The problematization method applied to the subject nursing administration/Metodología de la problematización aplicada a la disciplina de la gestión en enfermería

Headnote

Abstract

The aim of this paper is to enhance reflections on the impact of the Brazilian National Curricular Guidelines in undergraduate Nursing education, in the subject Nursing Administration. Another aim is to cooperate with the elaboration of strategies to be developed for the construction of professional competences, in accordance with the education and professional qualification standards demanded in the job world. The guidelines prioritize the preparation of a generalist, critical and reflexive nurse, with competences and skills to act in distinct realities, mainly in the Unified Health System. The importance of teachers' active, encouraging and problematizing participation is emphasized, helping students to gain "knowledge" and "know-how" in their academic education, permitting competency development for nursing education.

Key words: education, nursing; management; curriculum.

Metodología de la problematización aplicada a la disciplina de la gestión en enfermería

Resumen

Este artículo tiene como objetivo promover la reflexión sobre el impacto de las Directrices Curriculares Nacionales para el pregrado de Enfermería, en la asignatura de Administración. También se pretende colaborar en la elaboración y desarrollo de estrategias para la construcción de competencias profesionales, de acuerdo con los estándares de formación y cualificación profesional exigidos en el mundo laboral. Las directrices priorizan la formación de un enfermero generalista, crítico y reflexivo con competencias y habilidades para actuar en distintas realidades, principalmente en un Sistema Único de Salud. Se destaca la importancia de la participación activa de los profesores, incentivadora y problematizadora, que ayude al alumno a "saber" y a "saber hacer" durante la formación académica, permitiendo el desarrollo de las competencias para la formación de enfermeros.

Palabras clave: educación en enfermería; gerencia; curriculum.

Metodologia da problematização aplicada a disciplina de administração em enfermagem

Resumo

Este artigo tem como objetivo promover a reflexão sobre o impacto das Diretrizes Curriculares Nacionais para o pré-graduação de Enfermagem, na matéria de Administração. Também se pretende colaborar na elaboração de estratégias a ser desenvolvidas para a construção de concorrências profissionais, de acordo aos padrões de formação e qualificação profissional exigidos pelo mundo trabalhista. As diretrizes priorizam a formação de um enfermeiro generalista, crítico e reflexivo com concorrências e habilidades para atuar em diferentes realidades, principalmente num Sistema Único de Saúde. Destaca-se a importância da participação ativa dos professores, incentivadora e problematizadora, que ajude ao aluno a "saber" e a "saber fazer" durante a formação acadêmica, permitindo o desenvolvimento das concorrências para a formação de enfermeiros.

Palavras chave: educação em enfermagem; gerência; currículo.

Introduction

Since the start, nursing education has been influenced to respond to the social and political issues of each age and, after the establishment of Nursing school, to attend to public health needs. In social terms, the 1930's and 1940's were marked by the industrialization process, enhancing the need to qualify the occupational health workforce and services. This was one of the factors that triggered the growth of Nursing programs. In 1949, the compulsory existence of Nursing education at all universities or medical schools became official, defining teaching directed at the hospital area, centered on the clinical model and based on a minimal curriculum.1

According to this model, the duration of the course was reduced from four to three years, as public health became offered as an optional specialization, in compliance with the minimal curriculum, prioritizing physical and biological science subjects, to the detriment of social sciences.2 Even with the University Reform that took place in 1968, requests for changes in the minimal curriculum were partially attended to, as nursing education remained focused on biological subjects, technical and individualist. In view of the new organization forms of health work, considering scientific as well as technological aspects, driven by the globalization process that started in the 1970's, new professional qualification forms became necessary, oriented at interdisciplinarity in knowledge construction.3

The profile of competent Nursing professionals is generalist, critical and reflexive, capable of recognizing and intervening in health-disease processes, as described in the National Curricular Guidelines for Nursing Courses (DCNENF), based on CNE/CES Resolution No. 3, issued on November 7th 2001, with a view to encouraging professional qualification to respond to this new demand in the labor world.4 The following is highlighted: the "need to advance, not only in the preparation of a new professional but, above all, of a critical individual and citizen, prepared to learn to create, to propose, to construct".5 Thus, Nursing educators face the challenge of breaking with former teaching patterns and contributing to society through the education of nurses who are competent to develop health actions.

In this historical context, the university plays a social role through its commitment to seek new and socialize existing knowledge, offer professional education and intervene in the solution of problems. In that sense, teaching actions committed to the social function would be the preparation of competent professionals.6 Thus, this study is justified by the concerns aroused during two years, while responsible for the subject Supervised Training in Administration, regarding the students' difficulties to manage, lead and develop nurses' administrative functions, besides the students' lack of participation and commitment in decision processes, in the course as well as in the subject.

The activity was developed to promote reflections on the National Curricular Guidelines (DCNs) for Nursing Courses and their development in the subject Nursing Administration, and also to support the elaboration of professional competency construction strategies in the subject nursing administration, thus encouraging students' critical and reflexive aspects concerning the teaching quality offered and their active participation in knowledge construction, granting them the opportunity to discuss their role in the teaching-learning process. The aim of this report is to describe an experience in the Nursing education context, using the problematization method based on Maguerez's Arch.

Problematization experience

The group taking the subject Supervised Training in Administration at Universidade Estadual do Centro Oeste - Unicentro, consisting of 27 students, was invited to participate in the assessment of the subject, through a Student Reflection Workshop. In total, 25 students and four teachers participated, who met at the university classroom in October 2010. As the intention was to have all students participate in the discussions, four meetings were held, supported by the problematization method with the help of Maguerez' Arch.7 This method permits students' more effective participation in the construction of the teaching-learning process, permitting criticism and reflection, as well as the construction of strategies to transform the reality students are inserted in.

Maguerez' Arch involves five steps: observation of reality, identification of key points, theorization, solution hypotheses and application to reality. During the first meeting, the observation of reality and key points were applied. Theorization took place during the second encounter, the formulation of problem-solving hypotheses in the third and the application to reality in the final meeting. During the first encounter, besides explaining the objectives of the workshop, the method that would be used was presented. As the Maguerez Arch technique is not appropriate for large groups, the class was divided in five groups of five students.

In the first step of the method, different instruments can be used, explored through questions, to observe reality.7 Each group received a sheet of cardboard and pen, the teaching plans for the subject and the Law of National Curricular Guidelines for Nursing Courses. Then, the first phase of the Arch started, in which reality was observed and problems were identified. At that moment, the students read the didactic material and reflected on the guiding questions: What are the disagreements between theory and practice you experience? What difficulties do you face to experience the competences recommended in the guidelines?

In the second step, the elements present in the problems are distinguished and their causes are identified, thus listing the key points of the situation. In this step, each group elaborated the key points members considered pertinent, which were displayed on the board for the sake of better visualization and integration among the participants. In view of the result, the entire group again debated on the most focal points that generated the others, reaching a conclusion and formulating a single key point, which was: "the nurse's administrative function". The students further elaborated this aspect in the third step of the Arch.

The third step of Maguerez' Arch, related to theorization, establishes that scientific knowledge explains problems. Thus, during the second meeting, the theorization step was developed, when the students sought information about the key point defined in literature, in the library as well as in the informatics laboratory. The students who looked in the library used the basic bibliography the teachers had indicated in the teaching plan as the reference framework. Based on the theoretical background, the students met during the third encounter to develop the fourth and fifth steps of the Arch. In these steps, students use their creativity to propose solution hypotheses, with confrontations and dialogue between the hypotheses and the limitations of reality. Students should return to reality to execute the proposed projects that are feasible, with a view to its transformation.

This phase was developed based on the verbalization and observation group dynamics (GV/GO). Thus, students were conducted to analyze situations, raise hypotheses, organize information, besides stimulating observation and the interpretation and comparison of data.8 The students were organized in two group, each of which was later divided in two subgroups: one verbalizer and the other observer. Each member of the verbalizer group started by summarizing the study developed during the previous meeting and presenting the group's considerations and hypotheses to solve the problems. Then, the observer group registered the information presented during the GV discussion and contributed with the group's own syntheses and considerations about the discussions. At the end of the dynamics, each group reported the conclusion deriving from the discussion between the verbalizer and observer groups. These conclusions are the hypotheses to solve the problem and were written out on the board for the sake of the class' visualization and interaction.

In view of the hypotheses, the group reflected on which of them could actually be applied to reality in different training contexts - hospital, collective health - and in the teaching process of the subject nursing administration itself, choosing the hypotheses that could be developed in the short term. As for ethical aspects, the group authorized the dissemination of the experience.

Experience results

The results of the discussions and respective key points, as well as reflections on the theorization and respective solution hypotheses, are summarized in Tables 1 and 2.

The aim of using a new teaching method, the problematization method, was to stimulate students and teachers' critical and reflexive thinking and commitment to the construction of their own reality. While presenting the problems, the students broadened the discussion beyond the administration subject, reflecting on course-related issues like the curriculum and hour load. Clarifications were needed about the responsibilities of the course and how the Brazilian Ministry of Education and Culture (MEC) defines it. Hence, we focused on the reality we can modify and how the subject can interfere through actions by the responsible faculty members. At that moment, students' lack of knowledge about the course regiment and structure was perceived, and how important this process is to enhance the students' inclusion in the university and participation in the development of the course, as well as to stimulate their political articulation in society.

After a general discussion on the focus of the activity on the Administration subject and education according to the DCN, the group reflected further on the contents of the subjects and their practical experience during the training. After each group had listed a key point (Table 1), a general presentation was given, reaching a consensus on a general key point: "Definition of the nurse's administrative function", as all groups converged towards this theme.

As a result of the GV/GO dynamics, many reflections emerged, which were repeated among different members in both groups during the debate. This fact may suggest that, even in different groups, the anxieties were the same, demonstrating the students' agreement on the view of the subject and the experience achieved in the training programs.

Some of the results described in Table 2 showed that, according to the group, contact with the administrative and mainly leadership aspects should happen since the start of the course, which is a factor that can enhance their development throughout the course, and not just in the final year. The students' greater involvement in course issues and research and community service projects are also appointed as factors that strengthen the visibility of the profession, the development of autonomy, acknowledgement in society and to improve knowledge on and the development of administrative planning, organization, control and assessment actions.

No direct solution was found for some of the hypotheses suggested, like in the case of discouragement, submission and non-adequacy of the functions the nurse performs. The group identified this situation as a personal factor for each professional, making it difficult to present an external intervention proposal. The students valued these problems though, which compromise the quality of nurses' work.

To finish the trajectory of Maguerez' Arch, in the final step, we returned to reality and applied the proposed solutions. At that moment, discernment was needed to choose the hypotheses that best applied to our institutional and regional context within a short time period. Initially, the following ideas were selected: 1) organize a conversation group about the profession and the students' challenges together with the student association, in which final-year students meet with younger ones to socialize their knowledge; 2) after the end of the training period, formally present the projects and activities the students developed in the field to the training units, enhancing integration among the institutions and the visibility of academic work; 3) students' planning, organization and execution of a community service project.

In this scenario of proposals, first, the elaboration of a community service project was executed. Two students who did their training in the university's "Wound Project" planned and organized a community service project within a preset period, targeting fourth-year students who had not had the opportunity to participate in a training program in this specific area in previous course years.

The course involved two modules, one theoretical and one practical, in which the students practiced wound dressing in pairs, under the supervision of the trainees and teachers participating in the wound project. Another proposal accomplished was the formal presentation of the activities developed during the training program to the training area coordinators and competent authorities like the Municipal Health Secretary. Some nurses from the collective health units were present. Information exchange, valuation of students' work and of the partnership between the university and the training area marked that moment. The other proposals were discussed in the board that manages the subject, so as to readapt the teaching plan for the subsequent course year, with a view to constructing a more integrated, open and dynamic subject, enhancing a more efficient teaching-learning process.

Final considerations

In the elaboration of this study, the choice of the method and the development of the activities proposed during the meetings were motivated by the aim of starting to reflect on the subject 'Supervised Training in Nursing Administration' in accordance with the National Curricular Guidelines for Nursing Courses. These recommend the preparation of generalist, critical and reflexive nurses, with competences and skills to act in distinct realities, mainly in the Unified Health System. This motivation originates in the need to adapt the course to the guidelines and needs of student education.

Thus, the method adopted in the teaching process offered in the subject 'Supervised Training in Nursing Administration' and the main difficulties last-year undergraduate Nursing students experienced to develop the competences recommended in the DCN had to be reconsidered.

During the meetings, the extent to which the students' critical and political position is influenced by the curricular structure they are submitted to when starting the course was perceived. Hence, the mere description of the guidelines in the pedagogical project is incapable of transforming professional education and developing competences. Both students and teachers, in their respective subjects, should work together, sharing the responsibilities for competency-based education, as this is not about isolated and disconnected actions, but about a process that should be constructed in all learning phases.

Another aspect observed was the students' unanimous acceptance of the problematization method, which they identified as a facilitator of teacher-student interaction and learning, which demonstrated that they were open to critical and reflexive learning. When seeking answers to the suggested key point, the students perceived that the nurse's administrative function is not an isolated activity, separated from care. It is performed at the same time as care management, during the entire Nursing Process. The concept of what used to be seen as a dichotomy could be deconstructed based on this experience, further enhancing the interaction among actions pertinent to the profession.

In this experience, it could be perceived how teaching practice is developed and what needs students feel with regard to their education. The need for a more active, encouraging and problematizing participation was verified, which helps students to "gain knowledge" and "know-how" in their academic education. This interaction and involvement between teachers and knowledge represents the base to develop the recommended competences.

References

References

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