498
REFLECTI ONS ON NURSI NG TEACHI NG I N THE POST-MODERNI TY ERA AND THE
METAPHOR OF A THEORY- PRACTI CE GAP
Zey n e Alv es Pir es Scher er1 Edson Ar t hur Scher er2
Sch er er ZAP, Sch er er EA. Reflect ion s on n u r sin g t each in g in t h e post - m oder n it y era an d t h e m et aph or of a t heor y - pr act ice gap. Rev Lat ino- am Enfer m agem 2007 m aio- j unho; 15( 3) : 498- 501.
Th is ar t icle pr esen t s a t h eor et ical r ef lect ion on n u r sin g t each in g. Fir st , w e con t ex t u alize t h e t opic r eg ar d in g t h e g lob alized w or ld an d t h e r ep er cu ssion s of it s p ar ad ig m s on m an k in d an d , con seq u en t ly , on n u r sin g st u den t s’ lear n in g. Nex t , w e f ocu s on t h e t h eor y - pr act ice gap est ablish ed in t h e n u r sin g lear n in g. Edu cat or s ar e ex pect ed t o sh ow st u den t s t h e r elev an ce of in t egr at in g t h ese dif f er en t t y pes of k n ow ledge. Mor eov er , t o play a piv ot al r ole in a pr ocess t hat helps st udent s t o apply t heor et ical k now ledge in pr act ical sit uat ions, r educing t he differ ence bet w een w hat is consider ed ideal and w hat is r eal. The bio- psy cho- social-econom ic- cult ural m odel values t he care for t he individual in t he different organizat ional cont ext s and can base t h e p r act ice. An ot h er in q u ir y t h at em er ged is ab ou t t h e ex t en t t o w h ich w e h av e assist ed ot h er s in t h eir cor por al, m ent al, spir it ual and noet ic dim ensions, in addit ion t o t he at t ent ion deliv er ed t o t he car e- giv er .
DESCRI PTORS: nur sing; t eaching; nur sing educat ion; lear ning
REFLEXI ONES SOBRE LA ENSEÑANZA DE ENFERMERÍ A EN LA POSTMODERNI DAD Y LA
METÁFORA DE UNA LAGUNA TEÓRI CO-PRÁCTI CA
Se p r e se n t a u n a r e f l e x i ó n so b r e l a e n se ñ a n za d e e n f e r m e r ía . I n i ci a l m e n t e f u e r e a l i za d a u n a cont ext ualización con relación al m undo globalizado y las repercusiones de sus paradigm as sobre el hom bre y, en consecuencia, sobre el aprendizaj e del est udiant e de enferm ería. Seguidam ent e se enfoca la laguna ent re la t eoría y la práct ica durant e el aprendizaj e de enferm ería. De los profesores se espera que m uest ren la im port ancia de la int egración de los diversos conocim ient os para los alum nos. Así com o, que sea la base de un proceso que perm it a a los est udiant es aplicar el conocim ient o t eórico en sit uaciones práct icas, reduciendo la diferencia ent re lo ideal y lo real en el t rabaj o. El m odelo bio- psico- social- económ ico- cult ural valora el cuidado al individuo en sus diversos cont ext os organizacionales y fundam ent a la práct ica. Una ot ra discusión se suscit a cuando cuidam os del ot ro en su dim ensión corporal, m ent al, espirit ual y fenom enológica, adem ás de la at ención dada al individuo que cuida.
DESCRI PTORES: en f er m er ía; en señ an za; edu cación en en f er m er ía; apr en dizaj e
REFLEXÕES SOBRE O ENSI NO DE ENFERMAGEM NA PÓS- MODERNI DADE E A METÁFORA
DE UMA LACUNA TEÓRI CO-PRÁTI CA
Tr a t a - se d e u m a r e f l e x ã o t e ó r i ca a ce r ca d o e n si n o d e e n f e r m a g e m . I n i ci a l m e n t e é f e i t a u m a cont ex t ualização em r elação ao m undo globalizado e as r eper cussões de seus par adigm as sobr e o hom em e, con seq ü en t em en t e, sob r e o ap r en d izad o d o est u d an t e d e en f er m ag em . Em seg u id a é en f ocad a a lacu n a t eór ico- p r át ica est ab elecid a n o ap r en d izad o d a en f er m ag em . Dos ed u cad or es é esp er ad o q u e m ost r em a r elev ância da int egr ação dest es difer ent es saber es aos alunos. Além dist o, que sej am o piv ô de um pr ocesso que aj ude os est udant es a aplicar o conhecim ent o t eór ico nas sit uações pr át icas, r eduzindo a difer ença ent r e o que é consider ado ideal e o que é r eal no t r abalho. O m odelo bio- psico- social- econôm ico- cult ur al v alor iza o cu idado ao in div ídu o n os dif er en t es con t ex t os das or gan izações e pode v ir a f u n dam en t ar a pr át ica. Ou t r o qu est ion am en t o su scit ado é qu an t o t em os cu idado do ou t r o n a su a dim en são cor por al, m en t al, espir it u al e noét ica, além da at enção ao indiv íduo que cuida.
DESCRI TORES: en f er m agem ; en sin o; edu cação em en f er m agem ; apr en dizagem
I
PhD, Professor at t he Universit y of São Paulo at Ribeirão Pret o College of Nursing Psychiat ric and Hum an Sciences Depart m ent , WHO Collaborat ing Cent re for Nursing Research Developm ent , e- m ail: [email protected]; I I Psychiat rist , Doct oral St udent , Assist ant at Hospit al das Clínicas Universit y of São Paulo at Ribeirão Pret o Medical School
Disponible en castellano/ Disponível em língua portuguesa SciELO Brasil w w w .scielo.br/ rlae
Rev Lat ino- am Enferm agem 2007 m aio- j unho; 15( 3) : 498- 501 w w w .eer p.usp.br / r lae
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I NTRODUCTI ON
T
h e cu r r en t social con t ex t h as d em an d ed increasingly qualified hum an resources. Since t he endof t h e t w en t iet h cen t u r y, ed u cat ion h as u n d er g on e
ch an ges an d k n ow ledge h as been r ev olu t ion ized all
around t he world. Consequent ly, new inform at ion and
c o m m u n i c a t i o n t e c h n o l o g i e s i n t h e p e d a g o g i c a l
pr ocesses ar e being dem anded fr om univ er sit ies, as
w e l l a s i n cr e a se d q u a l i f i ca t i o n , n e w a b i l i t i e s a n d
com pet encies and ar t iculat ion w it h societ y ( 1).
These are challenging issues to the institutions
t hat educat e and pr oduce k now ledge and, t her efor e,
d em an d b r oad d iscu ssion s. Tod ay, u n iv er sit ies ar e
engaged not only wit h t he uncondit ional search for t he
truth, but also with the construction of society( 1). We live
in a world wit h advances in sciences and t echnologies,
w hich values personal abilit ies and com pet encies and
not only the quantity of acquired inform ation. Universities
are dem anded t o increm ent alt ernat ive and int egrat ed
st rat egies, favorable t o t he collect ive const ruct ion of a
fairer and m ore hum ane societ y.
Fr om t his per spect ive, educat ion m ust adopt
t he pr em ises of t he “ need t o consider t he flex ibilit y,
i n t e r d i sci p l i n a r i t y, t h e co n t e x t u a l i za t i o n a n d t h e
unificat ion of t he t heory- pract ice relat ion and respect
for et hical, est het ic, and polit ical values”( 2). According
t o t his view, nursing schools have at t em pt ed t o adopt
p r op osals t h at in t eg r at e sev er al asp ect s of h ealt h
pr oblem s, con sider in g t h e com plex it y of t h e h u m an
b e i n g , t h e e n v i r o n m e n t w h e r e ( s ) h e l i v e s a n d
pr ov idin g r esou r ces t h at allow f or t h e f or m at ion of
com pet ent pr ofessionals t o deal w it h t he challenges
of t he t w ent y- fir st cent ur y( 3).
GLOBALI ZATI ON AND I TS REPERCUSSI ONS
Current ly, we live in a post m odern m om ent ,
w it h it s pr agm at ic unfolding of t he globalized w or ld.
Cert aint y and order have been replaced by t he cult ure
of uncert aint y and indefinit eness, generat ing changes
accom panied by cr ises and r upt ur es( 4).
Glob alizat ion b ot h d iv id es an d u n if ies. Th e
c o m p r e h e n s i o n o f t i m e / s p a c e , w h e r e t i m e i s
a ccel er a t ed a n d sp a ce co m p r i sed , t h e ev er m o r e
g lob alized elit es ar e separ at ed f r om t h e r em ain der
of t h e popu lat ion , ev en m or e “ localized”, open in g a
g ap b et w een t h ose w h o h av e an d t h ose w h o h av e
not . The adv ent of t he com put er is t r anslat ed in t he
decline of t ruly public space. The hum an being is m ore
easily found and, consequent ly, cont r olled. Who is in
cont rol of t he sit uat ion? Despit e t he fact t hat hum an
act ions happen on a global scale, ev ent s cannot be
dict at ed. We only obser ve pr inciples, inst it ut ions and
fr ont ier s changing rapidly and unpr edict ably. Ar e t he
n eed y b ein g assist ed m or e r ap id ly an d ef f icien t ly ?
Has t he poor’s sit uat ion im proved or w orsened? Who
w ill hav e higher access t o j obs in t his new m obilit y
h i er a r ch y ? I n t h i s w ay, w e o b ser v e p eo p l e b ei n g
ov er load ed w it h an x iet y cau sed b y in secu r it y an d
uncer t aint y, generat ed by t he cur r ent ex ist ence( 5).
I n t he face of t his r ealit y, t he hum an being
becom es vulnerable t o crises. Crisis can be underst ood
as a m om ent of t ransit ion in which t wo opposit e m odels
live sim ult aneously. I t is an unst able m om ent , because
t he previous order ceases t o exist and t he new one is
not sufficient ly clear t o provide defined param et ers of
behavior. The t ransit ion not only dem ands coping wit h
t h e u n k n o w n , b u t t r i g g e r s t h e p e r so n ’ s cr e a t i v e
capacit y. The rigid post ure t ends t o lead t he individual
t o perceive crises as chaos. Therefore, in order t o live
w it h n ew m odels, on e is su pposed t o h av e a m or e
flexible view. This m om ent is expect ed t o be underst ood
as a redefinit ion for t he developm ent t o occur.
I t is necessary t o be at t ent ive in order not t o
let t he phenom ena t hat dehum anize, t hat m echanize
t h e h u m an b ein g , im p r eg n at e t h is n ew ch ap t er of
hum anit y ’s evolut ion hist or y. The new ( post m oder n)
cult ur al par adigm m ak es possible t he em er gence of
anot her st y le for societ y t hr ough t he com m unit ar ian
desir e an d t h e f eelin g cu lt u r e. Th is cu lt u r al r ebir t h
presents a friendly relational com m unication, which has
been t he essent ial pr inciple t hat fundam ent s nur sing
pract ice, alt hough a valuat ion by rat ionalist , t echnical
an d scien t ist ic log ic is ack n ow led g ed , cau sin g t h e
dehum anization of the art of taking caring of the other( 6).
The care delivered t o t he pat ient t ends t o be
execut ed in a fragm ent ed w ay. Ther e is a dichot om y
bet w een discou r se an d act ion , bet w een t h eor y an d
pr act ice, in w h ich t h e ex pr essiv e aspect of n u r sin g
c a r e i s l i t t l e d e v e l o p e d i n c o m p a r i s o n t o t h e
inst r um ent al aspect t hat holds t he nur se’s at t ent ion,
leading him ( er ) aw ay fr om t he hum an being( 7).
THE METAPHOR OF A THEORY-PRACTI CE GAP
I n t he specific sit uat ion of nur sing t eaching,
t h e m et aph or of a gap bet w een t h eor y an d pr act ice Reflect ions on nursing t eaching...
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i s f i r m l y est ab l i sh ed . So m e au t h o r s ar g u e t h at i t
w ill alw ay s ex ist , becau se t h er e ar e dif f er en t t y pes
of k n ow led g e in v olv ed . On e of t h em , f or in st an ce,
r e f e r s t o t h e o r y a s a k n o w l e d g e “ k n o w t h a t ”
acq u ir ed in b ook s; an d t h e p r act ice as k n ow led g e
“ k n ow h ow ” g ain ed t h r ou g h d ir ect ex p er ien ce of a
sit u at ion( 8 ). Th is dich ot om y seem s t o ex ist becau se
t h e t h eo r et i cal co n cep t s ar e o u t d at ed . Th u s, i t i s
s u g g e s t e d t h a t n u r s i n g t h e o r y n e e d s t o b e r e
-c o n -c e p t u a l i z e d, s o t h a t t h e o r y a n d p r a c t i c e
e x c h a n g e i n f o r m a t i o n a n d d e v e l o p f r o m e a c h
ot her( 9 ). Ther e ar e scholar s w ho believ e t her e is no
t h eor y - pr act ice gap, bu t r at h er a t h eor y - t h eor y gap,
becau se t h er e ar e t w o dif f er en t t h eor et ical n u r sin g
p e r s p e c t i v e s , u s e d b y p r o f e s s o r s a n d n u r s i n g
p r o f e ssi o n a l s( 1 0 ). I n o r d e r t o so l v e t h e p r o b l e m s
cau sed b y su ch g ap , it is ex p ect ed t h at ed u cat or s
sh o w t h e r el ev an ce o f i n t eg r at i o n t h ese d i f f er en t
k in d s of k n ow led g e t o st u d en t s. I n ad d it ion , t h ey
m u st be t h e piv ot of a pr ocess t h at h elps st u den t s
t o apply t heor et ical k now ledge in pr act ical sit uat ions,
r edu cin g t h e differ en ce bet w een w h at is con sider ed
ideal an d w h at is ideal in n u r sin g w or k .
Ai m i n g t o so l v e t h e t h e o r y - p r a ct i ce g a p ,
e d u c a t o r s t e n d t o f o c u s t h e i r a t t e n t i o n o n t h e
environm ent al condit ions in which t he st udent learns.
Th e st u d en t ’ s co g n i t i o n , t h o u g h v er y r ea l , i s n o t
palpable an d is in h er en t t o each h u m an bein g an d,
t her efor e, not accessible t o t he t eacher. I n addit ion,
it is k now n t hat t heor et ical and pr act ical k now ledge
ar e br ou gh t by t h e lear n er s an d ar e n ot separ at ed
experiences from one anot her( 11). There is also a lack
of sy st em at ized st u d ies t h at in clu d e t h ese asp ect s
r elat ed t o t he st udent ’s per son.
FI NAL CONSI DERATI ONS
At t h i s t i m e o f r e f l e ct i o n , t h e p e r ce p t i o n
em er ges t h at t h e global an d in t er r elat ion pr oblem s
generat ed by t he posit ivist paradigm , hegem onic unt il
t hen, and it s em phasis on t echnological developm ent ,
have dist anced hum anit arian aspect s ( involvem ent and
affect ) . Th e ex plicit obj ect iv es of t ech n ology, u n der
t he posit ivist aegis, are cont rol, m ass product ion and
t he st andardizat ion, shelt ering in rat ionalit y, t echnique,
organicism , believing in t he unlim it ed growt h illusion.
I n t he current educat ional syst em , com prom ised wit h
t he valuat ion of self- affirm at ion m anifest ed as pow er,
co n t r o l a n d d o m i n a t i o n o f o t h e r s t h r o u g h f o r ce
( p r ed om in at in g p at t er n s in ou r societ y ) , b ased on
com pet it iv e behav ior, or iginal ideas and quest ioning
of au t h or it y ar e d iscou r ag e. Th u s, it is clear t h at
com pet it ion is prom ot ed t o t he det rim ent of cooperat ion.
Th e act ion becom es dir ect , t h e t ech n ical r ou t in e is
im plem ent ed and reflect ion, t hinking and creat ivit y are
put aside. Thus, it can be concluded t hat , w hile t his
sit uat ion of desegr egat ion of t he w hole per sist s, our
pract ice is insufficient and incom plet e( 4).
Re t h i n k i n g t h e s e p o s t u r e s w i l l p o s s i b l y
influence t he at t it udes regarding t hose who we deliver
c a r e t o , p r o v i d e d t h a t i t i s b a s e d o n t h e
b i o p s y c h o s o c i a l - e c o n o m i c - c u l t u r a l m o d e l , w h i c h
v a l u es t h e i n d i v i d u a l i n t h e d i f f er en t co n t ex t s o f
organizat ions ( healt h inst it ut ions, t eaching and ot her) .
I t is also im por t ant t o quest ion how m uch w e hav e
t ak en car e o f t h e o t h er i n h i s( er ) b o d i l y, m en t al ,
spirit ual and noet ic dim ensions. Also, t o reflect about
t h e in div idu al w h o deliv er s car e. Has t h e car egiv er
been w or r ied w it h his( er ) hum an t ot alit y ?
REFERENCES
1 . Mi n i st ér i o d a Ed u cação ( BR) [ h om ep ag e n a I n t er n et ] . Br asília: Minist ér io da Educação; [ Acesso em 2004 fev er eir o 1 9 ] . Se m i n á r i o I n t e r n a c i o n a l Un i v e r s i d a d e XXI : n o v o s ca m i n h o s p a r a e d u ca çã o su p e r i o r : o f u t u r o e m d e b a t e . Result ados do Sem inár io: Declar ação de Br asília; [ 3 t elas] . D i s p o n ív e l e m : h t t p : / / w w w . m e c . g o v. b r / u n i v x x i / p d f / declar a_ p. pdf
2. Forum Nacional do Profae, 1; . Relat ório geral: const ruindo u m a p o l ít i ca p ú b l i ca d e f o r m ação p r o f i ssi o n al em saú d e. Br asília ( BR) : Minist ér io da Saúde, 2003. p. 145- 71. 3. Clapis MJ, Nogueira MS, Mello DF, Corrêa AK, Souza MCBM, M e n d e s M M R. O e n s i n o d e g r a d u a ç ã o n a e s c o l a d e enferm agem de Ribeirão Pret o da Universidade de São Paulo ao l o n g o d o s seu s 5 0 an o s ( 1 9 5 3 - 2 0 0 3 ) . Rev Lat i n o - am Enfer m agem 2004 j aneir o; 12 ( 1) : 7- 13.
4. Gom es JB, Casagrande LDR. A educação reflexiva na pós-m o d e r n i d a d e : u pós-m a r e v i sã o b i b l i o g r á f i ca . Re v La t i n o - a pós-m En f er m agem 2 0 0 2 set em br o; 1 0 ( 5 ) : 6 9 6 - 7 0 3 .
5. Baum an Z. Globalização: as conseqüências hum anas. Rio de Janeir o ( RJ) : Jor ge Zahar ; 1999.
6. Ferraz CA, Trevizan MA, Mendes I AC, Nakao JRS. Reflexões sobr e a ação com u n icat iv a n a ar t e de cu idar do ou t r o em t e m p o s p ó s - m o d e r n o s . I n : Me n d e s I A C, Ca r v a l h o EC, coordenadores. Com unicação com o m eio de prom over saúde. 7 º Sim p ósio Br asileir o d e Com u n icação em En f er m ag em ; 2000. j unho 5- 6; Ribeir ão Pr et o, São Paulo. Ribeir ão Pr et o: FI ERP; 2 0 0 0 . p . 1 3 7 - 4 1 .
7 . S c h e r e r Z A P, Lu i s M AV. Pe r c e p ç õ e s e s i g n i f i c a d o s at r ibu ídos pelos pacien t es à v iv ên cia da qu eim adu r a. Act a Pau l En fer m agem 1 9 9 8 m aio; 1 1 ( 2 ) : 6 4 - 7 2 .
8. Burnard P. Tow ards an epist em ological basis for experient ial lear ning in nur sing. J Adv Nur s 1 9 8 7 ; 1 2 : 1 8 9 - 9 3 .
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9. Corlet t J. The percept ions of nurse t eachers, st udent nurses and precept ors of t he t heory- pract ice gap in nurse educat ion. Nu r se Ed u c Tod ay 2 0 0 0 ; 2 0 : 4 9 9 - 5 0 5 .
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11. Gallagher P. How t he m et aphor of a gap bet ween t heory an d pr act ice h as in f lu en ced n u r sin g edu cat ion . Nu r se Edu c Tod ay 2 0 0 4 ; 2 4 : 2 6 3 - 8 .
Recebido em : 10.11.2005 Aprovado em : 13.9.2006
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