pará State in 2012, succeeded the Carta de Belém para a Educação em Enfermagem (Charter of Belém for Nursing Education). This paper presents a series of propositions regarding the processes of training of nurses in the country. Among them, it is necessary to rethink the practice of SI and the challenges encountered in the implementation of this teaching-learning method in vocational training(5).

The IS presents itself as a tool to approach the academy and services, since it can enable the use of knowledge, skills and professional attitudes seized by the student, who at the moment of the training strengthens their competences inserted in the work processes of health institutions. The objective is to lead the student to articulate theory and practice in a process of participatory training, permeated by the interlocution between teaching and learning in outdoor environments, with the active participation of professionals from the field of training, university and community(3).

The SI subsidizes the construction of a critical, curious and knowledge-building subject. Its methodology must collaborate to sharpen the faculties of observation of the future professional, besides developing the need to seek new knowledge of communication, flexibility and decision-making. Thus, the SI is immersed in the field of complexity of the training process, because it is through it that the student has the possibility of becoming an individual that boosts changes, once it is led to reflect on the reality of work processes and propose solutions to real problems experienced(4).

Thus, the future professional must have a differentiated vision of the field of work, being able to develop activities inherent to the exercise of Nursing. The context of the work encourages the professional to develop autonomy, responsibility, freedom, creativity, commitment, mastery of practice and social role, deepening knowledge and encouraging the professional to take on a transforming praxis(6).

Among the difficulties and challenges faced by undergraduate courses, the Belém Charter emphasizes the lack of clear conceptualization between practical activity, laboratory activity, theoretical-practical activity, clinical practice and SI; lack of clarity regarding the role of the field of nurses in SI activities; and the difficulties in broadening and regulating the offer of clinical practice fields and SI, among which the charter cites improving the conditions to accommodate students, tutors and professors for the development of clinical practices(5).

In response to the questions raised in that SENADEn(5), the Federal Nursing Council (COFEn- Conselho Federal de Enfermagem) published Ordinance 441/2013, positioning itself on the participation of the nurse in the supervision of the practical activity and the supervised internship of nursing students in the different levels of professional training, besides clarifying the concepts among the different activities(7). However, there are no reviews in the national literature that could help the discussion about the means, methods of teaching in SI, their results and their importance for the professional training of nurses, thus triggering the need for an integrative literature review.

OBJECTIVE

To search and analyze the evidence available in the literature on the contributions of Supervised Internship in nursing training in Brazil, in addition to the teaching-learning methods employed.

METHOD

This is an integrative review, which includes theoretical and empirical literature, as well as studies with different methodological designs (qualitative and quantitative). Its conclusion is the construction of a conclusion based on the synthesis of the main findings, making possible the analysis of preexisting knowledge about the subject investigated(8).

For its accomplishment, six stages were covered: identification of the theme and selection of the research question; establishment of inclusion/exclusion criteria (sample selection); definition of pre-selected and selected studies; categorization of studies; analysis and interpretation of results; and presentation of knowledge review/synthesis(8-10).

The Patient/population strategy, Intervention or issue of interest, Comparison intervention or issue of interest, Outcomes and Time (PICOT) strategy(11-12) was used to construct the guiding question. Component C was not used as it is not intended to make comparisons with other teaching methods.

Therefore, the following guiding question was defined: What is the scientific production that presents the contributions of Supervised Internship to the process of training nurses, their means and methods of teaching in Brazil, from 2002?

Chart 1 presents the elements used to construct the research question, and the descriptors and keywords from the PICOT strategy (11-12).

Chart 1 Description of the strategy Patient/population, Intervention or issue of interest, Comparison intervention or issue of interest, Outcomes and Time (PICOT)(11-12) 

Acronim/
Definition
Study proposal DeCS/MeSH Descriptors Keywords
P: Patient/
population
Undergraduate students in nursing. Nursing Students.
I: Intervention/
issue of interest
Teaching through Supervised Internship in primary health and hospital care. Means and methods for nursing training. Education; Learning; Education, Nursing; Education, Nursing, Baccalaureate; Nursing Education Research; Internship, Nonmedical; Models, Educational. Research in nursing education; curriculum internship; Supervised Internship; teaching-learning process.
O: outcomes
Expected Results
Contribution of the Supervised Internship to the training of nurses.
T: time
Intervention time period
After the institution of DCN for the Undergraduate Education in Nursing - 2002 to 2016.

For the selection of articles, the following databases were used: Latin American and Caribbean Literature in Health Sciences (LILACS), Scientific Electronic Library Online (SciELO), US National Library of Medicine/National Institutes of Health (PubMed/MEDLINE) and Education Resources Information Center (ERIC) between June and July 2016. EndNote® software was used to manage references and to import articles from databases by organizing articles into groups called “selected for reading in full” and “deleted after reading title and abstract”.

The combination of descriptors and keywords was carried out using the Boolean operators AND (restrictive combination) and OR (additive combination), and the descriptors/keywords of the same acronym of the PICOT strategy(11-12) were used. OR, and for the combination of different acronyms, the AND(11-12).

The inclusion criteria were: original studies (quantitative, qualitative, quanti-qualitative, experience reports and case studies) available in full; published in Portuguese, English or Spanish, that portrayed the practice of SI at the national level, published in national and international journals and that were within the time frame from 2002 to 2016, considering that the publication of the DCN occurred in November 2001.

The exclusion criteria were: surveys that dealt with internships in the high school of nursing and/or undergraduate nursing courses; to investigate the internships and/or practical classes in the field of specific subjects, for example, nursing administration subjects; who had used the SI moment to analyze the whole process of training and/or implementation of a new curriculum structure; that did not present the students’ perspective about SI, but only one of the actors involved with the process (tutor or professor).

In order to extract the data, a spreadsheet in the Microsoft Excel 2007® program was prepared from an instrument validated and authorized by the author(13), with the following items: main author, country, language, year of publication and type of scientific journal; institution of the study (university, hospital, research center, single or multi-center institution); (clarity, type of study, location, characteristics of the subjects, method of data collection and analysis and methodological rigor - level of evidence(14)); results (SI concept, means and methods for its performance), conclusions or final considerations and implications for practice(15).

After the bibliometric analysis(16), the findings were analyzed, which were grouped by similarity and organized into thematic categories, resulting in the presentation of the knowledge review/synthesis(8).

RESULTS

The results were obtained after systematically covering all stages of the Integrative Review. The search strategy in the databases raised 4,699 articles, of which 40 were chosen to read the full text and 14 composed the work, as shown in the flowchart of Figure 1.

Figure 1 Flowchart of the methodological steps that made up the integrative review for the selection of articles 

It was verified that the 14 selected studies were published between the years 2006 and 2014, with 28.6% occurring in 2014. There was a fair distribution among the journals that published research on the subject, considering that the articles were disclosed by 11 different journals, one article was published in an international journal and all articles were available in Portuguese. Regarding the classification of publication vehicles, it is observed that 50% and 28.6% of the journals were classified with Qualis Capes(17) B1 and A2, respectively, which shows the interest of the journals by the theme.

We found 35 different descriptors, of which 27 were controlled and the most frequent were: Nursing (42.8%), nursing students and nursing education (both with 35.7%). No specific controlled descriptors were observed, with supervised internship classified as a keyword, which makes it difficult to retrieve the scientific material for two reasons: the descriptors used are broad and portray nursing teaching in general, and the journals have opted for the use of descriptors and not keywords, making it impossible for the SI to be declared as a descriptor.

Most articles selected (85.71%) were obtained through the LILACS VHL database and only two were captured from SciELO. The surveys mainly portrayed the experience of the Public Universities, two portrayed the teaching in Private Universities, and one came from the service. The authorship is distributed among master’s degree (64.28%) and PhD (35.71%). The level of evidence of the studies can be considered low, since of the 14 selected, 7.15% had Level of Evidence IV(14) and 92.85% were classified with Level of Evidence VI(14). The student’s experience in the SI was the main focus of the studies (50%), followed by the teaching strategies (28.57%) used. Chart 2 shows the data used for the bibliometric review(16) of the studies.

Chart 2 Bibliometric analysis of the studies, according to year of publication, journal titles/classification, country of origin/language, database and level of evidence 

Year Title/classification of jornals (Qualis Capes, 2015) Country of origin/language Database Design/
Level of Evidence(15)
Place of study/Titling of main author
2014(18) Revista de Enfermagem do Centro Oeste Mineiro - B3 Brazil/
Portugues
VHL LILACS Qualitative study of the type of experience report/
Level VI.
Universidade do Estado do Rio Grande do Norte/ Master's degree
2014(19) Revista Brasileira de Enfermagem - A2 Brazil/
Portugues
VHL LILACS Qualitative study of documentary analysis type/
Level VI.
Universidade Estadual de Campinas/ PhD
2014(20) Revista de Enfermagem da UERJ - B1 Brazil/
Portugues
VHL LILACS Qualitative study of the type of experience report/
Level VI.
Universidade Estadual de Londrina/ Master's degree
2014(21) ACTA Paulista de Enfermagem - A2 Brazil/
Portugues
SciELO Quasi-experimental quantitative study/
Level IV.
Universidade Brasília/PhD
2013(22) Revista da Rede de Enfermagem do Nordeste - B1 Brazil/
Portugues
VHL LILACS Qualitative study of the type of experience report/
Level VI.
Universidade do Noroeste do Paraná/Master's degree
2013(23) Revista da Escola de Enfermagem da USP - A2 Brazil/
Portugues
SciELO Qualitative study of the type of experience report/
Level VI.
Faculdade de Medicina de Marília/PhD
2012(24) Revista da Rede de Enfermagem do Nordeste - B1 Brazil/
Portugues
VHL LILACS Qualitative study of the type of experience report/
Level VI.
Universidade Severino Sombra/Master's degree
2011(25) Escola Anna Nery - B1 Brazil/
Portugues
VHL LILACS Qualitative study of the type of experience report/
Level VI.
Universidade Estadual do Vale do Aracajú/Master's degree
2011(26) Revista da Rede de Enfermagem do Nordeste - B1 Brazil/
Portugues
VHL LILACS Qualitative study of the type of experience report/
Level VI.
Secretaria Municipal de Saúde(Municipal Health Secretary) / Master's degree
2010(27) Revista de Salud Pública - B1 Colômbia/
Portugues
VHL LILACS Qualitative study of the type of experience report/
Level VI.
Universidade Federal de Goiás/Master's degree
2009(28) Revista Brasileira de Ciências da Saúde - B3 Brazil/
Portugues
VHL LILACS Qualitative study of the type of experience report/
Level VI.
Universidade Federal da Paraíba/PhD
2008(29) ACTA Paulista de Enfermagem - A2 Brazil/
Portugues
VHL LILACS Qualitative study of the type of experience report/Level VI. Universidade de São Paulo/PhD
2006(30) Revista Mineira de Enfermagem - B1 Brazil/
Portugues
VHL LILACS Qualitative study of the type of experience report/
Level VI.
Faculdade de Medicina de Marília/Master's degree
2006(31) Ciência, Cuidado e Saúde - B2 Brazil/Portugues VHL LILACS Qualitative study of the type of experience report/
Level VI.
Universidade Estadual de Maringá/Master's degree

The synthesis of knowledge was carried out through the following findings: objectives of the SI and/or concepts that the authors use teaching-learning methods employed during the SI and contributions to nursing education, considered as outcomes. The synthesis table is presented in Chart 3.

Chart 3 Distribution of selected studies, second title, objectives and/or concepts of Supervised Internship, means and methods of teaching learning and outcomes 

Title Concepts and objectives of SI Intervention/means and methods of teaching and learning Outcomes
Sharing knowledge through school health education: supervised internship interfaces in nursing(18). Intervention in the reality of the production of nursing services from the development of health education practices. The Theory of Practical Intervention of Collective Health Nursing (TIPESC) is the tool that nursing undergraduates apply to high school students, identifying the real needs of interventions and which are the most effective health education strategies. Nursing students experienced a new way of working on Health Education, looking for ways and settings of action capable of renewing the exercise of the educational process in health, aiming at overcoming punctual and linear practices of care.
Supervised Internship: analysis of student experience(19). Integrate individual and collective attention, theory and practice, teaching and service, to train professionals able to meet the health demands of the population, contributing actively to the construction of the SUS. Did not present Experience has contributed to building a link between theory and practice. The personal and professional growth mentioned by the students seems to have reflexes in the security with which they will leave the undergraduate course to act as professionals, minimizing the rupture of this change of roles.
Nursing internship: the meaning for the inmates of a public university(20). Nursing boarding provides a broad and concrete view of their profession, providing technical and scientific experiences, with the development of roles with responsibility, ethics, leadership, communication skills and decision-making. The questioning is the main teaching methodology. The student is encouraged to participate in educational activities involving the entire health team of the unit. On Fridays, theoretical meetings are held between interns and professors to discuss topics relevant to nursing management. Learning emphasizes the union of theory and practice and thereby forms critical and reflective professionals. Academics felt prepared to enter the job market and achieved the development of core competencies to act as nurses. Management issues were important for students to turn the practice into units and to become part of the team as care managers.
Nursing students' opinion about realistic simulation and curricular internship in a hospital setting(21). Did not presente The students remain during a period in the hospital environment where the internship activities are permeated by theoretical classes. The simulation is the teaching-learning strategy tested as a means of preparation and reflection of the students to enter the field of internship. Students recognize curricular simulation and internship as practices that, when combined, reinforce learning. On the contrary, it was verified that the IS, alone, exposes the student to the confrontation of insecurity and the lack of independence to act.
Care for pregnant women in Primary Care: report on activities in curricular internship(22). Development of critical awareness and technical competence for decision making, since professor supervision is periodic and there are weekly meetings between student and professor for discussions about internship. The activities are divided into moments: setting in the service, participation in the routines and procedures; survey of the main needs of the service; preparation of an action plan that could be jointly implemented (student/professor/health team); implementation of the Action Plan. The tool used is the Altadir Method of Popular Planning (MAPP) Method. The way of working together, between the health team and the student, in surveying the needs of the service and selecting a problem for the construction of the Action Plan, in addition to training the FHS team, provides the student with better professional training, improving his critical eye regarding the activities developed with the community, the promotion of health and the prevention of diseases.
Problemas éticos vivenciados no Supervised Internship em enfermagem de um currículo integrado(23). Practical teaching mode that facilitates the transition from the academic world to the world of work, being a privileged space of contact with the reality of services and work in health. Pedagogical Cycles: questioning of significant experiences for the student that starts from real situations of the world of work. Sharing experience, identifying knowledge gaps, formulating learning issues. Next, students reorganize the knowledge anchored in the scientific literature and share it. It provides opportunities for critical reflection on professional practice, services and the health system, allowing questioning if the legal and administrative norms respond ethically to the health problems of the population.
Supervised nursing internship in basic care: the dialogic planning as of the teaching-learning process(24). Transform teaching practices, allowing integration between professors and care professionals, envisioning a critical professional, able to understand reality and intervene in it, guided by SUS principles. The main teaching-learning methodology is questioning. The student realizes a collective teaching-service plan, participates in multidisciplinary actions, identifies the assistance needs of the Family Health Strategy (FHS) and integrates the discussions about the health needs of the users. It contributes to the teaching-service interaction, broadening the training experience. It is believed that it is necessary to break with conveniences and traditional practices. The constant improvement of professors and preceptors is required, as well as the study plans and the objectives of the activities, and it is up to the academy to use them.
Leadership learning: contributions from the boarding school in nursing to the student's training(25). Provide the integral experience in the field of health care and development of leadership skills. Did not present It has contributed decisively to leadership learning, considering that it makes possible the student's more prolonged contact with the health institution, professionals, patients and family members.
Family health strategy:
experience of nursing students in curricular internship(26).
Held during a semester, where the student is enrolled in an FHS, accompanied by a professor to put into practice the seized contents, seeking the development of technical, reflexive and scientific skills. Insertion of the student in the actions developed by nurses, participation and implementation of promotion and prevention programs of the Ministry of Health, nursing consultations, health education actions, home visits and health promotion actions in elementary schools. Practical learning, uniting the theory and adapting it to reality. It promoted the elucidation of the role of the nurse within the FHS in the search for effective care in collective health, in addition to the development of moral values and the emergence of a sense of co-responsibility in the search for an egalitarian health system.
Strategic planning of a family health unit - eastern region of Goiânia(27). Did not present anning, Situational Strategic Planning (PES) is used by academics in IS as a methodology for solving problems collectively and shared. It has fostered the integration of intercompany projects and the socialization of the problems experienced, developing a spirit of understanding, unity and motivation, being significant both for academics and professionals who understood that PES is fundamental for the development of health care and for the directing actions.
Service needs and requirements of academia: a possible articulation(28). Period destined to the training realized through the application of the theoretical-practical knowledge acquired throughout the course, providing experience in caring for the individual, family and community. Students apply administrative tools learned during training, especially the Normative Planning anchored in the problem solving needs of the services. It is up to the student to develop the capacity to seek the integration between theory and professional practice. The contents of the applied nursing disciplines in Nursing were used, although they were not immediately recognized by the trainees. There is a lack of guidance to the trainees regarding the existence of overcoming problems and administrative deficiencies of the services. Professors often do not have enough knowledge in the area of nursing administration.
Student assessment tool based on management competencies of nurses(29). Develop the nursing management work process based on acquired individual competencies; to exercise the role of manager of nursing in the management of services and to develop autonomy and security for insertion in the different multiprofessional groups. Case study, whose theme is selected from a problem situation detected in the field of practice. Proposes implements and evaluates the intervention. The performance evaluation is performed through a tool containing ten predictors, graduated from zero to ten. The student performs his/her self-evaluation and participates in the joint evaluation carried out by the professor and nurses of the unit, place of internship. The evaluation tool has been applied for three years and it is verified the need for greater time of use in the evaluation process. It can be inferred that the student evaluation has promoted the responsibility and the commitment of the student, seeking solutions to the problems of teaching and learning, being configured in a participatory process of action-reflection-action, aiming to transform the construction of knowledge.
The use of simplified strategic planning by nursing students: preparing future professionals(30). A teaching-learning strategy that allows students to live in the world of work, where the student applies the knowledge acquired in previous years, incorporates new knowledge and develops skills and attitudes expected for their professional training. Students are supervised daily by health care nurses; the professors hold weekly meetings and both evaluate the students about the acquisition of competence described by the discipline. The simplified PES leads the student and the team in collective reflection on reality, transforming the unwanted health situation. It is understood that the execution of health planning during undergraduate is an important teaching-learning strategy, considering the preparation of the student for professional life. Students experience the world of work and are actors in this real setting, which makes possible the reflexive process through action-reflection-action, and favors the transformation of health practices.
The use of the Altadir Method of Popular Planning in curricular internship activities(31). Did not present Active participation in the daily activities of the FHS, survey of problems and elaboration of an intervention plan that uses the MAPP as tool. MAPP is effective in teamwork to raise issues, identify its causes, descriptors and consequences, select fronts of attack and operationalize the demands of action.

Note: SI - Supervised Internship; PES - Planning, Situational Strategic Planning; MAPP - Altadir Method of Popular Planning; FHS- Family Health Strategy.

DISCUSSION

Once the findings were organized and analyzed, the data were discussed through three thematic categories that best describe the results found: the understanding about the role of SI; the teaching-learning processes employed in the development of SI; and the contributions of the SI to the training of nurses.

Understanding the role of Supervised Internship

The SI has a core role in the professional training of nurses because it is not restricted to the academy nor to the technical and mechanical development of the future professionals to perform work activities inherent to the profession. It enables the student to be inserted into the health system of the Brazilian Unified Health System, as it is presented, without manipulations or even adjustments for the realization of teaching-learning processes(18-20,23-25,28,30).

By inserting the student into the real world of work, tutored by the concrete figure of the nurse professional, mediated by the didactic-pedagogical organization of the professor, with the objective of making real interventions in the work processes, seeks to ensure that teaching- part of the training process. This will aid the process of building professionals capable of making praxis (theory-practice articulation) subsidize collective reflections, resulting in changes in real health situations(18-19,23-24,28).

Mentoring has been recognized in the international literature as a strategy to maximize the benefits of nursing education in terms of acquisition of knowledge and skills, safety and professional socialization. Professionals play a fundamental role in the socialization, teaching and evaluation of nursing students, helping them to integrate theory with practice(32).

This, therefore, is a complex moment in the process of professional training, since the student who enters the SI requires the knowledge, skills and attitudes to develop the professional competence that so longs for, that is, to develop the capacity to mobilize, consciously and systematized, their cognitive, psychomotor and attitudinal functions in health decision making, whether clinical or management(33).

For some schools, it is during the SI that the student will exercise the role of nursing care manager, fostering the development of management skills: leadership, decision making, teamwork, communication, among others(20,22,25,29,33). This perspective attributed to the SI comes from the historical construction of the professional nursing training process in Brazil, because in 1972, Opinion 163/72 and Ordinance 04/72, both of the Federal Council of Education (COFEN), introduced the term Supervised Internship and linked this format to the discipline of administration applied to Nursing, which should be done at the end of the undergraduate course(3,34).

The development of management skills introduced the concepts of innovation, flexibility, teamwork and decentralized decisions in the work processes of the professionals who are in front of teams, guaranteeing the most effective participation of all those involved in the administrative and operational processes of an institution. Considering the role that nurses play in health teams, the discussion on management competencies has gained prominence both in the scope of work and professional training. In this sense, considering that of the six competencies pointed out by the DCN(1) five are management and one is considered indirect purpose of the management work(33), it is justified the tendency of the SI to work with administrative tools and management competencies.

In order to carry out the IS, the student must be matured in his professional training process and be able to mobilize theoretical and practical knowledge acquired in the various disciplines that integrate the curriculum, in order to contribute to the development of his own professional qualification(19,28). Therefore, it is clear why DCN determines that 20% of the total course workload should be allocated to the SI, and this should be developed in the last year of the course. Throughout their training, the student should be tooled by theoretical disciplines, disciplines that contemplate teaching through controlled practices, enabling skills training, and disciplines that contain clinical practices capable of developing in the student the ability to make clinical decisions(1,3).

Definitely, the practical class is not characterized as SI; therefore, this class has the purpose of leading the student to perform the practical part of certain content already worked in the classroom through theoretical studies. It also happens in health institutions, however, the student is constantly accompanied by the professor, learning to perform, prioritized, technical procedures, also mobilizing prior knowledge and developing professional attitudes through the real cases contained in the theory(7). Not to value the SI as a pedagogical strategy can lead to gaps in the learning process, contributing to the devaluation of Higher Education, since it collaborates in an important way for the development of critical thinking and for the improvement of the quality in the training of professionals(3).

The teaching-learning processes employed in the development of the Supervised Internship

All the teaching-learning methods presented by the authors are based on a real situation experienced by the student, who, supported by the internship nurse and the professor, reflects, theorizes and proposes strategies that can transform the local health reality into a movement of action-reflection-action(18,22-24,27-28,30-31).

Methods that introduce the student to the world of work, such as the questioning through the Arch of Maguerez, lead him to reflect on this reality, subsidizing the re-signification of concepts and knowledge that have as theoretical reference the liberating education, also called critical pedagogy. This pedagogical perspective argues that the student will only be critical if he knows reality, understands it, understands it in order to reflect, and, from this reflection, appropriates a critical character about it(33,35-36).

The teaching-learning methodology that was most cited by the authors is the Problem-Solving Methodology(20,23-24), which aims to solve work problems, whether in education or in other sectors through the indispensable association between theory and practice. Such a method aims to bring students closer to the reality of the profession, allowing them to learn from it, obtaining elements to take something back to that reality, in the form of reflections or suggestions to answer or solve specific problems, or at least soften them(36).

Other strategies from the science of management, for example, Normative Planning, Situational Strategic Planning (PES), Simplified Strategic Planning and the Altadir Method of Popular Planning (MAPP) have also been cited as a means of delivering interventions in reality. Administrative tools start from the perception of a problem, in which the student must collect data, systematize them, analyze them, reflect on these data and propose interventions for the real problem experienced at work(18,22,24,27-31). The use of these tools in the teaching-learning process characterizes the use of active teaching methodologies.

Realistic simulation is also used as a way to guarantee the student greater security and autonomy for the activities that make up the SI(21). It is one of the active learning methods used in health education for the development of basic nursing skills. However, currently, the simulation has taken more contemporary approaches, offering opportunities to develop work experiences through complex clinics in safe learning environments. The American Association of Nursing Colleges recently released a report stating that there has been a large increase in the use of realistic high fidelity simulation in Higher Education in Nursing for the potential to develop clinical reasoning and decision making in a controlled and safe manner(37).

Active methodologies are in line with the need to review old traditional, content-oriented, professor-centered training processes(35) and advance to those that can develop complex thinking, decision-making, and differentiated skills, transposing personal characteristics that have simple and primary mental processes that are incapable of guaranteeing prominent positions in the competitive and fast labor market today(36).

Thus, in both situations, the student mediated by the teaching work will be using a process that is born of observation and reflection and culminates in the transforming action. This allows him to see that in order to change he has to develop the capacity to intervene in reality, a very complex task, but which guarantees him the development of new knowledge, skills and attitudes, making him subject to history and not mere object(35), coming to the meeting of the role of the SI in the professional training of nurses.

The contributions of Supervised Internship to the training of nurses

The SI is the moment in which the student is expected to be able to insert himself in the reality, experiencing the professional work of the nurse in its historical, political, social, cultural and financial context, guided by the teaching action and supervised directly by the nurse who actively collaborates with the process of professional development. In this way, the student is able to build knowledge, skills and values in articulation with the nursing and health team of the partner institution, fostering the construction of the professional identity of the future nurse(3).

All articles raised contain the contributions to the training and many of them because they are reports of experiences highlight the student’s vision of their experience in supervised internship.

The authors defend that the IS gives the student opportunities and action settings capable of building professional practice; to develop the transformative praxis fostering the safe and quality action; to consolidate occupational skills and safety for the realization of the professional role in the labor market; assists in the critical reflection on the professional practice and health institutions, developing moral values, ethics and respect, clarity in the understanding that it is necessary to break with traditionalistic nursing and teaching practices, besides fomenting the development of managerial competences. The evaluation processes that have been used strengthen the promotion of the student’s responsibility and commitment to their learning, preparing them for working life(18-31).

Regarding the pedagogical practices, they affirm that the activities simulated before the SI guarantee independence and autonomy during internship. Due to the active involvement of professors, field nurses and health services, the IS also makes it possible to strengthen teaching-service-community links(18-31).

These contributions, as a tool to break paradigms of attention and health training, become a reality if the student is inserted early in the health services. In these settings, the actors involved in the development of the SI are fundamental pieces for the construction of competences, considering that nurses professors are professors linked to higher education, or nurses who work in the fields of internship in health institutes are the bearers of the profession and have the task of ensuring that nursing students have the competence to act in the clinical-dynamic setting(38-39).

The teaching-service-community dialogue, one of the principles of IS, has the potential to contribute to the training of professionals anchored in the biopsychosocial vision of the user in the system, directing them to the analysis of the social determinants of health of the society itself and the demands for she generated(35,38).

In addition, health services are growing in complexity, which creates diverse learning opportunities. This implies that the nurse, professor or health care professional has the challenge of educating future professionals to obtain skills and knowledge critical to prioritizing, manipulating ambiguous situations and tolerating uncertainties that are part of the work processes(32). However, professors, students and nurses must be committed to reducing the existing dichotomy between theory and practice, during academic training and between discourse and concrete action observed in reality(39).

It is necessary to emphasize here the role of the nurse, who symbolizes the profession materialized for the student, in the effectiveness of educational practices in a real work setting. Nurses must carry out their services within the highest quality standards and the ethical principles of their profession, especially when it is believed that the responsibility of Health Care does not end with professional work, but with the resolution of the health problem, both individually and collectively(38).

Study limitations

There are no exact descriptors for the subject, which justifies the number of articles raised in the first stage of the selection, in which, after analysis, there were many denominations and understandings related to this moment of training. Due to the amplitude of the searches, we found research that dealt with the issue from the perspective of other actors involved with IS: the internship nurse and the professor. However, the scope of this study was to identify the contributions of SI in the perception of those who are the target of the formative process - the student.

Contributions to the sector of Nursing

The SI, although it has been described in the DCN since 2001, has been the subject of forums, debates and resolutions, since its realization in the Brazilian Nursing Schools is not yet agreed, nor is its existence in some curricula that practice it as practice at the end of undergraduate course, generating a gap in training. The many concepts of SI and the ways of doing it, in nursing undergraduate education in Brazil, reveal a gap in the training processes and also in education research, indicating the need to strengthen the debates on this subject.

FINAL CONSIDERATIONS

Evidence shows that Supervised Internship is one of the fundamental elements in the nursing education of nurses, since it allows the re-signification of the knowledge acquired during the course, fostering the development of the capacity to identify problems, to critically analyze the factors that make up the situation experienced and to propose solutions based on area references. Supervised Internship enables the development of critical thinking, communication skills, leadership and decision making in the real world of work. The means and methods of SI development are structured by critical pedagogy, with active methodologies being the main choices of the authors.

There is no research in the national literature that portrays the way in which Nursing Schools operate their Supervised Internships, which have been the hourly loads destined for this moment of training, what is the qualification of the teaching staff to act at that very complex moment, what contributions from the Supervised Internship to the professional practice in nursing or even if the Nursing Schools have performed SI, or only clinical practices at the end of the undergraduate course.

It is necessary to consider the necessity of the development of more robust researches from the methodological point of view. From the arsenal that composed this SI, a research was classified as Level of Evidence IV(14), quasi-experimental research. The others are evidence derived from a single descriptive study of unique experiences.

FUNDING

Coordination of Improvement of Higher Level Personnel - CAPES.

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Recibido: 16 de Mayo de 2017; Aprobado: 16 de Octubre de 2017

CORRESPONDING AUTHOR: Larissa Sapucaia Ferreira Esteves E-mail: larissasapucaiaesteves@gmail.com

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