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Social entrepreneurship in the professional training in Nursing

Emprendimiento social en la capacitación profesional de Enfermería

ABSTRACT

Objectives:

to assess the knowledge and practices that stimulate social entrepreneurship in the professional training of Nursing students.

Methods:

qualitative exploratory-descriptive study carried out with 44 Nursing students from a University in the South Region of Brazil. Data were collected between May and August 2021, through individual online interviews. The participants were students of nursing course in the 6th semester or above, who had previously participated in teaching, research, or university outreach activities on entrepreneurship.

Results:

the data was organized and analyzed according to the thematic analysis technique and resulted in three thematic categories: Meanings of social entrepreneurship, Factors that sparked social entrepreneurship, and Recognizing oneself as an entrepreneurial nurse.

Final Considerations:

the knowledge and practices that stimulate social entrepreneurship in the professional training of Nursing students are associated with teaching, research and university outreach activities that allow concrete experiences in the living and dynamic world of communities.

Descriptors:
Teacher Training; Occupational Health; Nursing; Education, Nursing; Nursing Education Research

RESUMEN

Objetivos:

conocer los saberes y las prácticas que estimulan el emprendimiento social en la capacitación profesional de los estudiantes de Enfermería.

Métodos:

es una investigación cualitativa de carácter exploratorio-descriptivo, realizada entre 44 estudiantes de Enfermería de una Universidad del Sur de Brasil. Los datos se recopilaron entre mayo y agosto de 2021, mediante entrevistas individuales en línea. Participaron del estudio estudiantes de enfermería del 6º semestre que habían asistido previamente a actividades empresariales de docencia, investigación o extensión universitaria.

Resultados:

los datos organizados y analizados con base en la técnica de análisis temático implicaron en tres categorías: Significados del emprendimiento social, Experiencias emprendedoras en la formación del enfermero y Reconocimiento del Enfermero emprendedor.

Consideraciones Finales:

los saberes y las prácticas que fomentan el emprendimiento social en la formación profesional de los estudiantes de Enfermería están relacionados con las actividades universitarias de enseñanza, investigación y extensión, que se hacen posibles a través de experiencias concretas en el mundo vivo y dinámico de las comunidades.

Descriptores:
Capacitación Profesional; Ocupaciones de Salud; Enfermería; Educación en Enfermería; Investigación en Educación de Enfermería

RESUMO

Objetivos:

conhecer saberes e práticas que estimulam o empreendedorismo social na formação profissional de estudantes de Enfermagem.

Métodos:

pesquisa qualitativa de caráter exploratório-descritivo, realizada com 44 estudantes de Enfermagem de uma Universidade do Sul do Brasil. Os dados foram coletados entre maio e agosto de 2021, por meio de entrevistas individuais na modalidade online. Participaram do estudo estudantes de Enfermagem a partir do 6º semestre e que previamente haviam participado de atividades empreendedoras de ensino, pesquisa ou extensão universitária.

Resultados:

os dados organizados e analisados com base na técnica de análise temática resultaram em três categorias temáticas: Significados de empreendedorismo social, Experiências empreendedoras na formação do enfermeiro e Reconhecendo-se Enfermeiro empreendedor.

Considerações Finais:

os saberes e práticas que estimulam o empreendedorismo social na formação profissional de estudantes de Enfermagem estão relacionados às atividades de ensino, pesquisa e extensão universitárias, possibilitadas pelas vivências concretas no mundo vivo e dinâmico em comunidades.

Descritores:
Formação Profissional; Ocupações em Saúde; Enfermagem; Educação em Enfermagem; Pesquisa em Educação de Enfermagem

INTRODUCTION

Social entrepreneurship has been gaining ground in different areas of knowledge. Characterized as a self-organizing process that promotes new attitudes, processes and services, social entrepreneurship enables the (re)construction of professional knowledge and practices and the improvement of the living conditions of individuals and communities(11 Lomba MLLF, Toson M, Weissheimer AS, Backes MTS, Büscher A, Backes DS. Social entrepreneurship: translation of knowledge and practices in Brazilian nursing students. Rev Enferm Ref. 2018;19(4):107-16. https://doi.org/10.12707/RIV18064
https://doi.org/10.12707/RIV18064...
).

In the last decade, the theme of social entrepreneurship has gained prominence in academic research in the field of Nursing, especially in the context of Graduate Studies(22 Backes DS, Toson MJ, Dal Ben LW, Erdmann AL. Contribuições de florence nightingale como empreendedora social: da enfermagem moderna à contemporânea. Rev Bras Enferm. 2020;73(Suppl 5):e20200064. https://doi.org/10.1590/0034-7167-2020-0064
https://doi.org/10.1590/0034-7167-2020-0...
). Social entrepreneurship in Nursing can be characterized by the attitude of promoting healthy living for individuals, families and communities, through interactive and associative processes, with a view to their emancipation, placing them as protagonists of their own stories(33 Backes DS, Zamberlan C. Colomé J. Souza MT, Marchiori MT, Erdmann AL, et al. Interatividade sistêmica entre os conceitos interdependentes de cuidado de enfermagem. Aquichan. 2016;16(1):24-31. https://doi.org/10.5294/AQUI.2016.16.1.4
https://doi.org/10.5294/AQUI.2016.16.1.4...
).

Several national and international scientific articles demonstrate the growing level of entrepreneurial engagement in Nursing, through the circulation of professional knowledge and practices that can affect people’s care and quality of life. International studies(44 Ubochia NE, Osuji JC, Ubochi VN, Ogbonnaya N P, Anarado A, Iheanacho PN. The drive process model of entrepreneurship: A grounded theory of nurses’ perception of entrepreneurship in nursing. Int J African Nurs Sci. 2021;15(100377):1-10. https://doi.org/10.1016/j.ijans.2021.100377
https://doi.org/10.1016/j.ijans.2021.100...
, 55 Jahani S, Abedi H, Khoshknab MF, Elahi N. The experience of Iranian entrepreneurial nurses on the identification of entrepreneurial opportunities: a qualitative study. J Fam Med Prim Care. 2018;7(1):230-6. https://doi.org/10.4103/jfmpc.jfmpc_233_17
https://doi.org/10.4103/jfmpc.jfmpc_233_...
) demonstrate that, despite their far-reaching presence at all levels of the health care system, nurses still do not sufficiently exploit the entrepreneurship opportunities available to them. In the same direction, national research reveals the efforts of Brazilian Nursing in the training of entrepreneurial professionals, with a view to promoting better health care practices(66 Richter SA, Santos E P, Kaiser DE, Capellari C, Ferreira GE. Entrepreneurial actions in nursing: challenges of nurses in a strategic leadership position. Acta Paul Enferm. 2019;32(1):46-52. https://doi.org/10.1590/1982-0194201900007
https://doi.org/10.1590/1982-01942019000...
, 77 Trotte LAC, Santos JLG, Sarat CFN, Mesquita MGR, Stipp MAC, Souza P, et al. Entrepreneurial tendency of Nursing students: a comparison between graduating beginners and undergraduate students. Rev Latino-Am Enfermagem. 2021;29:e3402. https://doi.org/10.1590/1518-8345.4397.3402
https://doi.org/10.1590/1518-8345.4397.3...
). Therefore, social entrepreneurship can help nurses gain new perspectives, so that they can envision new opportunities and entrepreneurial possibilities.

Even though it is not a simple and linear process, the practice of social entrepreneurship must be encouraged in the training of Nursing professionals. Future nurses must find an environment that stimulates and enhances initiatives, so that they can envision new opportunities and feel encouraged to explore entrepreneurial possibilities(77 Trotte LAC, Santos JLG, Sarat CFN, Mesquita MGR, Stipp MAC, Souza P, et al. Entrepreneurial tendency of Nursing students: a comparison between graduating beginners and undergraduate students. Rev Latino-Am Enfermagem. 2021;29:e3402. https://doi.org/10.1590/1518-8345.4397.3402
https://doi.org/10.1590/1518-8345.4397.3...
).

The new National Curriculum Guidelines for the area of Nursing has provided important advance. In these guidelines, social entrepreneurship appears as an overarching topic and as a trigger for new teaching and learning processes. With this approach, the Curriculum Guidelines seek to break with the social welfare culture and promote the students’ protagonism, aiming to achieve better and greater results in the Nursing profession(88 Vieira MA, Lima CA, Martins ACP, Domenico EBL. National curriculum guidelines for the nursing graduation course: implications and challenges. Rev Pesqui Cuid Fundam. 2020;12:1099-104. https://doi.org/0.9789/2175-5361.rpcfo.v12.8001
https://doi.org/0.9789/2175-5361.rpcfo.v...
).

Nurses must be able to fulfill their attributions and competences in a proactive and autonomous manner, in the different scenarios of practice. In addition to technical skills, these professionals must also have a critical-reflexive attitude and prospective leadership skills to innovate and identify the necessary transformations in the healthcare sector.

Nursing professionals have numerous reasons and opportunities to create their own enterprises, processes, or services, as this profession has an expanded understanding of the reality and needs of human beings in their different contexts. However, a social welfare culture prevails among Nursing professionals, and it needs to be transposed and overcome through methodologies that motivate future nurses and propose new ways of thinking and acting(22 Backes DS, Toson MJ, Dal Ben LW, Erdmann AL. Contribuições de florence nightingale como empreendedora social: da enfermagem moderna à contemporânea. Rev Bras Enferm. 2020;73(Suppl 5):e20200064. https://doi.org/10.1590/0034-7167-2020-0064
https://doi.org/10.1590/0034-7167-2020-0...
).

Based on the above, the following research question arose: What knowledge and practices stimulate social entrepreneurship in the professional training of Nursing students?

OBJECTIVES

To assess the knowledge and practices that stimulate social entrepreneurship in the professional training of Nursing students.

METHODS

Ethical aspects

The recommendations of Resolution nº. 466/2012 of the National Health Council were followed. The project was submitted and approved by the institutional Research Ethics Committee. To maintain the anonymity of the participants, the speeches were identified by the letter “P” (Participant), followed by an Arabic numeral that corresponds to the order of the speeches: P1, P2... P44.

Theoretical and methodological framework

The assumptions of social entrepreneurship were used as theoretical framework, and qualitative research as methodological framework. In the social entrepreneurship perspective, it is argued that the Nurse has a decisive and prospective role in the social and health context. It is also argued that the training process can promote teaching and learning processes that transcend one-dimensional knowledge and welfare practices.

Study type

This is a qualitative, exploratory-descriptive study. Its approach has meanings that allow expanding perceptions, perspectives and behaviors that cannot be reduced to linear variables. The present study was structured and conducted based on the Consolidated Criteria for Reporting Qualitative Studies (COREQ)(99 Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care. 2007;19(6):349-57. https://doi.org/10.1093/intqhc/mzm042
https://doi.org/10.1093/intqhc/mzm042...
).

Methodological procedure

Study setting

The study was carried out with 44 students from an Undergraduate Nursing Course in the South Region of Brazil. This course was created in the 1950s and has about five thousand alumni nurses spread across the different states of Brazil and other countries. The course is organized into ten academic semesters and has an annual enrollment of around 70 students.

The pedagogical proposal of the course is organized into compulsory subjects, elective interdisciplinary subjects, theoreticalpractical activities, and diversified complementary activities, in addition to curricular internships in different health services, starting in the 8th semester of the course. The course privileges a complex, systemic theoretical framework and active/meaningful teaching and learning methodologies, with the aim of promoting students’ autonomy and social protagonism(1010 Backes DS, Zamberlan C, Siqueira HCH, Backes MTS, Sousa FGM, Lomba MLLL. Educação de qualidade na enfermagem: fenômeno complexo e multidimensional. Texto Contexto Enferm. 2018;27(3):e4580016. https://doi.org/10.1590/0104-070720180004580016
https://doi.org/10.1590/0104-07072018000...
).

In order to train generalist nurses and proactive and entrepreneurial leaders that can face different healthcare demands, the course encourages students to insert themselves in different social realities, especially in areas of greater social vulnerability, since the first semester of the course. In the Scientific Methodology subject, students are encouraged to work in groups to find a research question, based on experiences with vulnerable social groups. In other subjects, focused on outreach projects, students are challenged to experience, in different settings, the stages of the Nursing Process: anamnesis, diagnosis, planning, implementation and evaluation of the Nursing system.

The focused Nursing course has a research group on Social Entrepreneurship in Nursing/Health and a subject called “Leadership and Entrepreneurship in Nursing”. This subject is based on theoretical and methodological approaches related to leadership and entrepreneurship, and the learning product is the “Project Entrepreneur Nurse”. Students are organized in small groups and stimulated and guided, from the conception to the development of an entrepreneurial idea, which is presented to a jury of experts on the institution’s Technology Show, which occurs annually in the entrepreneur’s month. Among the entrepreneurial ideas developed freely, there are nursing consulting and advising companies, software, management and nursing care tools, among others. This autonomous development requires, on the part of students, dialogue and support from professionals of other areas, polling responses, and market research.

Data collection and organization

Data were collected between May and August 2021, through individual online interviews (via Google Meet), with an average duration of 30 minutes. The interviews were previously scheduled and conducted by an experienced researcher, based on guiding questions, which were deepened in the interview: What do you understand by social entrepreneurship? What elements awakened social entrepreneurship in you? How did social entrepreneurship contribute to your professional training in nursing?

The participants were students of nursing course in the 6th semester or above, who had previously participated in teaching, research or university outreach activities on entrepreneurship, as previously described. Social entrepreneurship activities are characterized as those that foster students’ autonomy and social protagonism, based on theoretical and practical teaching, research, or university outreach activities, as well as those that aim to add social value to population groups, contributing to the improvement of living and health conditions.

The following exclusion criteria were applied: students from other courses who had only participated in subjects in Nursing, students transferred from other educational institutions, students who had participated in only one entrepreneurial activity and students who did not attend the interviews on the day and time previously scheduled. Based on these criteria, 44 nursing students were included.

Data analysis

The data were coded according to the thematic content analysis technique(1111 Bardin L. Análise de conteúdo. Lisboa (PT): Edições70; 2016. 280 p.), following three stages , as detailed below:

  • a) Pre-analysis: This stage comprised the organization of the material and the (re)formulation of hypotheses, to allow the researcher to resume the initial questions. For that, the material was skimmed over, the documents for analysis were selected, the corpus was compiled based on exhaustion, representativeness, homogeneity and relevance, hypotheses and objectives were formulated, and the material was prepared.

  • b) Exploration of the material: In this stage, the data were classified to grasp and reach an in-depth understanding of the meanings. Empirical data were coded and then categorized according to similarities and differences of ideas. Data coding considered the recording and context units to classify the set of speeches or dispersed elements selected in the previous steps. The enumeration of data was also considered, according to presence (or absence), frequency, intensity, direction, order and co-occurrence. Semantic (thematic categories), syntactic (verbs and adjectives), lexical (classification of words according to their meaning) and expressive (classification of language disorders) criteria were also considered.

  • c) Interpretation of results: At this stage, the results were interpreted through specific inference based on the proposed theoretical framework.

RESULTS

The 44 nursing students who participated in this study were between the 6th and 10th semester of the course. All had participated, in some way, in teaching, research or university outreach activities related to social entrepreneurship.

The organized and analyzed data resulted in three thematic categories, namely: Meanings of social entrepreneurship, Factors that sparked social entrepreneurship and Recognizing oneself as an entrepreneurial nurse.

Meanings of social entrepreneurship

Among the various meanings of social entrepreneurship pointed out by students, the most recurrent is related to the idea of achieving a common good for the community. This notion is strongly associated with promoting the protagonism of individuals who live in vulnerable communities and with the possibility of making improvements through Nursing care.

It was noted that social entrepreneurship is associated with new professional attitudes and postures that can transcend the space of the hospital. It is also related to the ability to transcend the individual dimension and envision collective benefits for a community/society, as expressed:

Getting out of the circle of a nurse who only works in the hospital. Entrepreneurship makes you search for new alternatives. (P10)

For me, social entrepreneurship is basically to undertake for a common cause, for example, to bring benefits not only to you, but to society as a whole. (P31)

Although some students have associated social entrepreneur-ship with innovation and development of autonomous businesses, the notion is still linked to attaining a common good with social impact and improving the population’s living and health conditions. From this perspective, the interviewees recognize that, in addition to profit, social entrepreneurship aims to improve living and health conditions at an individual and community level:

It is a process that allows us to create businesses, companies, thinking about innovation and bringing some kind of value to society, with the objective of changing the reality of people and communities, especially those where we can identify some type of vulnerability or important need. I think entrepreneurship exists to make a positive impact and support individual and community health. (P17)

I understand social entrepreneurship as a tool that allows building a business, managing a business that has a social impact, not only for profit, but aiming to solve a problem and meeting a social need. (P28)

Unlike business entrepreneurship, social entrepreneurship aims to build technologies and innovations for the health of the community. It includes businesses that develop educational and preventive actions aimed at the community to promote healthy living for people. (P39)

Several speeches demonstrated that the notion of entrepre-neurship is strongly associated with working in poor communities and/or with individuals who are in social vulnerability. This understanding may be related to academic activities carried out in recycling associations, which have vulnerabilities in several dimensions, such as structural, financial, and environmental vulnerabilities, among others:

It helps people who are socially vulnerable or who are not being helped by the competent bodies. Entrepreneurship in nursing enables solutions that impact the lives of these people. (P24)

Therefore, social entrepreneurship is related to the entrepreneur’s abilities to identify needs and, based on this diagnosis, develop strategies to meet them. In this direction, the students mentioned health care, based on the expansion of concepts and the inclusion of new intervention approaches:

For me, the social entrepreneur is a person who can evaluate, identify, and diagnose what can be changed in relation to a problem and, from that, develop ways to solve this problem, either by coordinating an innovative action, or by implementing new ideas, services or business. (P16)

The possibility of achieving new things, new understandings of health care, by innovating, and generating significant changes in society through new approaches to the concept of health, bringing equality to the most vulnerable populations. (P28)

It was noticed that social entrepreneurship, despite some divergent speeches, is associated with notions and meanings that transcend the individual dimension with a view to achieving a collective common good. This notion is associated with the ability to identify needs and envision changes with a social impact.

Experiences that sparked social entrepreneurship

In the students’ perspective, social entrepreneurship was initiated in the first semesters of the Nursing course. In general, all mentioned the visits to a recycling association, carried out in the first semester of the course, with the purpose of identifying a research question for the development of an experience report for the subject of scientific methodology. This experience in the recycling association went beyond the identification and writing of an experience report, as it led to critical reflection, autonomous construction, and involvement with the community:

In the subject of scientific methodology, early on, we visited an Association of women who recycle. We identified the research problem, developed activities with them, and wrote an experience report. This experience was very strong. It brought a lot of learning and reflection. (P34)

In general, students recognize that social entrepreneurship was stimulated throughout the various semesters of the course. In this context, they highlighted the support and challenges proposed by the professors of the Nursing course. Special recognition was given to the subject Leadership and Entrepreneurship, in which students are encouraged to develop the “Entrepreneurial Nurse Project”, designing and developing an entrepreneurial idea that is presented at the institution’s Technology Show:

Since the beginning, the teachers have always encouraged us. I believe that, throughout the undergraduate course, this came from the professors who stimulated and challenged us, especially in the subject of leadership and entrepreneurship. This subject provided the most incentive in terms of entrepreneurship. But, during the entire undergraduate course, it was presented as a challenge by the course coordination. (P15)

In the 8th semester, it was more prominent. The subject of entre-preneurship encouraged us to reflect on whether we are already capable of entrepreneurship. I notice that, in some subjects, we discuss a lot about management and leadership. It’s something that caught my attention - if we’re being a role model for someone, and I think that’s what entrepreneurship is, it’s already getting out of the bubble. (P21)

I believe that the subject of social entrepreneurship, in which we developed the entrepreneurial project, challenged us to go further. We learned how you can design and plan, down to the smallest details. How to come up with an entrepreneurial idea and seek partnerships in other areas. For me, this project was the strongest. (P41)

Other factors that stimulated social entrepreneurship are related to the outreach projects proposed by the University, which favor the development of critical reflection skills and autonomy. In this direction, it is possible to highlight the university outreach projects in different contexts, especially in communities or homeless populations. In this context, the Better Early Childhood Program (Primeira Infância Melhor) stands out. This program allows students to experience the monitoring of poor children up to two years of age. These realities require students to develop autonomy and decision-making skills, as they hardly find ready-made answers or recipes:

I am part of a University project. So, we have a lot of contact with people, with more vulnerable people. This awakens a lot of entrepreneur spirit in me, especially in these groups and places, because there is a lot to do in these contexts. (P1)

The Better Early Childhood Program, which is linked to the University, opens the door to be inside different environments. I believe that, in order to develop a socially relevant work, you first need to be inserted in the context to identify weaknesses. For that, you need to develop critical-reflection skills. (P17)

The students interviewed also mentioned, as factors that sparked social entrepreneurship, the settings where they do their practices and curricular internships, especially in visits associated with the Family Health Strategy. At the same time, the students mentioned their voluntary participation in vaccination campaigns, most strongly during the Covid-19 pandemic, when they had the possibility to give vaccines to homeless people:

Throughout all semesters, we were encouraged to engage in social entrepreneurship. I think it is a continuous construction, with different teachers and in different practice settings. (P32)

My experience [poor community] taught me a lot, especially in home visits, when giving vaccines to homeless people who sought care [...] people who were able to be in social environments, in the labor market. This caught my attention. The day I gave vaccines to homeless people, a world opened up around me. This inspired me to find what could be done with this population. (P38)

The set of speeches showed that social entrepreneurship is sparked and triggered in experiences in environment of greater social vulnerability, where students feel indignation and have to use critical-reflective thinking. This process generated, in most students, new attitudes and personal and professional behaviors, which are the basis for the (re)construction of traditional paradigms in health care.

Recognizing oneself as an entrepreneurial nurse

It was noted that the empowerment of students throughout the course, starting in the first semester, favored the teaching and learning process and, at the end of the course, students felt able and encouraged to be entrepreneurs. In this context, it was noticed that critical-reflective approaches contributed both to the deconstruction of models crystallized by technical work and to the autonomous construction of new healthcare references. The self-recognition of students as entrepreneurs was demonstrated by their proactive involvement and the desire to transcend traditional and welfare paradigms of being a nurse and doing nursing:

Developing entrepreneurship skills allowed me to understand different realities. This process enabled an expanded understanding of health. Healthcare involves a set of factors and social determinants. To provide care, the professional needs to identify the general context in which people are inserted. But for that, you need to have developed critical-reflection and creativity skills, so that you can be innovative in care whenever possible. I grew a lot and today I feel strong to be an entrepreneur. (P5)

A new vision of the world, of the profession. A new model that transcends biomedical logic and technical issues of the area. Interdisciplinary work, research and practical experiences contributed a lot for this. We know that entrepreneurship involves the whole scientific and research areas. We can all be entrepreneurs, but I need to follow my own process. (P17)

In a way, it is an incentive that leads us to step out of our comfort zone and take advantage of opportunities. Entrepreneurship shows us that it is necessary to create your own path instead of waiting for things to come ready. We have to create, evolve, and find our path. I try to evolve and create new things that bring benefits to people and return something for us. (P41)

Several speeches showed the students did not conform to traditional and welfare nursing. In the practice environments, more specifically in the vaccination campaigns, the students felt encouraged to suggest changes and to propose new forms of organization and management. These attitudes may be related to the promotion of the nursing process throughout the different semesters of the course, encouraging students to identify demands and propose strategies for change:

During the course, I started to participate in vaccination campaigns, more recently Covid-19 vaccination. One of the things that infuriated me was the disorganization. But social entrepreneurship allowed me to think about new forms of organization and to propose changes in the process. (P20)

Today I feel empowered as a person who wants to innovate, who wants to take risks in the new market. I want to do get a graduate degree in aesthetics and explore a new market for nurses now that I’m getting to know nurses in the area. But it’s still very new, very recent, so I see myself as an esthetician nurse. (P23)

Students, in general, perceive themselves as capable of reinventing professional practice. They demonstrate that nursing care is per se entrepreneurial, as it identifies people who are different and who require singular and multidimensional actions. This may be associated with the fact that students are challenged to identify the problems of the practice and to propose prospective strategic plans for their resolution:

I believe I can be an entrepreneur. We have already done that in practice, whenever we sought to perform Nursing care in a new and different way, because each person is different. We are challenged every day to think in a broader way and to find solutions for the problems of the practice. (P17)

Their self-perception as entrepreneurs in nursing is associated not only with theoretical approaches. It was noticed that the theoretical-practical experiences in different social environments and in different healthcare settings allowed students to confront their own existential reality. This existential confrontation generated, in most cases, a process of disorder and the possibility of a new organization, that is, new attitudes and personal and professional postures.

DISCUSSION

The entrepreneur aims to make social impact through the development of projects, services, and businesses. Nursing entrepreneurship offers nurses opportunities for autonomous ventures (material or immaterial) that allow them to pursue their personal vision and passion to improve health outcomes using innovative and transformative approaches. However, the desire to be an entrepreneur is not enough. In addition to specific technical knowledge, nurses must have leadership skills and experience in different scenarios to encourage them to discover their entrepreneurial path(1212 Hamizan-Roslan MH, Hamid S, Ijab MT, Bukhari S. Social entrepreneurship learning model in higher education using social network analysis. J Phys Conf Ser. 2019;1339:012029. https://doi.org/10.1088/1742-6596/1339/1/012029
https://doi.org/10.1088/1742-6596/1339/1...
, 1313 Chadwick IC, Raver JL. Not for the faint of Heart? a gendered perspective on psychological distress in entrepreneurship. J Occup Health Psychol. 2019;24(16):662-74. https://doi.org/10.1037/ocp0000157
https://doi.org/10.1037/ocp0000157...
).

The path for the development or enhancement of entrepreneurial behavior is directly related to professional training. In this context, studies show a correlation between educational level and enterprising pace, indicating that higher rates of education will lead to a higher level of entrepreneurship(1313 Chadwick IC, Raver JL. Not for the faint of Heart? a gendered perspective on psychological distress in entrepreneurship. J Occup Health Psychol. 2019;24(16):662-74. https://doi.org/10.1037/ocp0000157
https://doi.org/10.1037/ocp0000157...
, 1414 Alourhzal H, Hattabou A. Social Entrepreneurship Education: a systematic review of curricula contents and teaching methods. Afr Sci J. 2021;3(7):001. https://doi.org/10.5281/zenodo.5651821
https://doi.org/10.5281/zenodo.5651821...
).

Social entrepreneurship is, from this perspective, a mechanism that must be awakened in professional training, preferably in the initial semesters of undergraduate Nursing courses. In addition to specific theoretical-practical discussions, it is essential that students are inserted in communities, so that they can perceive themselves as protagonists and proponents of improvements in health care. This idea is corroborated by the speech of one of the participants of this study, who mentioned that it is necessary to transcend the hospital setting and expand the insertion in communities throughout their training path.

The perception that the community is a promising space for promoting social entrepreneurship has already been demonstrated in a doctoral thesis on entrepreneurial nursing care, defended in 2008(22 Backes DS, Toson MJ, Dal Ben LW, Erdmann AL. Contribuições de florence nightingale como empreendedora social: da enfermagem moderna à contemporânea. Rev Bras Enferm. 2020;73(Suppl 5):e20200064. https://doi.org/10.1590/0034-7167-2020-0064
https://doi.org/10.1590/0034-7167-2020-0...
). Based on the development of a middle-range theory, this thesis demonstrated that the community space enhances dialogue, favoring the identification of needs and the development of strategies to solve problems. In the hospital setting, care is usually focused on the disease and the intervention processes, which are frequently isolated and linear, and the process uses less of the critical-reflective skills of the professionals.

The results of this same thesis also demonstrate that, to spark entrepreneurship in Nursing, it is necessary to (re)invent professional training, providing the student with experiences that arouse indignation and require new ways of thinking and acting. In the same direction, other studies demonstrate that business or social entrepreneurship requires prospective professional attitudes that need to be awakened through confrontation and dialogue with social reality, in the most diverse contexts and realities(1515 Edwards-Schachter M, García-Granero A, Sánchez-Barrioluengo M, Quesada-Pineda H, Amara N. Disentangling competences: interrelationships on creativity, innovation and entrepreneurship. Think Skills Creat. 2015;16:27-39. https://doi.org/10.1016/j.tsc.2014.11.006
https://doi.org/10.1016/j.tsc.2014.11.00...
, 1616 Entrialgo M, Iglesias V. The moderating role of entrepreneurship education on the antecedents of entrepreneurial intention. Int Entrepren Manag J. 2016;12(4):1209-32. https://doi.org/10.1007/s11365-016-0389-4
https://doi.org/10.1007/s11365-016-0389-...
, 1717 Stoehr F, Müller L, Brady A, Trilla A, Mähringer-Kunz A, Hahn F, et al. How COVID-19 kick-started online learning in medical education-The DigiMed study. PLoS ONE. 2021;16(9):e0257394. https://doi.org/10.1371/journal.pone.0257394
https://doi.org/10.1371/journal.pone.025...
, 1818 García-González A, Ramírez-Montoya MS. Social entrepreneurship education: changemaker training at the university. HESWBL. 2021;11(5):1236-51. https://doi.org/10.1108/HESWBL-01-2021-0009
https://doi.org/10.1108/HESWBL-01-2021-0...
).

National and international studies also reinforce that social en-trepreneurship requires the development of social and emotional behaviors at each level of education. These studies recommend that these teaching and learning processes be included in the curriculum, so that teachers and students can develop and practice skills and competences related to social entrepreneurship(1717 Stoehr F, Müller L, Brady A, Trilla A, Mähringer-Kunz A, Hahn F, et al. How COVID-19 kick-started online learning in medical education-The DigiMed study. PLoS ONE. 2021;16(9):e0257394. https://doi.org/10.1371/journal.pone.0257394
https://doi.org/10.1371/journal.pone.025...
,1919 Manyaka SJ. Social entrepreneurship: a solution for transforming the disadvantaged community of Nellmapius. J Theol Stud. 2015;71(3):1-7. https://doi.org/10.4102/hts.v71i3.2821
https://doi.org/10.4102/hts.v71i3.2821...
, 2020 Elliott RM. Social entrepreneurship as a catalyst to break the poverty trap: an analysis of the motivational factors in South Africa. AOSIS, Acta Com. 2019;19(2):1-13. https://doi.org/10.4102/ac.v19i2.652
https://doi.org/10.4102/ac.v19i2.652...
).

The present study showed that the students started to see themselves as entrepreneurs after an intense movement of dialogue in/with the community, in teaching, research, and outreach activities. In this direction, studies show that students need to be challenged and stimulated to go out of their comfort zone and, when confronted with adverse realities, become indignant and promote new connections of meaning, life and profession(2121 Kummitha RKR, Majumdar S. Dynamic curriculum development on social entrepreneurship: a case study of TISS. Int J Manag Educ. 2015;13(3):260-7. https://doi.org/10.1016/j.ijme.2015.05.005
https://doi.org/10.1016/j.ijme.2015.05.0...
, 2222 Fridhi B. Social entrepreneurship and social enterprise phenomenon: toward a collective approach to social innovation in Tunisia. J Innov Entrep. 2021;10(14). https://doi.org/10.1186/s13731-021-00148-6
https://doi.org/10.1186/s13731-021-00148...
).

In the face of the growing social problems, especially those resulting from the Covid-19 pandemic, it is no longer possible for teachers and students to be passive actors and recipients of demands. In addition to being interlocutors, they must be able to provoke changes and find new paths and processes to improve the population’s living conditions, that is, they must be able to promote social entrepreneurship(2323 Halberstadt J, Timm JM, Kraus S, Gundolf K. Skills and knowledge management in higher education: how service learning can contribute to social entrepreneurial competence development. J Knowl Manag. 2019;23(10):1925-48. https://doi.org/10.1108/JKM-12-2018-0744
https://doi.org/10.1108/JKM-12-2018-0744...
).

However, these attitudes and behaviors must be awakened throughout the training process. This idea is supported by the results of this study, as students perceive themselves as protagonists, that is, they feel capable of (re)organizing processes, suggesting improvements and adaptations in services, and enabling better living and health conditions for people in conditions of social vulnerability.

The path to social entrepreneurship is not only through the inclusion of subjects or entrepreneurial projects in professional training courses, even though this inclusion, like proposed in the new National Curriculum Guidelines for Nursing courses, is highly promising. A study indicates that, in addition to theoretical approaches, social entrepreneurship is enhanced through experiential education, combined with self-reflection and discussion, as an ideal path for the student’s entrepreneurial maturity(2424 Hockerts K. The effect of experiential social entrepreneurship education on intention formation in students. J Soc Entrep. 2018;9(3):234-56. https://doi.org/10.1080/19420676.2018.1498377
https://doi.org/10.1080/19420676.2018.14...
). In this context, entrepreneurship can increase the visibility of the profession and encourage the creation of new spaces for nursing work(2525 Copelli FHS, Erdmann AL, Santos JLG. Entrepreneurship in Nursing: an integrative literature review. Rev Bras Enferm. 2019;72(Suppl 1):301-10. https://doi.org/10.1590/0034-7167-2017-0523
https://doi.org/10.1590/0034-7167-2017-0...
).

Study limitations

A limitation of this study was the collection of data in a single educational institution. However, it should be considered that the Nursing course of this institution has a trajectory of six decades and is a regional reference. Another limitation is associated with the lack of studies related to entrepreneurial training within the scope of Nursing courses, which made it difficult to compare these results with previous research. However, despite this limitation, this study proposes strategies that can be incorporated in other educational institutions.

Contributions to the field of Nursing

The contributions of this study are associated with the promotion of a (social) entrepreneurial culture in the area of Nursing and Health. This culture includes training for social entrepreneurship, mainly with theoretical-practical entrepreneurial experiences in different setting, which maximize the effort put into solving social problems. Another contribution of the study is associated with its alignment with the current National Curricular Guidelines, which encourage entrepreneurship in the professional training of Nurses. Even though it was conducted with students from only one teaching institution, this study allows theoretical reflections that transcend geographic boundaries.

FINAL CONSIDERATIONS

The knowledge and practices that stimulate social entrepre-neurship in the professional training of Nursing students are associated with teaching, research and university outreach activities that allow concrete experiences in the living and dynamic world of communities. The results of this study demonstrate the relevance of paradoxical movements and community dialogue since the first semesters of the Nursing course.

The factors that enable prospective experiences of social entrepreneurship are associated with the subjects of leadership and social entrepreneurship, university outreach projects in various social settings, participation in programs such as Better Early Childhood, voluntary participation in community activities such as vaccination campaigns, among others. It was noticed, however, that, in addition to these curricular activities, the students highlighted activities that required greater autonomy, responsibility, and protagonism to solve previously identified problems.

Considering the scarcity of research on professional training for social entrepreneurship in nursing, interprofessional discussions on the subject should be conducted, as well as impact assessment studies on the influence of the national curriculum guidelines for nursing courses on theoretical and practical teaching and learning. It is important that social entrepreneurship be included as a curricular component in Nursing courses, so that future nurses can contribute to the improvement of the social and health conditions of the population in general.

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Edited by

EDITOR IN CHIEF: Dulce Barbosa
ASSOCIATE EDITOR: Álvaro Sousa

Publication Dates

  • Publication in this collection
    23 Sept 2022
  • Date of issue
    2022

History

  • Received
    29 June 2022
  • Accepted
    07 July 2022
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