The truth value in nursing education: a phenomenological study

Abstracts

O presente artigo é balizado na teoria de valor. A enfermagem possui um conjunto de valores do qual se nutre para elaborar uma escala que direciona e justifica o agir profissional. Objetivo: compreender no ato de educar do enfermeiro-docente o valor verdade e discuti-los a luz dos pressupostos de Max Scheler. A metodologia é qualitativa, centrada no enfoque fenomenológico. Participaram do estudo sete enfermeiros-docentes de três instituições de ensino superior de enfermagem, localizadas na cidade do Rio de Janeiro. O período de realização foi de maio a junho de 2008. Os dados foram obtidos através de entrevista e analisados compreensivamente. Resultado: o valor verdade emergiu no discurso do enfermeiro-docente no ato de educar. Considerações finais: foi por meio do ato de educar que o enfermeiro apresentou o valor verdade ao educando, ratificando-o como instituinte para a práxis assistencial da enfermagem.

Enfermagem; Educação; Cultura; Filosofia

ORIGINAL ARTICLE

The truth value in nursing education: a phenomenological study

El valor verdad en la educación de enfermería: un estudio fenomenológico

Gilberto de Lima Guimarães^I; Ligia de Oliveira Viana^II; Selme Silqueira de Matos^III; Daclé Vilma Carvalho^IV; Fabíola Carvalho de Almeida Lima Baroni^V

^IDoctor of Nursing. Adjunct Professor. Department of Basic Nursing, School of Nursing, Federal University of Minas Gerais. Member of the Research Nucleus in Nursing and Health Education. Anna Nery School of Nursing. Federal University of Rio de Janeiro

^IIDoctor of Nursing. Full Professor. Department of Methodology. Member of the Research Nucleus in Nursing and Health Education. Anna Nery School of Nursing. Federal University of Rio de Janeiro

^IIIDoctor of Nursing. Adjunct Professor. Department of Basic Nursing. Member of the Study and Research Nucleus on the Systematization of Care in Nursing. School of Nursing. Federal University of Minas Gerais

^IVDoctor of Nursing. Associate Professor. Department of Basic Nursing. Member of the Study and Research Nucleus on the Systematization of Care in Nursing. School of Nursing. Federal University of Minas Gerais

^VDoctor of Nursing. Adjunct Professor. Department of Basic Nursing. Member of the Research Nucleus on the Systematization of Care in Nursing. School of Nursing. Federal University of Minas Gerais

Author's address

ABSTRACT

This article is based on the value theory. Nursing possesses a set of values that are used to develop a scale that directs and justifies professional action. Objective: To understand, the act of educating of the nurse- professor, the truth value and discuss it in light of Max Scheler's assumptions. The methodology is qualitative, focusing on phenomenological approach. Study participants were seven nurses-teachers from three institutions of higher nursing education, located in the city of Rio de Janeiro. The study was conducted from May to June 2008. Data were collected through interviews and analyzed comprehensively. Result: Truth emerged in the speech of the nurse-professor in the act of educating. Final Thoughts: It was through the act of educating that nurses presented the truth value to the student, ratifying it as the establishment of nursing assistance praxis.

Descriptors: Nursing. Education. Culture. Philosophy.

RESUMEN

Este artículo está enmarcado en la teoría del valor. La enfermería tiene un conjunto de valores de los que se nutre para desarrollar una escala que dirige y justifica el acto profesional. Objetivo: Comprender en el acto de educar de enfermeros-docentes el valor verdad y discutirlo a la luz de las presuposiciones de Max Scheler. La metodología es cualitativa, centrada en el abordaje fenomenológico. Los participantes del estudio fueron siete enfermeros-docentes de tres instituciones de educación superior de enfermería, ubicadas en la ciudad de Río de Janeiro. El período de ejecución fue de mayo a junio de 2008. Los datos fueron recolectados a través de entrevistas y analizados exhaustivamente. Resultado: El valor verdad emergió en el discurso del enfermero-docente en el acto de educar. Consideraciones finales: Fue a través del acto de educar que el enfermero presentó el valor verdad al estudiante, confirmándolo como parte integrante de la praxis asistencial de enfermería.

Descriptores: Enfermería. Educación. Cultura. Filosofía.

INTRODUCTION

The human being presents itself as existential reality, occupying a place in the world, and capable of giving it meaning and sense. Thus, the mere fact of being man does not, in principle, confer on man the position that reflects an ability to act human; it is necessary to direct him/her towards the process of his/her humanization⁽¹⁾.

It is in the field of social practice, in its co-existence with another that man reveals the direction that leads to the construction of this ability to act human, by the meaning and sense he/she attributes to his/her existence. It is possible for him/her to have this capacity of signification, arising from the value he/she learns, and which provides an orderliness that he/she judges appropriate for his/her life⁽¹⁾.

Because the word value has become worn out over the course of time, it is necessary to conceptualize it, in order to clear up any doubt. In this study, the concept of value is assumed to be that which has value to man, is capable of meeting a need and promoting his/her growth and development as a person⁽¹⁾.

Thus, when considering man as a needy being, seeing the effort he/she makes in the trajectory of his/her social life in endeavoring to meet this need is widely known. All one needs to do is go back in time to see that from an early age, evaluative demands linked to his/her own material life and physical well being arise. In the following moment, the awareness of needs linked to his/her own body: health, well being, physical strength, and even point out values capable of meeting the need⁽¹⁾.

Afterwards, they require the values of utility such as how the material and non material are united. Man's intelligence, interfering in the material, invents the goods of value that will meet his/her needs. Therefore they contemplate the values that will correspond to the non material wishes of the human person: the desire for the truth, for good among others⁽¹⁾.

Next, the logical value is sought by reason, in his/her constant search for the truth by means of research and science. However, it is emphasized that the values of the contents of human knowledge are not considered, but the truth that encloses them. The human being wishes to know the real, and at the same time, exerts effort on the process of his/her humanization. Therefore, man turns to education, recognizing in it the moderating element of this process⁽¹⁾.

Nursing is a scientific and social practice, therefore, endowed with a body of theoretical-practical knowledge. As a scientific practice, it performs its action in the area of health, its object of interest being the care of nursing ⁽²⁾. It will make use of this care to provide the conditions of health promotion, prevention and recovery in the dialogical meeting with its client/community. While, as a social practice, it has a set of values that endow it with sense and meaning⁽³⁾.

As far as nursing education is concerned, the act of educating, developed by the nurse-docent assumes an outstanding role in the direction towards professional training, because it will be in this way that the docent will present the values of nursing⁽³⁾.

The values form an axiogram (hierarchized scale) of the profession, which is its evaluative self-declaration on which it bases itself to guide and justify its actions⁽⁴⁾. The values at the basis of this axiogram were identified by the researcher in Florence Nightingale's writings on Notes about Nursing⁽⁵⁾, forming an amalgam, namely: social value, ethical value, useful value and true value.

When inserted into society, the educated person brings to the scenario of his learning, the values that were acquired there, and that become part of his/her personality. These values form the axiogram assumed by him/her and reveal what he/she is, how he/she acts and expresses his/her cosmovision⁽³⁾. Therefore, when seeking professional qualification in nursing, the student will undoubtedly, through the docent's intermediation in the pedagogical-assistential act, compare his/her axiogram with the axiogram of nursing, discuss and hierarchize it, in harmony with the exercise of his/her volition, and in this comparison, may rectify or ratify his/her attitude⁽⁶⁾.

In this sense, when the nurse-docent directs the student to the axiological field that permeates the profession, he/she constructs the possibility of making the student grow and develop within himself/herself, at the same time in which he/she allows the student to elaborate an identity that is consistent with the evaluative presuppositions of nursing, by recognition of value as the element that complements his/her incompleteness, moving and justifying his/her professional action.

Thus, value imposes itself on the student and wraps him/her in the sense of must-be⁽⁷⁾, allowing his/her visualization of him to see himself in the various forms of realizations of the Being-nurse in the world, while being concrete in history. From reflections on pedagogical-assistential practice, the researcher began to question himself about which of the values he would be presenting to the undergraduate students, and whether these formed part of the axiological field at the basis of the profession. Thus, the aim of the present study was to understand the true values in the act of education of the nurse-docent and discuss them in the light of Max Scheler's presuppositions⁽⁸⁾.

This article is the fruit of the doctoral thesis presented to the Post-Graduation program of the School of Nursing Anna Nery, of the Federal University of Rio de Janeiro⁽⁹⁾.

Theoretical Mark

As a basis of this study, the theoretical perspective of Max Scheler was adopted to seek evaluative comprehension, because it shares the view that values are learned by feeling and not by reason⁽⁸⁾.

The phenomenology of Max Scheler, inspired by Husserl is, above all, a philosophy of values. Its intention is to construct an ethics on the basis of objective and strict data from which arise an axiology of absolute foundations, radically opposed to axiological rationalism⁽¹⁰⁾.

Thus, true philosophy must admit a complementary form of participation in the essence of things starting from the emotional pathway. This begins to constitute an element capable of producing the knowledge of being. On proceeding with the reflection about acting human, Scheler perceived that there was a type of knowledge, whose objectives were entirely inaccessible to reason: the knowledge of values⁽¹⁰⁾.

Values are revealed by means of emotional intuition, thus, it rejects the distinction between sensitive and rational knowledge; it elevates the emotional to the level of the rational, admitting a world of experiences whose objects are inaccessible to understanding, and which only the emotional places man authentically before this world, therefore, the knowledge of value occurs in the a priori manner⁽⁸⁾. On establishing the basis of his philosophy on emotional intuition, Scheler proposed a new fundamentality, because the world of values began to enjoy validity independent of the subject, constituting a world of itself, whose values hide behind the feeling of value, as an objective and material datum⁽¹¹⁾.

Therefore, values constitute independent phenomena, and not data that are abstracted from goods. To Scheler, with respect to the experience obtained from this world of goods, values and their hierarchy result a priori. Nevertheless, he insists that values are clearly perceived by means of goods, however, knowledge of value may occur before knowledge of things. Therefore, it is possible for man to enter the world of values, in a similar manner as to the ideal platonic world, however, it becomes easier for man to capture it when, in his social life, value is visualized in the good in which it is incarnated⁽⁸⁾.

When values are given by intermediary of objects, they do not become the properties of these objects; these are only the supports of values. Therefore, values transcend any type of specification given by the objects, and are composed of essentials⁽⁸⁾.

In continuation, he affirms that the being of values is independent of things, even when, in its realization, value somehow presents itself as inherent to the object which provides it with support⁽⁸⁾. Thus, it would be difficult to distinguish the goods from the values if the values were equal to things. In the natural perception one has of the world, the contents of sensations are not given firstly, rather the goods-things. The contents are given only to make us distinguish the thing as such; that is to say, a depository of signification⁽¹²⁾. The goods do not fuse with the object; they are only perceived and are the depository of value, and therefore, something valuable. Therefore, the goods make the appearance and objectivity of value become real.

The truth value and nursing

The truth may be considered value, not by its content, but because it corresponds to human desire to know the real, as man is not satisfied with error and lies⁽⁸⁾. He wants to and desires to know the truth. His incompleteness is not resolved with deception. Only the truth has the possibility of complementing him⁽¹⁾.

The Schelerian proposition affirms that the established truth is scientific knowledge, therefore, science is a phenomenon resulting from the rational construction of man. Reason is perfected when it goes beyond common sense to the scientific, from the effort in the organization of knowledge⁽⁸⁾.

In nursing, the movement of recognition of scientific knowledge as guidance in assistential practice, historically goes back to the 1950s, in the last century, when it sought to delineate itself, seeking a foundation for the techniques used, and an approximation of its bases to the natural sciences and medical knowledge⁽²⁾.

In this process of elaboration of the science of nursing, scientific rationality, the fruit Truth value, has been incorporated into practice, notably influencing the assistential and educational fields^(13-15).

Thus, nursing, just as science, discipline and profession, seeks the truth in the sense of constructing a consistent theoretical referential, contributing to the evolution in both the individual and collective fields, whether or not they belong to a scientific community. Therefore, for the education of the nurse the truth value assumes real signification, because it confers justification and legitimacy on the profession⁽¹⁾.

Moreover, the science of nursing will take advantage of the knowledge of the areas of health and human sciences, in order to constitute a body of knowledge that will back up its action⁽²⁾. This process is dynamic and is not restricted to the synthesis of knowledge, because the nurse, in his/her work in the most diverse scenarios ^(13-14), is given the opportunity to reconstruct knowledge, applying it to nursing in a singular manner through the practice of research⁽¹⁵⁾ .

METHODS

This research is of a qualitative nature with a phenomenological focus. This methodology seeks comprehension of the world of day to day life, endeavoring to elucidate the meaning from the descriptive reports of social life, which allow the researchers the understanding of living, and not of definitions of concepts, as it is an understanding directed towards the meaning of perceiving oneself. The research object of investigation is the phenomenon that shows one to oneself and in oneself⁽¹⁶⁾.

The scenarios were three institutions of higher learning in nursing, located in the city of Rio de Janeiro. With regard to legal order, two were public, connected to the Federal and State regime, and the third institution was of a private nature.

The research complied with the parameters of Resolution No. 196/96, of the National Health Council ("Conselho Nacional de Saúde - CNS"), and was sent to the Research Ethics Committee of the School of Nursing Anna Nery-UFRJ, registered under Number 026/07, and was approved on 07/24/2007. Data was collected after the subjects had been informed about all the ethical aspects of the research, and send the Term of Free and Informed Consent.

The study subjects were seven nurses-docents working in undergraduate courses. This number was delineated after exhaustion of the data and the phenomenon had been revealed to the researcher. The interviews were held in the period from April to June, 2008.

The technique used was the phenomenological interview, recorded on magnetic tapes, with the following guiding question: 'How do you perform the act of educating nursing students?' The phenomenological interview has peculiarities that need to be considered, in order for it to have the strictness required for using it⁽¹⁷⁾. Therefore, the need for perception was demanded of the researchers, in the sense of: seeing and observing, free of prejudices, maintaining an empathetic relationship, characterized by a state of approximation, appreciating and respecting everyone; interpreting the language of the interviewee and its signification comprehensively, supported on active listening, remaining receptive and avoiding judgments that could interfere in the narrative of the interviewees⁽¹⁸⁾.

The interviewees were identified in the text by the letter E, in addition to Arabic numbers disposed from 1 to 7. They were of a mean age of 42 years, and six of them were of the female and one of the male sex. The mean time of docent activity was five years.

By means of comprehensive analysis we were permitted to unveil the meanings in the speeches. In order to do this, we first had to elaborate the speeches of the interviewees in full. After this the texts were read innumerable times, until the consciousness, definitive character of the interviewees' discourses were revealed, identifying the units of signification. From these the values attributed to nursing by the nurse-docent were obtained. Thirdly, this material was discussed in the light of Schelerian axiology^(15-19).

RESULTS AND DISCUSSION

In the speeches of the interviewees, four units of signification were identified, namely: social value, ethical value, useful value and true value. In this article, the unit of signification was highlighted: the truth value and two qualities connected with it, namely: feeling and knowing how to think. The discussion followed through the presuppositions of the theory of value, according to Max Scheler⁽⁸⁾.

Discussion began with sections of the discourses made by the interviewees to exemplify the truth value:

[...] obviously, for this you have to develop a scientific preparation; knowledge of the social scene; knowledge about the other person. But, all of this is based on this proposal of solidarity between one another, in addition to it being the idea of dependence [...] (E4).

[...] in higher learning, he learned the reason why, which lies behind how it is done. I always mention to them that there is a right way to prepare the medications and a scientific foundation for nursing care [...] (E6).

[...] it's not use for me just to give orders. Even to give orders, I have to know how to do it, so that I can win over my team. I have to know how I will perform the care. I try to relate the technique to the scientific side on which the procedure is based [...] (E7).

Thus, the nurse-docent expressed the recognition that in order to perform his/her professional attributes, it was necessary to replace the knowledge that came from common sense by scientific knowledge⁽²⁰⁾. This is the establishment of the truth value. It is perceived to be of fundamental importance for education, because it is by intermediary of it that the student establishes professional action.

Thus, the manifestation of this value occurs through the nurse-docent's desire to know the truth, know the real and present it to the student⁽⁸⁾. Only the truth has the possibility of complementing the students⁽¹⁾. The docent aspired to and moved himself/herself to seek this knowledge. He/she assumed a nonconformist posture towards deception and intended to obtain the answer to the question formulated, seeking to elucidate the web in which the binomial health-disease was inserted.

Scientific knowledge has the characteristic of dynamism that drives a permanent renovation, demanding from those who use it, an attitude that is consistent with it⁽¹⁵⁾. Therefore, it behooves the nurse-docent not only to appropriate knowledge, but develop an attitude center on learning to learn. This is of fundamental importance so that the undergraduate student will be capable of visualizing its significance and implication in pedagogical practice.

Learning to learn is the precursor germ to the practice of scientific research. It is the strategy that allows the apprehension and establishment of truth value, at the same time in which it fundamental to intellectual emancipation⁽¹⁵⁾.

Thus, in the act of educating, the nurse-docent needs to develop the attitude of learning to learn, in order to enable him/her to present it to the undergraduate student, making it possible for him/her to be directed towards reflexive movement, and in this process, incorporate this attitude into his/her attitude, if he/she so wishes. The undergraduate student who has this characteristic will keep himself/herself in a state of intellectual disquiet, and will not be satisfied with that which is given, but will constantly seek scientific knowledge, and will progressively be capable of perceiving and recognizing the practice of research as the nourisher of his/her professional practice⁽²⁰⁾.

When continuing with the analysis, it was found that the scientific knowledge required by the nurse-docent in order to perform the pedagogical-assistential action was not centered on the prism of biologicism. He recognized that the human being has a spiritual characteristic, a condition that moves him beyond material supply. Differently from the animals, man has a body. It is not the body that makes the man. It is he who makes his body.Thus, his biological life is linked to spiritual life in an undissociable manner⁽⁹⁾. Therefore, feeling is an integral quality of scientific knowledge for nursing care. There are the sections of the interviewee's discourses to illustrate this consideration:

[...] nursing is a profession in the field of knowledge directed towards caring for the needs of another [...] involving human relationship, the process of nursing, technical aspects [...] my nurse-docent trajectory involves this. (E1)

[...] even today many docents see the stimulus for the student to acquire the skill of doing as the most important aspect. I do not criticize them, because the nurse has to have technical competence, but his/her action must not be restricted to technique. The nurse needs to learn to "see" the other person as a whole [...] (E2).

[...] by the very configuration of the nurse's education, I see in him/her the role of articulator of the care practices that are developed [...] he/she is able to articulate the knowledge that has a technical basis, with an understanding of the human being he/she cares for [...] (E3).

The nurse-docent understood that in order to care for the client, the correct articulation with knowledge coming from rationality and feeling was necessary, with the intention of breaking the dichotomy created by the positivist influence. Thus, the docent recognized the complexity that constitutes the client, appreciating him/her as a person, and presented this characteristic to the undergraduate student. At the same time, it was from this experience that the student had the opportunity to reformulate the concept of his cosmovision/reconceituar a sua cosmovisão⁽¹²⁾.

Acting in this way, the nurse-docent reaffirmed the Schelerian presupposition that knowledge about man is not restricted to rationality⁽⁸⁾. Scheler perceived that there is a non rational logic, which allows understanding of human action, which he designated the "logic of the heart", – the seat of emotional life⁽¹²⁾.

It was in the field of activity of this "logic" that the docent sought to understand the client's action, and directed the student, with the object of leading him/her to growth and development in the axiological field that surrounded the profession, so that he/she could engage in a conscious manner in the provision of nursing care, elevating him/her beyond biological supply. At the same time, it allowed him/her to proceed to reflexive movement⁽¹¹⁾.

Therefore, the action of nursing acquires a greater signification, allowing the nurse-docent and the student to develop, in pedagogical-assistential practice, an attitude centered on meeting the client's needs, while being bio-psycho-social.

In this sense, the one who original evaluates starting with the social, that is, the one who measures everything, naturally has to feel and understand man in a different manner, recognizing him/her as a person⁽¹²⁾.

Thus, the nurse-docent and the student begin to establish a new direction for nursing assistance in pedagogical-assistential practice, as they being to perceive and recognize the client as a person⁽⁸⁾.

In continuation, it was pointed out that the truth value recognized by the docent had a second quality: knowing how to think. On appropriating scientific knowledge, the docent developed the alternative in the face of the difficulties of an operational order, which surrounded his day to day life, acting with creativity, demonstrating the plasticity that surround professional action, manifested to the student. Revealing to him that knowing to think is a unique condition for the performance of care. This consideration illustrates the discourse that said:

[...] Nursing is a profession that has a profile of overcoming all these adversities [...] nurses who do not have adequate material[...] nurses who do not have good support. And here they try to overcome this with creativity and develop a technology, providing better care for the clientele [...] (E5).

When proceeding with overcoming adversity with creativity, elaborating a technology to provide the care, the nurse-docent presented this characteristic that permeates the undergraduate student's scientific knowledge. Demonstrating to him that in providing care, it is necessary to take advantage of knowing how to think, so that one may judge the best manner in which to provide the care, allowing him to understand that the knowledge recorded on the pages of books and articles needs to be apprehended and contextualized by him, leading to the emergence of innovation. This is a characteristic that demonstrates the growth and development in truth value⁽¹⁾.

From the analysis, it was understood that the truth value and the implications discussed in this study will assume a sense of must-be⁽⁸⁾ for the growth and development of the student in the axiological field of nursing.

FINAL CONSIDERATIONS

It could be found that the truth value emerged in the discourse of the nurse-docent, and was presented by him in pedagogical-assistential practice with the student. He recognized that the legitimizing basis of professional action must be based on scientific knowledge, thus ratifying the truth value as belonging to the axiological field of nursing. There were two qualities of truth value perceived by the nurse-docent: feeling and knowing how to think.

Where feeling was concerned, the docent perceived that there was a non rational logic that allowed understanding of human action. It was in the field of activity of this "logic" that the docent sought to direct the student, so that he could perceive nursing care going beyond biological supply. With regard to knowing how to think, this brought about the possibility for the undergraduate student to reflect on the practice of nursing.

Therefore, the nurse-docent recognized the truth value, established from scientific knowledge, distinctive qualities that have made nursing what it is: science and art.

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Publication Dates

• Publication in this collection
  03 Apr 2013
• Date of issue
  Mar 2013

History

• Received
  23 May 2012
• Accepted
  16 Jan 2013