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Revista Gaúcha de Enfermagem

versão On-line ISSN 1983-1447

Rev. Gaúcha Enferm. vol.36 no.3 Porto Alegre jul./set. 2015

https://doi.org/10.1590/1983-1447.2015.03.49670 

Integrative Review

Teaching in higher education in nursing: an integrative literature review

Enseñanza en la educación superior en enfermería: revisión integradora de literatura

Daniele Delacanal Lazzari a  

Jussara Gue Martini b  

Juliano de Amorim Busana c  

aPrograma de Pós-Graduação em Enfermagem. Florianópolis, Santa Catarina, Brasil

bUniversidade Federal de Santa Catarina (UFSC). Departamento de Enfermagem. Florianópolis, Santa Catarina, Brasil

cPrefeitura Municipal de Navegantes. Navegantes, Santa Catarina, Brasil


ABSTRACT

Objective:

to analyze the knowledge produced about teaching in higher education in nursing.

Method:

Integrative literature review of full articles available on the LILACS, SciELO, BDENF and ERIC databases, through the descriptors "nursing faculty"and "practices of nursing faculty" and keywords "Teaching in nursing" or "Education in nursing"and "Nursing professors" and "Teaching knowledge" in Portuguese, English or Spanish, published from January 2008 to November 2013.

Results:

31 articles were identified. The data led to the following thematic categories: Training for faculty, Conflict of roles: being a nurse and being a teacher and Organization of the teaching work.

Conclusions:

it was found that there are numerous gaps in understanding the teaching activity in nursing. The concerns identified may offer help for understanding the teaching world and conceptions about being a teacher in nursing.

Key words: Faculty, nursing; Nursing faculty practice; Teaching

RESUMEN

RESUMEN

Objetivo:

analizar el conocimiento producido sobre la enseñanza en la educación superior en enfermería.

Método:

revisión integradora de artículos completos de la literatura disponible en LILACS, SciELO, BDENF y ERIC través de los descriptores " docentes de enfermería" y " práctica del docente de enfermería" y las palabras clave "enseñanza en enfermería" o "educación en enfermería" y "profesores de enfermería" y"conocimiento enseñanza" en portugués, inglés o español, publicados entre enero de 2008 y noviembre de 2013.

Resultados:

31 artículos fueron identificados. Los datos produjeron las siguientes categorías: Formación para docencia, Conflicto de los roles: ser enfermera y ser profesor y Organización del trabajo docente.

Conclusiones:

se encontró que existen numerosas lagunas en la comprensión de la actividad docente en enfermería. Las preocupaciones identificadas pueden ofrecer subsidios para la comprensión del universo y de las concepciones pedagógicas de ser profesor en la enfermería.

Palabras-clave: Docentes de enfermería; Práctica del docente de enfermería; Enseñanza

RESUMO

Objetivo:

analisar o conhecimento produzido sobre docência no ensino superior em enfermagem.

Método:

revisão integrativa de literatura de artigos completos disponíveis nas bases de dados LILACS, SciELO, BDENF e ERIC, por meio dos descritores "docentes de enfermagem" e "prática do docente de enfermagem" e das palavras-chave "docência em enfermagem" ou "ensino em enfermagem" e "professores de enfermagem"e "saberes docentes", em português, inglês ou espanhol, publicados no período de janeiro de 2008 a novembro de 2013.

Resultados:

foram identificados 31 artigos. Os dados originaram as seguintes categorias temáticas: Formação para a docência, Conflito de papéis: ser enfermeiro e ser professor e Organização do trabalho docente.

Conclusões:

constatou-se que existem inúmeros hiatos para compreensão da atividade docente na enfermagem. As preocupações identificadas podem oferecer subsídios para a compreensão do universo docente e as concepções sobre ser professor na enfermagem.

Palavras-Chave: Docentes de enfermagem; Prática do docente de enfermagem; Ensino

INTRODUCTION

While it is possible to observe changes in the teaching scenario in higher education for nursing, traditionally, graduates perform teaching activities in the absence of any pedagogical training. The training for teaching in nursing is activity that is still on the path to understanding and structuring.

The key element for the development of university teaching is, without a doubt, the professor. Said professor often has his or her identity process rooted in his or her specialty, scientific production or other activities that generate academic merit,( 1 ) without formal demands on their teaching skills inside the classroom or understanding of this universe( 2 ).

University teachers do not usually identify with the teaching, but rather with their professional area. In private schools, it is regarded as a form of wage supplement, given much of the faculty is hired part-time and they maintain professional activities in care giving. In public schools, whose dedication time, is often full, it is also secondary in the sense that centrality is shifted to research activities, and academic merit is a defining factor of teaching status( 3 ).

Studies on what makes up the teacher's knowledge incorporate the most varied perspectives, ranging from behavior( 4 - 5 ), manner of teaching( 6 ), to other perspectives related to the sociology of the professions, thinking about their structure and working conditions( 7 - 8 ). With relation to nursing, these studies are still incipient, indicating a vast field of research that endorses the teaching qualification, teaching process and the professional's own training in nursing.

In the context of these studies, various terms have been explored, and concepts, such as the reflective teacher, reflective-practices, teaching knowledge, skills, etc., have been incorporated into the debates( 4 ).

Given the diversity of situations experienced by nursing faculty and duplication of the role of the educators, the question becomes: what was the knowledge produced about teaching in higher education for Nursing? Therefore, the objective of this study was to analyze the knowledge produced about teaching in higher education for nursing.

METHODOLOGY

For this study we chose an integrative literature review, consisting of six steps: identification of the problem, establishment of inclusion/exclusion criteria (sample selection), definition of the information to be extracted from the selected articles, analysis of the information, interpretation of results and presentation of the review( 9 ).

This investigation began after consultations with the LILACS (Latin American Literature in Health Sciences), SciELO (Scientific Electronic Library Online), BDENF (Nursing Database) and ERIC (Education Resources Information Center) databases (The latter included for being the biggest database on issues related to education in the world), using descriptors and keywords (Chart 1).

To guide this review, the following question was formulated: what was the knowledge produced about teaching in higher education Nursing? The criteria for inclusion of publications in this study were: articles electronically available, in their entirety, on the theme; articles published in Portuguese, Spanish and English, from January 2008 to November 2013, concerning the subject in question. Excluded from this study were editorials, letters, opinion articles, commentaries, essays and preliminary notes, as well as duplicate publications in more than one database, theses, dissertations and manuals.

An analysis and interpretation of the data was performed after translation and reading of the articles, using the following steps: 1) identification of the hypothesis or guiding question - development of a problem by the researcher in a clear and objective manner, then a search using the descriptors or keywords; 2) sample selection - determining inclusion or exclusion criteria, when establishing the transparency in order to provide depth, quality and reliability for the selection; 3) categorization of the studies - defined as the extraction of information from articles reviewed in order to summarize and organize the information; 4) evaluation of the studies - critical analysis of the data extracted; 5) discussion and interpretation of the results - comparison and justification of the main results with theoretical knowledge and assessment regarding their applicability; 6) presentation of the integrative review and synthesis of the knowledge-information from each revised article in a succinct and systematized manner, demonstrating the evidence found( 9 ).

Data collection was carried out between the months of January and February 2014. The data extracted was organized, in spreadsheets, in ascending numerical order, in Microsoft Excel 2007, according to: year of publication, title, authors, journal, country of origin of the study, type/approach of the study and main aspects or results. As for the ethical aspects, copyright and content were respected, with no alterations of them to benefit the review.

RESULTS

1,148 articles were identified, which, after being fully read and submitted to the inclusion and exclusion criteria, resulted in 31. Of the total, 728 did not adhere to the theme, 102 were repeated, 55 were outside the time frame, 106 only had abstracts and 157 consisted of editorials, book reviews, dissertations or theses (Figure 1).

Source: Research data, 2014.

Chart 1  - Quantitative (n) of the articles found (E) and selected (S) after integrative review by database. Florianópolis, SC, 2014 

The SCIELO and LILACS databases revealed the highest number of productions found. The lowest number of productions in the BDENF and ERIC bases highlights the paucity of scientific literature on the subject in the area of nursing. With relation to the combination of descriptors, this was not effective for tracking the publications related to the keywords (Chart 1). This result can be attributed to the small number of available descriptors on the subject.

Noteworthy is the number of productions in Brazil, with 14 articles; the UK, US and Australia, each had four articles (Chart 2). Spain, Thailand, China, Chile and Portugal appeared with one article each. As for the year of publication, we perceived numerical expressivity in 2010, with 16 published articles (in the previous year, 2009, four articles were published). In the following years, a gradual reduction in the number of articles is apparent: 2011 six articles appear; 2012, three articles; 2013 two articles. No articles were found for the year 2008 that fit the proposed parameters.

For the evaluation of the articles, we took into account their similarities, with the intention of organizing and summarizing the information in a concise way, analyzing questions that can be used in a critical assessment of the selected studies, such as: the research question, the basis for the research question, structuring and relevance of the research question, the study methodology and adequacy of the subjects to the research question( 10 ).

DISCUSSION

Based on the materials analyzed, it was possible to identify important issues to be reported on teaching in nursing. The discussion of the results is divided into three main areas arising from the categorization of the planned studies in methodological assumptions of the Integrative Literature Review( 10 ): Training for faculty, Conflict of roles: being a nurse and being a teacher and Organization of the teaching work.

Training for teachers

To become a good teacher, it is necessary to understand the needs of the students and the development of attitudes that facilitate learning, making the process enjoyable( 11 ).

The identification of nursing professors is done using practical or experiential knowledge, since they define themselves as classroom professionals who, to teach, require pedagogical training( 12 - 16 ).

Source: Research data, 2014.

Figure 1  - Diagram of the results from applying the search filter, limits and criteria for inclusion of the articles. 

There is extensive need for development of new and diverse pedagogies to be used as a basis for teaching( 17 - 19 ), because individualized methods and techniques are still used, especially for lectures( 19 - 20 ). The positive appropriation of the individual characteristics of students strengthens the learning process( 12 , 21 - 22 ).

The need to include pedagogical aspects in the initial training of nursing teachers was evident, making continuing education a prerequisite due to the complexity of the content and the teaching( 23 - 24 ).

The knowledge required for nursing teaching practices and requirements for the development of the teaching act demand: understanding and skillfully transitioning between the specialty and pedagogy; enhancing the experiential knowledge in the creation of a professional identity; deepening the knowledge about the pedagogical practices; maintaining and fostering good relationships with students and worrying about initial and continuing education.

Conflict of roles: being a nurse and being a teacher

One of the key aspects in the literature with regard to the plurality of activities of nursing teachers. Awareness of this complex approach is needed, as well as the promotion of integration between clinical nurses and nursing teachers in order to facilitate the teaching-learning process( 25 - 27 ). On the other hand, a traditional vision, not only of education, but also the of the profession, still strongly linked to the biomedical character and charitable actions, is present (15, 28).

The non-professionalization or teaching as a secondary career devalues ​​the teaching action and leads to personal and professional dissatisfaction(19.29 to 30).

Speeches called maternal emerged predominantly in describing the relationship between teachers and students, particularly in the areas of nursing practice, through gestures of affection, protection, support, guidance and requirement of disciplinary behavior( 31 - 32 ). The maternal behaviors are close to social representations of the nurse, full of idealizations and stereotypes (mother, religion, sex symbol, aid, no social life due to complete dedication required for the profession, professional subordinate, etc.)( 33 ).

On the other hand, the immaturity of students given the educational proposals are among the aspects that modify the professors' behavior, making them sometimes adopt attitudes perceived as inflexible, related to holding students accountable for delays, breaches of agreements, inattention in the classroom, etc.( 34 ). Affectionate relationships are an important part of the teacher's daily life and constitute the picture in the students' imagination that, when faced with patient care, they feel situations emerge that they experienced in their personal histories, such as illnesses in close relatives.

The teacher should not neglect to understand the emotions and encourage their practice in a loving way, although the "emotionally colorful education" is considered a "rare guest"( 35 ) for teachers whose mindset remains in using the logic of specialties and the biomedical model. Thus, the idealizations present in relationships between teachers and students turn out to be significant in the nursing education universe.

Source: Research data, 2014.

Chart 2 Publications about teaching in nursing, according to authors, title, country, year, type of study, participants, and summary of the main results, 2008-2013. 

In scenarios where there is exclusive dedication to teaching, another factor present is the distancing of part of the professors from care and, consequently, patients( 15 , 25 , 35 ). The relationship established with them can range from indifference, to hostility to affection, and helps build the idea that the students' imagine about care.

On the other hand, in scenarios where exclusive dedication to teaching is not present, usually in private or public universities where there is no unrestricted requirement for exclusive dedication, the approximation to nursing care practice becomes a valued factor of the professor by the students.

Organization of teaching work

The increase in the number of temporary teachers or substitutes, especially in public universities, results in precariousness of the job. They believed that contribute to the process of teaching and learning, as they bring reality to teaching, favoring experimental knowledge( 36 - 37 ).

With regard to the daily work life, teachers point out feelings of pleasure and suffering and show the conditions and the organization of work as elements that enhance these feelings( 38 - 39 ).

Some of the issues that contribute negatively to the teaching work include the excess of activities; requirements of funding agencies; the constant need for updating; meetings; excessive class workload, scientific research guidelines; preparation of evaluations; participation in examiner and commission panels; publishing papers; among others( 14 . 39 ).

The shortage of nursing faculty that works on a full-time basis in European countries has contributed to the apprehensive expansion of undergraduate courses( 25 , 40 - 41 ). On the other hand, in Brazil, this reality presents itself differently, since the realities are different. Between 1999 and 2011, the growth of undergraduate programs in the country was around 754%, with a significant advantage of private courses, where there is no full time job requirement( 42 ).

FINAL CONSIDERATIONS

By analyzing the knowledge produced about teaching in nursing we can see that it is situated between understanding: the elements that make up the professorial universe through a lack of teacher training; the existence of conflicts between being a teacher and being a nurse, with particular praise for experiential learning; and organization of the teaching work, whose difficulties can be attributed to the absence of a pedagogical understanding and external factors such as public policy related to hiring and labor. Current prospects for training place the reflective processes at the center of the teaching exercise. Despite the limitations present in this study, resulting, mainly, from the low number of productions found, the evidence cited may be useful for discussions about the topic, as well as the development of future research that addresses the identity process of nursing teachers, knowledge necessary for teaching and the feelings of the teachers, among others, which may ratify or refute the findings.

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Received: August 18, 2014; Accepted: June 09, 2015

Author's address: Daniele Delacanal Lazzari Universidade Federal de Santa Catarina Centro de Ciências da Saúde Departamento de Enfermagem, bloco H, 4° andar, sala 414 88040-900 Florianópolis - SC E-mail:danielelazza@gmail.com

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