Genograma e ecomapa como estratégias lúdicas de ensino de enfermagem na Atenção Primária à Saúde

Genograma y ecomapa como estrategias lúdicas de enseñanza de enfermería en la Atención Primaria de Salud

ABSTRACT

Objectives:

to report the experience using ludic strategies for the teaching-learning in the elaboration of the genogram and ecomap; and the use of these instruments by Nursing students in the Primary Health Care services.

Methods:

an experience report of the discipline Integrity of Care I (Integralidade do Cuidado I), of the Nursing School of Ribeirao Preto. Problems scenarios were created to approach the genogram and ecomap, comprising different family arrangements, represented by pedagogic puppets.

Results:

students actively participated, held collective discussions, elaborated genogram, and ecomap, identified the type of family, and the stages of the vital cycle, providing increased dynamics and interactivity. Subsequently, in supervised activities in Primary Health Care services, students elaborated the genogram and ecomap to monitor a family.

Final Considerations:

the use of ludic strategies propitiates the teamwork, active interaction of the group, and the creativity. The articulation between theory and practice resulted in a significant learning.

Descriptors:
Nursing; Teaching; Family Relations; Holistic Health; Primary Health Care

RESUMEN

Objetivos:

relatar la experiencia del uso de estrategias lúdicas de enseñanza-aprendizaje en la elaboración del genograma y ecomapa; y de la utilización de eses instrumentos por estudiantes de Enfermería en los servicios de Atención Primaria de Salud.

Métodos:

relato de experiencia de la disciplina Integralidad del Cuidado I, de la Escuela de Enfermería de Ribeirão Preto. Para el abordaje del genograma y ecomapa, se elaboraron situaciones-problema, comprendiendo diferentes arreglos familiares, representados por muñecos pedagógicos.

Resultados:

los estudiantes participaron activamente, realizaron discusiones colectivas, elaboraron el genograma y ecomapa, identificaron el tipo de familia y las etapas del ciclo vital, propiciando mayor dinámica y interactividad. Posteriormente, en las actividades supervisadas en los servicios de Atención Primaria de Salud, los estudiantes elaboraron el genograma y ecomapa en el acompañamiento de una familia.

Consideraciones Finales:

la utilización de estrategias lúdicas propicia el trabajo en equipe, la interacción activa del grupo y la creatividad. La articulación entre la teoría y práctica resultó en el aprendizaje significativo.

Descriptores:
Enfermería; Enseñanza; Relaciones Familiares; Integralidad en Salud; Atención Primaria de Salud

RESUMO

Objetivos:

relatar a experiência do uso de estratégias lúdicas de ensino-aprendizagem na elaboração do genograma e ecomapa; e da utilização desses instrumentos por estudantes de Enfermagem nos serviços de Atenção Primária à Saúde.

Métodos:

relato de experiência da disciplina Integralidade do Cuidado I, da Escola de Enfermagem de Ribeirão Preto. Para a abordagem do genograma e ecomapa, elaboraram-se situações-problema, compreendendo diferentes arranjos familiares, representados por bonecos pedagógicos.

Resultados:

os estudantes participaram ativamente, realizaram discussões coletivas, elaboraram o genograma e ecomapa, identificaram o tipo de família e as etapas do ciclo vital, propiciando maior dinâmica e interatividade. Posteriormente, nas atividades supervisionadas nos serviços de Atenção Primária à Saúde, os estudantes elaboraram o genograma e ecomapa no acompanhamento de uma família.

Considerações Finais:

a utilização de estratégias lúdicas propicia o trabalho em equipe, a interação ativa do grupo e a criatividade. A articulação entre a teoria e prática resultou na aprendizagem significativa.

Descritores:
Enfermagem; Ensino; Relações Familiares; Integralidade em Saúde; Atenção Primária à Saúde

INTRODUCTION

Due to the practitioners’ innovative, creative, and versatile potential, nursing is admittedly one of the professions with the central role focused on the consolidation of the actions, and the health system on strengthening Primary Health Care (PHC)⁽¹⁾. In this sense, it is necessary to reflect on the education of nurses, historically based on the teaching content from a methodological perspective apart from the social scenario. The overload may affect the students and disfigures their creative and problem-solving skills⁽²⁾.

Changes in the National Curricular Guidelines (NCG) of 2018⁽³⁾ in the Nursing courses seek the education of practitioners to contribute to the effectiveness of the principles and guidelines of the Single Health System (SUS). For the effectuation of the NCGs, a paradigm change in teaching is necessary, based on the significant teaching-learning process, intending an awakening the creative potential, autonomy, and self-management of learning⁽⁴⁾.

In this perspective, it is recommended to embrace sensitive and innovative approaches that can provide the necessary abilities to the student for the effective insertion in the reality of the world of the health work. That is, it is about enabling strategies for significant learning and the use of diversified technologies that encourage student participation in the process of building knowledge⁽³⁾.

Ludic education is characterized as a pedagogical philosophy, a different way of conceiving the teaching-learning using the insertion of a ludic culture that favors the pleasure of learning. The term ludic is originated from the Latin word ludus that means “game.” Ludic activities are a synonym of game and play, a practical-didactic resource to facilitate the process, providing greater satisfaction. Ludic, as an epistemic option, refers to a learning path in which men build their horizon, emphasizing that the contentment provided leads to multiple learnings and allows contact with sensitivity and creativity⁽⁵⁾.

The insertion of ludic activities in the teaching-learning scenario is not new, mainly in children’s education, as expressed in the Piagetian and Vygotskyan theories approaches, however, this strategy may be used for adult education as well⁽⁵⁾. The ludic resource allows the teacher and the student to work, practice, and reflect on the nature of the human being and his incompleteness. Thus, it implies dialog actions, which open space to the new and to the creative reflection, which provides opportunities for the formation of critical awareness and broadens the vision through reflection and commitment to the real. Therefore, the individual becomes an active, transforming agent, who question the social structures of the environment he lives, and provokes change actions; it implies the creative intellectual practice⁽⁴⁾.

From the perspective of articulating the ludic with the nursing education, the use of puppets for the creation of various family arrangements was chosen, when teaching about the elaboration of the genogram and ecomap for the care of families in Primary Health Care (PHC). Genogram and ecomap are valued instruments used for the representation of the family structure and dynamic.

Genogram refers to a graphic representation, elaborated through symbols, which presents a family arrangement in at least three generations, and the basic relationships established in the family nucleus. The instrument allows a clear and objective view of the members that constitute the family, and information such as age, occupation, profession, education, in addition to representing the place held by each member in the family structure⁽⁶⁾.

Ecomap is a diagram of the family and community relationships and dynamics. It contributes to an evaluation of the available supports and their use by the family. It may represent the presence or the absence of social, cultural, and economic resources, being the representation of a certain moment in the life of family members⁽⁶⁾.

Thus, the use of the genogram and ecomap as strategies of the ludic teaching in the teaching-learning process may provide important subsidies to help the students to understand health issues, intergenerational relationships, important events in the family, and the constitution of a social support network to assist in the planning of integral assistance to individuals⁽⁶⁾.

OBJECTIVES

To experience report using ludic teaching-learning strategies with puppets in the elaboration of the genogram and ecomap and using these instruments by nursing students in the Primary Health Care System (PHC) services.

METHODS

Experience report of a teaching laboratory included in the discipline Integrality of the Health Care (Integralidade do Cuidado em Saúde I), held in 2019. The discipline is annually offered in the first semester of the Bachelor of Nursing course of the Nursing School of Ribeirao Preto - University of Sao Paulo (EERP-USP). This discipline aims to provide the theory-practice dialogue with the PHC services, focusing on a more comprehensive practice, contextualized regarding the different aspects of the territory and daily life of the users and families. In this discipline, it is used teaching strategies that stimulate clinical-social reasoning and the consideration of people’s subjectivities contributing to a practice consolidation of the integrality of care concept. In this sense, the Professional Practice Laboratories (PPL) are part of the practical activities, aimed at training students’ skills for later action in the health services that constitute the fields of internship of the discipline.

In such discipline, the family concept is widely approached, considering the social determination of the health-disease process and the various family arrangements of today. As a theoretical reference, family nursing is employed following the theses of the authors Wright and Leahey (2002)⁽⁷⁾ and Bomar (2004)⁽⁸⁾.

This theory emphasizes the power of the genogram and ecomap as essential instruments related to the evaluation and intervention with the families, considering that they allow encompassing the complexity and dynamics of the structure, function, and family relationships, helping the nurse to prepare a family diagnosis and provide and organize data to be better systematized and operationalized^(6-8).

The present experience report was developed in two moments and different scenarios: in the first moment, a training was applied to the students in PPL; and in the second, the implementation of the strategy in the real scenario of Primary Care.

In the referred PPL, for the genogram and ecomap approach, four problem scenarios were created, including different family arrangements that are presented in the contemporary society (extended, single-parent, reconstituted families), in the perspective of ensuring active acceptance of social, human, gender, race/color, ethnicity, social class, generation, disabilities and sexual orientation ⁽⁴⁾. The proposed objective, based on the evaluation of chaos, was to identify the family arrangement, the stages of the vital cycle, create the genogram and ecogram, and the family’s potential.

The activity was held in one of the laboratories of the Nursing Practice Simulation Center. This Center has a complex of simulation laboratories intended for curricular and extracurricular activities for graduation, undergraduate students, permanent education activities, and also to health research.

The problem situations were presented in different stations, describing the family and representing the family members by fabric puppets. Students were divided into small groups and passed by all teaching stations. The groups received guidelines and support from the participating teachers and nurses.

Having this information, the students created the ecomap and genogram of each case, identified the type of family, and the stages of the vital cycle, considering the theoretical knowledge previously acquired. The resources used for the creation of the genogram and ecomap were paper, pen, rule, colored bookmarkers, and colored pens, while other students opted for the construction of the genogram and ecogram on the computer.

At the end of the activity, each group had a moment for the evaluation of the process, and clarification of possible doubts.

The articulation of theoretical and practical knowledge with a view to the practical consolidation of the concept of Integrality is carried out in a second moment, through supervised immersions in the internship fields correspondent to the Primary Care of the municipality, ensuring the diversification of learning scenarios in real environments⁽⁴⁾ - and one of the main activities is the home visit (HV) to families registered in the units.

Thus, in the context of the territory of such services, the collection of data is operationalized by the students with the participation of family members aiming the creation of the genogram and ecomap. This process is carried out through about 6 meetings, with the same family and students peers, provided by the HV. The family presentation in the first HV is conducted by the Community health workers (CHW); the planning and follow-up of visits takes place under the supervision of the discipline’s teachers.

At the end of the course, the students presented the genogram and the ecomap of the families monitored to the CHWs and the multi-professional team, when they discussed the cases, emphasizing the health family needs, and the care plan elaborated by the students and the interventions and guidelines carried out by the peers and teachers during immersions. During practical activities, students were evaluated by the teachers through formative methods and, at the end of the course, a conversation was held with the students and they could express their feelings and experiences acquired throughout the course. It is worth mentioning that the screen activity was positively evaluated by the students.

RESULTS

The students actively participated in the activity, created the genogram and ecomap, and held a discussion in small groups. We identified that the use of puppets opened space for their imagination and creativity during the discussion of cases and was significant to provide the interaction between the affective dimension and learning. The students had positive reactions when handling the puppets, which facilitated the understanding of family arrangements, the way individuals relate to each other and the environment, and elaborate hypotheses. The activity interactively enabled the creation of the genogram and ecomap, allowing a greater dynamic and proactivity of the students.

Thus, the results confirm the authors that emphasize the ludic use in the adults teaching-learning scenario as a provider of active participation in school activities, becoming more attractive and casual. Also, the ludic activities contribute to a better action of the teacher, making him move away from the routine of traditional classes and search for ways to introduce playfulness into pedagogical praxis⁽⁵⁾.

Furthermore, permeating the stations by groups of students shows that teamwork allows the interaction and cooperation between peers, experiences, and information exchanges, facilitates problem-solving, and enhances positive thinking. Such actions are present in ludic tasks, which require a partner, a company, and not loneliness⁽⁴⁾.

In the next stage, undergraduate students go under supervised immersions in the Primary Health services of the municipality, and one of the main activities is the HV to users of the PHC services. In those moments, students have the opportunity to understand family relationships and bonds, and also the internal and external structure of the families and their members. At the end of each HV, students discuss the cases with teachers, nurses, and other colleagues, and clear doubts related to the complexities identified in the family scenario, and the structure of the instruments in question.

The immersion in Primary Health services, emphasizing the family care, allows the understanding of social production of determinants and conditions of the health-disease process, the creation of the genogram and ecomap, and the development of an introductory care plan based on psychosocial and health needs identified. Thus, subsidies are provided for the knowledge application in the professional practice scenario and for carrying out actions aimed at comprehensive care for individual and collective needs.

The results of such a teaching process have emphasized the genogram as a true facilitator instrument to approach the families and effective in their evaluation, in the view of its clarity in structuring the family composition and visualizing the relationships between its members⁽⁶⁾. Also, we denote the use of the genogram and ecomap as resources that have a certain therapeutic nature, because they allow the identification of vulnerable points, risk factors, and also a support network in the territory and Community, widening the perspectives about the life scenario of those families⁽⁶⁾.

At the end of the course, the genogram and ecomap are presented and discussed with the team of the unit, especially to community health workers and nurses, highlighting the perceptions about the family arrangements, health needs, and vulnerabilities, social support network, and the elaboration of an individualized health care plan for each family, developed by the students during the immersions. The material produced is attached to the family record and promotes the continuity of care with the health team and future students, interns, or resident physicians who will provide care for the family.

Some students also presented the produced material to the families, who felt valuable and, eventually, moved when saw their loved ones represented in the genogram, when they see part of their story and biography told through the instrument. It brings students closer to their families, shows communication, bonding, and the involvement of all family members in the development of the activity in the discipline, generating satisfaction and motivation in students.

CONCLUSIONS

Genogram and ecomap, as ludic strategies in the teaching-learning process propitiate the teamwork, the active interaction of the group and the creativity, making the class more attractive. The immersion in Public Health Units as well as the use of the genogram and ecomap by the students allow the approach to families, provide significant learning, through the articulation between theory and practice, acquisition of concepts and skills, in the clinical and affective dimensions

• FUNDING
  Postgraduate Program in Psychiatric Nursing, College of Nursing at Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, Brazil; Coordination for the Improvement of Higher Education Personnel (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior).

REFERENCES

• ¹
  Thume E, Fehn AC, Acioli S, Fassa MEG. Formação e prática de enfermeiros para a Atenção Primária à Saúde: avanços, desafios e estratégias para fortalecimento do Sistema Único de Saúde. Saúde Debate. 2018;42(1):275-88. doi: https://doi.org/10.1590/0103-11042018s118
  » https://doi.org/10.1590/0103-11042018s118
• ²
  Andrade SM, Cordoni Jr L, Carvalho BG, Gonzáles AD, Silva AMR. Bases da saúde coletiva. Londrina: Eduel; 2. ed. 2017. 1144 p.
• ³
  Conselho Nacional de Saúde. Resolução CNS n. 573, de 31 de janeiro de 2018 [Internet]. [cited 2020 Apr 25]. Available from: https://conselho.saude.gov.br/resolucoes/2018/Reso573.pdf
  » https://conselho.saude.gov.br/resolucoes/2018/Reso573.pdf
• ⁴
  Silva LVS, Tanaka PSL, Pire MRGM. BANFISA e (IN)DICA-SUS na graduação em saúde: o lúdico e a construção de aprendizados. Rev Bras Enferm. 2015;68(1):124-30. doi: https://doi.org/10.1590/0034-7167.2015680117p
  » https://doi.org/10.1590/0034-7167.2015680117p
• ⁵
  Santo EE. Educação lúdica da Paideia à contemporaneidade: elementos para uma práxis educativa no ensino de jovens e adultos. Rev Intersaberes. 2012 [cited 2020 Apr 25]; 7(13):159-77. Available from: https://uninter.com/intersaberes/index.php/revista/article/view/253/162
  » https://uninter.com/intersaberes/index.php/revista/article/view/253/162
• ⁶
  Nascimento LC, Dantas IRO, Andrade RD, Mello DF. Genograma e ecomapa: contribuições da enfermagem brasileira. Texto Contexto Enferm. 2014;23(1):211-20. doi: https://doi.org/10.1590/S0104-07072014000100025
  » https://doi.org/10.1590/S0104-07072014000100025
• ⁷
  Wright LM, Leahey M. Enfermeiras e Famílias: um guia para avaliação e intervenção na família. São Paulo: Roca, 2002.
• ⁸
  Bomar PJ. Promoting health in families: applying family research and theory to nursing practice. Philadelphia: Sauders; 2004.

Edited by

EDITOR IN CHIEF: Antonio José de Almeida Filho

ASSOCIATE EDITOR: Priscilla Valladares Broca

Publication Dates

• Publication in this collection
  09 June 2021
• Date of issue
  2021

History

• Received
  11 Nov 2020
• Accepted
  06 Jan 2021