Care and management actions developed in the Supervised Curricular Internship: perceptions by involved actorsABSTRACT
Objective: To assess the Supervised Curricular Internship of the Nursing undergraduate course of two higher education institutions in the state of São Paulo based on specific skills described in the Brazilian National Curriculum Guidelines regarding preparation to the development of nursing care and management actions from the perceptions of professors, undergraduate students, and alumni.
Method: Descriptive study in which a questionnaire was applied to 59 undergraduate students, 111 alumni, and 27 professors of a Nursing undergraduate course involved in the Supervised Curricular Internship in the analyzed institutions.
Results: The perceptions of the actors involved in the development of management and care actions were positive, although part of the alumni pointed out that the Supervised Curricular Internship does not allow the students to: develop all the activities performed by the nursing team; work towards comprehensive health care; professional technical confidence; and interfere with the work dynamics.
Conclusion: In the perception of those involved, the Supervised Curricular Internship is seen as positive and important in the training of students, as it introduces students into the professional reality of nurses. However, this discipline still needs structural changes, particularly in the perception of the alumni.
DESCRIPTORS: Education, Nursing; Curriculum; Clinical Clerkship; Education; Competency-Based Education; Education, Higher
RESUMEN
Objetivo: Evaluar la Pasantía Curricular Supervisada de la carrera universitaria de Enfermería en dos centros de enseñanza superior del Estado de São Paulo, a la luz de las competencias específicas descritas en las Directrices Curriculares Nacionales, relativas a la preparación para el desarrollo de acciones de gestión y asistencia de enfermería, a partir de las impresiones de los docentes, los alumnos del último curso y los graduados.
Método: Estudio descriptivo, que aplicó un cuestionario para 59 alumnos del último curso de la carrera universitaria de Enfermería, 111 graduados y 27 docentes involucrados en la Pasantía Curricular Supervisada en los centros analizados.
Resultados: La mirada de los actores involucrados en lo concerniente al desarrollo de las acciones asistenciales y de gestión fue positivo, sin embargo una parte de los graduados señaló que la Pasantía Curricular Supervisada no proporciona al alumno: desarrollar todas las actividades realizadas por el equipo de enfermería; actuar en la asistencia integral a la salud; la seguridad técnica profesional; e interferir en la dinámica laboral.
Conclusión: En la percepción de los actores involucrados, la Pasantía Curricular Supervisada se la ve como positiva y fundamental en la formación del alumno, pues inserta al alumno en la realidad profesional del enfermero, sin embargo, necesita adecuaciones estructurales, especialmente en la percepción de los graduados.
DESCRIPTORES: Educación en Enfermería; Curriculum; Prácticas Clínicas; Educación Basada en Competencias; Educación Superior
RESUMO
Objetivo: Avaliar o Estágio Curricular Supervisionado do Curso de Bacharelado em Enfermagem em duas Instituições de Ensino Superior do estado de São Paulo, à luz das competências específicas descritas nas Diretrizes Curriculares Nacionais, relativas ao preparo para o desenvolvimento de ações de gerenciamento e assistência de enfermagem, a partir das impressões dos docentes, alunos concluintes e egressos.
Método: Estudo descritivo, que aplicou um questionário para 59 alunos concluintes do Curso de Bacharelado em Enfermagem, 111 egressos e 27 docentes envolvidos no Estágio Curricular Supervisionado nas instituições analisadas.
Resultados: O olhar dos atores envolvidos acerca do que tange ao desenvolvimento das ações assistenciais e de gerenciamento foi positivo, porém uma parcela dos egressos apontou que o Estágio Curricular Supervisionado não proporciona ao aluno: desenvolver todas as atividades realizadas pela equipe de enfermagem; atuar na assistência integral à saúde; a segurança técnica profissional; e interferir na dinâmica do trabalho.
Conclusão: Na percepção dos atores envolvidos, o Estágio Curricular Supervisionado é visto como positivo e fundamental na formação do aluno, pois insere o aluno na realidade profissional do enfermeiro, entretanto necessita de adequações estruturais, especialmente na percepção dos egressos.
DESCRITORES: Educação em Enfermagem; Currículo; Estágio Clínico; Educação Baseada em Competências; Educação Superior
INTRODUCTION
Curricular and extracurricular internships represent a major opportunity for students to develop their skills and competencies based on scientific knowledge. Internships are aimed at bringing students closer to the reality that they will find after graduating; thus they have an essential role in the training process of students.
An internship comprises the period in which students have the opportunity to generate and build their professional identity, as it allows experiences in both the technical-scientific sphere and in the preparation of the undergraduate professionals to perform their roles in a responsible and ethical way, developing leadership, communication skills, and decision making1.
In addition, the students’ experience also has the potential to change perspectives, understandings, and values of the professionals and of the health and educational organizations, representing a seed for changes2.
Internship based on the professional praxis may contribute to a meaningful learning, improving and developing skills and competencies in the students in a critical and reflective way, based on ethical, instrumental, epistemological, and human issues3. Therefore, one main purpose is sought in the internship: a political and professional construction in an autonomous manner by students4.
Supervised curricular internship (SCI) is a relatively new teaching modality in health courses, officially implemented in nursing undergraduate courses (NUC) by Resolution 3/2001, which provides for the Brazilian National Curriculum Guidelines (NCG)5. The existence of questions regarding their effectiveness and efficacy in the training of future nurses is natural; however, although it is not possible to limit the training of these professionals to one single discipline, the SCI is of paramount importance as it introduces students to the reality of the labor market.
The SCI learning scenarios shall have the compulsory presence of a supervisor nurse and include general and specialized hospitals, outpatient clinics, and primary health care. Although the amount of hours for each scenario has not been defined, a minimum of 20% of the total hourly load of the course must be respected. The hourly load shall be specified in the Internship Letter of Commitment signed by the higher education institutions (HEI) and the public and/or private institutions granting the internship in accordance with Law 11.788/20086)-(7.
The SCI seeks to provide students with the consolidation of the knowledge acquired throughout the course by means of a nursing care that consolidates the relation between theory and practice. Furthermore, it allows students to enter and work in the social context as individuals that determine changes in the health social production environments, with impacts on the strengthening of the Brazilian Unified Health System8.
It is important to mention that despite the essential nature of the SCI, a scarcity of scientific publications approaching the assessment of this discipline was observed, reinforcing the need for studies investigating the theme in order to support proposals of interventions that are more assertive in the guidance of the developed activities. In addition, the need for research involving all the actors participating in the SCI process was identified, as different perceptions may allow the construction of more effective strategies to fix possible failures and fill existing gaps, and the assessment times are convenient for this discussion.
In this sense, the objective of the present study was to assess the SCI of the Nursing undergraduate course of two higher education institutions in the state of São Paulo based on the specific skills described in the NCG in relation to the preparation for the development of nursing care and management actions from the perceptions of the teaching staff, undergraduate students, and alumni.
METHOD
A descriptive, survey9 study was conducted to assess the SCI discipline in relation to the skills proposed by the NCG for Nursing undergraduate courses.
The study included two higher education institutions with NUC licensed and active in the records of the Ministry of Education, both located in the state of São Paulo; one was a private, non-profit legal entity, and the other was a state public institution. The HEI present an internship hourly load/total hourly load of 800 hours/4,000 hours in the private organization and 840 hours/4,140 hours in the public organization. In both organizations, the SCI is carried out in primary health care and in the hospital environment.
The population of the study included individuals from both HEI, consisting of 87 students that completed the SCI discipline in the first semester of 2016, 280 alumni from 2013, 2014, and 2015, and 48 professors that worked in the discipline for at least one semester. The search for the subjects was carried out in the HEI, and the contact information of the potential participants was requested in an official letter.
The data collection instrument was developed by the researchers and assessed by experts (with expertise in the area of development and validation of instruments and/or professors responsible for the SCI) in order to meet the criteria described in the literature: objectivity, simplicity, clarity, variety, modality, credibility, and neutrality9)-(10.
Initially, the instrument contained 75 items. After the assessment by the experts, the resulting instrument presented a total of 58 items. The construct was divided into two parts: the first, related to the characterization of the professors, undergraduate students, and alumni in relation to gender, age, and sociodemographic variables; and the second, consisting of 58 statements, in which the individuals assessed the items according to a Likert scale, with values ranging from 1 to 5 (number one referring to total absence of agreement, and number five to unconditional agreement). The items related to the development of care and management skills are presented in Tables 1 and 2, respectively.
Data collection was carried out between April and June 2016. For undergraduate students of the SCI the data collection in the private higher education institution was carried out in two shifts of the same day (morning and afternoon) on the occasion of the presentation of intervention projects occurred at the end of the SCI. In the state higher education institution data collection occurred in the morning on a single day, during the final assessment meeting of the SCI. Data collection of the alumni and professors of both institutions was carried out through tools like emails, social networks, and mobile message exchange applications.
Sociodemographic data analysis was performed through the use of absolute, relative, and mean frequencies. For the statistical analysis of the instrument that analyzed the SCI in the perspective of the involved actors, it was decided to sum up the results obtained in the extreme responses, that is, the relative frequencies presented in the assessments named: totally disagree and disagree, as well as in those named totally agree and agree, as these impressions are understood as being very close to each other. Statistical analysis was conducted through the Statistical Analysis System (SAS®), version 9.3. The project was approved by a research ethics committee in December 2015 under protocol CAAE number 49697415.0.0000.5393, and all the requirements of Resolution 466/12 of the National Health Council were met.
RESULTS
Of the 87 undergraduate students of the higher education institutions analyzed in the study, 59 (67.81%) answered the questionnaire. Of these, 35 were students of the state HEI (55.55%) and 24 were students of the private HEI (100%); their mean age was 24 years and 3 months. Among the undergraduate students of the HEI there were four (6.77%) men and fifty-five (93.22%) women. Regarding the 280 alumni, 85 had graduated in the private HEI, and 42 of them (50.58%) answered the questionnaire. Among the 195 alumni of the state HEI, 69 (35.38%) participated in the research. Of the 111 alumni that actually answered the research, nine (8.1%) declared to be male, and 102 (91.89%) female, with a mean age of 26 years and 9 months.
Of the 48 professors that worked and/or had worked in the SCI discipline, 27 (56.25%) participated in the research. Among the 42 professors of the state HEI, 22 (52.38%) participated in the research, and among the six professors of the private HEI, five (83.33%) took part in the study. Among the 27 professionals, two (7.4%) declared to be male and 25 (92.59%) female. The mean age of the participants was 48 years and 9 months.
The following items were arranged to assess whether the SCI approached the specific skills related to care in the students’ training process: 2) Students were provided with the opportunity to develop all the activities performed by the nursing team; 23) The SCI provided clarity on the integration of the theoretical and practical aspects of the professional exercise; 25) The SCI enabled students to develop psychomotor skills; 33) The SCI did not allow students to work in comprehensive health care programs throughout the evolutionary cycle of human beings; 52) The SCI did not provide students with the necessary technical confidence to work professionally in the different care scenarios; and 53) The SCI discipline provided students with self-confidence to assume responsibilities with a higher level of autonomy. Data pertinent to these items are presented in Table 1.
Regarding item 2, most participants linked to the state institution agreed or totally agreed, representing 91.43% of the undergraduate students, 95.46% of the professors, and 71.02% of the alumni. However, among the respondents linked to the private higher education institution, the rates were lower among the undergraduate students (62.5%) and alumni (50%). Among professors of the private higher education institution, a rate of 100% was observed.
Most undergraduate students and alumni agreed or totally agreed with the assertion of item 23. However, while 81.82% of the professors of the state HEI agreed with this item, only 40% of the professors of the private higher education institution had this same opinion, and 20% disagreed or totally disagreed. Regarding item 25, in both higher education institutions, most respondents agreed with the proposed assertion. On the other hand, in the analysis of item 33 most respondents disagreed with the statement in both HEI.
Regarding the negative assertion proposed in item 52, among the respondents linked to the state HEI, the study highlights that 94.29% of the undergraduate students, 68.18% of the professors, and 55.07% of the alumni disagreed or totally disagreed with the item. However, among the latter, 26.08% agreed or totally agreed with the assertion of the item. A similar fact occurred in relation to the private higher education institution, as 66.67% of the undergraduate students, 60% of the professors, and 47.62% of the alumni corroborated the opinion of their peers from the other higher education institution. However, 35.71% of the alumni disagreed with their peers from the same higher education institution. Most respondents from both HEI agreed or totally agreed with item 53. However, a significant part of the alumni of the private higher education institution (19.05%) disagreed with the item.
Described in Table 2, items 40 to 47 were established in the instrument in order to assess the management actions developed in the SCI and their contributions to the training of the students considering the specific skills of nurses suggested by the NCG of NUC.
Items 40 and 41 were related to the management of care, and reported, respectively, that the SCI did not enable students to diagnose health problems and that the SCI enabled students to develop intervention strategies in the nursing care. According to Table 2, the general perception of the respondents about these items was positive; the proposal of item 40 was rejected by most participants in both HEI, and the proposal of item 41 was generally accepted.
Through item 42, the respondents assessed whether the SCI provided students with the appropriate preparation for decision making in adverse and non-routine situations. The analysis showed rates of disagreement and total disagreement among 85.72% of the undergraduate students, 72.73% of the professors, and 75.36% of the alumni of the state HEI. The rate presented by the undergraduate students of the private HEI (79.17%) was close to the number presented by the state HEI undergraduate students. However, it is noteworthy that 60% of the professors and 33.33% of the alumni did not agree nor disagree with the item.
Item 43 assessed whether, in the development of the SCI, it was possible for students to interfere with the dynamics of the institutional work. The results showed that the assessment was divided among the alumni of both higher education institutions, as 37.68% of those from the state institution and 42.86% from the private institution agreed with the item. In addition, 39.13% of the alumni of the state institution did not agree nor disagree. In relation to the other categories of respondents, 71.43% of the undergraduate students and 54.54% of the professors of the state institution rejected item 43, while among those from the private institution the rates were 58.33% for undergraduate students and 100% for professors that disagreed or totally disagreed with the item.
Item 44, stating that the SCI did not encourage students to critically analyze the performance of the supervisor nurses, was rejected by most respondents of the institutions. Item 45, approaching the qualification of the students during the SCI to consider teamwork and suggest improvements, was positively assessed by most interviewees.
A high rate of agreement with the statement of item 46, related to the possibility to develop nursing work management actions, was observed. In contrast, in item 47, the assertion that the SCI did not enable students to take the lead of the work team was rejected by 80% of the undergraduate students, 81.82% of the professors, and 57.97% of the alumni of the state institution, while among those from the private institution the rates were 58.33% for undergraduate students, 60% for professors, and 47.62% (less than half) for the alumni.
DISCUSSION
In view of the results presented in Table 1, a positive perception in relation to the opportunity to develop care actions during the SCI was observed among the respondents from both higher education institutions.
However, some specific aspects, such as clarity in the integration of theoretical and practical aspects (item 23), showed a significantly lower rate of professors of the private institution that agreed with the theme in comparison to the other categories. This fact is highlighted as the professors that worked in the SCI of this institution also gave lectures in the disciplines that serve as a theoretical foundation for the internship, and therefore they would have more possibilities to promote such integration. This disaggregation between theory and practice in the SCI may be possibly justified by the existence of a disconnection between the different fields of internships or by the separation between the educational institution and the practice environment, or by the lack of coordination between the supervisor and the preceptor of the internship11.
In addition, the collected data pointed out the need to reflect on the readjustment of the way the activities are conducted during the SCI, as the NCG of NUC recommend that the internship comprises the discipline in which the development of the specific skills in the training of nurse professionals is established. Therefore the SCI is extremely important to provide students with an opportunity to self-discover themselves as professionals, promote the coexistence with other professional colleagues, strengthen commitments and responsibilities, and learn and put into practice skills such as leadership, communication, and teamwork5),(12.
The participation of the alumni in the assessment process of the SCI is essential, as a significant part of these individuals are already placed in the labor market or are pursuing an insertion, thus presenting a more realistic perspective of what is required in the work environment. In relation to the assessment of technical confidence to work in the different care scenarios (item 52), the alumni pointed out the need for changes in the development of the SCI. This perception may occur to the detriment of a more accurate perception on what is technically required by the employers. The study reaffirms the need to maintain a communication link between the university and the alumni in order to support strategies to allow higher education institutions to adapt their SCI, consequently providing a solid professional training.
In this aspect it is important to mention a study approaching the perception of alumni on the SCI that revealed the need for nursing educational reformulations in the field of internships in order to replicate the positive points (correct answers), avoid the negative points (mistakes), and approach the new requirements of the market13.
A significant part of the alumni from both institutions, as well as professors of the private institution, disagreed with the opinion of most respondents in relation to the provision of self-confidence to assume responsibilities with autonomy (item 53), contrasting with a study developed in the Southwestern region of the state of Bahia, in which most students in the last year of the NUC described that the supervised internship provided the possibility to practice autonomy and, consequently, improve their professional growth12. It was observed that the achievement of this autonomy requires the availability of tools so that students may develop technical and scientific knowledge, also providing access to all the activities performed by nursing professionals. Among these tools, this study highlights the active learning methodologies available in virtual learning environments, realistic simulation in laboratories, and software that allow students to experience situations that are similar to those that they will find in the actual scenario of the SCI.
Both the virtual learning environments and the realistic simulations in nursing are tools that may improve the teaching-learning process and the dialogue between students and professors, thus enabling a higher capacity of autonomy and development of new skills. Through these two tools it is possible to: reduce the existing gaps in the learning process; achieve the autonomy of students; transfer knowledge and cognitively stimulate their users; favor a proactive behavior by the students; and encourage the practices related to patient safety. These strategies are not aimed at suppressing the contact between professors and students, but rather to collaborate in the learning process14)-(17.
It is important to mention that the SCI helps in the construction of learning in the care and management dimensions, as well as in the relationship between them. Nursing care management is characterized by the interrelation between management and care aspects in the nursing work scenarios aimed at the implementation of best care practices in the health services18. Based on the information above, analysis of the management aspects to be developed in the SCI discipline is considered relevant, as shown in Table 2.
There is a series of barriers in the daily routine of nurses in the management of their team, the unit, and the care activities. These barriers start in the professional training, which is based on the traditional approach administration, and follow through the labor market and, consequently, the practical applicability, a moment in which nurses face a structural formality, evidenced by vertical power relationships, implementation of standards, and a list of tasks to be developed19.
It is important to mention that most respondents from both institutions demonstrated a fruitful perception on the development of management actions during the SCI, confirming that the discipline complied with the NCG, which state that students should be able to diagnose and solve health problems, present communication skills, make decisions, interfere with the work process, work as a team, and cope with situations of permanent change5.
However, a significant number of participants of the categories of professors and alumni diverged in relation to the following aspects: lack of preparation of students to make decisions in adverse and non-routine situations (item 42), impossibility for student to interfere with the institutional work dynamics (item 43), and deficiency in the qualification of students to take the lead of the team (item 47). This evidence may point out the presence of problems in the relationship between the HEI and the health services in the SCI, generating barriers and limiting the development of management and/or direct care activities by the students. It is believed that overcoming these barriers requires bringing institutions and health services (public and private) closer, contributing to clarify the fields of internship and highlighting the importance of the mutual socialization of knowledge and interinstitutional interventions3.
The effective participation of nursing professionals working in the institutions where the SCI is developed is essential, from the elaboration of its programming to the supervision of students. However, this is not usual, and in most cases the health service is limited to providing the space and defining the number of vacancies offered. Also, the higher education institutions are considered responsible for not defining their counterpart for the health institution, and for not offering appropriate support for the follow-up of students8.
The difficulties faced by HEI in the implementation of the NCG for nursing undergraduate courses have been pointed out in studies that highlight the inconsistencies between the theoretical and practical training and the professional practice, and the strategies to overcome these difficulties should be more explored by the teaching staff20, which should feel challenged to seek new pedagogical approaches to conduct the teaching process and provide a solid training by competencies21. Such strategies should provide subsidies so that undergraduate students may articulate with the system, services, and health care in the perspective of comprehensiveness and integration between teaching and service, thus meeting the needs of the population18.
Among these strategies, active, innovative educational methodologies are recommended; they should be explored by professors of nursing undergraduate courses in order to promote an actual approach between the academic training and the professional praxis; besides, it is necessary to reflect on the diversification of the practice scenarios, with emphasis on the Unified Health System, representing a constant challenge for the articulation of the knowledge construction process22.
Some authors complement that the learning process, particularly the nursing management process, will only achieve its transforming potential by means of a new approach, new technical-pedagogical practices, and changes in the training process strategies, seeking an emancipatory educational practice that favors the reflection on the daily routine, questioning, and social transformation. This can be achieved through active methodologies, such as problematization15),(23. Moreover, in the search for alignment of nursing training with the proposals expressed in the NCG, other strategies may be implemented, provided that they offer the society a critical, reflective, humanitarian professional that is open to the constant updates and scientifically grounded to assume their role of protagonists in the nursing care management, in addition to leadership.
CONCLUSION
From the perceptions of professors, undergraduate students and alumni, this study concluded that the Supervised Curricular Internship was considered positive in relation to the preparation for the development of nursing care and management actions. However, part of the alumni pointed out that the SCI: does not provide students with an opportunity to develop all the activities performed by the nursing team; does not allow students to work in comprehensive health care programs; does not provide the necessary technical confidence for the professional performance; and cannot interfere with the institutional work dynamics.
Throughout the Supervised Curricular Internship, students developed management skills, becoming qualified to diagnose health problems and elaborate intervention strategies to solve them appropriately, respecting the ethical and legal principles. It was also considered essential in the student training as it reflects the professional reality of the nurse, inserting them in learning scenarios appropriate to their development and the labor market. However structural adaptations are still necessary, a fact particularly corroborated by the perception of the alumni.
This paper introduces important considerations for the practice of Education in Nursing as it presents both positive aspects, which should be maintained, and negative aspects, which should be improved from the perspective of the actors involved in this discipline. However, considering that the present study presented as limitation the approach to only two higher education organizations of the state of São Paulo, it is necessary to develop further research in higher education organizations with different characteristics from those of this study, such as public higher education institutions administered by federal and municipal authorities, as well as in other regions of the country.
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Publication Dates
-
Publication in this collection
01 Nov 2018 -
Date of issue
2018
History
-
Received
31 Aug 2017 -
Accepted
19 Apr 2018
