Permanent education in nursing in
a university hospital
*O
RIGINAL
A
R
TICLE
EDUCAÇÃO PERMANENTE EM ENFERMAGEM EM UM HOSPITAL UNIVERSITÁRIO
CAPACITACIÓN PERMANENTE EN ENFERMERÍA EN UN HOSPITAL UNIVERSITARIO
* Taken from the Project “Educação Permanente de Trabalhadores de Enfermagem do Hospital Universitário da Universidade Federal de Juiz de Fora”, 2007-2009. 1 Ph.D. in Nursing. Associate Professor, School of Nursing, Universidade Federal de Juiz de Fora. Juiz de Fora, MG, Brazil. cristina.pinto@acessa.com 2 Ph.D. in Nursing. Assistant Professor, Juiz de For a School of Health. Coordinator of the Permanent Education Service at the University Hospital of Universidade Federal de Juiz de Fora. Juiz de Fora, MG, Brazil. mary.hu@ig.com.br 3 Ph.D. in Nursing. Associate Professor, School of Nursing, Universidade Federal de Juiz de Fora. Juiz de Fora, MG, Brazil. sueli.santos@ufjf.edu.br 4 Ph.D. in Nursing. Associate Professor, School of Nursing, Universidade Federal de Juiz de Fora. Juiz de Fora, MG, Brazil. arleteamaral@oi.com.br 5 RN. Scientifi c Initiation Grantee, Professional Training Program, Universidade Federal de Juiz de Fora. Juiz de Fora, MG, Brazil. leticiarochajf@yahoo.com.br 6 Ph.D. in Production Engineering. Associate Professor at Universidade Federal do
RESUMO
A educação permanente enfai za a interdis-ciplinaridade da equipe de saúde, focaliza a prái ca como fonte do conhecimento e colo-ca o profi ssional para atuar ai vamente no
processo educai vo. Este estudo objei vou idenifi car demandas e expectai vas, fatores que interferem na qualifi cação de
trabalha-dores de enfermagem de um hospital uni-versitário e propor prái cas de capacitação na perspeci va da educação permanente. O processo invesi gai vo fundamentado nos princípios da pesquisa-ação foi realizado no período de 2007 a 2008, tendo como sujei-tos enfermeiros, técnicos e auxiliares de en-fermagem. Os dados foram obi dos em ofi -cinas de capacitação com 114 trabalhadores de enfermagem. Os resultados permii ram idenifi car as condições insi tucionais em que as ações educai vas ocorrem, a possi-bilidade de mobilização dos trabalhadores para idenifi cação e resolução de problemas no trabalho e a necessidade de mudanças nas prái cas de capacitação. Esta pesquisa subsidiou a elaboração da proposta de um Núcleo de Educação Permanente em Enfer-magem para a insi tuição.
DESCRITORES
Serviço Hospitalar de Educação Educação em enfermagem Capacitação em serviço Pesquisa qualitai va ABSTRACT
Permanent educai on emphasizes on the interdisciplinarity of the health team, fo-cuses on praci ce as the source of knowl-edge and places professionals as aci ve ac-tors of the educai onal process. The
objec-i ve of this study was to ideni fy demands and expectai ons, i.e. factors that interfere in the qualifi cai on of nursing workers of a university hospital, and propose capaci-tai on praci ces from the perspeci ve of permanent educai on. The invesi gai on process founded on the principles of
ac-i on-research was performed from 2007 to 2008. Subjects were nurses, nursing tech-nicians and nursing aides. Data colleci on was performed in training workshops with 114 nursing workers. The results permit ed to ideni fy the insi tui onal condii ons in which educai onal aci ons take place, the possibility of mobilizing workers to ideni fy and solve problems at works, and the need to make changes in training praci ces. This study provided support for elaborai ng a proposal of a Center for Permanent
Educa-i on in Nursing at the insi tui on.
DESCRIPTORS
Educai on Department, Hospital Educai on, nursing
Inservice training Qualitai ve research
RESUMEN
La capacitación permanente enfai za la in-terdisciplinaridad del equipo de salud, foca-liza la práci ca como fuente de conocimien-to y coloca al profesional para trabajar
ac-i vamente en el proceso educai vo. Estudio que objei vó idenifi car demandas y expec-tai vas, factores que interfi eren en la califi
-cación de trabajadores de enfermería de un hospital universitario, y proponer práci cas de capacitación permanente en
perspec-i va de educación permanente. El proceso invesi gai vo fundamentado al principio de la pesquisa-acción se realizó entre 2007 y 2008, siendo sujetos enfermeros, técnicos y auxiliares de enfermería. Datos obtenidos en talleres de capacitación con 114 trabaja-dores de enfermería. Los resultados
iden-ifi caron las condiciones insi tucionales en que se efectúan las acciones educai vas, la posibilidad de movilización de trabajadores para idenifi cación y resolución de proble-mas laborales y la necesidad de cambios en práci cas de capacitación. Esta invesi gación respaldó la elaboración de la propuesta del Núcleo de Educación Permanente en Enfer-mería para la insi tución.
DESCRIPTORES
Servicio de Educación en Hospital Educación en enfermería Capacitación en servicio Invesi gación cualitai va Maria Cristina Pinto de Jesus1, Mariangela Aparecida Gonçalves Figueiredo2, Sueli Maria dos Reis
INTRODUCTION
Curricular guidelines for health and especially nursing professionals’ educai on appoint permanent educai on as a requisite for professional nursing praci ce commit ed to the populai on’s true health needs(1).
To respond to the transformai ons occurred in the la-bor world, permanent educai on should be considered a strategy for worker qualifi cai on. It represents an
impor-tant change in concepi on and in training praci ces and supposes an inversion of the process’ logic, incorporai ng learning into organizai ons’ daily life; it encourages chang-es in educai ve strategies, so as to focus on praci ce as a knowledge source and make professionals act aci vely in the educai ve process. Besides, it emphasizes the interdis-ciplinary team and broadens educai ve spaces(2).
In Brazilian health policies, permanent educai on emerges as a strategic aci on proposal, capable of con-tribui ng to the transformai on of educai on processes, pedagogical and care praci ces and service
organizai on, with ari culated work between the diff erent spheres and managements of the health system and training insi tui ons(3).
The permanent educai on concept ad-opted in this study refers to a knowledge construci on strategy in the technical-sci-enifi c, ethical, sociocultural and relai onal
area, involving daily issues at the insi
tu-i on. It seeks ari culai on with health policy guidelines from the perspeci ve professional training for the health area, using pari cipa-tory methods that lead to autonomy(4-8).
In the context of the University Hospital (UH), the study scenario, specifi cally
regard-ing nursregard-ing workers’ trainregard-ing praci ce, it is
observed that problems exist to put aci ons in praci ce, in view of emerging needs for changes in health praci ces in line with the principles of the Unifi ed Health System
(UHS).
Educai ve aci ons aimed at these workers are being in-cluded in nursing management’s aci vity planning, with a nurse designated to take charge of team training. These aci ons are ari culated with the nursing service only, without any link with a proposal regulated by the human resource sector, in the context of the UH’s general man-agement targets. As a priority, training aci ons have been programmed for nursing auxiliaries and technicians, but do not extend to nurses.
The stari ng point for this study was nursing manage-ment’s dissai sfaci on with the way training aci ons were been accomplished, as no actual changes were observed in workers’ care praci ces. Inii ally, there was the premise that the lack of a formal link between permanent
educa-i on and other administrai ve enii es at the insi tui on
was the main aspect hampering the reversal of training into qualitai ve changes in the work performed.
The refl eci ons of university hospital workers, faculty
and students at the School of Nursing of the federal edu-cai on insi tui on regarding the need for an administrai ve eni ty for permanent educai on purposes pointed towards the need to review the training process accomplished uni l then. In that context, it was considered relevant to
iden-i fy nursing workers’ qualifi cai on demands and
expecta-i ons, as well as the possibilii es to establish a Permanent Educai on Center aimed at training these workers.
The following concerns guided this study: what are the qualifi cai on needs of nursing workers at the university
hospital? What factors interfere in training aci ons, facili-tai ng or hampering permanent educai on? How can the establishment of a permanent educai on center be made feasible with nursing workers’ pari cipai on?
The knowledge produced based on this research con-tributed to a bet er understanding of the reality addressed
and to defi ne strategies that are more
com-pai ble with nursing workers’ qualifi cai on
needs at the study insi tui on. The research-ers hope to contribute in order to si mulate refl eci ons on the relevance of changes in
health and nursing professionals’ educai on praci ces, refl eci ng in care improvements,
besides entailing the possibility of further research in the area.
OBJECTIVES
To ideni fy demands and expectai ons, factors interfering in the qualifi cai on of
nursing workers at a university hospital, as well as to propose training praci ces from a permanent educai on perspeci ve.
CONSIDERATIONS ON PERMANENT EDUCATION
In Brazil, educai ve inii ai ves for health workers were emphasized as a result of the Unifi ed Health System (SUS)
and the Brazilian Curricular Guidelines in the 1990’s. In 2004, a Permanent Educai on Policy in Health was estab-lished, through Decree GM/MS No. 198/04, as an SUS consolidai on strategy to train health workers through a permanent educai on process. This process aims to trans-form technical and social praci ces, focusing on interdis-ciplinary aci ons and insi tui onalized praci ce aimed at the strengthening of teamwork, aci ve appropriai on of technical-scienifi c knowledge and insi tui onal changes(3).
It is known that reports and discussions on worker educai on have been present in health since the 1970’s, when the World Health Organizai on (WHO) and the Pan American Health Organizai on (PAHO) started discussion
In Brazilian health policies, permanent
education emerges as a strategic action proposal, capable of contributing to the
transformation of education processes, pedagogical and care practices and service
groups to address issues fi rst referred to as coni nuing
educai on, and reconsidered as permanent educai on as from the end of the 1980’s(9).
Decree No. 1.996, issued on August 20th 2007, sets
guidelines to put in praci ce the Brazilian Permanent Edu-cai on Policy in Health and defi nes direci ves and
strate-gies to put in praci ce permanent health educai on, in line with the operai onal guidelines and regulai ons of the Pact for Health(10).
In nursing, the search for competency, knowledge and recycling is esseni al to guarantee the survival of profes-sionals and the profession. Permanent educai on’s con-tribui on to professional praci ce is evidenced through ai tudes professionals assume in care, including the com-mitment with themselves, through the moi vai on to seek self-knowledge, improvement and updai ng, and foresee-ing improvements in care delivery to clients and the com-munity. Permanent educai on leads to the understanding that individuals should set self-improvement as a target to be aspired to across the lifei me(5).
The importance of recycling, updai ng and a crii cal and refl exive ai tude towards the situai ons experienced
in health promoi on, preveni on and rehabilitai on is evi-denced, in the context of public health and educai on pol-icies. Developing people not only means giving
informa-i on for them to gain new knowledge, skills and ai tudes and become more effi cient in what they do. It mainly means providing basic educai on for them to learn new ai tudes, solui ons, ideas, concepts, modify habits and behaviors and become more eff eci ve in what they do(4).
Permanent educai on is understood as the constant search to learn, as one of the aci ons that permits the development of the change process and aims for profes-sional qualifi cai on of nursing and, consequently, the
ac-complishment of competent, conscious and responsible professional praci ce(5). It consi tutes a route towards the
emancipai on and autonomy of health workers, as it is at the encounter between the educai on and job worlds that “learning and teaching are incorporated into the daily lives of organizai ons and into work. [...] it is based on the problemai zai on of the work process and quality, at each health service, that qualifi cai on needs are idenifi ed,
guaranteeing the applicai on and relevance of contents and established technologies”, with a view to dignifi ed
and high-quality care(3). METHOD
This study followed the ethical precepts of research in-volving human beings. Approval was obtained from the In-si tui onal Review Board responsible for the study, under Protocol 962.0.2007, Opinion No. 010/20070729/2006.
Aci on-research was used as a theorei cal-method-ological foundai on, as it permits aci ng or or solving a
col-leci ve problem, which pari cipants are pari cipai vely and cooperai vely involved in(11).
Aci on-research is an inteni onal aci on aimed at making a complex object or phenomenon more intelligible, so as to construct concepts that will feed the reasoning of research-ers planning a deliberate interveni on in reality. Pari
cipa-i on is esseni al. It can occur to diff erent extents –ranging from representai on over cooperai on to co-management. Each pari cipant takes part in the aci on and in refl eci on
on the common aci vity that needs to be complied with. The goal of aci on-research is co-management, that is, all members’ pari cipai on in all decisive aci vii es from the start to the end of the research process. It implies inseri ng subjects in an understanding, aiming for a profound change at the level of thoughts and aci ons. To achieve the group aim, at eni on should be paid to the need for a common language that levels out pari cipants with a view to their involvement in the research process. This phase can take some i me, but is esseni al for pari cipants to gain an ac-ceptable understanding of the research object(12).
Change is the goal of aci on-research. This change includes the pari cipants’ values and takes place in the nature of the research itself, at i mes when aci ons and thoughts are reviewed, pari cularly enriching praci cal knowledge. Thus, aci on-research aims for the
produc-i on of theorei cal knowledge, but also contributes to refl eci ons on insi tui onal problems and tensions. It is
concerned with the research process and necessarily in-cludes aci ons. Subjects are seen as autonomous beings and esseni al agents in their own evolui on. The process and product are equally important and their object is a social phenomenon. Researchers interact with the means and pari cipate through their values, taking into account other people’s values. Aci on-research is based on the ne-goi ai on among pari cipants with a view to making the process fl exible, discerning the globality, complexity and
coherence of what is real(12).
Aci on-research is considered a way to create knowl-edge in which there are constant relai ons between theo-ry and praci ce, between research and aci on. It aims for a strategic aci on that demands the actors’ pari cipai on, “it consi tutes a process in which three aspects intermingle, consi tui ng a spiral: planning, aci on and constant infor-mai on colleci on on the group and its own context”(12).
Based on the theorei cal-methodological
founda-i ons, the following phases were accomplished: pari ci-patory survey of nursing workers’ training needs in the work context: broad discussion and themai zai on with pari cipants; defi nii on of principles for the elaborai on
of a training proposal for diff erent nursing categories, in-cluding content produci on that puts forwards work as an educai ve principle.
auxil-iaries, totaling 114 professionals who worked in diff erent shit s. Some workers were part of the insi tui on’s perma-nent staff , while others worked on a temporary contract.
All workers who formally accepted to pari cipate in the study were included. Only those workers on a leave of ab-sence for health treatment or worked in another funci on were excluded.
Data were collected and analyzed between October 2007 and September 2008, using educai ve workshops as a space for data survey, themai zai on and content pro-duci on, and also for the proposal of colleci ve aci ons aimed at permanent educai on in nursing.
With a view to moi vai ng pari cipants’ manifestai on, the following guiding quesi ons were elaborated: in your work environment, what do you like most and what do you like least? What would you add for your work to get bet er? Specifi cally regarding permanent educai on, the
following quesi ons were asked: what problems in your daily praci ce could be solved through workers’ training? What facilitates and what hampers workers’ training at the University Hospital? What is the goal of a Permanent Educai on Center?
The fi rst quesi ons were asked to give room for
profes-sionals to spontaneously describe the work environment, appoini ng facilitai es and diffi culi es in daily reality at the insi tui on. The fi nal quesi ons aimed to ideni fy these
workers’ training demands, factors hampering training praci ces and expectai ons about the changes needed to develop educai ve aci vii es.
During the data colleci on and return movement to the workers, the researchers provided theorei cal support for the analysis of the reality the professionals evidenced and which would make them refl ect on the training
pro-posal to be insi tui onalized at the university hospital. At that i me, considering nurses as triggering elements for changes and for the implementai on of training aci ons, at empts were made to further involve these profession-als in the workshops. To arouse refl eci ons, the following
guiding quesi ons were presented: how do UH nurses take part in the nursing work process? What are the routes to-wards permanent educai on at the UH?
The workers’ tesi monies and colleci ve produci on during the workshops were registered, using a digital re-corder, posters the pari cipants elaborated themselves and photographs.
The number of study pari cipants evidenced the wealth of meanings. The collected data were considered suffi cient to answer the research quesi ons and aims.
For data analysis, the observai on, classifi cai on and
conclusion phases were adopted(12). The observai on phase
was centered on the discovery of solui ons and the mean-ing of nursmean-ing workers’ aci ons, who at empted to diagnose the study quesi on. This phase was based on
awareness-raising educai on, humanisi c principles and the premises of health educai on. For data classifi cai on, the units of
meaning deriving from interaci ons with workers during the workshops were grouped. These units were consi tuted based on the exchange of ideas between workers and re-searchers. The conclusion phase was centered on under-standing the meaning of the events observed and on indi-cai ons of possible solui ons to the problems.
The discussion of results was illustrated using workers’ statements, using the let ers N, T and A, respeci vely, for nurses, nursing technicians and auxiliaries, following by the number corresponding to the statement and ideni
-fi ed in the text as [N1]; [T1]; [A1], for example, and so on,
so as to guarantee anonymity.
RESULTS AND DISCUSSION
The following themes emerged from this research: qualifi cai on demands and expectai ons for nursing work;
factors interfering in training praci ces and training from a permanent educai on perspeci ve.
Qualifi cai on demands and expectai ons for nursing work
Through the nursing workers’ idenifi cai on of their
qualifi cai on demands, the importance of and need for
technical-scienifi c knowledge was underlined. Besides,
the relevance of including aspects of the paradigm change in professional educai on and healthcare was highlighted. Pari cipants emphasized professional valuai on and auton-omy to accomplish aci vii es related to nursing competenc-es, and permanent educai on as a strategy for knowledge acquisii on and updai ng and for the preparai on of muli -plying agents to work with users and the health team.
[...] do training, education to improve knowledge [A4]. [...] you need love, respect and responsibility [A1]. Staff policies and valuation of workers at the institution [N17].
The tesi monies reveal the prevalent understanding of training as scienifi c knowledge acquisii on to direct care
with a view to standardized procedures. The scienifi c base
of care is valued. The need for scienifi c foundai ons to
ac-complish pai ent care and training was underlined, in the sense of rescuing knowledge. Workers expect to broaden scienifi c foundai ons and gain new technical knowledge.
This praci ce was also observed in a study on health professionals’ permanent educai on, accomplished at public hospitals in São Paulo. Educai ve aci vii es were di-rected at task performance and health recovery, with pre-dominantly tradii onal teaching strategies(13).
During refl eci ons, the nursing workers considered that
[...] theory and practice need to go hand in hand [N5]. You lose what you have learned in theory if it is not articu-lated with practice [N3].
A continuous updating process is needed, as well as changes in line with the pedagogical conception adopted at the UH [N15].
When associai ng the educai ve aspects with the work context, the pari cipants consider that the training proposal should be ari culated with the reality it is
des-i ned for. These workers’ stance fi nds support in a study
accomplished at a teaching support hospital in São Paulo, in which nurses report on the importance of and need for educai ve aci ons and underline the growing demands for technological renewal and inveni on, knowledge
integra-i on and the need for a new view on health work(14).
Another issue the workers raised is the need to seek disi nguished methods for the permanent educai on pro-cess. They indicate that this process should be based on the dialogical and transformai ve educai on concept, with a view to improving health professionals’ educai on and qualifying user care.
A work process is needed based on the problem-solving method [N16].
Addressing the inversion of models – prioritizing human-ization to the detriment of technology [N18].
Training aci ons should be based on methods that permit establishing the relai on between proposals and reality, i.e. methods that permit a crii cal view for deci-sion making, choosing those methods that are most in line with the reality of the work process and with users’ needs in the care praci ce context(9).
The change in health services’ insi tui onalized praci ces is directly related with the change in educai ve aci ons. Not only academic knowledge, but also praci cal knowledge needs to be valued, enhancing shared and systemai c
re-fl eci on, depari ng from what professionals already know(2).
Factors interfering in training praci ces
The management of praci ces and the insi tui onal policy direci ng nursing work processes at the university hospital were idenifi ed as interfering factors that hamper
the effi cacy of training aci ons.
The need to discuss the work process is revealed based on problem idenifi cai on in the work and interpersonal
communicai on spheres.
I consider that there is a lack of communication among the sectors [T3].
Some sectors are disorganized [A5].
Diffi culty to integrate the technical team [N10]. Training is needed for the relationship [T4].
In this context, nurses’ distancing from their posii on as nursing team leaders is highlighted, and as strategic professionals for changes to take place.
[...] we get orders from many people, which prevents us from being the nurses we are [N6].
There is a lack of defi nition on nurses’ role and action phi-losophy [N2].
Nurses assume different functions, including those of oth-er professionals [N8].
The workers’ posii ons revealed nurses’ absence and their distancing from some aci vii es inherent in their funci on with regard to the care work and nursing man-agement process.
There is a lack of supervision by the heads [A6].
The nurse is not integrated in the work process as a whole [N9].
There is no (daily, weekly, yearly) work planning [N10].
It was apprehended that nursing and specifi cally
nurs-es’ work is weakened with regard to the insi tui onal hu-man resource policy, cultural and job market
transforma-i ons, whether insi tui onally or in society.
The physical, organizai onal and service maintenance condii ons at the insi tui on were also appointed as factors contribui ng to the limited effi cacy of training aci ons and/or to the small impact of these aci ons. Some situai ons make workers feel dissai sfi ed, with a lack of moi vai on for work
and knowledge recycling, specifi cally considering the diff
er-ent job contracts, which grant stability to part of them.
There is the problem of wage differences and contract in-stability [N7].
The institution does not provide suffi cient orientation on the work process [N11].
We perform the work process empirically [N12].
It is highlighted that changes in health work start with the establishment of the SUS. The established healthcare model demands a cooperai ve work and democrai c man-agement process, in which nurses should aci vely perform in the group they are leading with a view to healthcare delivery. In care delivery, professionals assume ai tudes, which include the moi vai on to seek knowledge, recy-cling and updai ng with a view to improving care to users and the community(5).
The work condii ons refl ect workers’ valuai on. In this
study, the workers meni oned the lack of space for meals, re-laxai on and healthcare for nursing staff . The need to structure work roui nes was highlighted with a view to humanizai on.
[...] humanization aiming for quality in human relations [A2].
Talking about humanizai on in the hospital and health-care environment means considering the physical, techno-logical, human and administrai ve structure at the insi tui on, as well as valuing and respeci ng human beings’ dignity(15).
The lack of humanizai on is also refl ected in the lack of
adequate physical space for user care.
There is a lack of physical space, producing disorganiza-tion [T1].
There is no technology to support the care process [N14].
It was evidenced that some material resources are obsolete, there is a lack of preveni ve maintenance and
fi xing equipment takes i me, besides the lack of material.
There is a lack of material, there is no preventive mainte-nance [N4].
[...] when some material is broken, it takes time to fi x it [N1].
For educai ve aci ons to result in ai tudes that en-hance changes in the nursing work process, nurses need to get involved in the permanent educai on process with a view to coni nuously gaining skills and competences, in view of the epidemiological context and health scenarios’ needs. Besides, insi tui onal commitment can facilitate the planning and development of educai ve aci ons(6).
Training from a permanent educai on perspeci ve
During the aci on-research process, training and qual-ity concepts were evidenced in nursing care. In this respect, training was put forward as a tool to achieve improvements in care and also understood as a way to value workers.
What the professionals’ desire is concerned, moi
va-i on does exist to get training, to learn, but there are
dif-fi culi es interfering in the accomplishment of educai ve
aci ons and largely in the applicai on of what is learned as well. The professionals admit that it is diffi cult to put in praci ce what is learned and appoint administrai ve is-sues as factors interfering in the accomplishment of
ac-i ons. It seems that a deadlock is produced, training is accomplished, but no condii ons are created in praci ce for changes based on educai ve aci ons, in line with the guiding principles.
[...] people have an enormous will to learn but, in general lines, face diffi culties to follow what they have learned [T4]. Support is needed in practice to implement what you have learned [T2].
Addressing work fl exibility issues for training [N18]. Enhancing integration, welcoming and humanization at work [N19].
The nursing workers evidenced the need for change and innovai ons in training praci ces during refl eci ons:
[...] we have to address health policies, rights and obliga-tions, institutional organization, legal regimen, staff moti-vation [N7].
These changes go beyond the nursing sphere to the extent that they include technical-scienifi c and
organiza-i onal aspects.
To produce results, permanent educai on aci ons need to be ari culated with organizai onal change devices, mainly with new staff management styles. They are not limited to making professionals incorporate knowledge, but should make them ideni fy what knowledge they need to learn, what situai ons should cease to exist and what should be done for the group to adopt the new knowledge, in short, changes in the organizai on and its contexts are necessary(2).
It should be taken into account that the students need to pari cipate in the educai ve process to get involved in it. The nursing workers’ tesi monies indicate that they do not pari cipate in all planning and decision making phases on the training process and on educai ve aci ons. They have repeatedly affi rmed that training pari ally depends on workers’ interest, desire and involvement.
Further attitude, participation and knowledge exercise by nurses and the team is necessary, leading to credibility [N5]. It is important to value the assessment of the activities per-formed [N15].
Transforming the work process involves the survey of needs, expectai ons, problemai zai on and technical sup-port for professionals aware of their commitment to users to perceive the poteni als and limits of their praci ce(14).
As a research product, focusing on the proposition of training practices from a permanent education per-spective, a proposal was constructed for the creation of a Permanent Education Center in Nursing at the Univer-sity Hospital, to be included in the institutional chart, whose actions include recycling and in-service special-ization programs, work initiation programs, practicums and experiences, besides support to stricto sensu
grad-uate programs.
The understanding about a Permanent Educai on Cen-ter in Nursing took the form of an administrai ve eni ty that facilitates the accomplishment of training aci ons, marking insi tui onal responsibility. And also as an oppor-tunity to integrate training demands, put them in praci ce, accomplish them and assess them as a coni nuous pro-cess, with insi tui onal support.
Establishing a well-defi ned Center, with exclusive nurses; a Multidisciplinary Center for training all UH professionals [N20]. The Center as an integrative element between health schools and the University Hospital [N17].
area), which articulates work with nursing management regarding nursing service organization [N21].
The nurses’ pari cipai on permit ed the elaborai on of guidelines to structure the university hospital’s perma-nent educai on service, in line with the Unifi ed Health
Sys-tem and current pedagogical requirements. The work dy-namics resuli ng from the aci on-research facilitated this pari cipai on. Pari cipatory studies can be conceived as a way to reestablish the human dimension of health care, as they demand an eff eci ve relai on among people – health professionals, pai ents and families(16).
CONCLUSION
The method used in the research process is highlight-ed in this study, permii ng a broad diagnosis of nursing workers’ training demands and expectai ons, as the start-ing point for plannstart-ing aci ons that are more appropriate to the insi tui on’s characterisi cs and needs.
The colleci ve knowledge construci on work evoked a feeling of belonging and valuai on in the group, originai ng in the percepi on of a space where they are heard. It led to understanding about the importance of involvement and accountability for one’s own professional educai on and the role of nurses, as nursing team leaders, to facilitate edu-cai ve aci ons for nursing technicians and auxiliaries.
The group problemai zed issues they considered rel-evant and sought achievable solui ons, besides reassess-ing its behaviors. Change proposals based on the structur-ing of the permanent educai on service became coherent with the needs of university hospital workers.
The aci on-research represented an opportunity for refl eci on on the reality of nursing work, besides
permit-i ng workers’ mobilizai on, the percepi on of problems from stakeholders’ perspeci ves and, at the same i me, the triggering of a Permanent Educai on Center structure. This Center not only enhances permanent educai on in nursing, but also represents a space for planning, moni-toring and assessing the pedagogical proposals related to the demands in the teaching, research and community service context of the University Hospital.
The researchers hope that training praci ce resuli ng from the concrete Permanent Educai on Center in nursing will not remain limited to punctual aci ons, but will com-prise aci ons in line with the premises and mission of a health insi tui on ari culated with a teaching insi tui on.
To advance on theorei cal and praci cal knowledge with a view to pui ng permanent educai on in praci ce, further research is needed, mainly aimed at assessing the impact of educai ve aci ons performed, guided by
educa-i on and health policies.
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