NURSI NG EDUCATI ON: SEEKI NG CRI TI CAL-REFLEXI VE
EDUCATI ON AND PROFESSI ONAL COMPETENCI ES
Kênia Lar a Silv a1 Roseni Rosângela de Sena2
Silva KL, Sena RR. Nursing educat ion: seeking crit ical- reflexive educat ion and professional com pet encies. Rev Lat ino- am Enferm agem 2006 set em bro- out ubro; 14( 5) : 755- 61.
The st udy describes changes t hat are not ed in st udent s during t raining and w hich cont ribut e t o define a pr ofession al pr ofile. We car r ied ou t a descr ipt iv e- ex plor at or y st u dy w it h a qu alit at iv e appr oach , based on dialect ics as a t heor et ical- m et hodological fr am ew or k . The dat a w as obt ained fr om docum ent ed analy sis and t hrough focal groups wit h t eachers, st udent s and service nurses. The result s show t he st udent ’s posit ion as an act ive subj ect in t he t eaching- learning process, t hrough a m ovem ent of t ransform at ion of academ ic st ruct ures. A cor r elat ion w as f ou n d b et w een t h e m ov em en t t h at seek s st u d en t s’ g r eat er p olit ical, act iv e an d cr it ical part icipat ion as a way of det erm ining and guiding t he profile of t he generalist nurse and great er social insert ion. We conclude t hat , despit e effor t s, t r aining guidelines and t he definit ion of t he pr ofessional pr ofile in t he st udy set t ings is dir ect ed at t he dem ands of t he labor m ar ket , and t hat com pet ency- based t r aining is st ill incipient .
DESCRI PTORS: edu cat ion ; n u r sin g pr ofession al com pet en ce; pr oblem - based lear n in g
LA EDUCACI ÓN DE ENFERMERÍ A: BÚSQUEDA DE LA FORMACI ÓN
CRÍ TI CA Y REFLEXI VA Y DE LAS COMPETENCI AS PROFESI ONALES
El est udio describe los cam bios en los est udiant es durant e la form ación y que apunt an para la definición de un perfil profesional. Est udio descript ivo explorat orio con aproxim ación cualit at iva, que ut ilizase la dialéct ica com o r efer encial t eór ico- m et odológico. Los dat os fuer an obt enidos con docum ent ación y gr upos focales. Los r esult ados indican la posición del est udiant e com o suj et o act ivo en el pr oceso enseñanza- apr endizaj e desde el m ov im ien t o de cam bio de las est r u ct u r as académ icas. Se iden t ificó u n a cor r elación en t r e el m ov im ien t o de bú squ eda de m ay or par t icipación polít ica, act iv a y cr ít ica de los est u dian t es com o f act or qu e det er m in a y or ien t a u n per f il del en f er m er o gen er alist a y de m ay or in ser ción social. Se con clu y e qu e, n o obst an t e los esf u er zos, la or ien t ación de la f or m ación y la def in ición del per f il pr of esion al en los escen ar ios del est u dio est án dirigidas a las norm as del m ercado de t rabaj o, siendo insuficient e la form ación baseada en com pet encias.
DESCRI PTORES: edu cación en en fer m er ía; com pet en cia pr ofesion al; apr en dizaj e basado en pr oblem as
A EDUCAÇÃO DE ENFERMAGEM: BUSCANDO A FORMAÇÃO
CRÍ TI CO-REFLEXI VA E AS COMPETÊNCI AS PROFI SSI ONAI S
O est udo descreve result ados de um a pesquisa que ret rat a m udanças que são percebidas nos est udant es durant e a form ação e que cont ribuem para a definição de um perfil profissional. Est udo descrit ivo- explorat ório, com abor dagem qualit at iva, que se ancor a na dialét ica com o r efer encial t eór ico- m et odológico. Os dados for am obt idos de análise docum ent al e at ravés da realização de grupos focais com docent es, est udant es e enferm eiros d e ser v i ço . Os r esu l t ad o s d em o n st r am a p o si ção d o est u d an t e co m o su j ei t o at i v o n o p r o cesso en si n o -aprendizagem , a part ir de um m ovim ent o de t ransform ação das est rut uras acadêm icas. I dent ificou- se correlação en t r e o m ov im en t o de bu sca de m aior par t icipação polít ica, at iv a e cr ít ica dos est u dan t es com o f at or qu e det erm ina e orient a um perfil do enferm eiro generalist a e de m aior inserção social. Conclui- se que, apesar dos esforços, a orient ação da form ação e a definição do perfil profissional nos cenários do est udo est ão volt adas às ex igências do m er cado de t r abalho, sendo incipient e a for m ação baseada em ár eas de com pet ências.
DESCRI TORES: edu cação em en fer m agem ; com pet ên cia pr ofission al; apr en dizagem baseada em pr oblem as
1 RN. M.Sc. in Nursing, Faculty, Pontifícia Universidade Católica de Minas Gerais, e- m ail: kenialara17@yahoo.com .br; 2 RN, PhD in Nursing, Adj unct Professor
( Retired) , Minas Gerais Federal University
I NTRODUCTI ON
T
e a ch i n g - l e a r n i n g e x p e r i e n ce s a r e d et er m i n ed b y t h e p o l i t i cal , so ci al , cu l t u r al an d econom ic cont ext t hey are insert ed in. The m odern w or ld r equir es pr ofessionals t o hav e a m ult iv alent t r ain in g, or ien t ed t ow ar ds t h e globalizin g v iew of reality and a perm anent attitude of learning to learn( 1).Th e d er eg u l at i o n o f n at i o n al eco n o m i es, i m p o se d b y t h e i n t e r n a t i o n a l d i v i si o n o f w o r k , com m ends t he adopt ion of privat izat ion program s in t he public sect or, including in healt h and educat ion. These t ransform at ions change work relat ions which, in com bination with technological innovations, im pose new relat ions in t he labor w orld and, consequent ly, new requirem ent s in t erm s of workers’ profile( 2).
I n the health sector, transform ations occur in w o r k o r g a n i za t i o n , e n t a i l i n g r e p e r cu ssi o n s f o r t echnological incorporat ion, associat ed wit h changes in t he Br azilian populat ion’s epidem iological pr ofile a n d d e m o g r a p h i c p a t t e r n . I n t h i s co n t e x t , m odificat ions should be acknow ledged w hich der ive from t he im plant at ion of new t echnological and care m odels, posin g dem an ds in t er m s of pr of ession al pr ofile.
I n Br azil, t hese m odificat ions occur in t he fr am ew or k of t he pr ocess t o consolidat e t he Single Healt h Syst em - SUS, including effort s t o t ake form in et hical, t heor et ical, or ganizat ional and oper at iv e principles relat ed t o healt h, defined as a right of all citizens and a duty of the State, which is responsible for assuring social and econom ic public policies t hat guarantee the population’s physical, m ental and social w ell- being.
The t heories and principles guiding t he SUS are addressed in Decree 8.080( 3), especially: universal
health service access at all care levels; care integrality; preservation of people’s autonom y in defense of their physical and m oral int egrit y; equalit y of healt h care, without any kind of prej udices or privileges; political-a d m i n i st r political-a t i v e d ecen t r political-a l i zpolitical-a t i o n , w i t h o n e si n g l e m a n a g e m e n t i n e a ch g o v e r n m e n t sp h e r e ; r eg ion alizat ion an d h ier ar ch izat ion of t h e h ealt h service net work; problem - solving capacit y of services at all care levels.
I n the attem pt to consolidate the SUS, efforts have been m ade to construct a m odel that gives social responses t o healt h problem s and needs, in view of Br azil’s h et er ogen eit y an d polit ical, econ om ic an d cult ural diversit y.
Heal t h w o r k er s’ t r ai n i n g , i n ser t ed i n t h e cont ext of professional t raining, m ust be guided by t he definit ion of com pet ency areas ( knowledge, skills and at t it udes) t hat allow for m ult iprofessional act ion a n d i n t e r a ct i o n . Ge n e r a l g u i d e l i n e s f o r h e a l t h professional educat ion in t he 21st cent ury st at e t hat
com pet ency developm ent should be orient ed t owards t he search for healt h care int egralit y, cont ribut ing t o t h e f or m at ion of p r of ession als w h o j oin d ecision -m ak in g , co-m -m u n icat ion , lead er sh ip , -m an ag e-m en t and perm anent educat ion apt it udes( 4).
I n order t o cope wit h rapidly em erging and m odify ing dem ands in healt h pr ofessional t r aining, t here is a need for changes in t he t eaching- learning process, adapt ing it t o cont em porary realit y and t o t he com plexit y and unforeseeabilit y charact erist ic of healt h work.
Pr epar ing pr ofessionals for t he labor w or ld r e q u i r e s t h e d e v e l o p m e n t o f k n o w l e d g e , i d e a s, abilities and, also, dispositions, attitudes, interests and behaviors. These should adapt to the possibilities and d e m a n d s o f w o r k m o d e s a n d t h e w a y t h e y a r e or ganized( 5).
I n t his per spect iv e, significant m obilizat ion effor t s h av e been m ade t o t r an sfor m pr ofession al t raining m odels, seeking t o int egrat e t he universit y wit h segm ent s of civil societ y and com m unit ies, in a par t ner ship t hat r aises t he pot ent ial of alt er nat iv es f o r p ed ag o g i cal an d o r g an i zat i o n al ch an g es an d inst it ut ional int er act ions. This is necessar y for t he academ y t o dem onst r at e it s r elevance in t he social cont ex t and t o allow for st udent t r aining based on concr et e, r eal pr oblem s.
Attem pts to revert traditional teaching m odels dem onst rat e t hat different act ors m ust part icipat e in t he definit ion of a pr ofessional pr ofile: gr aduat es, faculty, students, service professionals, health service m anagers, m em bers of class organizat ions and civil societ y, in a m ovem ent t hat guides t raining and t he d e f i n i t i o n o f t h e p r o f e ssi o n a l p r o f i l e , b a se d o n com pet ency ar eas.
Defining com pet encies is a har d t ask . I t is im portant to m ove from the analysis of practices to a r eason ab le in v en t or y of com p et en cies con sid er ed e sse n t i a l , w h i ch co n st i t u t e t h e b o d y o f t h e pr ofession( 6).
-com pet en cies; in for m at ion ; v alu es; at t it u des; an d percept ion, assessm ent and reasoning schem es( 7).
I n term s of health professionals, besides this concept , t he need should be added t o incorporat e a p r osp ect iv e an aly sis of p r of ession al p r act ices, in con t ex t s of t ech n olog ical in n ov at ion s, ch an g es in health services and in the population’s epidem iological profile and dem ographic pat t ern.
I n t he cont ext of t hese t ransform at ions, t he n o t i o n o f co m p e t e n cy e m e r g e s t o r e o r d e r t h e u n d e r st a n d i n g o f t h e w o r k / e d u ca t i o n r e l a t i o n , deviating the focus from em ploym ents and tasks to a reference fram ework cent ered on hum an praxis and i n cr easi n g t h e p o t en t i al o f w o r k er em an ci p at i o n act ions( 8- 9).
Apply ing t he not ion of com pet ency im plies inst it ut ionalizing new for m s of educat ing / t r aining w or k er s and m anaging or ganizat ions and t he labor m ar k et int er nally, in v iew of econom ic- pr oduct iv e, social-historical, cultural and political m ediations in the det erm inat ion of t he t eaching- learning process( 8- 9).
Th u s, w e defen d t h at t h e n u r sin g t r ain in g m odel should be anchored in the reference fram ework of critical- reflexive pedagogy( 1,10- 11), contributing to the const ruct ion of professional com pet encies t hat allow for act ions focused on int egral care.
METHODOLOGY
Th is st u d y p r esen t s p ar t ial r esu lt s of t h e r e se a r ch “U N I Pr o j e c t a s t h e s c e n a r i o f o r n e w
e x p e r i e n c e s i n t h e t r a n s f o r m a t i o n o f n u r s i n g
edu cat ion” * realized by researchers from t he St udy and Research Group on Nursing Teaching and Practice - NUPEPE at Minas Gerais Federal University between 2000 and 2003. I n t his r esear ch, w e at t em pt ed t o an aly ze t h e ch an g e p r ocess in n u r sin g ed u cat ion experienced by nursing courses at Brazilian institutions t hat developed t he UNI Proj ect .
The UNI Proj ect - A New I nit iat ive in Healt h Pr o f e ssi o n a l Ed u ca t i o n , a p o l i t i ca l - p e d a g o g i ca l pr ogr am t hat had been encour aging innov at ions in healt h professional form at ion since t he early 1990’s, in partnership with health services and the com m unity, w as d ev el o p ed i n Br azi l b y t h e f o l l o w i n g h i g h er ed u cat ion in st it u t ion s: Lon d r in a St at e Un iv er sit y,
Marília Medical School, Bahia Federal Universit y and Rio Grande do Nort e Federal Universit y.
The Proj ect presented a proposal to teaching and service inst it ut ions and t heir act ors, t o give up t he exist ing paradigm in capit alist societ y, in w hich professionals are educated to attend to needs related to profit and capital accum ulation, and prioritize hum an n e e d s, t h e p o p u l a t i o n ’ s h e a l t h n e e d s a n d t h e im provem ent of sanit ary environm ent s, assum ing t he com m it m ent t o t rain professionals who are willing t o w or k t ow ar d s q u alit y of lif e as a w h ole, w it h ou t abandoning the valuation of the dialectic construction of t he healt h- disease process( 12).
We decided t o adopt a qualit at ive approach, based on dialect ics( 13) as a t heoret ical- m et hodological
r efer ence fr am ew or k , w hich r ev eals a belief in t he m ovem ent process that perm anently exists in society, a s w e l l a s i n t h e h i st o r i ca l , cu l t u r a l a n d so ci a l co n st r u ct i o n o f h e a l t h p r o f e ssi o n a l s’ e d u ca t i o n p r o cesses an d i n t h e cap aci t y t o t r an sf o r m an d overcom e cont radict ions t hrough new pract ices.
I n order t o capt ure realit y, we used prim ary data, collected through the realization of a three- hour focus group( 14) in each scenario. I n t ot al, 27 facult y, e i g h t st u d e n t s a n d e i g h t se r v i ce p r o f e ssi o n a l s participated. Their discourse was recorded, transcribed a n d t h en su b m i t t ed t o D i sco u r se An a l y si s( 1 3 , 1 5 ).
Secon d ar y d at a w er e ob t ain ed f r om r ep or t s an d d o cu m e n t s m a d e a v a i l a b l e b y t h e r e se a r ch institutions, which helped us to understand the change p r o ce ss i n n u r si n g t r a i n i n g a t e a ch o f t h e f o u r i n st i t u t i o n s. I n t h e r esu l t s sect i o n , d i sco u r se i s identified by the letter C and a num ber ( 1, 2, 3 or 4) , which random ly indicat e t he research scenarios.
Before starting data collection in the field, the r esear ch pr oj ect w as appr ov ed by t h e Et h ics an d Re se a r ch Co m m i t t e e a t Mi n a s Ge r a i s Fe d e r a l Un i v e r si t y - COEP/ UFMG, i n a cco r d a n ce w i t h Resolut ion 196/ 96 by t he Nat ional Resear ch Et hics Co m m i ssi o n . Par t i ci p an t s’ t est i m o n i es w er e o n l y recorded aft er t hey agreed t o part icipat e and signed t he Free and I nform ed Consent Term .
This st udy describes t he changes m anifest ed and/ or perceived during t he st udent t raining process a n d w h i ch ca n b e d e m o n st r a t e d a s e l e m e n t s contributing to the definition of a professional profile. We at t em pt ed t o describe t he change m ovem ent in
nursing t raining, indicat ing shared point s in subj ect s’ t h i n k i n g a n d p r a ct i ce i n e a ch sce n a r i o , w h i ch support ed t he const ruct ion of t he em pirical cat egory: “ From crit ical st udent t o generalist nurse” and how t his m ov em ent has cont r ibut ed t o t he definit ion of t he professional com pet ency area.
RESULTS AND DI SCUSSI ON
The focus group participants’ discourse in the f ou r scen ar ios r ev ealed, at t h ese in st it u t ion s, t h e student’s position as an active subj ect in the teaching-lear ning pr ocess, w it h r oom t o t ak e posit ions and propose changes. This condit ion has been facilit at ed b y a ca d e m i c st r u ct u r e t r a n sf o r m a t i o n s, b y t h e const ruct ion of a polit ical- pedagogical proj ect based on cr it ical and r eflex iv e r efer ence fr am ew or k s, t he a d o p t i o n o f a ct i v e t e a ch i n g m e t h o d o l o g i e s, t h e ex pan sion an d div er sif icat ion of t each in g- lear n in g sce n a r i o s a n d a t t e m p t s t o a d o p t f o r m a t i v e assessm en t .
Focus gr oup par t icipant s indicat ed t hat t he ch an ges in t h e t each in g m odel con t r ibu t ed t o t h e construction of a political- pedagogical proj ect in which st u den t s ar e con sider ed as act iv e su bj ect s in t h e co n st r u ct i o n o f t h ei r o w n k n o w l ed g e ( C1 ) , t h u s becom ing crit ical, inquiring, innovat ive subj ect s wit h m ore m at ure at t it udes ( C3) .
Par t icipant s affir m ed t hat , dur ing t r aining, at t em pt s have been m ade t o const ruct t he profile of a r ef l ex i v e p r of essi on al , w h o k n ow s t h e et h i cal , p o l i t i ca l , h i st o r i ca l , i d e o l o g i ca l a n d cu l t u r a l det erm inant s of t he profession ( C4) , in line wit h t he Mi n i st r y o f Ed u ca t i o n ’ s g u i d e l i n e s f o r n u r si n g educat ion( 4).
Discou r se in t h e f ou r scen ar ios con t ain ed q u o t a t i o n s t h a t d i scl o se t h e m o v em en t seek i n g st u d e n t s’ g r e a t e r p o l i t i ca l , a ct i v e a n d cr i t i ca l part icipat ion, as a fact or t hat det erm ines and guides a generalist nursing profile with greater social insertion. Th i s co n si d er at i o n i s r em ar k ab l e f o r t h e reorganization of teaching and health care processes, as professional t raining exert s posit ive effect s, t o a great er or lesser ext ent , on healt h service pract ice, in consonance wit h t he est ablished t eaching- learning pr ocess.
Th e ch an ges descr ibed in discou r se abou t st udent s’ at t it ude reflect labor m arket requirem ent s. This m arket st im ulat ed t he const ruct ion of a profile
for fut ure professionals t o at t end t o a new dynam ics in health work ( C3) , requiring professionals to be able t o a ct i n t h e p r o g r e ssi v e h e a l t h ca r e n e t w o r k , m ob ilizin g k n ow led g e in in d iv id u al an d collect iv e preventive and curative actions, in order to guarantee healt h care qualit y ( C4) .
I n scen ar io 1 , p ar t icip an t s in d icat ed t h at changes in t eaching occur r ed t o at t end t o nur ses’ t raining needs to work in the Fam ily Health Program . Subj ects’ discourse in this scenario displayed constant con cer n abou t in v er t in g t h e h ospit al an d disease-cent er ed m odel, t o const r uct a healt h m odel based on social healt h product ion.
The Fam ily Healt h Program is a st rat egy t o r eor gan ize basic car e in Br azil, w h ose act ion s ar e direct ed t o t he needs of fam ilies wit hin it s t errit ory, as a geopolit ical space, in a cont inuous, t ailor- m ade and act iv e w ay ; em phasizing healt h pr om ot ion and problem prevention, but without ignoring the curative-rehabilitating focus, with a high problem - solving level; at low dir ect and indir ect econom ic or social cost s and articulated with other sectors determ ining health. I n scenario 3, part icipant s affirm ed t hat t he change in t he care m odel, t hrough t he im plant at ion of t h e Fam ily Healt h Pr og r am , st ar t ed t o r eq u ir e pedagogical pract ices t hat em phasize int egral healt h car e, w hich influenced t he change in t he polit ical-pedagogical proj ect , incorporat ing new concept s and new t eaching pract ices t o accom pany t his t endency. Par t icipan t s in scen ar io 4 m en t ion ed t h eir con cer n abou t im plem en t in g a t r ain in g pr ocess t o contribute to social changes, related to education and nurses’ insert ion in t he labor m arket . They affirm ed that, to accom pany this “ pattern”, i.e. the Fam ily Health Program , the course has been guided by the principle of introducing the student into real practice scenarios o f cu r r e n t h e a l t h m o d e l s, p r i o r i t i zi n g h e a l t h sur v eillance act ions.
Discourse analysis reveals t hat t raining and professional profile definit ion in t he st udy scenarios ar e d ir ect ed at lab or m ar k et r eq u ir em en t s, w h ile t r aining based on com pet ency ar eas is in an init ial st ag e. Th ese ar eas g o b ey on d t h e t r an sit or y an d m om ent ary requirem ent s of a m arket and affirm t he construction of a set of abilities and attitudes that will a l l o w p r o f e ssi o n a l s t o a ct i n d i f f e r e n t a n d unforeseeable daily work sit uat ions.
should be orient ed by m eans of a com pet ency area-based education, in which m arket dem ands are taken into consideration. However, this factor should not be the priority elem ent in the definition of the professional pr ofile, pr epar ing nur sing pr ofessionals not only t o at t en d t o l ab o r m ar k et d em an d s, b u t m ai n l y t o t ransform t he condit ions im posed by t his m arket .
Focu s g r ou p p ar t i ci p an t s m en t i on ed t h at p r o f e ssi o n a l t r a i n i n g i s e x ce ssi v e l y p r i v i l e g i n g k n o w l e d g e o f so ci a l a r e a s, t o t h e d e t r i m e n t o f knowledge about t echnical areas. They indicat e t hat t rained nurses are professionals who are very crit ical w it h r espect t o social pr oblem s, but do not m ast er t he t echnical knowledge and inst rum ent s needed t o develop nursing pract ice ( C3) .
This finding goes against the prem ises of the training m odel in force until that tim e, which privileged curat ive and individual act ion, based on t he hospit al-centered biom edical m odel and strongly characterized b y a t ech n icist or ien t at ion . How ev er, p ar t icip an t s p e r ce i v e d t h a t so ci a l a n d p o l i t i ca l i ssu e s a r e em p h a si zed t o t h e d et r i m en t o f t ech n i ca l sk i l l s developm ent of “ healt h clinic”. Therefore, we believe that the m odel is still fragm ented and does not allow st u den t s t o dev elop t h em selv es sim u lt an eou sly in t ech n ical- scien t if ic an d polit ical- social com pet en cy areas, m obilizing them to guarantee integrality in their t raining and healt h care process.
Th i s r ev eal s t h e n eed t o r est r u ct u r e t h e t r ain in g pr ocess, adopt in g an in t egr al v iew of t h e h ealt h - disease pr ocess an d of r eceiv in g car e an d, t hus, overcom ing t he fragm ent at ion bet ween biology / social, curative / preventive, clinical / epidem iologic, su b j ect iv it y / sociab ilit y in t h e con st r u ct ion of a t e a ch i n g - l e a r n i n g p r o ce ss t h a t m a k e s f u t u r e p r o f e ssi o n a l s d e v e l o p sp e ci f i c p r o f e ssi o n a l co m p et en ci es, co m b i n i n g so f t - h a r d , l i k e cl i n i ca l t e ch n o l o g y, a n d so f t t e ch n o l o g i e s l i k e b o n d i n g , welcom ing and account abilit y( 16).
Th e an aly sis of d ocu m en t s f r om t h e f ou r scenar ios allow s us t o affir m t hat t he pr ofessional profile expressed in t he polit ical- pedagogical proj ect was designed on the basis of an analysis of the labor m arket, of the population’s dem ands and health needs and fut ur e pr oj ect ions about nur ses’ inser t ion int o healt h service product ion scenarios, orient ed t owards t h e co n so l i d a t i o n o f t h e Si n g l e He a l t h Sy st e m . However, schools cont inue st ruct uring t heir curricula by cont ent s and obj ect ives, which is charact erist ic of t r adit ional t eaching m odels. This differ ence seem s
not ew or t hy in t he possibilit y t o const r uct pr oposals that go beyond the understanding that it is necessary t o at t en d t o t h e labor m ar k et an d st r en gt h en t h e
m odus operandi of schools and pedagogical practices, su st a i n e d b y t h e p e d a g o g i ca l co n ce p t i o n o f t ransm ission and condit ioning.
Th er ef o r e, t h e t each i n g - l ear n i n g p r o cess m ust be assum ed on t he basis of a crit ical- reflexive pedagogical concept ion t hat guides m et hodological opt ions dir ect ed at changing t he cent r alism of t he t eaching- learning process in t he t eacher, in order t o t ransfer it , m ake it account able and est ablish a new m eaning in the student( 11,17).
Th e ch a n g e a n d r e d e f i n i t i o n o f n u r se s’ professional profile has been established on the basis of op p or t u n it ies st u d en t s ar e of f er ed d u r in g t h e course, to act in m ultiprofessional activities, using the int er disciplinar y focus in w or k t eam s act iv e in new t eaching- lear ning scenar ios ( C4) .
Various proposals are being applied in nursing education, such as curricular integration, teacher- care int egrat ion, com pet ency- based curriculum , aim ed at t r aining pr ofessionals w ho ar e com m it t ed t o healt h policies and at developing specific com pet encies and skills to exert an im pact( 18).
Th ese ex p er ien ces h av e b een t h e f r u it of n u r si n g ed u cat i o n p r o g r am s’ d i ssat i sf act i o n an d fragilit y at all levels. This fragilit y can be underst ood as a lack of t heoret ical bases for act ion, at t est ed by t he t radit ional lack of reflect ion about why and what for, by the obsession to innovate for the m ere sake of innovation, in short, by education processes with little adherence t o realit y, w here t he dichot om y bet w een theory and practice is still rem arkable and where the co n ce p t i o n o f t h e h e a l t h a n d d i se a se p r o ce ss subordinated to biological sciences and individual care is perpet ually reproduced( 18).
Focus group participants also m anifested that the financial support of the UNI Proj ect contributed to the exercise of research m ethodology am ong students ( C3 ) . Th e docu m en t ar y an aly sis also r ev eals t h at support was direct ed at st rat egic- inst it ut ional plans, const ruct ed by t he t eaching / service part nership t o design change pr ocesses.
different disciplines and dest ruct ures t he dichot om y bet ween t eaching and care pract ice.
I n line w it h t his analy sis, pr act ice analy sis and research are t raining m et hods t hat allow for t he co n st r u ct i o n o f p r o f e ssi o n a l i sm , t h r o u g h t h e dev elopm ent of a m et a- com pet ency : k now ing how t o analyze( 7).
This seem s to be a differentiating elem ent in t h e sear ch f or cr it ical- r ef lex iv e t r ain in g, in w h ich learning is t he fundam ent al at t ribut e in t he relat ions bet ween t he subj ect s involved in int eract ions in t he t eaching- lear ning pr ocess, t hr ough st udent s’ act iv e part icipat ion, t he problem at izat ion of realit y and t he t h e o r y / p r a ct i ce a r t i cu l a t i o n , i n a p e r m a n e n t m ovem ent of learning t o learn.
I n t his per spect iv e, st udent s can const r uct knowledge based on problem s from concret e realit y, ar t iculat ing k now ledge fr om differ ent ar eas, based on interdisciplinarity and on the integration of contents and actions. This training has the potential to support act ions in t he com plex it y and unfor eseeabilit y t hat are charact erist ic of daily healt h work.
Th e an aly sis of f ocu s g r ou p p ar t icip an t s’ discour se r ev eals t hat t he t eaching / w or k r elat ion st im u lat es t r an sf or m at ion s in t each in g w h ich ar e nour ished by t he r eor ganizat ion of t he healt h car e m o d e l , i n t h e s e a r c h f o r c a r e i n t e g r a l i t y. Pa r t i ci p a n t s r ev ea l ed t h a t t h e r el a t i o n b et w e e n t e a c h i n g a n d s e r v i c e h a s b e e n a p o s i t i v e ex per ience for all act or s, allow ing for t he t r aining of pr ofessionals w ho ar e in line w it h t he r ealit y of h ea l t h ser v i ce a n d w i t h t h e p o p u l a t i o n ’ s h ea l t h d em an d s an d n eed s, con sid er in g t h e com p lex it y an d t r an sf or m at ion s of h ealt h w or k .
FI NAL CONSI DERATI ONS
The research result s disclosed t hat adopt ing a crit ical- reflexive focus in t he t raining process can affect the health and nursing work process, being able to affirm care delivery by subj ects with values, culture and ideology, com m it t ed t o solving t he populat ion’s a n d h e a l t h se r v i ce s’ co n cr e t e h e a l t h p r o b l e m s. Therefore, t his m ovem ent should not only be guided by technical and instrum ental rationality, but basically by new possibilit ies for com m unicat ion, organizat ion as well as int ersubj ect ive and care relat ions.
Thus, we need to think about ways to flexibilize the teaching system , constructing processes that help t o st r u ct u r e p r op osals t h at ar e m or e ad ap t ed t o r eq u ir em en t s in t h e m od er n an d f u t u r e w or ld of uncertainties. This m ore flexible teaching system should be m anifested by the introduction of new contents but, m ainly, it should give a m eaning to students as subjects who need t o be capable of t hinking creat ively, have sel f - est eem , can f ace p r o f essi o n al ch an g es an d construct their own network of beliefs and values.
This indicates the need to reorient professional nur sing t r aining t ow ar ds solv ing concr et e and r eal problem s, as an alt ernat ive t o develop t he capacit y t o creat e, recreat e and proj ect new t hings from t he perspective of creative practice, allowing for subj ects’ dev elopm en t in t h eir m u lt iple dim en sion s: social, hist orical, cult ural and holist ic.
Th u s, w e con sid er t h at n u r sin g ed u cat ion should distinguish itself by the search for integral care, const ruct ed during t raining, on t he basis of crit ical-reflexive references in t he definit ion of professional nur sing com pet encies.
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