CHALLENGES TO THE ADAPTATION TO HIGHER EDUCATION IN NURSING UNDERGRADUATE STUDENTS

ABSTRACT

The transition to Higher Education involves significant changes. This study aimed to understand the main challenges reported by students entering the first year of a Bachelor’s and Licentiate in Nursing course at a public university. This is a qualitative research carried out with 78 students who participated in two de reflexão groups, one with freshmen in 2018 (n=38) and another in 2019 (n=40). These meetings were audio-recorded, transcribed and subjected to thematic content analysis. Emerging themes refer to social support, mental health and the high course load. Veteran students can form a significant support network because they have been through similar situations. It is suggested that the challenges narrated in a group can be appreciated collectively, avoiding a position of individual blame. It is recommended that the transition to Higher Education can be reflected by university management, triggering more inclusive and welcoming policies aimed at this public.

Keywords:
higher education; nursing; student

RESUMO

A transição para o Ensino Superior envolve expressivas mudanças. Este estudo teve como objetivo conhecer os principais desafios relatados por alunos ingressantes do primeiro ano de um curso de Bacharelado e Licenciatura em Enfermagem de uma Universidade pública. Trata-se de uma pesquisa qualitativa realizada com 78 estudantes que participaram de dois grupos reflexão, um com ingressantes em 2018 (n=38) e outro em 2019 (n=40). Esses encontros foram audiogravados, transcritos e submetidos à análise de conteúdo temática. Os temas emergentes referem-se ao suporte social, à saúde mental e à elevada carga horária no curso. Os alunos veteranos podem compor uma significativa rede de apoio pelo fato de terem passado por situações semelhantes. Sugere-se que os desafios narrados em grupo possam ser apreciados coletivamente, evitando uma posição de culpabilização individual. Recomenda-se que a transição para o Ensino Superior possa ser refletida pela gestão universitária, disparando políticas mais inclusivas e acolhedoras voltadas a esse público.

Palavras-chave:
Ensino Superior; enfermagem; estudante

RESUMEN

La transición a la enseñanza universitaria abarca expresivos cambios. En este estudio se tuvo como objetivo conocer los principales desafíos relatados por alumnos ingresantes del primer año de un curso Graduación y Licenciatura en Enfermería de una Universidad pública. Se trata de una investigación cualitativo realizado con 78 estudiantes que participaron de dos grupos reflexivos, un con ingresantes en 2018 (n=38) y otro en 2019 (n=40). Esos encuentros fueron audio grabados, transcritos y sometidos al análisis de contenido temática. Los temas emergentes se refieren al soporte social, a la salud mental y a la elevada carga horaria en el curso. Los alumnos veteranos pueden componer una significativa red de apoyo por el hecho de tener pasado por situaciones semejantes. Se sugiere que los desafíos narrados en grupo pueden ser apreciados colectivamente, evitando una posición de culpabilización individual. Se recomienda que la transición a la enseñanza universitaria pueda ser reflejada por la gestión universitaria, disparando políticas más inclusivas y acogedoras volcadas a ese público.

Palabras clave:
universitaria; enfermería; estudiante

Attending a university is an important experience in the lives of many young people, especially in the Brazilian context, in which a considerable portion of the Brazilian population is still historically excluded from this process by diverse reasons that include social, cultural, political, and economical elements (Terra, Carraro, & Ferreira, 2019). One of the challenges of higher education is to guarantee permanence, psychosocial development, quality formation and the means to finish the course for every student (Barbosa, Oliveira, Melo-Silva, & Taveira, 2018; Dias, Carlotto, Oliveira, & Teixeira, 2019), which will later have to be observed by indicators related, for example, to transition to the job market.

Social expectations and academic demands for formation in higher education most often cause feelings of excessive pressure among university students. In this scenario, diverse difficulties might be created when it comes to adaptation and also in the experience of this period, which manifest themselves in different ways, such as dissatisfaction, poor academic performance, health problems, and evasion. Thus, identifying and understanding the emerging difficulties in the trajectories of university students might lead to better adaptation by this contingent in the new context (Dias et al., 2019; Scorsolini-Comin, & Gabriel, 2019).

According to the literature, the challenges faced by young people upon entering higher education include themes that can be academic, institutional, related to social relationships, related to psychosocial developments, and vocational (Cabras & Mondo, 2018). In this trajectory of changes and adaptations, entering university represents an important step in students’ educational trajectories, and this transition is a process that can be complex and delicate, involving an array of changes in personal, emotional, social, and professional realms while leading students to the need to adapt to this new life context and its specificities (Cabras & Mondo, 2018).

University students might display behaviors that are still typically expected at the adolescence stage such as greater dependence on parents or issues related to self-image as well as typical characteristics of adult life, with greater labor engagement, for instance (Preto, 2018). This stage, also known as emergent adulthood, might cover the transition from adolescent into adulthood with all the challenges that are inherent to this transition between the stages of life cycle (Barbosa et al., 2018).

On the other hand, adaptation into higher education has no longer been investigated as a condition that is exclusively anchored on the students themselves and on their capacities for such transition. Thus, it becomes evident that higher education institutions have the responsibility to provide students with support during the students’ process of adaptation, considering a better search for results in their trajectory, whether personal, academic, or professional (Scorsolini-Comin & Gabriel, 2019).

Although the effects of this transition might affect all university students, research points at the specificities of undergraduate students in the health area and the fact that such students are more likely to issues related to mental health due to exposure to stress, to competition, and to an extensive routine of studies, internships, and examinations (Almeida, Carrer, Souza, & Pillon, 2018; Marchi, Bárbaro, Miasso, & Tirapelli, 2013). Concerning the Nursing Course, these demands are related to the construction of a career that is strongly connected to long work hours and the realization of procedures that demand rigorous discipline, technical management, and exposure to risks and mistakes caused by these activities (Almeida et al., 2018). Understanding that these students are already likely to have to deal with human suffering during graduation is essential for understanding that occupational stress might be already present since the beginning of academic life (Marchi et al., 2013).

The types of Nursing courses in Brazil include the Bachelor Degree, the licentiate graduation course, and the degree that combines bachelor and the licentiate graduation. The bachelor degree prepares general practice nurses to work in the caretaking of individuals, families, and community groups, aiming at the promotion of health, the prevention and treatment of illnesses, and the realization of studies that provide answers to emerging issues in the country. Some institutions still offer regular graduation courses that focus on professionals that have already had training in Nursing and who aim at getting the title of professor nurse and work at nursing technical schools, in addition to the management of other sections.

In 2006, another mode was created. Known as Bachelor Degree in Nursing, it aims at graduating general practice nurses who are able to work in the assistance practice of nursing and also in the education area. In order to do so, students have opportunities to learn as they work on their formation as nurses in the competence area of full caretaking for collective and individual needs according to the principles of primary attention to health care. In the professional field of so-called licensed nurses, the aim is to offer courses that lead students to build up their knowledge, competences, and attitudes that are necessary for teaching at nursing vocational courses for nurses and nursing assistants. Besides that, licensed nurses are also prepared to work in elementary education by means of health promotion strategies and to continue their formation in terms of post-graduation, which will lead these professionals to work in higher education institutions (Ribeirão Preto Nursing School - EERP/USP, 2018).

The Bachelor and Licentiate Degree have a minimum duration of five years, unlike the two other modes that, generally, get finished within a period of four years. The research realized regarding this mode comprehend the incentive to the promotion of health in the curriculum (Nakano & Gonçalves, 2019), as well as the pedagogical-scientific methodologies that are approached throughout the course (such as portfolios, pedagogical cycles, reports, and searches) (Gonçalves, Andrade, & Silva, 2019). An emergent blank space consists of getting to know how these students have experienced the entrance to the University, while discussing elements that might facilitate this process. After this panorama, this study had the objective to get to know the most important challenges reported by students entering the first year in a Bachelor with Licentiate Degree in Nursing at a public university. He identification of these elements might benefit, afterwards, the outlining of strategies that might strengthen the entrance process and support the permanence of these students in higher education.

METHOD

Type of study and ethical considerations

It is an exploratory, descriptive research of qualitative approach (Flick, 2009) and based on the methodology of reflexive groups (Dellarossa, 1979). The reflexive character group is a mode that is indicated to help in diminishing anxiety and stress in the participants. It is guided by the comparison of a phenomenon or a trigger that is common for all participants or that can be motivating enough for all. Concerning the present, this phenomenon was the ticket to higher education (Rossato & Scorsolini-Comin, 2019). The project that led to this study was approved by the Committee of Research Ethics of the institution where the researchers work (CAAE 99807118.0.0000.5393).

Participants

78 students participated in the study. They were attending a Bachelor and Licentiate Degree course at a public university in the state of São Paulo, distributed into two groups. One group was made up of students who had entered the course in the year 2018 (n=38), and the other group was from 2019 (n=40). The students were enrolled in the second semester of the course and were invited to participate in the study after some advertising of the research in the classrooms.

In 2018, 38 of the 46 enrolled students of the first year of the Bachelor and Licentiate Degree in the referred institution participated in the research, that is, 79,2%. Most of the students, 76.3%, were female. In 2019, out of the 48 of the enrolled students of the first year of the Bachelor and Licentiate Degree Nursing Course, 40 participated on the study, that is, 83,3%. Out of this contingent, 87,5% were female, which corroborates the perception of feminization of the Nursing profession, which can also be understood as a reflection of socio-cultural and historical values that get by the profession throughout time (Souza, Araújo, Silva, & Bêrredo, 2014). Such elements associate Nursing with caretaking, which is made available generally by women. Besides that, these considerations are shadowed by the fact that Nursing is a career with less remuneration when compared with other professions in the health area, which cannot be understood in disconnection with asymmetry in the relations of gender and with the way the profession has been portrayed in our context, where it has often been associated with aspects such as maternity and personal care.

Most of the students who entered the course in 2018 (n=24; 63,1%) came from high school at public institutions. In the year 2019, this proportion got more even (n=20; 50%), when half the number of students came from public schools and the other half from private schools, which might produce an effect on the current policies for access to public higher education with the existence of affirmative action. The access policies are inserted in this context, because in the beginning of the 2000s affirmative action was adopted by some universities and, in the year 2012, Law no. 12.711/2012 guaranteed the reservation of 50% of the enrollments per course and time of day at the federal institutions of higher education and the students who had done their full high school studies at public institutions. At the higher education institution where the data were collected, due to the fact that they were run by state administrations, the adoption of affirmative action only took place after the year 2018. Thus, the present research was realized in the first two years of such affirmative action in the referred university.

PROCEDURE

Data collection

The collection of data was realized at the end of the second semester of year 2018 and at the end of the semester of 2019, so that the participants could share experiences related to the first year of course, contemplating not only the ones produced in the first weeks, when major adaptations can be observed, but also in terms of knowledge regarding the campus, the functioning of the university and also the new routine of studies. Experiences produced throughout time are also included.

The collection of data took place in two days. The first day of collection took place in the month of December of the year 2018 with the student who had entered the course in the month of February of that year. The second day of collection happened in December of 2019 and included the participation of students who had entered the course in the month of February of 2019. At both moments, the invitation was made in the classroom and was it was explained that the collection would take place on a single day, with the maximum duration of two hours, in a room that had been reserved by the university. Participating students were organized into two groups, students with students who entered in 2018 and another with students who had entered in 2019. The corpus of this study, therefore, included two groups for analysis. Based on the consent of the participants, the term of free informed consent was provided, collectively read, and signed afterwards.

Both groups were conducted and coordinated by psychologist, without a direct connection with the groups of students, who was a doctorate student at the same university and supported by a co-coordinator, also a psychologist, professor at the institution who had once had a contact with the groups in disciplines offered in the first year of course. The groups were supported by a graduated student from the Bachelor and Licentiate Degree Nursing course who was, at the time, investigating the theme of adaptation into higher education in a scientific initiative. The coordinator as in charge of organizing group dynamics, conduct discussions, realize punctuations when necessary, and interpret the contents that emerged from the group field. The co-coordinator was responsible for organizing group dynamics. The student was supposed to realize the plans for group movements that could be relevant for the research and could contribute to the discussions.

The guiding question for the groups was: “What are the challenges related to entering the university?” this question aimed at understanding the students’ demands during entrance as well as how possible difficulties during the process could be dealt with. After the acquisition of the groups’ consent, the groups were recorded and afterwards transcribed fully and literally. The result of the 164 minutes recorded in audio in the two groups composed the analytical corpus.

Data Analysis

Data were organized and analyzed by means of theme analysis proposed by Braun and Clarke (2006), which took place a posteriori, that is, considering the contents of the group reports. The themes were primarily constructed in each one of the groups and then there was a new analysis integrating the categories produces at the first two moments of collection, in order not only to compare the senses produced in each group, but also to compose an array of themes that collectively approached the experiences of these two years of entrance. In the analysis, three major emerging themes were identified: (a) social support; (b) mental health at the university; (c) hours of higher education. Later on, these themes were interpreted by means of the extant literature both in the field of university transition and in the studies on the mental health of university students.

RESULTS AND DISCUSSION

Students, during the sessions, pointed at several situations related to the challenges of adaptation to university, along situations that directly influence school evasion, mental health, and adaptation. Among the approached topics: distance from home, independence, anxiety, responsibilities, social support, excessive hours, maturing, lack of support with the university, and mental health. During the analysis, it was observed that this transition period can be a determining factor and it configures a moment of major challenges and learning experiences as well. Afterwards, researchers discuss the elements that emerged with more frequency in both groups.

First theme: Social Support

During the sessions, there was evidence of how social support is considered a foundation at this moment of the lives of the students. In their reports, the student mentions their families, friends, and acquaintances made during college as factors that help them keep strong in the academic environment. This configuration can be associated to individual health and well-being, which can be helpful in understanding how relations can influence trajectories, whether positive or negative. It is also pointed out that social support is stronger when students live with their parents, a situation where they still share responsibilities without becoming overwhelmed with expenses during this period of their lives (Preto, 2018).

The social support from within the academic environment is provided by more experienced students because the reception provided by people who were also supported can be more trustworthy because the new students still have to handle uncertainty. The reports highlight the importance of this reception by more experienced students:

When I got started I didn’t even know how to go home after class. I was living at a republic and was not familiar with my surroundings so I was helped by the student who boarded with me. [Participant 17, group 1] A factor that makes a difference here (...) is the warm reception that I was given. (...) I remember that, when I came to do my registration, some older students came up to me and gave me a hug and said that I was very welcome to their community (...) it was something that really strengthened my feelings of affiliation. [Participant 32, group 1]

As reports are presented, it is possible to notice that peers provide emotional support for situations that can be very difficult during the adaptation of students to university life. What commonly happens is the end of previous friendship ties kept by these students because of the distance and the new reality they have to face. This new reality, which reflects itself by means of new friends within the academic cycle itself, emancipates the new friends to the status of a very important support network, which will be developed and strengthened during graduation. Although the family is a fundamental element of support for students entering higher education, the students’ circle of friends also plays an effective, significant role and it is essential for students to exchange course experiences, assessments, and other personal issues (Elmir, Ramjan, Everett, & Salamonson, 2019).

Changes still make themselves pungently felt at this time of adaptation. They include leaving the parents’ home, which is a determining turning point because it represents a stage of transition to adult life when young people have to deal with responsibilities, domestic chores, financial issues, their own safety and so on. For most of the students, it is necessary to move to another city, which leads them to leave their parents’ home and live with other people with whom most of them had never had any previous contact. These adaptation difficulties, along with emotional mattes, excessive hours, in addition to family problems, such as distance and parental pressure (Preto, 2018), can become a wearisome situation and lead to loss in academic and personal life for students. It is still possible to observe great support within the environment of student accommodations (such as republics), due to everyday experiences and challenges along the students’ learning trajectories.

It feels like getting a little certificate... it’s like, ok, from now on I will be a grownup and walk with my own legs. [Participant 18, group 2] Transition was difficult in the beginning too. I am 300 km away from home and the hours are intense and we have a lot of classes, and assignments and examinations, and I really miss home. [Participant 29, group 1]

In addition to these elements, the team of teachers can interfere in the process of adaptation to higher education, and must be willing to help students according to their emerging necessities. The reception right after the moment of entrance in the graduation course is a matter to be discussed because it helps students feel safer and have access to friendly environments in addition to facilitating the development of skills for facing future situations (Scorsolini-Comin & Gabriel, 2019).

The protection factors must be involved in this item, due to the considerable increase in the number of traumatic situations and their consequences when exposed to the challenges of the academic environment (Brondani, Hollerbach, Silva, Pinto, & Corrêa, 2019). In addition to that, students can work on situations that reduce the risk for developing emotional problems that will affect mental health. Social support seems to be a protection factor in this trajectory (Karaca, Yildirim, Cangur, Acikgoz, & Akkus, 2019).

Second theme: Mental health at the University

The participants in the study, predominantly young adults, go through emotional and physical impact due to this phase of their lives. The transition from high school to university proves rather challenging because everyday activities take on a more intense rhythm, hours become longer, as well as problems caused by the distance from family. Thus, such circumstances might cause in individuals’ feelings of irritability and preoccupation (Chaves et. al, 2015). This scenario has anxiogenic factors and can be considered possible triggers for depression, stress, anxiety, and loneliness, which are present in students’ lives during graduation and become more evident during the first academic year (Marchi et al., 2013).

In courses in the health area, proximity to suffering and death, for example, can be a stressing factor. Other stressing factors that permeate academic life can involve personal matters and conflicts (Pinho, Dourado, Aurélio, & Bastos, 2015), anxiety regarding academic expectations, distance from family, poor academic performance, low self-esteem and so on. Anxiety, a symptom that is quite prevalent among students nowadays, can become pathologic and be characterized by the occurrence of insomnia, lethargy, irritability, poor memories, concentration difficulty, and somatic complaints (Chaves et al., 2015). It is commonly associated with depression cases (Leão, Gomes, Ferreira, & Cavalcanti, 2018).

The average prevalence of depression in the non-university population is 9% while among university students it reaches 30,6% (Fernandes, Vieira, Silva, Avelino, & Santos, 2018). According to the characteristics and situations elated to the profile of each student, all presented events can directly influence individuals’ health. Some reports on mental health were produced in the groups:

There was an anxiety episode that had never happened to me before because I consider myself a rather calm individual (...) but this year (...) I felt something. I felt like I had reached a limit ... I had my first nervous breakdown (...) [Participant 10, group 2]

I am going through a lot of emotional stuff so… (...) it is quite a battle to get ready and come here especially now that I am going through all this anguish. When I was 17 I was in high school and it was a difficult year (weeping). That was when I got depressed and this year things are getting worse... [Participant 16, group 2]

These accounts show not only that the university environment can be a trigger for suffering but also how come processes of greater emotional engagement connect with previous schooling experiences, such as in high school. It is important, then, that university can represent for this student a space for change, but also for acceptance (Scorsolini-Comin & Gabriel, 2019). In this sense, we can observe that protection factors for such situations must be considered for the academic environment, but in order to do so, other characteristics have to be identified because they are associated with common mental disorders, leading to more assertive actions for health promotion. There is also a preoccupation to observe investments concerning research in the area, and focusing on the prevalence of symptoms referring to the mental health of students because the students point at a significant increase in psychological disorders in this phase (Leão et al., 2018).

Researchers also point at other risks for association with such suffering. There are characteristics such as low income, poor social support, difficulty to establish ties and age, which might directly compromise individuals that are in this phase of development (Feodrippe, Brandão, & Valente, 2013). These elements might be present in this transition since many students financially depend on their parents and are far away from support networks such as family and friends, and they are inserted into a new environment, which can cause difficulty in the creation of connections and in the establishment of safe, long-lasting relations.

In addition to all these problems related to cases such as the ones presented in the accounts, we ca observe the lack of support within the university, which can be considered a risk factor for students. There must be an amplification of qualified professionals for support inside the institutions, promoting support and better attention to individuals that display symptoms or already have diagnoses (Leão et al., 2018).

It is essential that the work of Psychology be put in evidence in this context. It must take place by means of a multi-professional practice in combination with psychiatry, Education and Social Service, for instance. When it comes specifically to psychological practice, we suggest not only individual and group interventions in a clinical proposal but also educational support for these students with a focus on adaptation to higher education. Listening, in this case, must be proposed in a more collective perspective that is integrated to educational aspects that constitute important markers in this period (Rossato & Scorsolini-Comin, 2019). In this sense, the present investigation is necessary in order to subsidize actions of intervention for mental health in the student community. Furthermore, it is important that students understand the infrastructure of the university and promote the development of strategies that facilitate their relationship with the academic environment (Pinho et al., 2015), melhorando o próprio desempenho escolar.

Third theme: Hours of higher education

The hours in Higher Education is a matter that was often approached by students during the group sessions when they shared the difficulties they faced in their courses, especially when their courses involved long hours. In this context, the working hours are seen as a major problem when it comes to the challenges of the transition from high school to higher education, and students need to adapt to this new reality and to academic demands. This point was made as a factor that has the potential to increase exhaustion during the students’ trajectories in the first year of course, limiting further dedication to extracurricular activities, better engagement in the course and in leisure activities outside the academic environment.

The timetable of the referred course, 4575 hours, is produced so that the disciplines for the education area are present since the first year. In the used pedagogical strategies the highlight is on the introduction of technological innovations such as simulations, pedagogical cycles, portfolios, case studies and so on. These devices can be considered facilitators in the learning process, but they must be integrated into a curriculum for reflexive-critical pedagogical conception (Ribeirão Preto Nursing School, 2018).

The long hours of graduation might lead students to feelings of insecurity and inadequacy to accomplish the tasks proposed by the institution while triggering anguish, nervousness, and anxiety regarding their obligations. This overload can be potentialized by aspects of social and personal life and the demands of professional careers (Almeida et al., 2018).

The other friends from college always have some free time (...) we come here willing to participate in different things and activities (...) but then we get too tired and all we want in the end is some time to rest (...) [Participant 30, group 1]

The process of adaptation involves a lot of demands related to routine, context, changes, and personal maturing. These issues demand that university students have more maturity to handle such events and manage to conciliate adult life with the difficulties faced in the transition, which is a situation that can be rather exhausting (Campos, Oliveira, Silva, Otrenti, & Dias, 2019).

Many students, during the sessions, reported that they did not have a real perception of the dimension of the hours at the moment of registration. The courses have classes in the afternoon and evening:

We make another mistake when we do our registrations. Sometimes we are informed that the classes are in the afternoon and in the evening so we think that we will have more time to study, but there we come up against further assignments and things to study in order to merely pass the disciplines. [Participant 12, group 1]

The difficulties in the management of time end up making it more difficult to conciliate leisure, family, and academic activities, and can lead to feelings of incapacity. Although time management and decision making are important skills for professional formation, such elements still prove challenging for these young people, since the course involves activities that must be realized outside the classroom at different times, which might lead students to burnout and serious repercussions in their mental and physical health.

FINAL CONSIDERATIONS

In this study, there was evidence on the challenges faced by students of a Bachelor and Licentiate Degree course in Nursing. All data found reflect the importance of attention and support by institutions and family members so that students can face difficulties at such delicate, and complex moment that is adaptation to higher education.

Although university can be an environment where students get more exposed to stress, it is necessary to develop ways to make this context more receptive, which might contribute to a decrease in evasion. The practice of psychology in this context can be important both in the sense of the construction of resources that will benefit this reception, as in the example of reflection groups and in the ones that we assessed in the present investigation, which lead to an exchange of information, a sharing of experiences and also the construction of strategies and collective solutions, such as an action connected to the promotion of health with the university public and also to a clinical attention paid to individuals as well as group matters that take place in a way that is integrated with institutional policies in pedagogical terms as well as in terms of permanence in higher education.

When it comes specifically to the referred context, the Nursing graduation courses are susceptible to exposure to activities practices in the internships, to overload and to too much contact with human suffering since the beginning of graduation, which might trigger greater stress and anxiety during this trajectory. This context must be considered not necessarily in the sense of construction of specific interventions for this contingent, but that psychology professionals must pay attention to markers such as important vertices for support for these students.

Based on this scenario, the students themselves can engage in the development of strategies for facing and managing situations that contribute to improvements in quality of life while benefitting adaptation to this new context. Although there are numerous challenges connected to this trajectory, it is important to highlight the fact that the institution must be prepared to receive the students, while providing support by means of professors, staff, and educational policies that are more inclusive and receptive, which can unequivocally count on the collaboration of psychology professionals.

The spaces for discussion realized by reflection groups, which take a common phenomenon as a trigger, in this case, entrance into higher education, can facilitate the sharing of challenges among students, and it is a moment when students feel more confident because the group is confidential and experiences are quite similar. It is important for students to understand problems and difficulties are collective and not necessarily collectively and not necessarily individual. These reflections can improve the conditions for mental health in this contingent, which might directly influence quality of life. The realization of these groups by psychology professionals might contribute to the successful management of possible discomforts, as well as to the identification of necessities of support that demand other interventions, such as individual support of certain cases or even assistance of multi-professional character.

This study showed implications for practices related to permanence and student support in higher education. Based on the summarized studies, we expect that university management propels effective strategies that will promote a welcoming reception and support for students, especially for the ones who are entering university and going through a process of adaptation.

The limitations to the present study are related to the researched course because it cannot be compared to others due to the different characteristics such as long hours, periods of availability, disciplines, and duration, not even when we consider other courses in the same area, such as the Bachelor Degree in Nursing. Although this limitation emphasizes a difficulty, it can also be recognized as a potential in the present study because it puts together important specific knowledge on the referred career, which must be appropriated and further investigated in the future research works.

REFERÊNCIAS

• Almeida, L. Y. D.; Carrer, M. O.; Souza, J. D.; Pillon, S. C. (2018). Avaliação do apoio social e estresse em estudantes de enfermagem. Revista da Escola de Enfermagem da USP, 52 https://doi.org/10.1590/s1980-220x2017045703405
• Barbosa, M. D. M. F.; Oliveira, M. C.; Melo-Silva, L. L.; Taveira, M. C. (2018). Delineamento e avaliação de um programa de adaptação acadêmica no ensino superior.Revista Brasileira de Orientação Profissional,19(1), 61-74. http://dx.doi.org/1026707/1984-7270/2019v19n1p61.
  » https://doi.org/1026707/1984-7270/2019v19n1p61
• Lei Nº 12.711/2012 (2012). Dispõe sobre o ingresso nas universidades federais e nas instituições federais de ensino técnico de nível médio e dá outras providências Diário Oficial da união (30-08-2012), coleção 3, 1. Recuperado de http://www.planalto.gov.br/ccivil_03/_ato2011-2014/2012/lei/l12711.htm
  » http://www.planalto.gov.br/ccivil_03/_ato2011-2014/2012/lei/l12711.htm
• Braun, V.; Clarke, V. (2006). Using thematic analysis in psychology. Qualitative research in psychology, 3(2), 77-101. https://dx.doi.org/10.1191/1478088706qp063oa
• Brondani, M. A.; Hollerbach, M. D.; Silva, G. P.; Pinto, E. R.; Corrêa, A. S. (2019). Depressão em estudantes universitários: fatores de risco e protetivos e sua relação nesse contexto.Disciplinarum Scientia Saúde , 20(1), 137-149. Recuperado de https://periodicos.ufn.edu.br/index.php/disciplinarumS/article/view/2629/2385
  » https://periodicos.ufn.edu.br/index.php/disciplinarumS/article/view/2629/2385
• Cabras, C.; Mondo, M. (2018). Coping strategies, optimism, and life satisfaction among first-year university students in Italy: Gender and age differences. Higher Education, 75(4), 643-654. https://doi.org/10.1007/s10734-017-0161-x
• Campos, C. M. S.; Oliveira, J. P. S.; Silva, S. G.; Otrenti, E.; Dias, V. F. G. (2019). Desgastes e fortalecimentos de graduandos de enfermagem expressos em mídia social. Revista de Medicina, 98(2), 114-119. https://doi.org/10.11606/issn.1679-9836.v98i2p114-119
• Chaves, E. C. L.; Lunes, D. H.; Moura, C. C.; Carvalho, L. C.; Silva, A. M.; Carvalho, E. C. (2015). Anxiety and spirituality in university students: a cross-sectional study. Revista Brasileira de Enfermagem, 68(3), 444-449. https://dx.doi.org/10.1590/0034-7167.2015680318i
• Dellarossa, A. (1979). Grupos de reflexión Buenos Aires: Paidós.
• Dias, A. C. G.; Carlotto, R. C.; Oliveira, C. T.; Teixeira, M. A. P. (2019). Dificuldades percebidas na transição para a universidade. Revista Brasileira de Orientação Profissional, 20(1), 19-30. http://dx.doi.org/10.26707/1984-7270/2019v20n1p19
• Elmir, R.; Ramjan, L. M.; Everett, B.; Salamonson, Y. (2019). Nursing students’ experiences of repeating units in an undergraduate program: A qualitative study. Nurse Education Today, 79, 147-152. https://doi.org/10.1016/j.nedt.2019.05.024
• Escola de Enfermagem de Ribeirão Preto. (2018). Projeto Pedagógico do Curso de Bacharelado e Licenciatura em Enfermagem Universidade de São Paulo. Ribeirão Preto, SP: Autor.
• Feodrippe, A. L. O.; Brandão, M. C. F.; Valente, T. C. O. (2013). Qualidade de vida de estudantes de Medicina: Uma revisão. Revista Brasileira de Educação Médica, 37(3), 418-428. https://doi.org/10.1590/S0100-55022013000300014
• Fernandes, M. A.; Vieira, F. E. R.; Silva, J. S.; Avelino, F. V. S. D.; Santos, J. D. M. (2018). Prevalência de sintomas ansiosos e depressivos em universitários de uma instituição pública. Revista Brasileira de Enfermagem, 71(Supl. 5), 2169-2175. https://doi.org/10.1590/0034-7167-2017-0752
• Flick, U. (2009). Desenho da pesquisa qualitativa (R. C. Costa, trad.). Porto Alegre: Bookman.
• Gonçalves, M. F. C.; Andrade, L. S.; Silva, M. A. I. (2019). Ciclo pedagógico e portfólios na licenciatura em enfermagem. Brazilian Journal of Development, 5, 10983-10996. https://doi.org/10.34117/bjdv5n7-2640
• Karaca, A.; Yildirim, N.; Cangur, S.; Acikgoz, F.; Akkus, D. (2019). Relationship between mental health of nursing students and coping, self-esteem and social support. Nurse Education Today, 76, 44-50. https://doi.org/10.1016/j.nedt.2019.01.029
• Leão, A. M.; Gomes, I. P.; Ferreira, M. J. M.; Cavalcanti, L. P. D. G. (2018). Prevalência e fatores associados à depressão e ansiedade entre estudantes universitários da área da saúde de um grande centro urbano do Nordeste do Brasil. Revista Brasileira de Educação Médica, 42(4), 55-65. https://doi.org/10.1590/1981-52712015v42n4rb20180092
• Marchi, K. C.; Bárbaro, A. M.; Miasso, A. I.; Tirapelli, C. R. (2013). Ansiedade e consumo de ansiolíticos entre estudantes de enfermagem de uma universidade pública. Revista Eletrônica de Enfermagem,15(3), 729-737. https://doi.org/10.5216/ree.v15i3.18924
• Nakano, M. M.; Gonçalves, M. F. C. (2019). Promoção da saúde na educação básica: Um estudo com licenciandos em enfermagem. Brazilian Journal of Development, 5(7), 10480-10491. https://doi.org/10.34117/bjdv5n7-196
• Pinho, A. P. M.; Dourado, L. C. D. C.; Aurélio, R. M.; Bastos, A. V. B. (2015). A transição do ensino médio para a universidade: um estudo qualitativo sobre os fatores que influenciam este processo e suas possíveis consequências comportamentais. Revista de Psicologia, 6(1), 33-47. Recuperado dehttp://www.repositorio.ufc.br/handle/riufc/17935
  » http://www.repositorio.ufc.br/handle/riufc/17935
• Preto, V. A. (2018).O estresse em universitários de enfermagem e sua relação com fatores pessoais e ambientais (Tese de doutorado). Universidade de São Paulo, Ribeirão Preto - SP. https://doi.org/10.11606/T.22.2018.tde-31082018-155141
• Rossato, L.; Scorsolini-Comin, F. (2019). Chega mais: o grupo reflexivo como espaço de acolhimento para ingressantes no ensino superior. Revista da SPAGESP, 20(1), 1-8. Recuperado dehttp://pepsic.bvsalud.org/scielo.php?script=sci_arttext&pid=S1677-29702019000100001&lng=pt&tlng=pt
  » http://pepsic.bvsalud.org/scielo.php?script=sci_arttext&pid=S1677-29702019000100001&lng=pt&tlng=pt
• Scorsolini-Comin, F.; Gabriel, C. S. (2019). O que pode ser considerado inovador no ensino superior contemporâneo? Considerações sobre o acolhimento estudantil. Revista da SPAGESP, 20(2), 1-6. http://pepsic.bvsalud.org/scielo.php?script=sci_arttext&pid=S1677-29702019000200001
  » http://pepsic.bvsalud.org/scielo.php?script=sci_arttext&pid=S1677-29702019000200001
• Souza, L. L.; Araújo, D. B.; Silva, D. S.; Bêrredo, V. C. M. (2014). Representações de gênero na prática de enfermagem na perspectiva de estudantes. Ciências & Cognição, 19(2), 218-232. Recuperado dehttp://www.cienciasecognicao.org/revista/index.php/cec/article/view/908
  » http://www.cienciasecognicao.org/revista/index.php/cec/article/view/908
• Terra, R. B. M. R. B.; Carraro, G. S.; Ferreira, M. P. R. (2019). As políticas públicas de inclusão ao ensino superior: uma análise do contexto brasileiro nos últimos 20 anos. Sequência(Florianópolis ), (83), 142-159. doi.org/10.5007/2177-7055.2019v41n83p142

• This study was financially supported by the University of São Paulo by means of a scholarship from the Programa Unificado de Bolsas de Estudos para Apoio e Formação de Estudantes de Graduação da USP (PUB), or Unified Program of Scholarships for Support and Formation of Undergraduate Students at the USP, granted to the first author and from the Coordination for the Improvement of Higher Education Personnel (CAPES), by means of a doctorate scholarship granted to the second author.

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  This paper was translated from Portuguese by Régis Lima.

Publication Dates

• Publication in this collection
  05 Jan 2024
• Date of issue
  2023

History

• Received
  02 Mar 2020
• Accepted
  01 June 2020