THE PEDAGOGICAL RELATIONSHIP IN PRACTICAL-REFLEXIVE EDUCATION: CHARACTERISTIC ELEMENTS OF TEACHING INTEGRALITY IN NURSE EDUCATION

ABSTRACT

Objective:

to identify the elements of the pedagogical relationship in practical-reflexive teaching that characterize the teaching of integrality.

Method:

a qualitative research using a case study. Data collection took place between May 2013 and September 2014, with eight faculty members from the integrating axis of the last four semesters of a nursing undergraduate course. Triangulation techniques for data collection, documentary analysis, non-participant observation and individual interviews were used. Data analysis was guided by Minayo’s operative proposal.

Results:

the pedagogical relationship in nursing undergraduate course is based on elements that enhance the teaching of integrality, bringing context examples of practice to education, connecting what was seen in theory with that is found in health services and providing a reflection process for the student and teacher.

Conclusion:

the elements of the pedagogical relationship in the practical-reflexive teaching that characterize the learning from the integrality principle during nurse education are related to the theory and practice connection, the development of professional artistic talent and to the reflection process on and about the action. The pedagogical relationship in the course assists in the education of professionals who are able to competently act in uncertain and conflicting situations found in the health services.

DESCRIPTORS:
Nursing; Education, higher; Integrality in health; Faculty; Students

RESUMO

Objetivo:

identificar os elementos da relação pedagógica no ensino prático-reflexivo que caracterizem o ensino da integralidade.

Método:

pesquisa qualitativa, do tipo estudo de caso. Coleta de dados ocorreu de maio de 2013 a setembro de 2014, com oito docentes de disciplinas do eixo integrador dos quatro últimos semestres de um Curso de Graduação em Enfermagem. Utilizou-se a triangulação de técnicas para coleta de dados, análise documental, observação não participante e entrevistas individuais. Análise de dados guiada pela proposta operativa de Minayo.

Resultados:

a relação pedagógica no Curso de Graduação em Enfermagem está fundamentada em elementos que potencializam o ensino da integralidade, trazendo para o contexto da formação exemplos da prática, conectando o que foi visto na teoria com o encontrado nos serviços de saúde e oportunizando um processo de reflexão para o estudante e para o docente.

Conclusão:

os elementos da relação pedagógica no ensino prático-reflexivo que caracterizam a aprendizagem a partir do princípio da integralidade, durante a formação do enfermeiro, estão relacionados à conexão teoria e prática, ao desenvolvimento do talento artístico profissional e ao processo de reflexão na e sobre a ação. A relação pedagógica no curso está caminhando para formar profissionais competentes para atuar diante de situações incertas e conflituosas encontradas nos serviços de saúde.

DESCRITORES:
Enfermagem; Educação superior; Integralidade em saúde; Docentes; Estudantes

RESUMEN

Objetivo:

identificar los elementos de la relación pedagógica en la enseñanza práctico-reflexiva que caractericen la enseñanza de la integralidad.

Método:

investigación cualitativa y del tipo estudio de caso. La recolección de datos se realizó entre mayo del 2013 hasta septiembre del 2014 con ocho docentes de las disciplinas del eje integrador de los cuatro últimos semestres de un Curso de Graduación en Enfermería. Se usó la triangulación de técnicas para la obtención de datos, análisis documental, observación no participante y entrevistas individuales. El análisis de datos fue guiado por la propuesta operativa de Minayo.

Resultados:

la relación pedagógica en el Curso de Graduación en Enfermería se fundamenta en elementos que potencializan la enseñanza de la integralidad, trayendo para el contexto de la formación los ejemplos de la práctica, conectando lo que fue visto en la teoría con lo encontrado en los servicios de salud y dando lugar a un proceso de reflexión para el estudiante y el docente.

Conclusión:

los elementos de la relación pedagógica en la enseñanza práctico-reflexiva que caracterizan el aprendizaje a partir del principio de la integralidad, durante la formación del enfermero, están relacionados con la conexión teórica y práctica al desarrollo del talento artístico profesional y al proceso de reflexión en y sobre la acción. La relación pedagógica en el curso está caminando para formar profesionales competentes para actuar ante las situaciones inciertas y conflictivas encontradas en los servicios de salud.

DESCRIPTORES:
Enfermería; Educación superior; Integralidad en salud; Docentes; Estudiantes

INTRODUCTION

Nursing education at undergraduate and postgraduate levels has occupied a fundamental position in the process of modernization and in the development of care provided to the population. It has the role of qualifying professionals to meet the multiple and increasingly complex demands of health services.¹ Therefore, we need to rethink education based on pedagogical principles that value the totality of the student and of the person cared for by this future professional.²

Integrality applied in the pedagogical relationship is also a possibility that is considered for nurse education which considers elements beyond the technical rationality, forming technically competent nurses, but also committed to social and human values. This possibility, allied to a reflexive practical teaching, allows future nurses to find alternatives to complex situations encountered daily in the health services.

The uncertain situations found in practice are most often presented as unique cases, which the professional cannot treat as an instrumental problem to be solved with the application of a rule or technique that they have previously learned. These situations are not foreseen in manuals, and therefore, they need to be treated competently with a certain type of improvisation, inventing and testing situational strategies produced by the professional himself.³

In this context, professionals use skills, called professional artistic talent, in order to solve uncertain and conflicting situations. Based on tacit knowledge, it is not always possible to describe it, but it is present during the execution of the action even if it has not been previously thought, complementing scientific knowledge and techniques dominated by professionals.³

In this sense, nurse education in the health service context will allow the student to reflect on the articulation between what is learned in theory and what is found in the field of practice, as well as to handle real and concrete situations, enabling them to care for the human being in its entirety.

We emphasize that the transformation movement in teaching has instigated the development of research on nurse education, however, we find gaps in the production of knowledge that investigates the pedagogical relationship in nursing courses, even though this is the fundamental pillar of a teaching anchored in reflective practice and in the principle of integrality.

Integrality, a guiding principle of the Unified Health System (SUS), should guide the practice of health professionals. However, it is perceived that this principle has been applied almost exclusively in health care, whose application has presented limitations. Educating health professionals in the perspective of integrality requires that this principle is also considered in the pedagogical relationship.⁴

In nurse education, the pedagogical relationship is established with the intention of building knowledge, teaching and learning and reflecting on the practices experienced during the course. It involves a network of elements that are related to the institution, the teacher, the student, the professionals and users of the health services involved in the education process. Therefore, we sought to identify the elements of the pedagogical relationship in the practical-reflexive teaching that characterize the teaching of integrality.

METHOD

A qualitative study with a single case study, conducted in a nursing undergraduate course at a public university in the south of the Brazil, which seeks to develop a critical, creative and reflective education for students. Eight professors from the integrative axis disciplines (disciplines dealing with professional nursing care) from the last four semesters of the course participated in the study. Two participants from each discipline from a total of 20 teachers were drawn at random. The following participant inclusion were considered: permanent teaching position in the chosen educational institution; have two or more years of teaching practice; institutional experience with theoretical and practical-theoretical activities.

Triangulation techniques were used for data collection, which involved documentary analysis, non-participant observation and individual interviews. Data collection was performed from May 2013 to September 2014 and the search for information in the teaching plans of the integrating pillar disciplines was initiated. This process was a valuable source of information, as it provided the first approximation to the context of the studied undergraduate nursing course.

The second stage of the data collection was the accomplishment of 85 hours of observation in 28 moments of teaching-learning of the participating teachers of the research, distributed in theoretical activities, theoretical-practical activities, supervised internship and guidance during the thesis conclusion. The data from the observations were recorded in a field diary, containing a description of reality and elements of the pedagogical relationship in reflexive practical teaching. In order to respect the anonymity of the participants, the teaching plans were identified by the letters PE (teaching plan), and the observations were identified by O (observation), followed by the letter D (teacher) and by the number assigned to each participant, plus by the letters CT for theoretical context and CP for practice context (OD1CT, OD1CP ... OD8CT, OD8CP).

In order to complement the information related to the documents and the observations, the interviews were performed after the observation were complete contributing to understand in depth the pedagogical relationship in the course researched. They were recorded on digital media and then transcribed in full. The interview statements were identified with the letter E (interview) and with letter D (teacher), followed by a random number distributed by the researcher (ED1, ED2, ED3 ... ED8).

Operative proposal was used for data analysis, described in two stages: exploratory phase of the investigation and the interpretative phase of the data. Firstly, the horizontal and exhaustive reading of the information from the documentary analysis, observation and interview was performed, establishing an interrogative relationship with the data and seeking the internal coherence of the information.⁵ In the second stage, each subset and the whole set were read, separating the themes and categories, putting the similar parts together, trying to understand the connections between them, and then storing them in codes.

The central ideas gave rise to the first stage of codification. Afterwards, the immersion and deepening of the information obtained in the first codification was carried out by reading line by line, searching for coherences and inconsistencies in the triangulation of information and recutting the information which structured the analysis categories once again.

The research was developed in accordance with the ethical principles required by resolution 466/2012. The project was approved by the Ethics Committee in Research with Human Beings of the Federal University of Santa Catarina, under CAAE N. 13975513.9.0000.0121.

RESULTS

The pedagogical relationship in the nursing undergraduate course is based on elements that enhance the teaching of integrality, bringing context examples from practice to education, connecting what was seen in theory with that found in health services and providing a process of reflection for the student and for the teacher. These elements of reflexive practical teaching are represented in the following categories: Approach of the professional context: a fertile element to connect theory and practice in nurse education for the purpose of integrality; Reflection in action and about action as potential elements for the teaching of integrality in the pedagogical relationship; Professional artistic talent: teaching skills and performances in the perspective of integrality.

Approach of the professional context: a fertile element to connect theory and practice in nurse education for the purpose of integrality

The findings of the study indicate that the approach and reflection on the practice context is an element of the analyzed course. In the teaching plans of the disciplines, it was possible to identify elements that potentiate this approximation.

The interlinking of theory and practice occurs in the context of the classroom, with the participation of professionals from practice and with approximation to the place where the theoretical-practical activities will be developed [...] in the scenario of clinical practice through observation and student performance in theoretical-practical activities (PED1D2). The students have activities in clinical practice that aim to compare what is recommended in the literature with the one practiced in actual practice (PED5D6).

We emphasize that, even though it is not described in all teaching plans as there is the relationship between theory and practice, there is a movement on the part of the teachers that aims to bring the student closer to the reality of practice, bringing their own experiences of practice and including professionals from practice to this debate. When occurring in theoretical classes, this articulation arouses the student’s interest in the debated subject, favoring questioning and reflection on the experiences of practice.

I try to bring the examples of my experiences and what we see most in our daily activities, everything I’ve had as a practice professional and now as a teacher. [...] The student remembers different forms of learning and the practical examples help the student to understand (ED6).

The teacher’s challenge to connect theory with practice is intensified, because the student is not always able to establish the connection to what was seen in the classroom to what is found in practice, considered a limitation due to the fact that often the teacher does not accompany the student during the theoretical content.

[...] The teacher needs to prepare the student to balance theory and practice. The theory has to guide practice and practice has to remake the theory, in a permanent process of reflection on the practice you theorize and from this you improve your practice (ED5).

The situations experienced in practice are the starting point for the discussion [...] the teacher connects the text regarding user embracement with the embracement performed by a student in the public health unit, bringing contributions to the practice (OD3CP).

Reflection on action and about action as enhancing elements of teaching integrality in the pedagogical relationship

The findings show that both the student and the teacher experienced moments of understanding and reflecting on the action, without necessarily progressing to the other stages of reflection (reflection on action and reflection on reflection in action) in the pedagogical relationship.

Practice with rich moments for reflection in and on action. During cervical cancer screening, the student has difficulty in locating the cervix, the teacher assists but does not stimulate the reflection process of the student during or after the procedure (OD4).

However, there is a partial movement of some teachers in moving from knowledge in action to reflection on and about the action, stimulating the student to reflect while performing nursing care, and later to this.

Sometimes I discuss, now, if the question comes and I feel confident or even unsure [...] sometimes I can even talk and reflect with them together, if it’s something I do not need to go look up, but if is something that I really do not know or that is an ethical thing that sometimes we can manage to solve in a conversation, but if not I will look it up and bring it to the students (ED7).

[...] sometimes it’s not possible to go over the things that have happened in the same day. I have a routine where the next day, when we are starting practice for that day we return to some situations that were experienced the previous day (ED8).

The results show that teachers reflect on their pedagogical actions, establishing a dialogue between thinking and doing, characterizing the stage of reflection on and about action. The present reflection on reflection in action initiates a dialogical process of thinking and doing through which teacher and student can become skilled in a particular action. This also applies to nursing care. Thinking about integrality in reflexive learning implies making an exercise in how its application has occurred during teaching-learning moments; understood not only in the relationship between the academy and the health system user, but also in the relationship between academia and academia, represented by the teacher and student.

We have to reflect and evaluate our practice, because we often plan an activity in a way with the student and sometimes it was not what was expected, the result that we imagined didn’t happen, it didn’t arouse curiosity, interest, which is the pursuit of student knowledge (ED1).

To teach integrality the student needs to see himself as a person, how does he/she respond to his/her needs? Then how he/she meets this demand when it comes to it in the professional context. The reality of the student is the starting point to discuss integrality, as a citizen and as a nurse (ED3).

The teachers’ statements allow us to understand the existence of a pedagogical relationship centered on student learning as a professional and as a person. This view, beyond the process of acquisition of knowledge and skills in nurse education, indicates that this subject is perceived in its integrality within nurse education. However, considering this perspective, the teacher must be open in order to understand the learning type and the difficulties of the students. This process is permeated with challenges due to the adopted stance of the student and the teacher.

This viewpoint, which at first may seem simple, becomes complex as the student advances in the course, since it is expected that they already have acquired knowledge in other disciplines and hope that the student already acts in a role very close to the profession.

There is the student who does not feel confident, he gets worse, he is not ready to manage a unit, he is not yet fit to do it and he goes there [...] There are students who have no commitment [...] I will be there with them and we will accompany them [...] That’s what makes me more tired, because I go every day until he feels that there’s someone there, that’s when things get really tight [...] you have to do it, where is your difficulty, let’s work together, what do have to watch for, where do you have to grow, what am I expecting from you today and what I expect from you at the end (DI6).

The teacher’s concern that the student has attitudes that are in accordance with the one recommended in the nurse’s work shows that the pedagogical relationship is turned to train professionals to act competently in health services and, especially, that they are able to solve uncertain situations and practice. This ability can be gained by developing the reflection process in action and about action during the nurse education itself.

Professional artistic talent: teaching skills and performances in the perspective of integrality

The manifestations of professional artistic talent potentiate and allow reflexivity in education with the perspective of integrality. Preparing students in order to acquire this performance and respecting their learning pace or artistic talent, are present in the performance of some teachers when they are in practice.

Negative student experience in an uncertain / conflictive situation (misunderstanding of the community health agents about the dynamics of the student-led meeting) contributed to the student reflecting that she / he acquired skill / performance in the relationship with the nursing team (OD5CP).

You have to be careful not to expect students to acquire skills that go beyond what is expected in the discipline, respecting the stage that the student is in the education process (ED8).

However, the findings revealed that there is still little incentive for the development of professional artistic talent both in the classroom and in practice, even in situations where it would be possible to approach this competence.

In practice, the student does something different from what is recommended in the manuals. The teacher does not criticize the student, but guides the student to do what is advocated. [...]Uncertain and conflicting situations in practice are little explored by the teacher (OD1CP).

When the technique is not so correct, but doesn’t cause any risk or harm, the technique has to revised, I show him where his difficulties are, so that he can make the corrections (ED4).

Although there is the fragility of exploring artistic talent in practice, there are signs that such an expectation is present in the statement. The teacher states that during the nurse education process the student needs to learn to deal with the differences between what is learned in the classroom and what is found in practice, requiring them to acquire skills and competences for the development of creativity in order to be able to act in uncertain and conflicting situations.

The student needs to learn to work with diversity and differences of what is learned in the classroom and what happens in practice. It is a new type of learning for the student where he or she will learn to adjust and improvise care. As a professional they will need to use this creativity, this flexibility in order to act in unexpected situations. (ED1).

Managing the demands of the practice during nurse education generates the feeling in the teacher that the pedagogical relationship occurs in a space that has limited governability between what needs to be learned in the formal nurse education process and the openness that the practice provides in order to solve unexpected and conflicting situations.

While being placed into the reality can create possibilities for the development of artistic talent, it is also limiting, because the student and teacher are external members of the team, and the capacity of action of both is in a very narrow and sensitive range, because depending on the conduct, it may imply or result in the loss of clinical placement location (ED5).

The skills and performances of artistic talent intertwine with the principle of integrality in care, because we cannot predict the uncertain and conflicting demands that we will find in the day to day routine of services. Care in the perspective of integrality is to meet the demand of those who seek health care, through a reflexive practice by both the teacher and the student, from the moment in which care is provided until the construction of new possibilities of care in the perspective of integrality.

DISCUSSION

The findings of the study indicate that the approach and reflection on the practice context is an element of the analyzed course. It was evidenced in the teaching plans that there are elements that strengthen the approximation with the context of the health services. However, the document alone does not validate this contextual approach, and it is up to the teacher to put into practice, through the pedagogical relationship, the reflection on the world of academia and the demands found in practice.

In the researched course, the connection between the world of academia and practice is the fundamental presupposition in nurse education, and a condition for the development of a reflective practical teaching in the perspective of integrality. However, the articulation of teaching and clinical work/practice needs to be anchored in a reflexive process that is intertwined with the reality of practice and not parallel to it.⁶

The university has the responsibility to train reflective students who can solve the uncertain situations in practice, responding to the health needs of the population and of nursing itself as a profession.⁷ When we find a dichotomous situation to this, i.e. reflective practice, it results in education that is incompatible with the demands of society and service.⁸

The interlinking between theory and practice is a challenge for the participating teacher of this study, since it is necessary to find methodological alternatives, so that the student reflects on the reality found in practice. The inclusion of practice professionals in theoretical classes, the description of examples experienced in the practice of the teacher and the experience of practice as a starting point for the theoretical discussion are methodological strategies that stimulate the student to reflect. Therefore, it is believed that the pedagogical relationship is the best guide when working in a perspective of a reflective practical teaching.

The methodology used by the teacher facilitates the teaching-learning process by relating theory and practice, contributing to the students making this connection.⁹ The use of real experiences and the inclusion into real situations in the day to day services , as evidenced in the study, makes successful learning, contributing to the student becoming critical and reflective. Thus, they can concretize in reality what they have learned from theory and, by bringing their experiences, widen their horizons of possibilities in the search for knowledge. In line with this construction process, teachers need to rethink the students’ autonomy space, considering them and respecting them in their learning journey.¹⁰

In the daily routine of services, when developing nursing activities, the teacher can become an role model of professional for the student as a result of their performance, so it is indispensable that the teacher and the students commit themselves to the practice and not simply understand these scenarios as something external to their daily routine. In this context, the pedagogical relationship also becomes a point of learning when it makes the connection between theory and practice, stimulating student participation and relating teaching, learning and real life.^11-12

There is a concern on the part of the teachers to stimulate the student to develop attitudes according to the professional exercise and as the student advances in the course they approach the nursing practice and establish a better relationship between theory and practice, making the teaching-learning process easier.⁹

The teaching-learning strategies are fundamental aspects in the teacher’s performance, however the success of a certain strategy depends on the integration of factors related to both the teacher and the student, which involve motivation, knowledge, persistence, interest and respecting differences.¹³

Thinking about strategies to motivate learning regarding the principle of integrality, with the reflexive practical teaching as a pillar, does not include education focused on technical rationality, in which professional knowledge will only respond to instrumental problems. The problems of the practice context do not present themselves to professionals with well-defined structures needing skills such as professional artistic talent to solve them. The development of this competence was a weakness found in the study, thus the process of constructing and valuing the knowledge and experiences of practice requires the creation of innumerable strategies and plans that make the dialogical construction between the world of the academy and the service possible.^3,8

It is necessary to adopt the epistemology of reflexive practice in nurse education, which is supported by the following pillars: knowledge in action, reflection on action, reflection on action and reflection on reflection in action.³

Knowledge in action is characterized as a spontaneous act that allows the development of routine tasks, execution and easy sequences of activities, without necessarily having to think about it. Reflecting on the action is the moment where we find an unexpected result in the development of the action, and we have the possibility to interfere in this action. These two moments occur without necessarily having a verbal description of what is being done.

As we reflect on reflection on past action, we reflect about action, which allows us to modify a future action. The reflection on the reflection in the action contributes to the professional constructing knowledge, helping to understand future problems or to discover new solutions.³

The learning culture committed to reflection is a valuable way of helping nurses to make sense of their practice.¹⁴ However, the reflection process in the context of the classroom and practice does not always advance in the chain of reflection, that is to say, reflection in action becomes reflection about action. However, there is a movement on the part of the teachers, as mentioned in this study, to create possibilities of teaching in integrality, establishing a process of thinking and doing that considers this principle in health care and the relationships established during nurse education.

In the pedagogical relationship in nurse education, knowledge in action becomes reflection on action when it does not occur within the expected limits, leading to reflection on the motives that generated the experienced situations. These moments may occur in all teaching-learning contexts, however, when we aim for a reflexive practical teaching, we also need reflection in action to be potentiated in the pedagogical relationship. The teacher, imbued with this pedagogical presupposition, expresses a reflective practice in his or her own actions and encourages the student to reflect on their actions.

Thus, it was observed in the study that, when the teacher creates possibilities for progress in the process of reflection, changing knowledge in action for reflection in action, and later for reflection on action, the teaching learning process breaks the logic of technical rationality and becomes a reflexive practice, opening a range of actions in the pedagogical perspective of the principle of integrality.

Nursing is not only a consumer, but also a producer of knowledge through coping with problematic situations experienced in practice. Thus, in addition to applying protocols, students should learn ways to question the conduct of nurses when they encounter unstable, ambiguous and unclear situations in the day to day practice. Teaching-learning process becomes accessible only when reflection is carried out in action.¹⁵

From this understanding, it is possible to affirm that the reflexive exercise on the application of the integrality principle in nursing education must be based on a collective manner, constructed by experiences of the academic practice and by reflections on the reality. This construction instigates changes in health practices and amalgamates the relationships established during the nurse education process, involving the subjects of the academy, service and population.⁴

In nurse education and in the professional practice of nursing, it is understood that dialogue is directly related to the capacity to reflect on the construction of knowledge and the caring process. Thus, it becomes a dialogical moment involving all subjects, encouraging the student to act responsibly, evaluating and modifying their academic practice, as well as enabling them to exercise their profession with higher qualification and respect to the user of the health service.¹⁶

The situations experienced in the context of the service place the teacher in a challenging position, since he needs to find pedagogical strategies that favor the adaptation and execution of concrete actions in a scenario with limited governability as highlighted by the teachers.¹⁷ The student enriches the discussion and consequently the teaching learning process by bringing real experiences of his professional life to the classroom. However, the teacher must articulate this knowledge with the current practices recommended in public health and education policies, encouraging the student to reflect on their actions and on these, thus building a body of knowledge of new actions.¹⁸

By stimulating the development of artistic talent in the face of uncertain and conflictive situations, the pedagogical relationship prepares the future nurse to deal with experiences in the care setting that require answers that escape the canons of technical rationality. In the classroom scenario, there is a wealth of statements, statements and languages, which, when explored by the teacher during interaction with the students, and through the adoption of teaching-learning strategies, contribute to the best use of the contents covered in the theoretical context.¹⁹ In the interim, the use of reflection in action in the classroom has already been proven to be essential to fill the gaps in education for practice and to incorporate new pedagogical proposals to strengthen the educational preparation of nursing students for high quality and competence in the care of health care users and their families.²⁰

For a pedagogical approach that incorporates reflective practice, the teacher must constantly reflect on his or her teaching practice, on the objectives of the teaching-learning process, and promote the strengthening of information debated in the classroom, (re)signifying concepts, creating learning opportunities that contribute to the strengthening of the pedagogical relationship and the development of professional artistic talent.¹⁹ This movement of reflection, reflection on action and reflection on reflection in action is a practice that contributes to integrality.

The adoption of active pedagogical practices by the research participants considers the student as a human being in the education process and the teacher as facilitator of this process, who stimulates a reflected practice that assures the student to develop skills and abilities that are in accordance with the national policies of health and education oriented to the interest of the Brazilian population.²¹ However, it is beneficial for the teacher to reflect on his/her continuous education beyond the basic development for teaching, providing changes in the way of thinking and teaching, at both the individual and collective levels.²²

The teacher’s reflection on his / her own performance or on student performance, as well as the student’s reflection on his / her own performance, or on the performance of the teacher may contribute to a noteworthy description of differences, clarify connections of a long and rapid set of demonstrations, or reveals the understanding that informs the superficial variations in the teaching-learning process.³

Starting with these principles, we will certainly be able to give voice to the subject, listening and attending to their health needs and we will find strategies to face the uncertain situations found in practice. Thus, during nurse education the student should be encouraged to develop artistic talent so that he/she can build himself professionally as a nurse who is able to seek answers to the uncertain and complex demands of health.

Developing artistic talent and caring in the perspective of integrality is a path that emanates from the pedagogical relationship and, therefore, cannot be treated parallel to it. Thus, when experiencing a relationship that stimulates these pedagogical principles during education, students are more likely to apply them during and after. Educating health professionals based on integrality also requires the inclusion of this principle in the pedagogical positions, perceiving the student as a being in the education process and recognized in their integrality.

CONCLUSION

The elements of the pedagogical relationship in the practical-reflexive teaching that characterize learning based on the integrality principle during nursing training are related to the theory and practice connection, to the development of professional artistic talent and to the reflection process on and about action.

The pedagogical relationship plays a fundamental role in “basing” theory and practice, stimulating the student to reflect on what was learned in the articulation between theoretical knowledge and the practice. However, although this articulation was little supported in the teaching plans, the teachers showed commitment and felt challenged to stimulate this student competence, both in the theoretical and practical context.

The process of knowing and reflecting on action needs to be stimulated so that it becomes more reflection on acti on and reflection on reflection in action. Thus, the logic of teaching based on technical rationality is broken down an epistemology of reflexive practice is approached that opens up possibilities for actions in the perspective of integrality. The pedagogical relationship in the course needs to create possibilities to train competent professionals to act in the face of uncertain and conflicting situations found in health services. The development of this competence and ability is directly related to the reflection process in the action and on action, encouraging the development of the professional artistic talent.

It is evident that these characterizing elements of teaching in the perspective of integrality are very recent, considering that nursing education has its basis built on technical rationality. Therefore, it is understood that, although we have public education and health policies that break this paradigm, we are still collectively building new pedagogical possibilities to meet both the health needs of the Brazilian population and the demands of the health education itself.

• 1
  Article extracted from the dissertation - The pedagogical relationship in the reflective practice education as an element for nursing education in the perspective of the integrality, presented to Programa de Pós-Graduação em Enfermagem (PEN), Universidade Federal de Santa Catarina (UFSC), in 2015.

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Publication Dates

• Publication in this collection
  2018

History

• Received
  25 May 2016
• Accepted
  03 July 2017