Review of scientific literature on the use of group activities in nursing work in Brazil: 1980 to 2003

Análisis de la producción científica sobre la utilización de actividades grupales en el trabajo del enfermero en Brasil: 1980 a 2003

Abstracts

Dentre as atividades do enfermeiro, muitas estão organizadas no contexto grupal. A constatação de que não havia estudo sistematizado, no Brasil, que oferecesse parâmetro para compreender como o enfermeiro utiliza esse recurso, motivou o desenvolvimento deste estudo, cujo objetivo foi analisar a produção científica sobre a utilização da atividade grupal, relacionada ao trabalho do enfermeiro entre 1980/2003. Pesquisa descritiva/exploratória, realizada por meio de investigação bibliográfica em periódicos nacionais, tendo como base um protocolo específico. Identificou-se 151 artigos que foram analisados quanto à expansão desse conhecimento e às diversas situações em que o grupo é utilizado nas atividades do enfermeiro. Na análise qualitativa, realizada a partir de categorias pré-definidas, identificou-se que o enfermeiro tem utilizado esse recurso na assistência, produção de conhecimento e formação de recursos humanos. A investigação permitiu traçar um panorama dessa produção e elaborar um catálogo que identifica aspectos importantes na construção desse conhecimento pela enfermagem brasileira.

enfermagem; grupos de estudo; pesquisa em enfermagem

REVIEW ARTICLES

Review of scientific literature on the use of group activities in nursing work in Brazil: 1980 to 2003¹

Análisis de la producción científica sobre la utilización de actividades grupales en el trabajo del enfermero en Brasil: 1980 a 2003

Maria Tereza Hagen de Godoy^I; Denize Bouttelet Munari^II

^IM.Sc. Assistant Professor, e-mail: [e-mail]

^IiPh.D. Full Professor, CNPq Researcher, e-mail: [e-mail]. Goiás Federal University Faculty of Nursing

ABSTRACT

Among the many and diverse activities carried out by nurses, many are organized within the context of a group approach. The realization that there were no systematized studies in Brazil, capable of providing parameters that would help to understand how nurses use this resource, motivated the authors to develop this study, whose objective was to review scientific literature on the use of group activity, as it relates to the work carried out by nurses, between 1980 and 2003. This was a descriptive/exploratory research developed through a bibliographic review in Brazilian journals, on the basis of a specific protocol. We were able to identify 151 articles that were reviewed in terms of the expansion of this knowledge and the different situations in which a group is used by nurses. The qualitative analysis done on pre-established categories enabled the authors to verify that nurses have been using this technique while delivering care, producing knowledge and developing human resources. This investigation allowed us to outline a panoramic view of this literature and to develop a catalogue, identifying important aspects in the construction of this knowledge by Brazilian nursing personnel.

Descriptors: nursing; focus groups; nursing research

RESUMEN

Entre las actividades del enfermero, muchas están organizadas en el contexto del trabajo en grupo. La constatación de que no había estudio sistematizado, en Brasil, que permitiese un parámetro para comprender como el enfermero utiliza ese recurso, motivó el desarrollo de este estudio, cuyo objetivo fue analizar la producción científica sobre la utilización de la actividad en grupo relacionada al trabajo del enfermero entre 1980/2003. Investigación descriptiva/exploratoria realizada a través de investigación bibliográfica en periódicos nacionales, teniendo como base un protocolo específico. Identificamos 151 artículos que fueron analizados en cuanto a la expansión de ese conocimiento y las distintas situaciones en que el grupo es utilizado en las actividades del enfermero. En el análisis cualitativo, realizado a partir de categorías previamente definidas, identificamos que el enfermero viene utilizando ese recurso en la asistencia, producción de conocimiento y formación de recursos humanos. La investigación nos permitió trazar un panorama de esa producción y elaborar un catálogo que identifica aspectos importantes en la construcción de ese conocimiento por la enfermería brasileña.

Descriptores: enfermería; grupos focais; investigacíon em enfermería

INTRODUCTION

Nursing activities often occur in the group context, as a strategy in different activity areas, research activities and professional training. In Brazil, Public Health Nursing was a pioneer in the publication of scientific studies focusing on this context⁽¹⁾.

Study and practice allow us to affirm that, in general, nurses use group activities as a care "technique", doing what they believe is correct without, however, seeking specific theoretical foundations to sustain the use of this work instrument. We believe that this fact is due, among other aspects, to a lack of knowledge about specific theoretical support for their actions, as this contents has not been systematically offered in undergraduate nursing courses^(2-3).

The use of groups in human care essentially requires knowledge about this instrument with a view to better professional performance. Hence, nurses need specific training to expand their knowledge in this area, offering a base for more assertive and efficient action.

The term group refers to a set of persons joined in the same place, with the same objective and attitude and with a common goal that conditions its members' cohesion^(4-5).

What determines the existence of a group is the interaction among its members, that is, that they experience the same emotions, and that these are sufficiently intense to constitute a group⁽⁶⁾. As important as its definition is knowledge about its nature and characteristics, especially when we intend to understand groups as a space for professional action, like in the case of nursing, where they are used for different activities.

One way of characterizing groups is on the basis of their purpose. They can be classified as operative and therapeutic. Operative groups are task-centered and their concept is wide-ranging, due to countless possibilities for practical applications. Many consider these as a continent of all other groups, including teaching-learning, institutional and community groups⁽⁵⁾.

Therapeutic groups are divided into self-help groups, which cover the medical area in general, the psychiatric area and the so-called psychotherapeutic groups, strictly designated for those types of groups aimed at acquiring insight^(5,7).

In nursing work, for example, an operative group focus is adequate, in view of the relative ease of training professionals to perform this activity, as well as to work with pregnant women, adolescents, hospitalized patients, among others^(5,8).

Group work offers opportunities for growth and change in relation to ourselves and the world. A group's life can and must be observed from different perspectives, in order to understand its complexity, vitality and potential⁽⁹⁾.

To apply this resource in different nursing work dimensions, we defined the term group activity as actions this professional performs in the group context. This definition will be used in this paper.

The study of these activities, their nature and application in nursing led to the observation that there was no systemized study offering parameters to understand how nurses have used this resource. This fact motivated us to study the subject in Brazilian literature, specifically in nursing journals, in view of our involvement in the development of this technology and its possible contribution to people wanting to work better with this tool in nursing.

The decision to focus on Brazilian production is justified by the fact that this theme is still developing, outlined by important sociocultural peculiarities that need to be known in a Brazilian context. The study's relevance exactly derives from the possibility to draw a national panorama about this knowledge production, which does not exist yet.

Thus, our aim is to characterize and analyze scientific production about the use of group activities related to nursing work, between 1980 and 2003, in Brazilian nursing journals.

METHOD

We carried out a descriptive and exploratory bibliographic study, i.e. the investigation of all written and published material to survey and analyze the production about a particular subject, characterized as the research theme^(10-11).

Bibliographic research allows researchers to have direct contact with what has already been written about the subject. Its main advantage is to allow for a wider coverage of the research phenomena, which would not be possible if the research were realized directly at the source^(10-11).

We decided to work only with Brazilian nursing journals, as their regular publication permits an analysis of Brazilian nurse researchers' production about the study theme.

The research period was delimited between 1980 and 2003, since an earlier study⁽¹⁾ indicated the 1980's as the start of research dissemination about nursing work using group activities in Brazilian journals.

The material was selected in the collections from the Ribeirão Preto Campus Central Library and the Glete de Alcântara Reading Room at the Ribeirão Preto College of Nursing, both of which are part of the University of São Paulo.

We adopted a number of inclusion criteria: indexed journals; regularly published with periodical circulation, to allow for an analysis across the study period; and availability at the research sites between July and December 2003.

The following journals attended to the inclusion criteria: Revista Brasileira de Enfermagem; Revista da Escola de Enfermagem da USP; Revista Gaúcha de Enfermagem; Revista Paulista de Enfermagem; Acta Paulista de Enfermagem; Texto & Contexto Enfermagem; Revista Latino-Americana de Enfermagem; Revista de Enfermagem da UERJ; Cogitare Enfermagem; Revista da Escola de Enfermagem Anna Nery.

To select the articles, we realized an active search in these journals, per volume and issue. If the previous reading of the title, abstract and methodology indicated that group activities were used in some way in the contents, the article was selected.

The selected articles were compiled, separated per publication year, submitted to careful reading and registered by means of a protocol, elaborated to identify relevant aspects for this study, such as: publications per journal and year; type of article (synthesis of master's thesis or doctoral dissertation, research, experience report, case study or others); authors' region of origin; descriptors; theme area; focus of group activity and specific theoretical framework about groups.

Data about authors' origin and profession were collected from the footnotes presented in each article.

Initially, we performed a descriptive analysis of the data included in the protocol, aimed at characterizing the above mentioned aspect. This gave us a panorama of the situation of knowledge production in this area.

In a second phase, the material was submitted to qualitative analysis⁽¹²⁾, based on a priori defined categories: a) The group as a resource in care; b) Nursing and groups: knowledge production and c) The group in human resource training. In defining these categories and distributing the articles, we especially considered the objectives the authors defined in their articles, as some studies fitted into more than one category.

Hence, what defined the article's inclusion into a category was the study's central focus, delimited in the objective. Therefore, we validated the articles' distribution into the respective categories, based on a careful review of each, in order to guarantee reliability and consistency in the description of data contents for qualitative analysis.

RESULTS AND DISCUSSION

The treatment of data through descriptive analysis of the aspects selected in the collection protocol and the search for the study objectives allowed us to reach the results presented below in terms of general characterization, as well as thematic content analysis.

General characterization of articles

In this topic, we present a general panorama of the studied articles, presenting the aspects delimited in the methodology. Although various other journals were published during the study period, the research inclusion criteria described above resulted in a research universe of ten articles, presented in Table 1.

Only one journal, the Revista Brasileira de Enfermagem, is originated in the Central West. All others are issued in the South and Southeast. Despite a comprehensive search, some issues of the selected journals were not located in due time and, hence, were not analyzed.

Table 2 presents the distribution of the studied articles, according to the year they were published, for the sake of better visualization of Brazilian production in journals.

Table 2 shows a growing increase from 1994 onwards, which can indicate both the increase of group activities in nursing actions and these professionals' increased interest in disseminating the results of their application.

With respect to the production volume per journal/year, we found that the average number of articles published, considering publications started until 2003, is more significant in some journals, as shown in Table 3.

We found that the Revista Brasileira de Enfermagem published a larger volume of publications in numerical terms, but smaller in terms of annual average (1.86), while the Revista Texto & Contexto Enfermagem presents the largest annual average volume of publications (3.33) in the study period.

As to the authors' region of origin, most articles in this study come from the Southeast (60 articles), followed by South (57 articles), Northeast and Central West (11 articles) and North (1 article).

The concentration of publications in the Southeast and South can be explained by the concentration of existing graduate courses in those regions, which facilitates and stimulates the development of knowledge production and, consequently, its dissemination. Nine of the ten journals we studies are affiliated with higher education institutions located in those regions and offering graduate nursing courses.

One significant piece of information that reinforces this assertion is the fact that 162 faculty members of higher education institutions, i.e. 51.4% of the research authors, served as authors or co-authors of 128 articles, 84.8% of the total.

In 15 articles, 27 professionals from other areas collaborated. Besides these professionals, 18 nursing students were partners in the publication of 12 articles, two of whom were the single authors. This fact indicates future professionals' awakening to the application of this technology, which will certainly strengthen the use of this tool in their professional activity with groups.

An analysis of the descriptors characterizing the articles identified a very large volume, as they highlighted the application areas of group work in nursing actions, instead of focusing on the group approach in itself. For this reason, we only selected and analyzed 25 descriptors that, in our perspective, were in some way related to group activities. Only five of these are available to characterize group activities in the BIREME database.

We also analyzed specific bibliographic references about group theories. Their occurrence was variable and irregular across different years, being used in studies published at the start of the 1980's, but not in articles published in 2003, which suggests the need for further study.

Sixty-one classical texts on group theory were used, as well as group technique manuals and books. These references were found in 39.1% (59 articles), 11 of which only referred to books and group technique and game manuals.

The clients attended by group activities mainly consist of health service users. This shows that this technique is becoming constant practice in nursing care. Thus, we can affirm the group as a big ally in nursing care, involving a wide range of clients with different problems. It is also a frequently used tool in teaching, research and to support service management.

Analysis of Knowledge Production: a thematic content analysis approach

Qualitative data analysis was constructed to show a panorama of Brazilian productions about the theme, without looking deeper into the articles' contents. We attempted to map them on the basis of thematic references, in order to group them in a priori defined categories - The group as a resource in care - Nursing and groups: knowledge production - The group in human resource training.

After exhaustive reading, distribution in categories and the validation process, which defined the contents of data in each category, each of these categories was analyzed separately, in view of the data volume (151 articles).

The group as a resource in care

The category: the group as a resource in care characterizes studies working with different care levels, ranging from health promotion to rehabilitation. Thirty-seven articles were included, corresponding to 24.5% of the total number of articles.

To facilitate the analysis of articles in this category, we used an earlier study⁽¹⁾, so as to divide them in line with the author's suggestions, in order to classify group activities performed by nurses with this purpose. Thus, articles characterizing care activities were distributed in the following subcategories: information and health education groups; groups to maintain individual and family care programs and projects and rehabilitation and emotional support groups.

Information and health education groups

This subcategory included 11 articles (7.3%), which described short group activities with little structure, such as waiting room groups, surgical advice groups, workshops and other educative actions.

Groups to maintain individual and family care programs and projects

This subcategory included 13 articles (8.6%), reporting different types of care performed through group activities in programs established by the Ministry of Health, or developed at institutions to improve the quality of individual and family care.

Rehabilitation and emotional support groups

The activities described in this category referred to groups of patients with the same disease or need (hypertensive, obese, diabetic and colostomy patients, among others). In these groups, the force of group motivation is the main therapeutic action instrument, due to the fact that patients use the same language and share the same suffering and difficulties^(5,7,13).

This subcategory included 13 articles (8.6%), whose objectives focused on support actions through group activities, aimed at coping with different situations experienced by patients who need to live with chronic health problems.

The advantage of this kind of work for this type of clients is its potential to change behaviors. People involved in these processes demonstrate a capacity to help, as well as an incredible therapeutic capacity, released by the freedom to express feelings provided by group experience⁽¹⁴⁾.

Nursing and groups: knowledge production

This category included 89 articles (58.9%) developing knowledge about the theme. They focus on the exploration of theoretical-technical concepts and aspects, based on classical theories about the movement of human groups and its application in nursing.

In itself, the importance of getting to know these concepts in order to understand the behavior of human groups and the functioning of society already justifies research about this object⁽¹⁵⁾.

This category also included articles about theoretical-technical aspects, applied in the daily reality of care practice, research, training and the assessment/validation process of using this strategies, as well as articles in which authors used group activities to collect research data.

To facilitate the analysis of this category, we divided the articles into four subcategories: theoretical studies; group activity models in care; human resource training models and use of group activities to collect research data.

Theoretical studies

This subcategory included 11 articles (7.3%) that contribute to theoretical knowledge about the group and its application in nursing work. These studies address concepts, theories and methodologies, as a source of information for professionals who want to work with this tool.

Group activity models in care

This subcategory covered articles proposing group activity models for care and reporting on the activities of groups active in care. Nineteen articles were included (12.6%).

Human resource training models

This subcategory included seven articles (4.6%), which theoretically describe group work models for human resource training. These studies demonstrate the great potential of this technology for human resource development, based on the advancement of the personnel management process in modern times^(3,11).

Use of group activities to collect research data.

This subcategory included articles in which authors use group activities and techniques to collect research data. Researchers have used this technique on a large scale in data collection, as this is the largest subcategory, totaling 52 articles (34.4%).

The analysis of this category showed that only a small number of researchers develop theoretical studies about groups (7.3%). This fact makes it more difficult for nurses to use this tool, due to the lack of specific references to support their practice. On the other hand, we proved interest in disseminating models for this activity in care, human resource training and as a research strategy, providing valuable contributions to the development of this technology by nursing.

The group in human resource training

This category concentrates studies that use group activities in human resource training, sensitization and permanent education of care professionals, and as a didactical-pedagogical resource with nursing students. Twenty-five articles (16.6%) were included in this category.

The use of group techniques leads the involved individuals to a feedback movement, increasing communication and benefiting the appearance of new ideas, concepts and directions, contributing to learning on a larger scale⁽¹⁵⁾.

Group activity as a didactic-pedagogical activity

This subcategory refers to articles in which authors use group activities/techniques as a didactical resource. This theme was included because it is a human resource training strategy par excellence. Thirteen articles were included (8.6%).

The group as a resource for team development and strengthening of professionals' interpersonal relations.

This subcategory covers articles that worked with personal training of all professional categories, in nursing as well as other health areas, using group activities. Twelve articles (8%) with this approach were included.

This group contained studies in which authors attempted to work with health professionals' feelings, with a view to care humanization.

The analysis of this category proved nurses' awakening interest in using group activities for human resource training, in nursing teaching as well as professional training. Group activity is an efficient way of dealing with the difficulties both professionals and students are confronted with, because it benefits the exchange of experiences and provides support through the group, helping participants to overcome anguish and conflicts deriving from emotional overload and stress in this kind of work^(2-3).

FINAL CONSIDERATIONS

The achievement of the initially proposed study objective allowed us to construct a panorama of group activities related to nursing work in Brazil, between 1980 and 2003. We observed an expansion in the development of this knowledge during the study period, particularly from the 1990's onwards.

We were able to characterize the situations in which groups have been used in nursing, which proved the use of this technology as a work tool in countless nursing activities.

One hundred fifty-one articles were identified, which were analyzed in terms of knowledge expansion and the different situations in which groups are used in nursing activities. In the qualitative analysis based on predefined categories, we identified that nurses have used this resource in care, knowledge production and human resource training.

This bibliographic research allows us to indicate some advantages of this type of study. One of them is the possibility to go back to the collected material as many times as needed, solving doubts whenever necessary. In our experience, the disadvantage of bibliographic research is that, often, researchers do not find answers to some of their questions and have to count on the author(s)' clarity of expression and the availability of material in libraries.

We also highlight the capacity to create new ways of group work as a nursing care strategy, revealed by nurses' reports throughout the research.

The occurrence of productions about this theme in all studied journals allows us to affirm a permanently increasing tendency to use and systemize group activities involving different types of clients and nursing actions.

This study allowed us to draw a panorama of this production and elaborate a catalogue that identifies important aspects in the construction of this knowledge by Brazilian nursing. This catalogued and descriptive material is available in the text of the thesis, as a valuable source for bibliographic consultation about the theme.

Recebido em: 7.3.2005

Aprovado em: 14.6.2006

• 1. Munari DB, Furegato, ARF. Enfermagem e Grupos. Goiânia (GO): AB Editora; 2003.
• 2. Saeki T, Munari DB, Alencastre MB, Souza MCBM. Reflexões sobre o ensino de dinâmica de grupo para alunos de graduação em enfermagem. Rev Esc Enfermagem da USP 1999; dezembro 33(4):342-7.
• 3. Esperidião E, Munari DB, Stacciarini JM. Desenvolvendo pessoas: estratégias didáticas facilitadoras para o auto conhecimento na formação do enfermeiro. Rev Latino-am Enfermagem 2002 julho-agosto; 10(4):5-16.
• 4. Novo Aurélio Século XXI: O Dicionário da Língua Portuguesa. 3ª ed. Rio de Janeiro (RJ): Nova Fronteira; 1999.
• 5. Zimerman DE. Fundamentos Básicos das Grupoterapias. 2ª ed. Porto Alegre (RS): Artmed; 2000.
• 6. Mailhiot GB. Dinâmica e gênese de grupos. São Paulo (SP): Livraria Duas Cidades; 1981.
• 7. Zimerman DE, Osorio LC. Organizadores. Como Trabalhamos com Grupos. Porto Alegre (RS): Artmed; 1997.
• 8. Mello Filho J de. (Organizador). Grupo e Corpo. Porto Alegre (RS): Artmed; 2000.
• 9. Loomis ME. Group process for nurses. Saint Louis: Mosby; 1979.
• 10. Marconi MA, Lakatos EM. Metodologia do Trabalho Científico. 6ª ed. São Paulo (SP): Atlas; 2001.
• 11. Ruiz JA. Metodologia Científica. 5ª ed. São Paulo (SP): Atlas; 2002.
• 12. Bardin L. Análise de conteúdo. Lisboa: Edições 70; 1977.
• 13. Rogers CR. Grupos de Encontro. 8ª ed. São Paulo (SP): Martins Fontes; 2002.
• 14. Fonseca LMM, Scochi CG, Mello DF. Educação em saúde de puérperas em alojamento conjunto neonatal: aquisição de conhecimento mediado pelo uso de um jogo educativo. Rev Latino-am Enfermagem 2002 março-abril; 10(2):166-71.
• 15. Barreto MFM. Organizadora Dinâmica de Grupo: história, prática e vivência. Campinas (SP): Alínea Editora; 2003.

1

Article extracted from the Master's Thesis, part of an integrated project with CNPq support

Publication Dates

• Publication in this collection
  13 Nov 2006
• Date of issue
  Oct 2006

History

• Accepted
  14 June 2006
• Received
  07 Mar 2005