Analysis of professors’ perceptions about the Escola Paulista de Enfermagem curriculum

Abstract

Objective

To identify the process of change in nursing education at Escola Paulista de Enfermagem , exposing teaching, management and pedagogical practices experiences.

Methods

This is a qualitative study, from the historical-social perspective, using the Thematic Oral History method. We assessed six undergraduate nursing professors at Escola Paulista de Enfermagem (EPE).

Results

The results demonstrate professors’ perceptions, which are described in categories related to the school curriculum used in the undergraduate nursing course capable of contemplating the integration of knowledge and practices present in the work routine. The curriculum cannot be understood as a simple document for describing isolated and fragmented school subjects, disconnected from professional nursing practice. Thematic content analysis was performed, resulting in three categories.

Conclusion

Perceptions about curriculum organization and structure allowed us to show how political, social, economic and cultural changes in the country were able to influence the teaching process of undergraduate nursing course between 1980 and 2010. EPE took over a social role with nursing education, using the curriculum to disseminate knowledge and delimit the school’s education profile.

Teaching; Education; Nursing education; Education, higher; Curriculum; Faculty

Resumo

Objetivo

Identificar o processo de mudança do ensino de enfermagem da Escola Paulista de Enfermagem, expondo as experiências de ensino, gestão e práticas pedagógicas.

Métodos

Estudo qualitativo, sob a perspectiva histórico-social e utilizando o método da História Oral Temática. Participaram seis docentes do Curso de Graduação em Enfermagem da Escola Paulista de Enfermagem (EPE).

Resultados

Os resultados demonstram as percepções das docentes, as quais são descritas nas categorias relacionadas ao currículo escolar utilizado no curso de graduação em Enfermagem capaz de contemplar a integração de saberes e práticas presentes na rotina de trabalho. O currículo não pode ser entendido como um documento simples para a descrição de disciplinas escolares isoladas e fragmentadas, desvinculadas da prática profissional de enfermagem. Foi realizada a análise de conteúdo temática, resultando em três categorias.

Conclusão

As percepções sobre a organização e estrutura curricular permitiram elucidar como as mudanças políticas, sociais, econômicas e culturais do país foram capazes de influenciar o processo de ensino da Graduação em Enfermagem entre 1980 e 2010. A EPE assumiu um papel social com a formação em enfermagem, utilizando o currículo para disseminar o conhecimento e delimitar o perfil de formação na escola.

Ensino; Educação; Educação em enfermagem; Educação Superior; Currículo; Docentes

Resumen

Objetivo

Identificar el proceso de cambio en la enseñanza de enfermería de la Escola Paulista de Enfermagem y mostrar las experiencias educativas, de gestión y prácticas pedagógicas.

Métodos

Estudio cualitativo, bajo la perspectiva histórica-social y con utilización del método de la historia oral temática. Participaron seis docentes de la carrera de Enfermería de la Escola Paulista de Enfermagem (EPE).

Resultados

Los resultados demuestran las percepciones de las docentes, que se describen en las categorías relacionadas con el diseño curricular escolar utilizado en la carrera de Enfermería, capaz de contemplar la integración de saberes y prácticas presentes en la rutina de trabajo. El diseño curricular no puede ser entendido como un documento simple para describir materias escolares aisladas y fragmentadas, desvinculadas de la práctica profesional de enfermería. Se realizó un análisis de contenido temático, que dio como resultado tres categorías.

Conclusión

Las percepciones sobre la organización y estructura curricular permitieron dilucidar cómo los cambios políticos, sociales, económicos y culturales del país fueron capaces de influir en el proceso educativo de la carrera de Enfermería entre 1980 y 2010. La EPE asumió un rol social con la formación en enfermería y utilizó el diseño curricular para propagar el conocimiento y definir el perfil de formación de la escuela.

Enseñanza; Educación; Educación en enfermería; Educación superior; Curriculum; Docentes

Introduction

Nursing education practices are transformed by the social, political and economic development of a country, which must be built through dialogues based on conceptions pertaining to reality.( ¹ - ³ )These aspects are educational challenges to be overcome, whose pedagogical proposals structure new teaching processes that qualify professors and, at the same time, provide more reflective and critical learning to students.( ⁴ )

To this end, it is important to understand the concept of school curriculum as an instrument that facilitates the learning of specific technical-scientific contents to be adapted to the teaching-learning needs. In other words, the curriculum is an official document that describes a comprehensive program capable of responding to the education path’s particularities, always following technological advances without conflicting with nursing education knowledge.( ⁵ )

The curricular program of Escola Paulista de Enfermagem (EPE), from 1962, was guided by Opinion 271 of October 19, 1962, which prescribed the minimum program, encouraging professors to rethink their teaching model.( ³ )

In 1968, with the university reform, the school reorganized the curriculum. Later, in 1972, it reformulated the curriculum emphasizing the public health nursing disciplinary content. During the following years, the Brazilian National Education Guidelines and Framework Law ( Lei de Diretrizes e Bases da Educação Nacional ), 1996, and the Brazilian National Curriculum Guidelines (DCNs - Diretrizes Curriculares Nacionais ), 2001, which guided the Curricular Plan and Pedagogical Political Project organization and structuring, were followed.( ⁶ )

In 1977, due to the school’s federalization process, the EPE was incorporated into the Escola Paulista de Medicina as a department, causing its administrative reorganization.( ⁷ )

In this regard, it proceeds to understand curricular programs’ specificities and their transforming mechanisms of nursing education, in order to determine the educational priorities that were directed to nursing education in this school.

The choice for the research object is justified by recognizing its importance as a reference space for nursing education since 1939. The time frame is between 1980 and 2010, as it is understood that the school underwent administrative and educational changes due to different implementations of public health and education policies.

To identify the process of change in nursing education at EPE, exposing teaching, management and pedagogical practices carried out in from 1980 to 2010.

Methods

This is qualitative research using the Thematic Oral History method. Oral history reports the experience of a person in a certain period and phenomenon, aiming at rebuilding events, through the understanding of their memories.( ⁸ , ⁹ )

The context chosen was EPE, as it recognizes the school’s importance and relevance for building technical-scientific knowledge in nursing education. To this end, nursing professors who worked at EPE in any period between 1980 and 2010 were invited. Thus, 6 directors, 10 vice-directors and 3 course coordinators who were in this period were identified; however, only six nurses agreed to participate in the interviews, one being a department director (retired), a department vice-director, two course coordinators and two professors with an active bond at this school.

The inclusion and exclusion criteria established to identify these nurses were employed through the host community organization, with the selection of school directors and vice-directors listed in the Directors Gallery. The course coordinators made up the colony and were identified through the list present in the undergraduate department. Professors were identified through recommendation of the network constituted.( ¹⁰ )

Individual interviews were carried out after guests’ consent, in compliance with the ethical precepts recommended by CNS Resolution 466/12 and with authorization from the Research Ethics Committee of the Universidade Federal de São Paulo (REC/UNIFESP), through Consubstantiated Opinion 4,359,027. Then, the interviews were transcribed, textualized and transcreated and, according to oral history’s methodological course, presented according to the positions occupied during the study period.( ⁸ )

It is worth noting that oral reports were guided through an interview script with semi-structured questions, carried out and recorded through Google Meet, with an average duration of 1 hour and 30 minutes, between November 2020 and May 2021, due to the condition of social isolation imposed by the COVID-19 pandemic. This procedure is based on REC/UNIFESP guidelines and Circular Letter 2/2021/CONEP/SECNS/MoH of February 24, 2021.

The interpretation and inference of each report were carried out using Bardin’s Content Analysis, which consists of organizing the sense and meaning extracted in each interview, identifying the message’s “vital tone”.( ¹¹ )

Three categories were defined, which bring together the contexts analyzed and interpreted in each interview report and provoke reflection on how the process of curriculum change and implementation at EPE was.

Results

Experiences will be presented in the following categories.

Improvement of nursing education according to curriculum structure

Initially, it is noteworthy that the reports allowed reflection on how the world of work progressed, the forms of education and what mechanisms influenced curriculum building. The curriculum was conceived through debates among professors about what needs pointed to a qualified and competent nursing practice. The curriculum model, implemented in the 1990s, was differentiated and reaffirmed EPE’s social commitment to the profession and the field of work. The professors’ concern was to develop educational processes capable of training nurses with critical and reflective thinking.

I think the course was very concerned with trained professionals. I think the course put a lot of emphasis on theoretical and practical aspects. So, I can say that our level of demand for students was very high. (Professor 1)

The curriculum occupies a significant space for nursing education in this school. It represents a different perspective for acquiring and building new knowledge and, thus, the outstanding characteristic in the pedagogical aspect is the integration of theoretical-practical teaching, emphasizing the development of care skills.

The curriculum was more extensive and intends to address all areas of health and, with this, professors also need to change. They cannot be the one who give only the content and students are satisfied with what they learn. (Department Director)

The interviewees emphasized that the knowledge of nursing education should focus on the stages of professional career evolution and the disciplinary content would need to follow the degree of complexity of each training period.

The curriculum comprised obstetric and gynecological nursing, clinical and surgical nursing. It was a period in which students had, at first, all the fundamental part and then entered for a specific part. (Professor 2)

The EPE has always valued the role and autonomy of nursing in the job market and, therefore, the administration component was included in the curriculum. It gained greater space in school education from the 1990s, due to the social importance of nurses in leading patient care and organizing health institutions.

To follow proposals and develop educational processes capable of promoting professional impacts of reference in nursing, the school was dedicated to offering students a vast field of practice to improve technical-professional skills close to care reality, even before entering the world of work.

Another perception was that those who were trained by the school had their marks. (Course Coordinator 1)

The operation of EPE’s undergraduate nursing course has always had an intense pace of learning, since the education’s curricular tendency was to provide the acquisition of knowledge of analysis of social, political and economic issues present in society. This type of curriculum imprinted a specific pattern for developing learning and appropriation of nurses’ identity.

Curriculum implementation at Escola Paulista de Enfermagem

This category presents perceptions regarding the undergraduate nursing course’s curriculum updates, which represented important moments for the advancement of the school. Curriculum development, arising from the implementation of a new curriculum, from the 90’s, printed a new school context, and the teaching model at school was renewed. The interviewees mentioned that, with each new update in the curriculum, professional education reaffirmed its importance. They emphasized the flexibility of classroom techniques and practice scenarios as motivating tools to promote more meaningful teaching. Public health policies were also responsible for influencing and promoting adaptation of the pedagogical process described in each curriculum change. The inclusion of new health care programs for the population made the school reflect on the importance of updating its curriculum and offering targeted disciplinary content.

Another curriculum change took place, with great discussions, and my department worked hard to try to make a joint effort adjustment between obstetric nursing, pediatric nursing and public health nursing. It was an interesting moment, because we had to unite these three great policies in Primary Care. (Vice-Department Director)

As it has a characteristic centered on the development of care practices, the school began to realize the importance of making its teaching processes more flexible and, with each curriculum change, the lesson plans became more innovative, creative and motivating.

It was observed that the curricular components’ interdisciplinarity was the focus of attention of professors, because, according to the interviewees, nursing education, from 1996 onwards, began to focus efforts on the development of a holistic view based on the reality of health.

According to the interviewees, 2004 was a year in which the school consolidated its curriculum changes and updated its disciplinary contents. From then on, discussions focused on minimizing the presence of repeated and overlapping contents, proposing integration between subjects. In 2008, the school included pedagogical actions to influence discussions on a new curriculum. This is the case of the participation of the undergraduate nursing course in the Pro-Health Program ( Programa Pró-Saúde ).

An interesting thing that happened was the Pro-Health project, which was a project of the Ministry of Health to try to integrate schools and the service. (Course Coordinator 2)

We got PROMED, nursing and speech therapy. [...] It was very good, because the professional categories worked on interdisciplinary activities. (Professor 2)

Curriculum changes allowed professors to take greater ownership of their teaching processes and gave them greater freedom to develop innovative and differentiated learning strategies.

Nursing education planning according to curriculum

This third category presents perceptions about how teaching practices were influenced by the curriculum change implemented in the undergraduate nursing course. It refers to the description of strategies planned to apply educational principles in nursing education.

The interviewees stated that it was necessary to offer professor improvement workshops with a view to updating the teaching practice in the classroom, in order to promote a more qualified educational process. This is because the undergraduate nursing course at the school has always sought to adapt its educational process to social needs and determinations of public policies in health and education.

In order for us to be part of this part of Primary Care, we did went through training and resumed learning in the area. [...] the entire department was available to review physical examination, nursing consultation in primary care. It was necessary, because we were 100% in the hospital area and primary care is different. (Professor 2)

The disciplinary contents described in the school curriculum made it possible to integrate the theoretical and practical concepts of the field of work, placing the school in a characteristic position of care education.

Nursing began to be well positioned when it implemented primary care, defining what nursing actions were, and delimiting the foundations and teaching strategies. For instance, in addition to teaching all the fundamentals of nursing, we were looking for a whole strategy to pass this knowledge on to our students who were more likely to work with the population, facilitating student learning. Students did not only see knowledge of the hospital, the ICU, they knew individuals in their family context. (Department Director)

A Teaching Work Plan was considered by the professors as a process of planning didactic actions in the classroom and, therefore, the interviewees emphasized that the school curriculum deserved many debates to direct the pedagogical work. Supervised internship is a practice that is strongly embedded in the curriculum and, therefore, it is important to develop it throughout students’ education path. The practice fields provided students with the development of technical-professional skills in a significant way.

I believe that the curricular internship should offer a way to improve, putting students as close as possible to the moment of work. (Professor 1)

The reports made it possible to recognize the path taken by the school to implement new educational structures. Thus, it is understood how teaching the undergraduate nursing course at EPE occurred.

Discussion

When analyzing the reports, it was possible to notice that the changes in undergraduate nursing education programs followed the country’s social, political and economic impacts. The experiences regarding the change in nursing education in EPE, between 1980 and 2010, invite reflection on implementing curricular developments in the classroom.

It can be said that the school curriculum emphasizes the importance of generalist education suited to social and technological contexts, with the development of integrated and articulated practices to the nursing routine’s technical-scientific knowledge capable of boosting students’ critical-reflective reasoning to develop a responsible work practice.( ¹² - ¹⁴ )Thus, it is possible to affirm that EPE created mechanisms to transform nursing education and curriculum. These actions provided the scope of subsidies to expand the school’s infrastructure.

It is also possible to say that education paths presented in curricular plans between 1980 and 2010 were focused on society’s and work’s interests, generating the integration of knowledge with reality. They built a differentiated nursing education, in line with the political advances of education and health. This means improving technical-scientific thinking beyond the reproduction of social customs, valuing pedagogical proposals, mitigating passive professional knowledge and inferring a critical action oriented towards the construction of complex new knowledge.( ¹⁵ )

The specific nursing knowledge developed with this pedagogical proposal demonstrates the materiality of teaching and learning processes. From this perspective, a concept of differentiated and strengthened teaching is constructed, representing its own administrative organization.( ¹⁶ )In other words, changes in curriculum and teaching methods have created a specific profile for nursing education.

The incorporation of interdisciplinary teaching develops the understanding of diversified knowledge, articulates the exchange of experiences between different professional knowledge and, in a collaborative way and with the rescue of ethical coexistence, focuses on the leadership of nursing care actions.( ¹⁷ )

This dynamic refers to the Framework for Action on Inter- professional Education and Collaborative principles, which calls on health education institutions to rethink their processes of transmitting specific knowledge, alerting them to integrate interdisciplinary professional knowledge.( ¹⁸ )

To carry out the curriculum changes, EPE created the Nursing Curriculum Studies Commission, in order to meet teaching demands. In 1991, it began to function with the objective of guiding decision-making for constructing and implementing a new curriculum.

In this regard, it is clear that the school, in the 1990s, made an effort to create its own education itinerary, inserting guiding tools for the pedagogical development of nursing education, long before the DCN implementation.( ¹⁹ )

All influences were anchored in the organization of Brazil’s public policies and driven by professional, care and educational reorientation. These actions reflected in the way of caring and, consequently, in the way of teaching in nursing.( ²⁰ )This gave a degree of flexibility to curriculum development, impacting the teaching process with the inclusion of new disciplinary content.( ²¹ )

It should be noted that the EPE curriculum of the 2000s overcame the challenge to integrate the knowledge and practices present in the work routine. There was an attempt to provide an understanding of nurses’ role, minimizing the fragmentation of school subjects and, with this, the curriculum had an influential force for school culture. It was a moment of construction, which brought together essential characteristics and aspects to outline the development of nursing education, aiming for recognition in professional education.( ²² , ²³ )

Discussions on improving professors stand out, from the perspective of professional education, so that they can promote the exercise of competences capable of referencing nurses’ knowledge, skills and attitudes.( ²⁴ )

Conclusion

This study sought to identify the process of change in teaching at EPE. With the methodological approach used, perceptions about the curriculum’s particularities and its mechanisms for nursing education, advancement of the world of work and influences on nursing education were observed. Political, social, economic and cultural changes in the country contributed to decision-making about the teaching process of undergraduate nursing between 1980 and 2010. They transformed the profile of nursing education in this school and printed a characteristic for its recognition as a reference center in teaching. Curriculum changes and updates have taken on an important role in nursing education; therefore, the school became socially responsible to the community, involving itself in the commitment to debate, reflection and guidance of care nursing. This study had as limitations the total number of interviews carried out, which focused on the collection of reports from professors working at the school from the 1980s onwards. It was not possible to gather the reports of professors working in the 1970s. Moreover, the fact of conducting online interviews limited access to some possible interviewees. However, the reports made it possible to identify the process of updating the undergraduate nursing school curriculum disciplinary contents. They allowed us to state that curricular updating mechanisms imposed priorities on school and professors about the knowledge responsible for nursing education, based on changes in public policies in health, education and technological transformations present in the labor market. These processes offered professors improvement of their teaching techniques and implementation of new teaching models, which served as mechanisms for disseminating knowledge to delimit the education profile at EPE. It is necessary to carry out further research in order to gather information to outline a complete historical trajectory and understand how the undergraduate nursing course was developed.

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Edited by

Associate Editor (Peer review process): Edvane Birelo Lopes De Domenico. ( https://orcid.org/0000-0001-7455-1727 ). Escola Paulista de Enfermagem, Universidade Federal de São Paulo, SP, Brasil

Publication Dates

• Publication in this collection
  06 Feb 2023
• Date of issue
  2023

History

• Received
  23 Dec 2021
• Accepted
  13 June 2022