The teaching of Bioethics in the education of nurses: interface with the adopted literature

Abstracts

OBJETIVO: Identificar e descrever as fontes bibliográficas, utilizadas pelos docentes no ensino da Ética/Bioética em Enfermagem nos cursos de graduação em Enfermagem de Salvador-BA. MÉTODOS: Trata-se de um estudo exploratório, quanti-qualitativo. A análise dos dados teve três momentos e foi guiada pelas temáticas da Ética, Bioética e Exercício Profissional. RESULTADOS: A análise dos dados de cinco cursos, mostrou que os docentes adotam obras que contemplam aspectos relacionados à deontologia, exercício da enfermagem, fundamentos da Bioética e da Ética. CONCLUSÃO: O ensino da Ética/Bioética nos cursos de graduação em Enfermagem de Salvador não se restringe a uma abordagem deontológica e fornece os subsídios básicos para a reflexão crítica e moral dos futuros enfermeiros.

Ensino; Ética em Enfermagem; Bioética; Bibliografia como assunto

ORIGINAL ARTICLE

The teaching of Bioethics in the education of nurses: interface with the adopted literature^*

La enseñanza de la Bioética en la formación del enfermero: relación con la bibliografía adoptada

Nildo Batista Mascarenhas^I; Darci de Oliveira Santa Rosa^II

^IUndergraduate student of Nursing (6^th semester), with a scientific initiation scholarship granted by the CNPq (National Council for Scientific and Technological Development), at the "Universidade Federal da Bahia" - UFBA - Salvador (BA), Brazil

^IIPh.D in Nursing. Professor of the Postgraduate Program in Nursing at the "Universidade Federal da Bahia" - UFBA - Salvador (BA), Brazil

^{Corresponding Author}

ABSTRACT

OBJECTIVE: To identify and to describe the bibliographic sources used by professors in the teaching of Ethics/Bioethics in nursing undergraduate courses, in nursing schools, in Salvador, Bahia.

METHODS: This is an exploratory and quantitative study. The data analysis was done in three stages and was guided by the themes: Ethics, Bioethics and Professional Practice.

RESULTS: The analysis of data from five courses showed that teachers use material that includes aspects related to: deontology, practice of nursing, Bioethics and Ethics foundations.

CONCLUSION: The teaching of Ethics/Bioethics in undergraduate courses in Schools of Nursing, in Salvador, is not limited to a deontological approach and provides the basic tools for critical thinking and moral development of future nurses.

Keywords: Teaching; Ethics, Nursing; Bioethics; Bibliography as topic

RESUMEN

Objetivo: Identificar y describir las fuentes bibliográficas, utilizadas por los profesores en la enseñanza de la Ética/Bioética en Enfermería

en los cursos de graduación de Enfermería en Salvador, Bahía. Métodos: Se trata de un estudio exploratorio, cuantitativo y cualitativo. El

análisis de los datos fue realizado en tres etapas y fue guiado por los temas: Ética, Bioética y Práctica Profesional. Resultados: El análisis de

los datos de cinco cursos, mostró que los profesores adoptan obras que incluyen aspectos relacionados con la deontología, con la práctica

de la enfermería, con los fundamentos de la Bioética y de la Ética. Conclusión: La enseñanza de la Ética/Bioética en cursos de graduación

en Escuelas de Enfermería, en Salvador, no se limita a un enfoque deontológico y proporciona los medios básicos para el pensamiento crítico

y el desarrollo moral de las futuras enfermeras.

Descriptores: Enseñanza; Ética en Enfermería; Bioética; Bibliografía como asunto

INTRODUCTION

The new characteristics of the globalized world and its accelerated process of modernization have caused society to face situations considered unthinkable until then. In the sphere of health, the relevant use of technology in the health care process has led to the appearance of a series of ethical dilemmas, posing challenges to professionals who work in this area. In this sense, "it is in this environment, marked by great advances and contradictory feelings, that Bioethics emerges as a new realm of reflection and practice, which is specifically aimed at human questions in their ethical dimension"⁽¹⁾.

Current evidence points out that the term "Bioethics" was first used by the German theologian Fritz Jahr, in 1927, revealing the emergence of ethical obligations not only towards man, but also all living beings. Due to peculiarities in German writing, he used the word Bio=Ethik⁽²⁾.

In 1970, the American oncologist Van Renssenlaer Potter, still considered by several scholars to be a pioneering point of reference in the use of the term "Bioethics", went on to use it again in articles and conferences. Then, in 1971, by publishing the work entitled "Bioethics: bridge to the future", added a broader meaning to this discipline, with the intention of "expressing a new science, which should be the link that reunites empirical and human sciences, more specifically ethics". Potter added an ecological sense to it, suggesting that it be the bridge between science and philosophy to promote survival⁽³⁾.

In Brazil, Bioethics appeared late in the mid-1990s, although its growth during this relatively short period of time has been remarkable, with the expansion of the creation of lato sensu and strictu sensu postgraduate programs in Bioethics⁽⁴⁾.

The inclusion of Bioethics contents into the Health Sciences and Nursing curricula of future professionals has enabled changes in the ethical-moral qualification of students in these areas, so as to surpass the academic debates, restricted to conceptual aspects, which permeated deontology and professional ethics exclusively. In this context, "the study of new themes and debates, with the appearance of the Practical Ethics or Bioethics, enables the student to develop their critical view of the plurality of values that permeate relationships in health"⁽⁴⁾.

However, in the perspective of professor and researcher Maria Madalena Santiago, in a lecture delivered at the 8º Congresso Brasileiro de Bioética (8^th Brazilian Congress of Bioethics), the teaching of Bioethics in Nursing is still passed on in a theoretical and abstract way, in addition to debates being guided by a conservative view that favors the deontological approach, i.e. restricted to norms and codes, lacking an inquisitive approach⁽⁵⁾.

Based on previous considerations, it must be stated that the teaching of Ethics/Bioethics to Nursing students should suit the new ethical qualification requirements, so that students and future nurses include, in addition to science and technology, a solid ethical-moral foundation into the exercise of their profession, aiming to review values and principles that are adequate for their professional reality.

In this sense, it is essential that Nursing students be capable of expressing values, knowledge and abilities when performing their function and that their actions be aimed to solve ethical problems appearing during the exercise of their profession. In addition, it is necessary for these students to be prepared to make decisions about technical, scientific, social and ethical questions. The teaching of Ethics/Bioethics emerges as a required instrument for Nursing students to think over the daily reality and moral conflicts that permeate their practice.

In this perspective of ethical-moral qualification of future nurses, it is essential that professors who teach the discipline of Ethics/Bioethics in undergraduate Nursing courses have a solid philosophical, ethical and bioethical foundation, in addition to knowledge about the directives inherent to the Science of Nursing, so that debates in this sphere are increasingly more associated with the daily routine of this profession. To achieve this, then, professors need to make a strict, relevant and current selection of works, authors and approaches that include, in addition to aspects inherent to deontology and the exercise of the nursing profession, the variety of bioethical themes, which are vital for students to make decisions, when dealing with situations requiring critical and systematic reflection, founded on social reality.

Based on the principle that "profound changes in the qualification system of health professionals are required, once the current individualistic and anthropocentric system does not meet the needs of individuals or the health work process"⁽⁶⁾; considering the fact that the main goal of the teaching of Ethics/Bioethics in the undergraduate Nursing course is to morally develop students, contextualizing this with the socio-cultural reality in which they live; and in view of the inter-disciplinary nature adopted by Bioethics, it could be affirmed that the professor of such discipline needs to have an active and innovative approach, allied to the criticalreflective development of the student, thus reaffirming the importance of the indissolubility of the theoretical-practical dimension for both professors and students.

In view of the facts previously presented, this study included the following guiding question: What are the bibliographic sources used by professors to be the basis of the teaching of Ethics/Bioethics in undergraduate Nursing courses, in the city of Salvador, Brazil?

To bring contributions to the process of reflection, criticism, understanding of transversality and interdisciplinarity in the teaching of Ethics/Bioethics, fundamental for the moral qualification of the nurse, authors in this study sought to answer this question and achieve the following objective: to identify and describe the bibliographic sources used by professors in the teaching of Ethics/Bioethics in undergraduate Nursing courses, in the city of Salvador, BA, Brazil.

METHODS

This is an exploratory, descriptive study, with a quantiqualitative approach, performed in undergraduate Nursing courses, in the city of Salvador, BA, Brazil, whose object of study were the bibliographic sources used in the teaching of Ethics/Bioethics in undergraduate Nursing schools of this city. This issue requires a qualitative approach, due to its subjectivity. The universe of application of this study were 12 undergraduate nursing courses in Salvador, operating at the time when this study was conducted. The instrument used to collect data were the programs of the discipline of Ethics/Bioethics/Exercise of the Nursing Profession, requested from course coordinators.

The steps followed to develop the research project were: Survey of the institutions that have undergraduate nursing courses in Salvador in the database of the Instituto Nacional de Estudos e Pesquisas Educacionais Anísio Teixeira (INEP - Anísio Teixeira National Institute of Educational Research and Studies); Acquisition of addresses and email and telephone contact with all institutions. Due to a delay of responses, authors contacted Ethics/Bioethics or Exercise of the Nursing Profession professors directly by telephone; and Collection of the Ethics/Bioethics/Exercise of the Nursing Profession discipline programs in the institutions.

Having obtained the programs of five courses, authors began the process of analysis of contents in the discipline proposals and bibliographic sources included, based on Ethics/Bioethics and Exercise of the Nursing Profession themes, to achieve the objective of this study.

The process of analysis of contents was comprised of three moments. In the first moment, the following stages were carried out: Receiving of course programs; Identification of works, according to a basic category; Identification of works, according to a complementary category; Identification of works, according to a supplementary category; and Transcription of the discipline proposals and basic, complementary and supplementary bibliographic sources into individual Chart.

In the second moment, titles, authors and the period of publication of works, contents of discipline proposals and works common to the courses were identified, according to the following steps: Identification of titles of works; Identification of authors; Identification of works common to the courses; Identification of publication periods; Identification of publishers of the bibliography adopted by the courses; Identification of the contents of discipline proposals; and Identification of the themes common to the courses.

The third moment was characterized by the description and analysis of the relationship between discipline proposals and bibliographic sources recommended, using similarity approximation and according to the following steps: Comparison among course discipline proposals; Comparison between themes identified in the discipline proposals and the basic bibliographic sources of each program offered by the courses; Comparison between the themes identified in the discipline proposals and the works from the complementary bibliography of each program offered by the courses; and Comparison between the themes identified in the discipline proposals and the supplementary bibliographic sources of each program offered by the courses.

RESULTS

Of the 12 higher education institutions of the city of Salvador, BA, Brazil, registered with the INEP and including an undergraduate Nursing course, five provided the programs requested. Of these, four had already qualified at least one class of nurses, while one had not qualified any yet. These five courses recommended the basic and complementary bibliographies and one also recommended the supplementary bibliography.

In terms of the basic bibliography adopted by the five undergraduate Nursing courses of Salvador, two sources were indicated by course 1 (C.1), three by course 2 (C.2), four by course 3 (C.3), seven by course 4 (C.4) and two by course 5 (C.5), totaling 18 bibliographic sources (Table 1). Of all these sources, two were common to two courses.

It is observed that the two courses with the highest percentages of recommendations of bibliographic sources were C.4, (38.9 %) and C.3 (22.2%), followed by C.2 (16.7%). It should be emphasized that the recommendation of the basic bibliography by INEP includes three titles, with a quantitative availability proportional to the number of students.

As regards complementary bibliographies, C.1 showed two sources; C.2 showed six sources; C.3, four; C.4, nine; C.5, three, totaling 24 bibliographic sources, as observed in Table 2.

It was observed that the course that recommended the highest percentage of works (37.5%) was C.4, followed by C.2 (25.0%) and C.3 (16.7%). In addition to the bibliographies previously mentioned, course 1 suggested two websites for student consultation - www.bve.org.br and www.scielo.com - and also included two other works as supplementary bibliography.

By comparing the basic bibliography of courses, the two following works were found to be common to courses 3 and 4: "Ética e Bioética: Desafios para a Enfermagem e a Saúde" (Ethics and Bioethics: Challenges for Nursing and Health) by Taka Oguisso and Elma Lourdes Campos Pavone Zoboli, "Problemas Atuais de Bioética" (Current Bioethical Problems) by Léo Pessini and Christian de Paul Barchifontaine. There were no works considered complementary in the programs that were common to all courses.

By comparing the basic bibliography and the complementary one, five works were found to be common: "Lições sobre Ética" (Lessons on Ethics) by Ernest Tugendhat, suggested as basic bibliographic source in course 3 and complementary source in course 1; "Ética e Profissionais de Saúde" (Ethics and Health Professionals) by Marcos Badeia, suggested as basic bibliographic source in course 2 and as complementary source in course 3; "Questões de Vida" (Life Issues) by Giovanni Berlinguer, suggested as basic bibliographic source in course 4 and as complementary source in course 1. The "Código de Ética dos Profissionais de Enfermagem" (Code of Ethics of Nursing Professionals) was recommended as basic bibliographic source in course 3 and as complementary source in course 2. "Resolução n.º 196/96" (Resolution 196/96) was suggested as basic bibliographic source in course 4 and as complementary source in course 2.

The following are among the authors who stood out, due to their interest in the study and publication of Ethics, Bioethics and Exercise of the Nursing Profession themes: Christian de Paul Barchifontaine, Taka Oguisso and Elma Lourdes Campos Pavone Zoboli.

The most frequently mentioned authors in course programs were as follows: Ernest Tugendhat, Léo Pessini, Christian de Paul Barchifontaine and Taka Oguisso (all of whom were mentioned three times), Elma Lourdes Campos Pavone Zoboli and Giovanni Berlinguer (mentioned two times).

The following works were those most frequently mentioned in the programs: "Problemas Atuais de Bioética" (Current Bioethical Problems) by Léo Pessini and Christian de Paul Barchifontaine; "Ética e Bioética: Desafios para a Enfermagem e a Saúde" (Ethics and Bioethics: Challenges for Nursing and Health) by Taka Oguisso and Elma Zoboli; "Código de Ética dos Profissionais de Enfermagem" (Code of Ethics of Nursing Professionals) by the Conselho Federal de Enfermagem (COFEN - Federal Nursing Council); "Lições sobre Ética" (Lessons on Ethics) by Ernest Tugendhat; "Questões de Vida: Ética, Ciência e Saúde" (Life Issues: Ethics, Science and Health) by Ernest Tugendhat; and "Diretrizes e Normas para Pesquisa Envolvendo Seres Humanos" (Directives and Norms for Human Research), all of which were mentioned two times.

The period of publication of books adopted by institutions was between 1990 and 2007. From 1990 to 1992, two works were published. From 1993 to 1995, only one; 1996-1998, 15; 1999-2001, eight; 2002-2004, nine; and 2005-2007, four (Table 3).

In the course programs, publishers with the highest number of recommendations of books were Loyola, with six works, and Manole, with one work recommended in two courses. The Southeastern region of the country was the one with the highest number of publications of books recommended in discipline programs, with 29 works published. Of these, 18 were published in the state of São Paulo and 11 in the state of Rio de Janeiro. Only one work published in the Northeastern region was identified, while there were none in the Northern region.

By analyzing the discipline proposals included in the discipline programs, the following six themes were identified, guiding the teaching of this discipline in undergraduate Nursing courses in Salvador: Deontology, Exercise of the Nursing Profession, (Foundations of) Bioethics, Daily Life Bioethics, Frontier Bioethics, and Philosophical Foundations of Ethics.

The guiding principles and Foundations of Bioethics were identified in the discipline proposal of three courses (C.1, C.4 and C.5); the deontological and legal aspects of Nursing were in all discipline proposals; Daily Life Bioethics were in three (C.1, C.4 and C.5); Frontier Bioethics in two (C.1 and C.4); Foundations of Ethics in all courses, except for course 2; and the aspects associated with the Exercise of the Nursing Profession were in all courses, except for course 1.

Courses 3, 4 and 5 were those that showed the greatest level of diversity of themes, with an emphasis on course 4, which showed all six aspects identified in its discipline proposal, in contrast to course 2, which showed only two of the six aspects previously mentioned. Courses 1 and 5 included five themes identified in their discipline proposals, while course 3 included three themes, as shown in Chart 1.

DISCUSSION

The increase in the number of works published between 1996 and 1998, when compared to previous periods, as evidenced in Table 3, is justified by the publication of Resolution 196/96, which regulates and sets norms for human research and was established in 1996, promoting the publication of works and studies on Ethics and Bioethics issues.

The basic bibliography adopted by course 1 shows suggestions that deal with Bioethics ("Introdução à Bioética/Introduction to Bioethics" by Sérgio Ibiapina Ferreira Costa; Volnei Garrafa; Gabriel Oselka) and Medical Bioethics ("Bioética Médica/Medical Bioethics" by Ernest Tugendhat), meeting the requirements of the discipline proposal in terms of guiding principles of Bioethics and aspects associated with the beginning and end of life.

Complementary bibliography recommendations are aimed at Daily Life Bioethics and Frontier Bioethics ("Questões de vida/Life Issues" by Giovanni Berlinguer), with an emphasis on assisted reproduction and euthanasia. Supplementary bibliographies include two sources of philosophical foundations that are associated with ethical conflicts ("Ética/Ethics" by Adolfo Sanchez Vásquez) and that reaffirm the biomedical ethics ("Ética Biomédica/Biomedical Ethics" by Spinsanti).

Despite this being a discipline that deals with Ethics and Bioethics, bringing aspects associated with Deontology and the Exercise of the Nursing Profession in the discipline proposal, no bibliographic source in this dimension could be found in the program offered by the course.

The basic bibliography of course 2 includes the Philosophical Foundations of Ethics with the work entitled "As Regras Morais e a Ética" (Moral Rules and Ethics) by David Lions, in addition to two more works: "Ética e Profissionais de Saúde" (Ethics and Health Professionals) by Marcos Badeia and "Bioética: uma Face da Cidadania" (Bioethics: an Aspect of Citizenship) by Fátima Oliveira. The complementary bibliography of this same course includes Deontology and the Exercise of the Nursing Profession in its discipline proposal ("Código de Ética dos Profissionais de Enfermagem/Code of Ethics of Nursing Professionals" and "Lei do Exercício Profissional/ Exercise of the Profession Law"), although there are no aspects associated with the Foundations of Ethics in it. The work entitled "Ética nas Organizações uma Introdução" (Ethics in Organizations: an Introduction) by philosopher Elizete Passos, recommended in the requested program, includes this theme.

In addition, this course suggested the following as complementary sources: "Fundamentos da Bioética" (Foundations of Bioethics) by Léo Pessini and Christian Barchifontaine, "Resolução n.º 196/96" (Resolution 196/ 96) and "Resolução n.º 292/1999" (Resolution 292/1999), which comprise themes associated with the Foundations of Bioethics; however, such themes were not identified in the program's discipline proposal.

In the discipline proposal of course 3, the following three themes were identified: Deontology, Exercise of the Nursing Profession and Philosophical Foundations of Ethics. The basic bibliography of this course includes the discipline proposal of deontological and legal nursing aspects ("Código de Ética dos Profissionais de Enfermagem/Code of Ethics of Nursing Professionals"), the Philosophical Foundations of Ethics ("Ética e Bioética: Desafios para a Enfermagem e a Saúde/Ethics and Bioethics: Challenges for Nursing and Health" by Taka Oguisso and Elma Zoboli), the Foundations of Bioethics and Frontier Bioethics, both themes represented by the work entitled, "Problemas Atuais de Bioética/Current Bioethical Problems" by Léo Pessini and Christian de Paul Barchifontaine.

The complementary bibliography of this course includes the discipline proposal of aspects associated with the Exercise of the Nursing Profession, with the work "Profissionalização da Enfermagem Brasileira/Professionalization of Nursing in Brazil" by Taka Oguisso "Ordem Médica e Norma Familiar/Medical Order and Family Norm" by Jurandir Freire Costa, "O Nervo Cala, o Nervo Fala: a Linguagem da Doença/The Nerve Silences, the Nerve Speaks: the Language of Disease" by Maria Lúcia da Silveira and "Ética e Profissionais de Saúde/Ethics and Health Professionals" by Marcos Badeia.

The basic bibliography suggested in course 4, whose discipline proposal was comprised of all six aspects previously mentioned, includes the Philosophical Foundations of Ethics, with the work entitled "Ética e Bioética: Desafios para a Enfermagem e a Saúde/Ethics and Bioethics: Challenges for Nursing and Health" by Taka Oguisso and Elma Lourdes Pavone Zoboli; the Foundations of Bioethics, with the same previously mentioned work, in addition to "Manual de Bioética: Fundamentos e Ética Biomédica/Manual of Bioethics: Foundations and Biomedical Ethics" by Elio Sgreccia and "Resolução nº196/96/Resolution 196/96". The basic bibliography suggested also comprises Daily Life Bioethics and Frontier Bioethics, with the following works: Life Issues ("Ética, Ciência e Saúde/Ethics, Science and Health") by Giovanni Berlinguer and "Problemas Atuais de Bioética/Current Bioethical Problems" by Léo Pessini and Christian de Paul Barchifontaine.

The complementary bibliography of the previously mentioned course comprises works that include the following themes: Bioethics and Foundations of Bioethics (Universal Declaration of Human Rights, "Introdução Geral à Bioética: História, Conceitos e Instrumentos/General Introduction to Bioethics: History, Concepts and Instruments" by Guy Durant and "Bioética, Novo Conceito: A Caminho do Consenso/Bioethics, a New Concept: Towards the Consensus" by Humbert Lepargneur); Foundations of Bioethics ("Ética e Cidadania: Caminhos da Filosofia/Ethics and Citizenship: Paths of Philosophy" by Silvio Gallo); Frontier Bioethics ("Bioética Paliativa" by J.L Manzini) and Deontology and the Exercise of the Nursing Profession, represented by the work entitled "Bioética na Enfermagem/Bioethics in Nursing" by Lucilda Selli.

This course, in addition to including all the six themes identified in the discipline proposals of courses, recommended a variety of works that are based on the qualification of undergraduate nursing students. This, as a result, provides them with a broader relevant theoretical foundation that serves as the basis for reflection and criticism, in view of the ethical and moral conflicts that permeate the daily practice of health professionals, especially that of nurses.

In the basic bibliography of course 5, the work entitled "Ética e Saúde: Questões Éticas, Deontológicas e Legais, Tomada de Decisões, Autonomia e Direitos do Paciente, Estudos de Caso/Ethics and Health: Ethical, Deontological and Legal Issues, Decisionmaking, Patient Rights and Autonomy, Case Studies" by Paulo Antonio de Carvalho Fortes includes the following themes, identified in the discipline proposal: Bioethics, Deontology and the Exercise of the Nursing Profession. Another work suggested as basic bibliography in this course ("Ética e Moral: a Busca dos Fundamentos/Ethics and Morals: the Search for Foundations" by Leonardo Boff) covers the Philosophical Foundations of Ethics and morals.

In terms of the complementary bibliography, this course points to another work that includes the Philosophical Foundations of Ethics ("Fundamentos da Filosofia/Foundations of Philosophy" by Gilberto Cotrim) and two more works that essentially discuss the theme of Ethics and Bioethics, with an emphasis on ethical conflicts caused by advances in genetics and science ("Da Ética a Bioética/From Ethics to Bioethics" by Álvaro Valls and "A Bioética e o Novo Milênio/Bioethics and the New Millenium" by Elio Sgreccia).

In the analysis of the course program, it was observed that the majority of recommended works are aimed at the philosophical, ethical and moral foundation of undergraduate students, which are important instruments for reflection and criticism, apart from their being the bases to understand ethical and bioethical conflicts that appear in the daily practice of nurses and essential to teach the discipline of Ethics/Bioethics/Exercise of the Nursing Profession in undergraduate nursing courses.

FINAL CONSIDERATIONS

In view of what has been described here, it was observed that course 4 was the one that most frequently recommended works from the basic and complementary bibliographies (37.5%). Among the six most often mentioned authors, half of them are nurses, dedicated to the study of Ethics, Bioethics and the Exercise of the Nursing Profession.

The highest number of works was published between 1996 and 1998. This is attributed to the publication of Resolução n.º 196/96 (Resolution 196/96) by the Conselho Nacional de Saúde (National Health Council), which caused professors and researchers' interest in Bioethics and publications on Ethics, Bioethics and the Exercise of the Nursing Profession to be aroused.

As regards the publishers of the bibliographic sources recommended in the programs offered, the ones that most frequently published works on Ethics and Bioethics are situated in Southeastern Brazil, especially between 1996 and 1998. This situation implies the need to promote the production and publication of works on Ethics and Bioethics in other regions of the country, particularly in the Northeast and North, once only one published work was found in the Northeast and none in the North.

Nursing professors in Salvador sought works to teach Bioethics that were produced by philosophers, nurses and theologians. There is a constant frequency among the previously mentioned works, suggesting a balance in the choices made by professors. Moreover, the majority of suggested bibliographic sources deal with philosophical principles and the foundations of Ethics and Bioethics, which should be the basis to teach these themes in undergraduate Nursing courses.

As regards the themes identified in the discipline proposals, it was observed that they direct the teaching of this discipline to the approach of Deontology, the Exercise of the Nursing Profession, and the Foundations of Ethics and Bioethics. These themes are essential to qualify critical, reflective nurses who have a relevant theoretical foundation to make decisions, when dealing with ethical dilemmas that may appear during the exercise of their profession.

Based on the combined analysis of discipline proposals and bibliographic sources recommended by the discipline programs, it could be inferred that the teaching of Bioethics in undergraduate Nursing courses of the city of Salvador is not restricted to a deontological and normative approach; it provides subsidies, such as current and relevant bibliographic sources, for critical and moral reflection of future nurses; and it has been directed towards the understanding of philosophical aspects of Ethics and Bioethics, the Exercise of the Profession and Deontology.

However, it is important to emphasize the fact that, despite the relevance of previously mentioned themes in the moral qualification of nurses, they should not be exclusive of the teaching of this discipline, especially when considering the current educational and professional demands resulting from a globalized world, whose technological and scientific advances have required changes in the qualification of health and nursing professionals.

By also considering the political and ideological framework of the Sistema Único de Saúde (SUS - Unified Health System) and the constructs of the Brazilian Health Reform, there arose the need to qualify professionals who perform on an individual and collective level, with responsibility and competence, and guided by ethical principles. It is essential, thus, that the teaching of Bioethics in the qualification of nurses be performed in agreement with the requirements of the modern world of work, where students will someday perform as professionals responsible for the prevention of risks and harm, rehabilitation, maintenance and promotion of health. This situation corroborates the need to integrate the teaching of this discipline with concepts and contents included in the ideological framework of the SUS, Brazilian Health Reform and Collective Health.

Moreover, it should be remembered that, in modern times, debates on the need to change the process of qualification of nurses can be observed. In the Brazilian reality, this is associated with the Diretrizes Curriculares Nacionais do Curso de Graduação em Enfermagem (National Curricular Directives of the Undergraduate Nursing Course) and the Lei das Diretrizes e Bases da Educação Nacional (Law of National Educational Directives and Foundations), which are the main legal means that recommend the promotion of changes in curricular sources and paradigms in the qualification of nurses.

Thus, the teaching of Bioethics in undergraduate Nursing courses should be adapted to these new requirements for the qualification of a new professional profile, i.e. a nurse who has general knowledge and who is a humanist, critical, thoughtful and, essentially, ethical, aiming to care for the social health needs in the individual and collective spheres. Consequently, the transversality of contents, founded on the inter- and trans-disciplinary perspective in the teaching of Bioethics, appears as a required alternative for the ethical qualification of nurses.

The present study brought about new contributions to the teaching of Ethics and Bioethics in Nursing. It should be emphasized the need to produce knowledge about the theme and the importance of the selection of relevant and current bibliographic sources to enable future nurses to become thoughtful and aware and to exercise their profession based on ethical and moral principles.

REFERENCES

1. Neves MCP. A fundamentação antropológica da bioética. Bioética. 1996;4(1): 7-16.

2. Bioética e Ética na Ciência [página na Internet]. Porto Alegre(RS): Goldim; 2009 [atualizado 2010 janeiro 11; [citado 2010Mar 01]. Disponível em: http://www.bioetica.ufrgs.br/

3. Nunes CRR, Nunes AP. Bioética. Rev Bras Enferm. 2004;57(5):615-6.

4. Zanatta JM, Boemer MR. Bioética: uma análise sobre sua inserção nos cursos de graduação em enfermagem em uma região do Estado de São Paulo. Bioethikos. 2007;1(2):63-9.

5. Carvalho M. 8º Congresso Brasileiro de Bioética. Um evento, duas faces. Radis. 2009;(88):28-33.

6. Ferreira HM, Ramos LH. Diretrizes curriculares para o ensino da ética na graduação em enfermagem. Acta Paul Enferm. 2006;19(3):328-31.

Received article 07/11/2008 and accepted 05/04/2010

*

Article extracted from the scientific initiation project entitled "Teaching of Ethics in higher education schools of Nursing: main bibliographic sources used in the teaching of Bioethics in Nursing", developed by the "Universidade Federal da Bahia" - UFBA - Salvador (BA), Brazil.

Publication Dates

• Publication in this collection
  29 July 2010
• Date of issue
  June 2010

History

• Received
  07 Nov 2008
• Accepted
  05 Apr 2010