Brazilian overview of nurses’ training during the COVID-19 pandemic

a cross-sectional study, carried out with 335 coordinators of undergraduate courses in Nursing and online data collection, between November 2020 and March 2021.

Results:

All Brazilian states were represented. Of Higher Education Institutions, 52.5% adopted remote learning within 10 days after determining social distancing and 23% after 100 days; 73.4% kept the students in a mandatory curricular internship. Practical classes had a reduction in the number of students per group (46.0%). Most faculty and students were contaminated by SARS-CoV-2 and showed worsening in mental health.

Conclusions:

The study identified heterogeneity in the resumption of activities, through remote teaching, which mostly occurred synchronously. There was a resumption of curricular internships and practical classes in health services, with a limitation on the number of students per field.

Descriptors:
Nursing; Nursing Education; Teaching; Pandemics; Coronavirus

Variables	Sample (n=335) ^A		Regions ^B
	Sample (n=335) ^A		North (n=31)		Northeast (n=88)		Midwest DF (n=39)		Southeast (n=89)		South (n=88)		p
	n	%	n	%	n	%	n	%	n	%	n	%	p
Administrative category													0.034
Private	174	51.9	19	61.3	43	48.9	20	51.3	54	60.7	38	43.2
Federal Public	74	22.1	9	29.0	21	23.9	12	30.8	12	13.5	20	22.7
State Public	36	10.7	2	6.5	17	19.3	6	15.4	8	9.0	3	3.4
Community	26	7.8					1	2.6	4	4.5	21	23.9
Philanthropic	19	5.7			4	4.5			10	11.2	5	5.7
Municipal public	6	1.8	1	3.2	3	3.4			1	1.1	1	1.1
Grouped Administrative Category													0.006
Private	219	65.4	19	61.3	47	53.4	21	53.8	68	76.4	64	72.7
Public	116	34.6	12	38.7	41	46.6	18	46.2	21	23.6	24	27.3

Variables	Sample (n=335) ^A		Regions ^B
	Sample (n=335) ^A		North (n=31)		Northeast (n=88)		Midwest DF (n=39)		Southeast (n=89)		South (n=88)		p
	n	%	n	%	n	%	n	%	n	%	n	%	p
Number of days until ER starts, from social distancing													<0.001¥
Mean ±standard deviation (amplitude)	51.6±75.8 (0 - 350)		60.3±75.3 (0 -250)		75.5±87.44 (0-334)		54.3±68.7 (0-196)		33.2±58.6 (0-250)		42.3±76.9 (0-350)
Median (1st - 3rd quartile)	9.0 (3.0 - 90.0)		30.0 (3 - 90) ^A		21.0 (7-150) ^A		10 (4-120) ^B		7 (4-18) ^B		5 (2-30) ^B
Number of days in lanes													0.005€
Up to 10 days	176	52.5	13	41.9	31	35.2	21	53.8	53	59.6	58	65.9
From 11 to 30 days	62	18.5	6	19.4	21	23.9	5	12.8	21	23.6	9	10.2
From 31 to 100 days	20	6.0	5	16.1	5	5.7	1	2.6	3	3.4	6	6.8
More than 100 days	77	23.0	7	22.6	31	35.2	12	30.8	12	13.5	15	17.0
Preparation of teachers for the transition of the teaching modality													0.332¶
Yes	288	86.0	29	93.5	75	85.2	32	82.1	75	84.3	77	87.5
No	47	14.0	2	6.5	13	14.8	7	17.9	14	15.7	11	12.5
Initiative to prepare teachers for the RE
Graduation direction or equivalent	201	60.0	22	71.0	55	62.5	19	48.7	51	57.3	54	61.4	0.033§
The nucleus of pedagogical practices or equivalent service	62	18.5	5	16.1	14	15.9	8	20.5	13	14.6	22	25.0	0.089§
Course Coordination	30	9.0	2	6.5	8	9.1	4	10.3	12	13.5	4	4.5	0.487§
There was no preparation, but general instructions	42	12.5	2	6.5	11	12.5	8	20.5	13	14.6	8	9.1	0.242§
Percentage of synchronous classes DA=1 (2.1%)
Mean ±standard deviation (amplitude)	72.5 ± 24.1 (1 - 100)		67.9±22.5 (30-100)		69.0±229 (5-100)		63.7±26.3 (10-100)		78.4±23.1 (1-100) ^A		75.4±24.5 (1-100)		0.001¥
Median (1st - 3rd quartile)	80.0 (50.0 - 90.0)		70 (50-80) ^AB		70 (50-86) ^AB		70 (40-80) ^B		80 (70-100) ^A		80 (60-100) ^A
Percentage of asynchronous classes DA=1 (2.1%)
Mean ±standard deviation (amplitude)	27.5 ± 24.0 (0 - 100)		32.7±21.8 (0-70)		30.4±21.8 (0-80)		36.3±26.2 (0-90)		20.8±22.5 (0-100)		25.8±25.7 (0-100)		0.001¥
Median (1st - 3rd quartile)	20.0 (10.0 - 50.0)		30 (20-50) ^AB		30 (14-50) ^AB		30 (20-60) ^A		10 (0-30) ^B		21 (3-40) ^B

Variables	Sample (n=335) ^A		Regions ^B
	Sample (n=335) ^A		North (n=31)		Northeast (n=88)			Midwest DF (n=39)			Southeast (n=89)			South (n=88)			p§
	n	%	n	%	n		%	n	%		n	%		n	%
Student Aid
Possibility of asynchronous access to class content	279	83.3	24	77.4	74		84.1	32	82.1		77	86.5		72	81.8		0.148§
Access to digital platforms	272	81.2	28	90.3	62		70.5	31	79.5		77	86.5		74	84.1		0.154§
Digital library	257	76.7	25	80.6	60		68.2	28	71.8		70	78.7		74	84.1		0.128§
Internet	226	67.5	25	80.6	57		64.8	24	61.5		56	62.9		64	72.7		0.105§
Training in the use of digital platforms	194	57.9	19	61.3	52		59.1	21	53.8		50	56.2		52	59.1		0.361§
Physical library	80	23.9	10	32.3	13		14.8	5	12.8		24	27.0		28	31.8		0.017§
University restaurant	10	3.0			4		4.5				4	4.5		2	2.3		- - -
			Administrative Category
	Sample (n=335) ^A		Public (n=116)							Private (n=219)							p§
	n	%	n			%				n			%
Student Aid
Possibility of asynchronous access to class content	279	83.3	99			85.3				180			82.2			0.893
Access to digital platforms	272	81.2	87			75.0				185			84.5			0.274
Digital library	257	76.7	74			63.8				183			83.6			0.009
Internet	226	67.5	101			87.1				125			57.1			<0.001
Training in the use of digital platforms	194	57.9	53			45.7				141			64.4			0.011
Physical library	80	23.9	14			12.1				66			30.1			0.006
University restaurant	10	3.0	4			3.4				6			2.7			- - -

Variables	Sample (n=335)
Number of days between social isolation and resumption of activities A DA=29(8.7%)
Mean ±standard deviation (amplitude)	103.41±91.7 (0 - 400)
Median (1st - 3rd quartile)	90.0 (0.0 - 161.0)
Number of days between social isolation and resumption of activities in time bands A DA=29(8.7%)
Up to 30 days	92	30.1
From 31 to 90 days	80	26.1
more than 90 days	134	43.8
Supply of PPE ^B
The HEIs provided the necessary PPE to the students	216	64.5
The HEIs provided the necessary PPE to the teachers	217	64.8
The Internship Granting Unit (health service) provided the necessary PPE to the students	98	29.3
The Internship Granting Unit (health service) provided the necessary PPE to the teachers	57	17.0
Students provided the necessary PPE	73	21.8
The teachers provided the necessary PPE	41	12.2
Conditions for the occurrence of mandatory internships
The guiding professors performed direct supervision	180	53.7
The guiding professors performed indirect supervision	48	14.3
The HEIs hired nurses to carry out direct supervision	79	23.6
There was no supervision, as there were no curricular internships	45	13.4
The Internship Granting Unit allowed the return of activities, without limits of students per field	11	3.3
The Internship Granting Unit allowed the return of activities, limiting the number of students per field	228	68.1
The internship granting unit did not allow the return of activities	46	15.0

Variables	Sample (n=335) ^A
Compulsory Curricular Internship
Number of students in Curricular Internship in 2020/1	246	73.4
Mean ±standard deviation (amplitude)	62.9±127.4 (1 - 1450)
Median (1st - 3rd quartile)	32.0 (21.0 - 60.0)
Number of students in Curricular Internship in 2020/2	256	76.4
Mean ±standard deviation (amplitude)	60.7 ±97.6 (2 - 970)
Median (1st - 3rd quartile)	34.0 (21.0 - 63.0)
Strategic Action Brasil Conta Comigo
Number of students at AEBCC in 2020/1	105	31.3
Mean ±standard deviation (amplitude)	28.8±80.4 (1 - 700)
Median (1st - 3rd quartile)	10.0 (3.0 - 22.0)
Number of students at AEBCC in 2020/2	91	27.2
Mean ±standard deviation (amplitude)	31.7 ±84.8 (1 - 700)
Median (1st - 3rd quartile)	12.0 (4.0 - 30.0)

Variables	Sample (n=335) ^A
Laboratory practices and skills training ^B	n	%
Laboratory classes were replaced by theoretical classes, via digital platforms	119	35.5
Laboratory classes were not held	115	34.3
The laboratory classes were carried out remotely: the student at home and the teacher in the laboratory, synchronously	104	31.0
The laboratory classes were carried out remotely: the student at home and the teacher in the laboratory, asynchronously	43	12.8
Others	133	39.7
Practical classes in health services ^B
The practical classes continued with their usual occurrence	16	4.8
Practical classes had a reduction in the number of students per group	154	46.0
The HEIs provided the necessary PPE to the students	139	41.5
The HEIs provided the necessary PPE to the teachers	150	44.8
Health services provided the necessary PPE to students	30	9.0
Health services provided the necessary PPE to teachers	17	5.1
Students provided the necessary PPE	43	12.8
The teachers provided the necessary PPE	17	5.1
The professors performed direct supervision	114	34.0
The HEIs hired nurses to carry out direct supervision	31	9.3
Health services allowed the return of activities, with no limits on student per field	5	1.5
Health services allowed the return of activities, limiting the number of students per field	135	40.3
Health services did not allow the return of activities	58	17.3
There were no practical classes in health services	145	43.3

Associação Brasileira de Enfermagem SGA Norte Quadra 603 Conj. "B" - Av. L2 Norte 70830-102 Brasília, DF, Brasil, Tel.: (55 61) 3226-0653, Fax: (55 61) 3225-4473 - Brasília - DF - Brazil
E-mail: reben@abennacional.org.br

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[1] Corresponding author: Claudia Capellari E-mail: capellaric@gmail.com