CONCEPTIONS OF NURSING STUDENTS ON HEALTH PROMOTION RELATED TO PSYCHOACTIVE SUBSTANCES

Este estudio de modalidad cualitativa tuvo como finalidad indagar acerca de la concepción que los estudiantes de enfermería de la universidad poseen sobre la promoción de la salud, ante el uso de sustancias psicoactivas. Participaron nueve estudiantes, cursando las últimas asignaturas del primer ciclo de la carrera, reunidos en dos grupos focales. El referencial teórico-metodológico se fundamentó en la Teoría de la Concientización de Paulo Freire. Los datos fueron interpretados mediante el análisis de contenido, evidenciándose que los estudiantes encuentran dificultades al planificar estrategias de intervención en promoción de la salud ante el fenómeno de las drogas, debido a que los conocimientos brindados en la universidad poseen una tendencia biologista, propia del modelo médico, reconociendo a su vez una desarticulación entre la teoría y la práctica. A pesar de ello, logran reconstruir sus conocimientos y tomar conciencia de su rol como futuros promotores de salud ante el uso y abuso de drogas.


INTRODUCTION
The drug phenomenon has become a worldwide social problem, particularly in Latin American countries.Constantly increasing and complex, this phenomenon is notably impacting the health of communities.
One of the most appropriate methodologies to visualize and understand this phenomenon is the holistic paradigm in international healthcare.It allows for the clear identification of several factors that play a role and the population health status, particularly in Latin America countries.It also implements actions focused on health promotion and the prevention of drug use and abuse (1) .
The consumption of psychoactive substances follows the human species since its origins and evolution.Nowadays, data referring to the prevalence of drug consumption in our society display frequent variations, produced by increased consumption of both cocaine chlorhydrate and marihuana in young population groups.This situation indicates a progressive tendency in the magnitude and damages to society, caused by indiscriminate use of psychoactive substances.In this context, Nursing professionals are essential agents in the process of social transformation in countries that participate in health promotion and drug reduction programs (2) .
In Argentina, 40% of young people between 12 and 15 years old have already consumed alcohol and tobacco, while the consumption of illicit drugs includes, in decreasing order: marihuana, cocaine chlorhydrate, tranquilizers, inhalants and solvents.
Gender differences tend to be insignificant (3) .Drug use has become universal, relating to subjects and sociocultural contexts that negatively influence people's daily life (4) .
For the last decades in Argentina, the perception of drug problems have been part of the collective imaginary, to the extent that psychoactive substances occupy an increasingly preponderant place in matters that have been influencing the evolution of societies.However, reality has changed objectively, as well as perceptions in societies.The evaluation of beliefs and values involved in care delivery is fundamental, as well as the evaluation of professional healthcare practice (5) .
According to this way of thinking, it is essential to determine the best way to respond to the innumerable changes and global tendencies that are critically affecting community health and welfare.Moreover, strategies concerning health promotion need to be developed, dealing with the inequalities and facing the new millennium demands in a pertinent way.
There is great profusion and diversity of information regarding the problem.However, not enough studies deal with psychosocial aspects, refer to knowledge about the drug phenomenon from an interpretative-social focus, and adopt the description of Nursing students' conceptions about health promotion, in view of the use of psychoactive substances, as their central axis.

METHODOLOGY
This research has exploratory-descriptive characteristics, in line with the logic of qualitative methodology, with the orientation towards problemsolving as one of the basic pillars.The goal is to get to know college students' critical and reflexive learning.
An exploratory approach is used, identifying how the research participants construct the consumption of psychoactive substances and health promotion and searching for the meanings in their statements and manifestations, in order to better understand their conceptions.To achieve those objectives, a discovery context was used, analyzing the processes in their complexity and addressing contextualized experiences, with the presence of the social reality in the interaction among members.
In an attempt to understand the reality, questions or assumptions were described as people interacted with them: "it is important that the researcher finds sense and meaning in the data provided by the social subjects and the context" (6) .
The methodological theoretical focus of the study is based on Paulo Freire's Educational Theory, which was considered appropriate to respond to the students' need to think about their own practices.
Likewise, its approach was considered to stimulate the students' subjectivity, since they are subjects that treat, discuss, decide and operate according to the knowledge acquired in college.These interviews were recorded for later transcription, effective when asking for information about perspectives and experienced events.
The observation was focused on capturing the object's complexity, finding out about the actual context and what the students perceive and feel, as well as the interrelations among members of the groups under analysis.This permitted questioning the processes the students perform when demonstrating their knowledge on health promotion and drugs consumption , from a problem-solving perspective.
The application of the previously described techniques allowed for the exploration of the members' actions regarding their attitudes, care models and healthcare needs of the community, offering a space that allowed them to freely express themselves about the knowledge acquired at university.Content analysis (7) was used for data reading and description, which made it possible to achieve the study purpose, since it was based on a group of analysis and communication techniques.
The material obtained from both group interviews and observation records was then explored and organized.During the entire methodological process, there was a continuous and sequential analysis of the episodes, which enabled and facilitated their interpretation.

RESULTS AND DISCUSSION
Three analysis categories could be extracted from the focus group participants' statements.
Nursing and Health Promotion.Application to future professional practice The members from both focus groups were situated in the new radical model, which responds to the premises of health promotion and education.This model focuses its orientation on the enlargement of people's critical awareness, including four specific actions: thinking about personal realities, stimulating the search for and collective identification of the causes and manifestations of this reality, examining its implications and developing actions aimed at changing it.
In this context, the subjects consider that promotion has to be done by everyone, by supporting actions aimed at the community and working in groups.The mentioned model maintains that, instead of working with isolated individuals, it should be done in groups, since the group environment facilitates the increase of critical awareness through its potential to promote exchanges of ideas among subjects.
It is necessary to know the needs of the population.It is necessary to perform fieldwork and be able to see the reality, talk to people and listen to them.The dialog created in this context determines the collective awareness of the people's living conditions.However, it also allows for the acknowledgement that, behind the decisions of the individuals, there is a complex combination of factors and elements that influence and would influence them, so that previously acclaimed empowerment would not be possible.
Students attribute great importance to health promotion in the context of psychoactive substance use according to social classes, when maintaining that poverty is a factor that predisposes the subject to the consumption of such substances, as it allows them to evade their reality.
Likewise, both groups agree that promotion campaigns against drug use are not useful, since most of them emphasize negative consequences, expressing: It is not positive to prohibit.They also mention that, when coming across subjects at risk of consuming psychoactive substances, they need to take actions  Praxis (8) is highlighted as a privileged place for nurses to apply health promotion strategies against the drug phenomenon.Then, the development of Lately, the negative consequences of drugs consumption have become more evident as they come up in the health and social sectors.These include both social connotations of drug dependence, marginality characteristics, illegality, marginalization; and infections and diseases associated to intravenous consumption (9) .
The These models characterize addiction to these substances as a progressive and incurable disorder with genetic-biological origins.Besides, when associated to individual development difficulties, they cause susceptibility and dependence (10)(11) . In .
In this context, the university is considered a social institution, responsible for human resource development at a high academic level.Consequently, it should educate and prepare professionals to face the increasing challenges successfully, whether in the scientific, technical or cultural field (11) .
Regarding the latter, the members of the groups express that the students have broad initiatives at their disposal to intervene in how some content related to practice is approached at the university but, later on, they cannot continue applying the same initiatives.In spite of the content offered, we do not have health promotion in view of drug dependence -only to treat the consumer, which depends on the attitudes of different professors.
It is worth mentioning the importance of content integration in the curricular project, in two directions: on the one hand vertical integration, connecting contents from the same discipline; on the other hand horizontal integration, which implies significant relations among the curricular contents of different disciplines (12) .
Members who already had work experience in the area consider the importance of learning and working on health promotion and drug dependence in an interdisciplinary way.They support that Nursing, as a single subject, can treat the problem partially.
Due to the complexity of drug abuse and its multiple causal factors, the possibility of getting a complete view of the phenomenon reveals to be an illusion.
Consequently, it generates the need to approach several disciplines that try, just like Nursing, to understand man in order to set a benchmark for interdisciplinary and intersectorial work.However, as interdisciplinarity advances, new challenges appear.
Science areas do not communicate often and are often resistant to communication, jeopardizing innovation (13) .
Gathering information on knowledge Professional education is considered as a process in which the subject undergoes different experiences and interacts with several knowledge bodies and foci, embracing both the periods of formal and systematic preparation and professional practice (14) .Both focus groups say We have some knowledge, but we miss the practice.
Regarding the theory-practice link, this study focused on the first years of practical experience and the educative value it offers.The student is introduced to the culture of the institution at the same time as action outlines are incorporated.In this context, it imposes the idea of reflecting on current practices, turning this into a conscious and autonomous process, in which a narrow relation among intentions, reality and the relations between base and action theories can exist.
In the presentation of practice, from an interpretative and critical perspective, there is an attempt to overcome limitations by incorporating notions of understanding, interpretation, meaning and action.Thus, theory is built in articulation with practice (15) .
Students expose uncertainties about the space they may and should occupy as future health promoters, as well as about when and how to participate, which strengthens this problem due to the lack of confidence generated by their inexperience.
Thus, a pedagogical transformation is needed, in which relations, functions and roles of the educators and students are changed, introducing a participative methodology and creating conditions that allow for the development of creativity and research capacity.
The ever-changing needs, nature and level of substance abuse require that nurses be ready to work with people whose problems are related to alcohol and drug abuse.Nursing performance is an essential resource in care delivery to subjects, families and communities.Besides, in order to be able to perform their activities, nursing professionals should have clinical, cognitive and relational abilities (16) .
When synthesizing the group meetings that were held, the students managed to evaluate the context, reality and resources at their disposal.This evaluation contributes by offering approach and solution strategies, trying to recover the learning in the reconstruction of professional knowledge.The students highlight the importance of interdisciplinarity to address those themes.
Interdisciplinarity is feasible whenever there is a world view with points in common, a certain similarity of intentions, shared values, perspectives to move beyond rigid and bureaucratic academic structures, as well as the conviction that sharing a task is much richer than doing it alone.
This study focused on a problem-solving benchmark, in which the students managed to articulate the theme they talked about with arguments and thoughts, evidencing their knowledge construction processes and including themselves as future health promoters in this scenario, by discovering that they possessed previous knowledge that could be recovered.
Health professionals are able to generate cognitive and metacognitive competences, capture knowledge that is socially valid and reproduce it in their work context.According to Paulo Freire, it should be asked: Why do we not talk to students about the concrete reality they should associate the content that is taught to?Why do we not establish links between the students' fundamental curricular knowledge and their social experience as individuals? (17).
to help them, since, by themselves, these subjects could not avoid the use and abuse of those substances.The subjects mention the difficulty they face to plan health promotion actions in Nursing care, since the medical models of health care, cure and rehabilitation predominate in their practice.They express that, at the university, although they receive significant content along the first semester of the course, they are generally taught to follow a biologistic orientation, and only some of it refers to health promotion in view of psychoactive substance use.They say they face obstacles to express the exact meaning of health promotion.Those obstacles, thus, prevent them from thinking of interventions they would perform in the community, alleging a lack of practical experience.
health education activities can be proposed, considered in some budgets, incorporating the recognition of dignity and integrity of the subjects involved in the educational process, including awareness and freedom.Generally, vertical focus, in-class learning and a biomedical health concept have preponderated in most healthcare education trends.In the opposite sense, Paulo Freire, in his popular education, says that participative methods activate people's confidence and free determination.These methods are popular nowadays, as their application is observed in the fields of healthcare education and communication.The drugs phenomenon: opinions and beliefs on the use of psychoactive substances The compiled data, as expressed by the students, reveal the relative importance they attach to the phenomenon.At first, they may not see it as a problem situation, which they can face through intervention actions or strategies in the community.
construction is the key to understand the process performed, since the knowledge owned by students is an indicator of the articulations between thought and action.Nowadays, social-historical and cultural constructivism is privileged as a pedagogical perspective, in which the intersubjective relation stands out as the fundamental base for learning.From interaction, the recognition of knowledge and life experiences, the overcoming critical theory reappears: the awareness pedagogy.Likewise, students know what is happening nowadays in a superficial way.They do not have much data regarding the reality around them, and are not interested in acquiring knowledge on the theme through autonomous and independent learning.As Paulo Freire said, they cannot move from the naïve curiosity to epistemological curiosity.
Society and culture demand reflection on health problems as part of a complex social configuration.If health promotion and prevention permit the visualization of the subject's life process in everyday dynamics, indicating lifestyle transformations and the process of thinking about one's own fears and judgments, different conflicting situations can be addressed.FINAL CONSIDERATIONSIn summary, the students' conceptions on health promotion, in their own social-cultural context, containing characteristics of the world around them, determined the meaning they grant to the use of psychoactive substances, as well as the possibilities to apply their knowledge in their future professional practice.These thoughts consider questions related to the role of the articulation between theory and practice in the development of students' experiences.Professional practice appears as a defining element in the incorporation of significant problems that affect professional exercise.That kind of representation regarding practice implies acknowledging the validity of certain identifying traits of the profession, enclosed in the historical conditions they are manifested in within a certain society.The inclusion, hiding or explanation of these practices and the way they are allocated by the disciplines and learning promoted are matters related to the presentation of content and define an interesting field for reflecting about the curricular structure of the career.