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REPENF – Rev. Parana. Enferm. Jan-Dec 2020; 3(1): 94-100.NURSING EDUCATION IN THE CONTEXT OF THE COVID-19 PANDEMIC: REFLECTING ON THE CHALLENGES FACED
ENSINO DE ENFERMAGEM NO CONTEXTO DA PANDEMIA DA COVID-19: REFLETINDO SOBRE OS DESAFIOS ENFRENTADOS ENSEÑANZA DE ENFERMERÍA EN EL CONTEXTO DE LA PANDEMIA DEL COVID-19: REFLEXIONANDO SOBRE LOS RETOS
ENFRENTADOS
Viviane Cazetta de Lima Vieira1; Eliete dos Reis Carvalho2; Fabiana Cristina Vidigal Gabriel3
ABSTRACT
Objective: To reflect on the challenges faced by professors in nursing education before the new format of remote synchronous classes held due to the COVID-19 pandemic. Development: This is a theoretical-reflective essay, constructed from the literature on the repercussions of the COVID-19 pandemic in nursing teaching and the authors’ experience. The sudden interruption of teaching activities generated impacts for professors, students, educational institutions, health services and users. Among the main challenges for professors are: the rapid incorporation of information technologies for teaching, the dropout of students, the psycho-emotional suffering of professors and students, the maintenance of the quality of non-face-to-face teaching; and the performance of practical activities. Final thoughts: To face such challenges, various tools and strategies are being implemented in an innovative way, favoring creativity and student participation. However, face-to-face teaching should not be replaced in its essence, given the need for the development of practical contents and fundamental human relationships for nurses’ training.
Descriptors: Pandemics; Nursing; Education, Higher; Adaptation, Psychological; Teaching. RESUMO
Objetivo: Refletir sobre os desafios enfrentados por docentes no ensino de enfermagem frente ao novo formato de aulas síncronas remotas realizadas em decorrência da pandemia da COVID-19. Desenvolvimento: Trata-se de um ensaio teórico-reflexivo, construído a partir da literatura sobre as repercussões da pandemia da COVID-19 no ensino da enfermagem e pela vivência das autoras. A interrupção repentina das atividades de ensino gerou impactos para docentes, alunos, instituições de ensino, serviços de saúde e usuários. Entre os principais desafios para os docentes estão: a rápida incorporação de tecnologias da informação para o ensino, a evasão dos acadêmicos, o sofrimento psico-emocional de docentes e alunos, a manutenção da qualidade do ensino não presencial; e a realização das atividades práticas. Considerações finais: Para enfrentar tais desafios várias ferramentas e estratégias estão sendo implementadas de forma inovadora, favorecendo a criatividade e a participação dos alunos. Entretanto, o ensino presencial não deve ser substituído em sua essência, visto a necessidade do desenvolvimento de conteúdos práticos e de relações humanas fundamentais para a formação de enfermeiros.
Descritores: Pandemias; Enfermagem; Educação superior; Enfrentamento; Docência. RESUMEN
Objetivo: Reflexionar sobre los retos que enfrentan docentes en la formación en enfermería ante el nuevo formato de clases sincrónicas remotas que se llevan a cabo como consecuencia de la pandemia del COVID-19. Desarrollo: Se trata de un ensayo teórico-reflexivo, construido a partir de la literatura sobre las repercusiones de la pandemia del COVID-19 en la enseñanza de la enfermería y de la experiencia de los autores. La repentina interrupción de las actividades docentes generó impactos en docentes, estudiantes, instituciones educativas, servicios de salud y usuarios. Entre los principales desafíos para los docentes se encuentran: la rápida incorporación de las tecnologías de la información para la docencia, la evasión de los académicos, el sufrimiento psicoemocional de docentes y estudiantes, el mantenimiento de la calidad de la enseñanza no presencial; y realización de actividades prácticas. Consideraciones finales: Para enfrentar estos desafíos, se están implementando distintas herramientas y estrategias de manera innovadora, favoreciendo la creatividad y la participación de los estudiantes. Sin embargo, la enseñanza en el aula no debe ser reemplazada en esencia, dada la necesidad de desarrollar contenidos prácticos y relaciones humanas fundamentales para la formación de enfermeras.
Descriptores: Pandemias; Enfermería; Educación Superior; Adaptación Psicológica; Enseñanza. ____________________
1 Nurse. Doctoral Student in Nursing from the State University of Maringá (UEM). Professor at the Nursing Department of the School of
Philosophy, Sciences and Language of the Mandaguari (FAFIMAN). E-mail: vivicazetta_@hotmail.com; ORCID: https://orcid.org/0000-0003-3029-361X
2 Nurse. MSc in Health Promotion. Professor at the Nursing Department of the FAFIMAN. E-mail: elyetereis@hotmail.com; ORCID:
https://orcid.org/0000-0002-3211-0648
3 Nurse. MSc in Nursing. Professor at the Nursing Department of the FAFIMAN. E-mail: vidigal.fabi@gmail.com; ORCID:
https://orcid.org/0000-0003-2820-8965
INTRODUCTION
At the end of 2019, suddenly, the world was surprised by a highly transmissible and planetary-wide virus, indicated by epidemiologists as one of the greatest health challenges on a global scale of this century. The virus in question is the coronavirus called SARS-CoV-2, which causes Coronavirus disease (COVID-19), initially identified in Wuhan, in China, and spread rapidly, and in just over two months, it became a pandemic. The high infectivity of its etiological agent, associated with the total absence of previous immunity in the human population, the unawareness of specific antiviral drugs and the lack of vaccine, led to the exponential growth in the number of cases(1).
In Brazil, as occurred in most of the world, measures such as the social isolation of suspected and confirmed cases, as well as their contacts and even the total lockdown in some localities, were used as strategies for facing the pandemic, in view of a complex health and social situation(2).
In this period when several sectors of industry and economy adjusted to the new realities, the Ministry of Education (MEC), through ordinance n. 343, of March 17, 2020, authorized the replacement of classroom teaching with classes that used information and communication means and technologies for the courses that were in progress, in order to mitigate the damage in the teaching-learning process caused by the pandemic(3).
The educational institutions in Brazil, especially the Higher Education Institutions (HEIs), were strongly affected in their structures and even pedagogical convictions and academic certainties. Thus, they had to reinvent themselves in a short time. In just under a week, face-to-face classes, theories of interaction, exchanges and conviviality in the classroom had to be rethought and began to occur synchronously remotely, having as allies the screens of computers, tablets, mobile phones and other media.
In this new scenario, students accustomed to traditional molds or active methodologies, but involving physical-personal contact, felt pressured with the amount of activities used to complement the workload and contents, as well as the professors, since in this modality the subjects seem to flow faster, in view of the lower participation/interaction of the students. Professors are known to be social actors who constantly need to adapt to new demands, thus, they exchange ideas and learn from their own experiences.The process of “learning with oneself”, already explored at other times, as a fundamental pedagogical knowledge for the
constant formation of the conscious exercise of the profession(4), becomes even more
necessary in the current period of challenges arising from the COVID-19 pandemic and social isolation.
In this context, reflecting on the intense changes suddenly imposed on the teaching-learning process in the context of nursing graduation before the pandemic, as well as sharing strategies to ensure the maintenance of quality training to students, with so many challenges in a course guided by clinical, laboratory practices and supervised internship experiences, has become pressing for us as teaching nurses.
In view of the above, it was proposed to conduct this essay, which aimed to reflect on the challenges faced by professors in nursing teaching in view of the new format of remote synchronous classes performed due to the COVID-19 pandemic.
DEVELOPMENT
This is a theoretical-reflective essay, constructed from the literature produced on the repercussions of the pandemic caused by COVID-19 in nursing teaching and through the experiences of the authors in teaching theoretical and practical subjects in a nursing course of a public-private municipal college located in the state of Paraná. It is noteworthy that our HEI has the particularity of being a public foundation, maintained financially from the collections of students’ tuition. Thus, we face the challenges typical of public and private institutions.
We start this reflection from the understanding that the essay is characterized by its reflective and interpretative nature, different from the classificatory form of traditional science. Its strength is not related to methodological rigor, but to the reflective capacity that is intended to be achieved to understand a reality, a phenomenon or a specific situation(5).
In this sense, this reflective analysis intends to collaborate constructively to understand emerging and expanding issues, such as COVID-19 and its impacts on nursing education. It is worth mentioning that the emerged reflections were organized from conductive lines about the theme, derived from interpretations of the pertinent literature, in addition to the experiences loved by the authors in nursing teaching.
Nursing teaching and the pandemic: listing and overcoming challenges
As mentioned earlier, this reflection was based on the experience of teaching nurses from an HEI, from the nursing collegiate, who
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REPENF – Rev. Parana. Enferm. Jan-Dec 2020; 3(1): 94-100.have been conducting remote synchronous classes since mid-March 2020, when the country was strongly affected by the COVID-19 pandemic.
The sudden interruption of teaching activities has generated and will continue to generate mid- and long-term impacts for all levels of education, especially in the most vulnerable socioeconomic populations with possible repercussions in the accentuation of social inequities regarding access to essential goods and services, such as education, safety, health, among others(6).
We identified that some of the main challenges for professors in our reality were: the rapid incorporation of information technologies for teaching, the dropout of students, the psycho-emotional suffering of professors and students, the maintenance of the quality of non-face-to-face teaching; and the execution of practical activities.
In this sense, articulated professors in the HEI need to adopt strategies for the continuity of their activities and maintain the engagement of their students, thus avoiding the evasion and consequent loss in the formation of human resources for health and the decrease in the financial collection for the HEI.In this sense, it is necessary to awaken in the student the understanding that the suspension of face-to-face activities does not necessarily terminate or interrupt their higher education project. However, the indicators of school dropout, which has been elevated beyond the expected rates, denounce difficulties in access, as well as the incorporation of the use of new technologies in the academic routine(7).
The literature characterizes evasion as the definitive exit of the student from his/her course. This phenomenon can be considered an international problem for both public HEIs, due to the idleness of resources, and for private HEIs, because it implies loss of revenue. The evasion harms the result of educational systems, bringing inefficiency of social and economic resources and represents a source of idleness of professors, employees, devices and physical space(8).
Therefore, it is important to reflect and focus on the development of intervention strategies that minimize the occurrence of evasion. Thus, in order to psychologically support the students in this environment and period of turbulence and uncertainties, the faculty of our department implemented as a measure of support calls to all students. The total number of students was distributed among the professors of the collegiate, being careful to ensure that each calling professor had already had a previous contact with the student, in order to strengthen the bond and bring the student/professor relationship closer. The connections calls an average of 40 minutes
and were about the impact of the pandemic on the personal and academic life of the student and his/her family in this pandemic period. The professors were surprised, for example, with reports of illness and death among relatives of the students because of COVID-19, demonstrating the complexity of the pandemic in the life of each student. Furthermore, the contact aimed to identify how the students were experiencing initial learning in the remote modality.
Nevertheless, educators shared the same feeling with their students about the concern necessary to provide future nurses with spaces to build bonds, especially in training, in order to provide conditions for them to feel embraced by their professors(4). The construction of this
identity is related, therefore, to the context of the profession, since embracement and care are movements inherent to nursing actions(6).
In this direction, the perspective of embracing students aimed at the development of the human being behind the telephone, which, within this historical context, has been a producer of qualitative transformations, always in motion, which has enabled him/her to conquer self-determination in nursing.
The pandemic condition puts in perspective the paradox that, by the same exercise of the nurse professor, particularly in the teaching of professional practice in health services, students seem to delimit what they do not wish to be(3). These meanings have
encouraged professors to place themselves as a mirror of the nurse they want to be. Humanization, embracement, empathy, ethical issues and interpersonal relationships are conditions that reinforced the need for professors to show their students that they should seek to improve every day.
In this moment of approximation through the connections, some students expressed confusion between remote synchronous teaching of emergency character and distance learning (DL). It is worth considering that distance education has programmed material, differing from remote classes, in which there is direct interaction with the student.In Brazil, as in the rest of the world, the teaching models adopted were not considered by academic literature as DL(6) and this needs to be clear in
the understanding of students, professors, workers linked to education and even the general public, so that, in the future, governors do not use this emergency situation to justify the defense of the DL for all forms of education, all areas of knowledge and all educational levels.
Therefore, in the practical field of nursing teaching, we highlight that both DL teaching and emergency remote synchronous classes have not been adequate at all, namely, as well as the insertion in the practical scenario,
hindering the experience, in the most diverse environments, of the future professional. Although they configure as alternatives in times of coping with COVID-19, they present themselves as gaps in the training process and require effort of the pedagogical team together with the professors to overcome strategies.We highlight that we are not opposed to the use of information technologies in the academic and teaching-learning space, quite the contrary, but in nursing teaching, especially, there are interpersonal contacts that are irreplaceable, although in classes of theoretical subjects, because relational skills, respect, teamwork, leadership and observation – indispensable to nurses – can only be acquired if, since the very beginning of the training process, they are stimulated in the classroom.
We also highlight that at this time tied to technical difficulties in the management of the Internet, applications, video editing programs and electronic devices, fear, anxiety and insecurity have been part of the daily lives of professors, who had to deal with all these adversities and at the same time try not to show the uncertainties to students, since many of them seek safety in professors. Moreover, it should be reflected that, specifically in the nursing course, pedagogical challenges overlap with the challenges inherent to the profession. The year 2020 long awaited by nursing, for marking the bicentenary of the birth of Florence Nightingale, was declared by the World Health Organization (WHO) as the “International Year of the Nurse” and in Brazil called the “International Year of Nursing”. In 2020, the triennium of the Nursing Now campaign ends, an initiative of the International Nursing Council, WHO and the British Parliament that has spread around the world in order to value and give visibility to nursing work(9), we realize that this movement,
which should have happened in other times, has never been more opportune.
Nursing professionals incessantly publish on social media appeals, since they are constantly exposed to situations of contamination by the virus, not having the choice to move away like most other professions. In the meantime, weaknesses in the team's work process are exposed such as precarious working conditions, lack of personal protective equipment, lack of appreciation of nursing work and the struggle for a decent wage floor(10). Such needs and struggles of
decades of the profession are not softened with applause in the window or with the title of superheroes for facing the pandemic.
These issues of struggles and historical demands of nursing need to be discussed and contextualized in the formation of human resources in health. The higher level of education is an environment that presupposes
excellence, and it is up being nursing professors responsible for discussing during the training of future professionals, who will act on the front line of services, issues relevant to their professional practices.
Understanding the importance of training qualified human resources articulated with the reality of health services was carried out during the nursing week in our HEI online, common practice for professional updating in times of social isolation, which had the participation of municipal health management, primary care coordination and epidemiological surveillance, addressing the reality of nursing and health services, in the context of the COVID-19 pandemic.
The articulation between teaching, service and community provides better training for professors, graduate students and service professionals, as well as favors the synergistic performance of these entities, promotes the understanding of the population's health needs, in addition to directing training to the Unified Health System (UHS), which will again benefit from the insertion of these future professionals in the service network(11).
This integration, therefore, can promote quality actions and services to the population, through the reorientation of primary care and the health care model in force in the national system. It also contributes to strengthen the qualified training of the student to act in the different scenarios of health care, to increase the process of professionals’ qualification in service, as well as to promote multiprofessional work at all system levels(12). Especially at this
time of COVID-19 pandemic, the integration between the different sectors (health, education, community, among others) is more relevant, in order to ensure, within the possibilities, the training of new health professionals and at the same time health care to the population, which continues to demand attention, not only by COVID-19, but also by all the diseases already present before the arrival of this new illness.
In addition, it is evident in the discussions between service and academia, how much nursing professionals are at the entrance of the different health care levels and represent an important workforce, and for this, they need to be strengthened and supported. In Brazil, in 2020, there were more than two million technical- and higher-level professionals registered with the Federal Nursing Council, of whom 108,840 were concentrated in the state of Paraná(13). Most of these professionals are in the
labor market working in care institutions, teaching, in management instances and involved in research, activities that are fundamental to the health of the population and to combat the new Coronavirus(14,15).
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REPENF – Rev. Parana. Enferm. Jan-Dec 2020; 3(1): 94-100.on the front line, the Federal Nursing Council (COFEN) offers emotional help through online care(15-16). However, a group rarely mentioned,
despite the significant impact on their lives and their education, is the health students, especially nursing students(17). In the
meantime, the question is: how do nursing professors reinvent themselves and offer support in this pandemic context, considering the fragility in which they are inserted? Seeking answers to this question, the faculty of the course produced a video that presented the daily routine of classes, demonstrating the challenges they need to overcome to offer quality teaching.
In the opportunity, scenes of professors adapting a physical space of their home, with various improvisations, the challenges of being at home with small children that require attention and dedication, as well as the search for tools in the strenuous routine to ensure the continuity of a quality teaching. This initiative was carried out aiming to demonstrate to students that we all go through provocations or moments that force us to adapt, the difference is in the way we deal with them. Brazilian nursing has its roots in its basic instruments, proposed by Wanda Aguiar Horta, including observation, creativity and teamwork(18) and
students need to use them to overcome the barriers imposed by the new reality.
We realize that moments of severe crisis are process accelerators and paradigm modifiers. Therefore, this moment can be understood as a catalyst that will drive the actions of professors in the nursing area to innovate and perhaps use online learning in a sustained way as a complementary pedagogical tool. It is hard to imagine that life will suddenly return to the previous status upon the solution of the pandemic. We will live
the “new normal.” However, we ask ourselves: what will the “new normal” of nursing education be? How will the relationships between students-teachers-users-services be established? We have no ready answer to these questions to be shared with our readers. However, we certainly understand that face-to-face learning will always remain an essential component of the nurse's curriculum, however, information technologies have proven to be a necessary supplement and maintainer of learning.
FINAL CONSIDERATIONS
This reflection leads us to understand that transformations in the teaching-learning process should be rethought to return to face-to-face classes, since several tools were implemented in an innovative way, which favored the creativity and participation of students positively.
Nevertheless, face-to-face teaching should not be replaced in its essence, given the need for developing practical contents and fundamental human relationships for the training of nurses. We emphasize that the physical and mental safety of students should be a priority and that all programs should act appropriately to preserve it, including the implementation of distance learning tools.
In conclusion, this unprecedented circumstance will change the pedagogical way of educating our students and training human resources for the Brazilian health system. This will require innovation and cooperation from teaching and leadership programs, as well as from our society to maintain strict standards of education, as well as training for teachers and students to adapt to new forms of teaching and interpersonal relationships.
Authors’ individual contribution: Vieira VCL, Carvalho ER and Gabriel FCV: Participated in the design and writing of the project; data collection, analysis and interpretation; writing of the article; relevant critical review of the intellectual content and final approval of the version to be published. All authors declare to be responsible for all aspects of the work, ensuring its accuracy and integrity.
Submitted: 08/11/2020 Accepted: 10/08/2020
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