Profile of students registered in nursing auxiliary and technician courses of the Nursing Worker Professionalization Project (PROFAE) in Rio de Janeiro - Brazil

Abstracts

O objetivo deste trabalho é apresentar o perfil dos alunos ingressos nos Cursos de Qualificação Profissional para Auxiliar de Enfermagem e Complementação para Técnico de Enfermagem do Projeto de Profissionalização dos Trabalhadores da Área de Enfermagem (PROFAE). Esta é uma pesquisa quantitativa, desenvolvida no Estado do Rio de Janeiro, no período de agosto de 2004 a janeiro de 2005, com aplicação de 1400 questionários. Os dados foram tratados com estatística descritiva, sob a forma de freqüência simples e percentual. Depois de tabulados, eles foram divididos nas seguintes categorias: dados sociodemográficos, formação escolar, perfil familiar, hábitos, atuação profissional, faixa salarial, expectativas sobre o PROFAE e a Enfermagem, dificuldades para participar do Projeto, e processo ensino-aprendizagem. Os alunos/trabalhadores formados pelo PROFAE tendem a melhorar a qualidade da atenção hospitalar e ambulatorial, contribuindo para a dinamização do mercado de trabalho no setor de saúde.

credenciamento; enfermagem; ensino

Este trabajo busca presentar el perfil de los alumnos que ingresaron a los cursos de Calificación Profesional para Auxiliar de Enfermería y complementación para Técnico de Enfermería del Proyecto de Profesionalización de los trabajadores del Área de Enfermería. Esta es una investigación cuantitativa, desarrollada en el Estado de Rio de Janeiro, en el período de agosto del 2004 a enero del 2005, con aplicación de 1.400 cuestionarios. Los datos fueron tratados con estadística descriptiva, bajo la forma de frecuencia simple y porcentaje. Después de tabular los datos, fueron divididos en las siguientes categorías: datos sociodemográficos, formación escolar, perfil familiar, hábitos, actuación profesional, piso salarial, expectativas acerca de PROFAE y de la enfermería, dificultades para participar del Proyecto y proceso de enseñanza-aprendizaje. Los alumnos/trabajadores formados por el PROFAE tienden a mejorar la calidad de la atención hospitalaria y ambulatoria, contribuyendo con la dinámica del mercado de trabajo en el sector de la salud.

habilitación profesional; enfermería; enseñanza

ORIGINAL ARTICLE

Profile of students registered in nursing auxiliary and technician courses of the Nursing Worker Professionalization Project (PROFAE) in Rio de Janeiro - Brazil

Beatriz Guitton Renaud Baptista de Oliveira^I; Isaura Setenta Porto^II; Márcia de Assunção Ferreira^III; Joyce Beatriz de Abreu Castro^IV

^IPhD in Nursing, Full Professor, Federal University Aurora Afonso Costa College of Nursing, e-mail: [e-mail]

^IIPhD in Nursing, Adjunct Professor, CNPq Researcher, e-mail: [e-mail]

^IIIPhD in Nursing, Adjunct Professor, e-mail: [e-mail]

^IVRN, M.Sc. in Nursing, e-mail: [e-mail], Rio de Janeiro Federal University Ana Nery College of Nursing

ABSTRACT

This paper aims to present a profile of students registered in the Professional Training Courses for Nursing Auxiliaries and Complementation Courses for Nursing Technicians of the Nursing Worker Professionalization Project - PROFAE. This quantitative study was carried out in the State of Rio de Janeiro, Brazil, from August 2004 to January 2005, through the application of 1,400 questionnaires. Data analysis used descriptive statistics, with simple frequencies and percentages. After tabulation, data were divided in the following categories: sociodemographic data, educational background, family profile, habits, professional activity, salary range, expectations about PROFAE and nursing, difficulties to participate in the project and the teaching-learning process. Students/workers graduated from the PROFAE program tend to improve the quality of hospital and outpatient care, contributing to labor market dynamics in the health sector.

Descriptors: credentialing; nursing; teaching

INTRODUCTION

Human resource training constitutes the basis for the realization of health actions and services, and the Nursing Work Professionalization Project (PROFAE) is a professional qualification strategy that strengthens health education as part of a public policy.

The implementation of innovative pedagogical experiences like the Large Scale Project, created in 1981 to integrate the health and education sector, brought the question of professional training into the work space, but was not able to attend to the entire workforce demand⁽¹⁾. In 2000, UNESCO established a technical cooperation project with the Brazilian Health Ministry to carry out the PROFAE. The development objective of this cooperation was to improve the quality of hospital and outpatient care in Brazil, creating conditions for the sustainability of auxiliary nursing staff training mechanisms⁽²⁾.

Research indicates that, in Brazil, there is a chronic lack of qualified technical professionals, which entails a risk for health care delivery to a majority of the population⁽¹⁾. During many years, job offers for nursing technicians were restricted, leading to the use of a non-qualified workforce without specific training.

PROFAE was proposed to train nursing workers without professional training who were active in the labor market, estimating, at the start of the project, a contingent of 225 thousand workers to be trained during a four-year period. About 25% of these professionals should also receive complementary basic education.

Later, about 100 thousand workers were added to this contingent, who worked at institutions developing nursing activities of high and medium complexity, had finished basic education and needed complementary qualification at the level of nursing technicians.

In the State of Rio de Janeiro, PROFAE ended in 2005. Besides all management and pedagogical difficulties that were faced, one important question that came up is about the profile of students who started the course. During the candidates' enrollment, first at Banco do Brasil and later at the Municipal Health Secretaries, many people registered without having the required nursing work profile, such as ambulance drivers, desk clerks, unemployed, among others⁽³⁾.

Nowadays, professionals should prioritize the search for further qualification and constant recycling, in view of the social damage its lack causes to less informed people in the globalized environment, characterized by rapid modification, fierce competition among companies and the violent struggle in the labor market. Hence, globalization has confronted professionals with challenges. These need to maintain the conditions needed to act in line with current market demands, as this new standard requires quality, flexibility and greater productivity.

The Rio de Janeiro State Regional Agency developed a corporate plan to supervise, monitor and assess PROFAE courses. In this plan, one of the studies addressed the profile of students who took the Professional Training Course for Nursing Auxiliaries (QP) and the Complementary Training Course for Nursing Technicians (CQP), and aimed to get to know some of their characteristics, interests and expectations about the course and the profession. These data were valuable to reorient pedagogical practices that attempted to attend nursing workers-students' needs more efficiently.

OBJECTIVE

To present the profile of students registered in the Professional Training Courses for Nursing Auxiliaries and Complementary Courses for Nursing Technicians in the Nursing Worker Professionalization Project (PROFAE).

METHODOLOGY

A quantitative methodology was adopted. The study was carried out in the State of Rio de Janeiro, between August 2004 and January 2005, including students who were starting the QP and CQP under the PROFAE project.

We applied 1400 questionnaires with 34 closed questions. For some questions, students could mark more than one answer. The questionnaires were answered by 109 students from the QP course and 1291 students from CQP. These were invited to participate in the study, received information about the study goal and guarantees about their anonymity.

Answers were transcribed to optic reading cards. Data were processed through descriptive statistics, using simple and percentage frequencies. After they had been tabulated, data were divided in the following categories: sociodemographic data, education, family profile, habits, professional activity, wage range, expectations about PROFAE and Nursing, difficulties to participate in the project, and teaching-learning process. Data analysis and discussion was based on relevant literature.

This research followed the procedures recommended by National Health Council / MS Decree No 196 / 86 and was approved by the Research Ethics Committee at Rio de Janeiro Federal University (UFRJ) Ana Nery School of Nursing / Teaching Hospital São Francisco de Assis. All participants signed the Free and Informed Consent Term.

RESULTS

The students' sociodemographic characterization showed that, during data collection, the group included predominantly women (85.7%), between 31 and 50 years old (65.6%), married or living with a partner (51.5%).

As to education, most students (69.7%) finished basic education in a regular course, although 39.5% of them obtained the degree through intensive adult education. Furthermore, 72.1% of students finished basic education more than 11 years ago; 28.4% of QP students answered that they concluded the last year of basic education between two and five years earlier. What secondary education is concerned, 52.3% of students from the auxiliary course were either taking the course or had not started it yet, while 59.7% of students from the technical course had graduated more than five years earlier.

Almost all students from the QP and CQP courses, that is, 90.5% of the study universe, answered that they did not speak any foreign language. With respect to computer use, 40.5% of the interviewees informed they could not use this equipment, while 39% used Word® (or equivalent software) with difficulties.

As to the education level of QP and CQP students' parents, as shown in Figure 1 below, a majority knew how to read and write, however, without finishing the fourth year of basic education (43.4% of mothers and 38.4% of fathers). These were followed by parents who finished basic education, with significant incidence levels (31% of mothers and 30.8% of fathers). Although the incidence of illiterate parents was far lower (14.6% of mothers and 9.4% of fathers), this level was nevertheless higher than for parents who finished secondary and higher education (7.4% of mothers and 9.7% of fathers). This analysis reveals that, in general, from an educational perspective, most students come from families with low instruction levels.

What the family universe is concerned, most students (84.4%) answered that they lived with between two and five other persons. As to family income, 39.5% of QP and 25.1% of CQP students received up to two minimum wages, according to Table 1 below.

The interviewees' living habits showed that 64.6% of them preferred to listen to music instead of listening to the radio; 82.9% preferred to watch the TV news and 51.1% read newspapers or journals every week.

Employment-related items showed that most students had a job (61.5% QP and 71.3% CQP), although 35.8% of students from the auxiliary course were unemployed.

As to their work load, 62.1% of students informed that they worked between 25 and 44 hours per week. What their remuneration is concerned, 49.3% of the interviewees from the QP course gained one salary and 43.3% from the CQP course between one and two salaries.

In the group of employed interviewees, 91.5% work in the health area, with 36.5% of QP students working as community agents and 76.8% of CQP students as nursing auxiliaries, 40.7% of whom indicated they had been working in this area for more than ten years.

With respect to the kind of institution they work at, 52% of students were municipal public servants, with 65.4% of students from the auxiliary course working in the basic network and 54.3% of technical students in the hospital network. Among the respondents who worked in the basic network, 58.8% of QP and 47.6% of CQP students, respectively, were active at Health Centers. Among students in the hospital network, 91.7% of QP and 69.7% of CQP students, respectively, were active in general hospitals.

Students' expectations about PROFAE are presented in Table 2 below. For 70.6% of QP and 80.6% of CQP students, the project mainly represents learning new techniques and procedures that are essential to the profession. According to 61.5% of QP and 77.4% of CQP students, the project represents knowledge to understand the meaning of the work they do.

When asked about what they intend to do after finishing the course, 63.4% of students said they intended to keep on studying. However, other issues were also appointed, such as changing one's function at work (17.4%) and changing one's profession (9.1%).

For 75.1% of students, nursing work is important for patients. According to 64.3%, it represents work that helps to maintain and recover health and, for 26.3%, an opportunity to help one's fellow human beings. Other issues received little mention, such as it's a job like any other (2.9%) and helps the physician's work (0.7%).

Table 3 lists the main difficulties students faced to participate in PROFAE, highlighting transport costs to go to school (51.9%). Other significant aspects were students' tiredness because of work (36.1%) and not being released by the employer (23.6%) to attend the courses.

As to the teaching-learning process, 66.9% of students said they considered it was easier to do group work, as many opinions need to be discussed.

DISCUSSION

Sociodemographic data show that the predominance of female workers (85.7%) ratifies one of the sociohistorical characteristics of the nursing profession. Brazilian nursing, organized and structured by the "Nightingalean" paradigm, developed as a female profession and is recognized as such in any sphere of society.

At colleges, male students started to enter the profession from the 1970's onwards, when entry exams were established. Until then, schools themselves used to select their candidates and generally only accepted women⁽⁴⁾.Although both genders have been active in nursing work for a couple of years now, data show that nursing auxiliaries and technicians are still substantially female functions.

Students' age range was concentrated between 31 and 50 years, revealing a more mature group seeking professionalization, mainly for QP students; for CQP students, on the other hand, the course meant knowledge expansion (Table 2). These results are coherent in that a professionalization course was offered to students who were mostly health workers and formally inserted in the labor market.

Sociodemographic profile data appointed important indicators that can support teachers in planning and conducting the teaching-learning process, in order to make students overcome their difficulties and conquer the challenges inherent in taking a professionalization course, such as the fact that 69.7% of students finished basic education in a regular course, 72.1% of whom more than 11 years ago. Students from the technical course informed they had finished secondary education more than five years ago. The time passed between this conclusion and the start of PROFAE courses certainly required the recycling of basic knowledge needed to develop some specific nursing contents.

Thus, these courses were able to provide professional qualification and raise education levels, as many students had to finish basic education to take the nursing auxiliary course, while other finished secondary education to take the complementary course.

In Brazil, professionalizing schools do not manage to train workers who attend the needs of countless labor market segments at the same speed as technological advances, particularly in information technology. Moreover, institutions should not restrict themselves to the simple act of training, as this attitude limits creativity, reduces the possibilities of autonomy and leads to a lack of flexibility in workers.

When talking about raising education levels, we need to heed to the quality of this process, that is, the guarantee of indispensable knowledge in order to, at least, make sure that professionals will be able to survive in a world marked by growing knowledge⁽⁵⁾. This challenge is also inserted in the context of professional education, which is no longer a local issue and acquires a broader dimension, directed at a demanding labor market that requires more diversified professional skills and knowledge⁽⁶⁾.

Another contributive factor to understand the context PROFAE students were inserted in is the social-family profile. Majority data about the families these students came from demonstrate that their parents' education level is low. This is mainly true for the mothers, as 43.4% of them knew how to read and write, but did not finish the fourth year of basic education, while 14.6% were illiterate. As to the fathers, 38.4% knew how to read and write, without finishing the 4th year of basic education, and 9.4% were illiterate. Less than 10% of students have one parent who finished secondary education.

Children's education level increased in comparison with their parents'. This entails the possibility of social, cultural and economic ascension in the family⁽⁷⁾. However, in order to reach a higher qualification level, these people had to surmount the difficulties imposed by the precarious basic education obtained from public schools⁽⁸⁾, by the lack of contact with people in a study environment, besides economic difficulties that distanced them from some facilities, such as access to informatics, scientific and cultural events. These students were characterized as a group that attempted to overcome the inequalities imposed by a capitalist system, seeking professionalization and the possibility of getting a job.

What students' family income is concerned, although a majority gained up to two minimum wages in the CQP group, we found only a small difference with families gaining between two and three minimum wages. These low wages signaled the countless difficulties these students had to face in order to study. The salary issue may also have been one of the aspects that motivated them to invest in these courses as, for most of them, qualification represented the opportunity to increase their financial revenues and improve their employability.

Low monthly salaries can explain most Brazilians' living habits, who prefer leisure at home. In their free time, they prefer to stay at home, tend to watch TV for 4h50min per day on the average, like reading and regularly read magazines⁽⁹⁾.

As to the students' employment situation, most of them had a job (61.5% of QP and 71.3% of CQP). It should be highlighted that 35.8% of QP students were unemployed. This may explain the relevance of these courses for their professional lives, as they represent new opportunities to get inserted in the labor market. However, if on the one hand unemployment can be considered a stimulus towards their professionalization, on the other, it becomes a barrier, considering the lack of resources to pay for transport expenses, food, among others.

The interviewees declared that they work between 25 and 44 hours per week. Nevertheless, in a PROFAE report, students who already worked as nursing auxiliaries declared that nursing professionals tend to have an exhausting hour load, as most of them have two or three jobs to compensate for low salaries⁽¹⁰⁾. Low remuneration produces an accumulation of jobs, stress, physical exhaustion and low motivation. As a result, professionals no longer make efforts to participate in professional recycling processes.

A significant number of employed students were active in the municipal health network, revealing a regional worker profile. A majority of QP students worked in the basic health network, as 36.5% of them were community agents and 34.6% also had other activities. In this sense, many students from the nursing auxiliary course worked at health institutions, mainly as ambulance drivers, receptionists and desk clerks, which are not considered part of health professions⁽³⁾.

Most students from the technical course were nursing auxiliaries who worked in the hospital network, seeking knowledge to improve their activities and positions, besides conquering greater possibilities in the labor market. This movement can be explained by the trend to extinguish the nursing auxiliary category. In line with these data, a research carried out in the State of São Paulo emphasized a certain parity between nursing auxiliary and technician courses, whose students already seek specialization in their professional course, mainly for the hospital area⁽¹⁾.

Students held many expectations about PROFAE. The following were most frequent, as they were aimed at improving their professional performance: acquiring greater knowledge about essential technical and procedures for the profession, and a better understanding about the meaning of their work in order to improve their activities and job position. Both types of students intended to keep on studying to improve their knowledge. The distinguishing element was that QP students were anxious to change their profession, while CQP students wanted to change functions in their current job.

As to the students' difficulties, most answers highlighted transportation costs to go to school, tiredness because of work and not being released by their employer. In this sense, the student aid PROFAE offered and the location of course groups close to students' homes or work places were important strategies to decrease absenteeism and benefit their continuation in the courses. In view of these difficulties, some students mentioned that, in attending the course, they attributed a higher priority to training than to theoretical classes⁽¹¹⁾.

With respect to the teaching-learning process, students indicated teaching strategies that offered them opportunities to work in groups, including in-class discussions. In PROFAE students' free testimonies, experience exchange appeared as quite a significant strategy to stimulate knowledge socialization⁽⁸⁾.

CONCLUSION

The analysis of students' records showed that they faced difficulties to take the course and needed to overcome many barriers to achieve the goal of professional training. Many problems emerged which had to be surmounted, related to financial matters, time availability and outdated knowledge. Most students mentioned that they were complementing their training because it was part of a public teaching policy and that, otherwise, they would not be able to pay for the courses. These data were observed by composing the students' profile, as most of them belonged to poorer social classes with fewer sociocultural opportunities, on the point of allowing them to compete equally in the labor market and in public employment contests.

The increase in workers' education level; professional training with emphasis on technical-scientific knowledge and work experiences were mediated by a pedagogical dimension and, mainly, by a social and ethical-political dimension. Moreover, to attend workers' training needs, other issues were taken into consideration, such as their education and certification.

Considering that human resource policies are aimed at staff preparation and utilization and professional regulation, the public policy to provide professional nursing training needs to be continued and expanded to health workers in general, as a permanent part of governmental actions, contributing to make the health labor market more dynamic and to improve care delivery to the Brazilian population.

Recebido em: 1º.11.2005

Aprovado em: 7.8.2006

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Publication Dates

• Publication in this collection
  15 Mar 2007
• Date of issue
  Feb 2007

History

• Received
  01 Nov 2005
• Accepted
  07 Aug 2006