DIDACTIC STRATEGIES IN THE TEACHING-LEARNING PROCESS OF NURSING MANAGEMENT

ABSTRACT

Objective:

to analyz the didactic strategies used in the teaching and learning process of nursing management.

Method:

an integrative review of the literature available in the Latin American and Caribbean Literature in Health Sciences and the Scientific Electronic Library Online databases using the following descriptors and keywords in Portuguese: teaching, nursing, management, administration, management, nursing education, organization and administration, distance education and health management. The sample consisted of 23 publications.

Results:

the didactic strategies used for teaching nursing management are especially related to the independent working method and team work method. Strategies that make the articulation between theory and practice possible are highlighted such as: situational strategic planning, the problematization methodology using Maguerez’ Arch, seminars, workshops, and dialogued and interactive lectures/classes.

Conclusion:

teaching nursing management is following the pedagogical changes of higher education in the health area.

DESCRIPTORS:
Higher education; Nursing faculty; Nursing faculty practice; Management; Nursing administration research

RESUMO

Objetivo:

analisar as estratégias didáticas utilizadas no processo de ensino e aprendizagem de gestão em enfermagem.

Método:

revisão integrativa da literatura na base de dados Literatura Latino-Americano e do Caribe em Ciências da Saúde e Scientific Electronic Library Online, utilizando-se os seguintes descritores e palavras-chave: ensino, enfermagem, gestão, administração, gerenciamento, educação em enfermagem, organização e administração, educação a distância e gestão em saúde. A amostra foi composta por 23 publicações.

Resultados:

as estratégias didáticas utilizadas no ensino de gestão em enfermagem estão relacionadas, principalmente, ao método de trabalho independente e método de trabalho em grupo. Destacaram-se as estratégias que possibilitam a articulação entre teoria e prática, tais como: planejamento estratégico situacional, metodologia da problematização com o método do Arco de Maguerez, seminários, oficinas e exposições dialogadas interativas.

Conclusão:

o ensino de gestão em enfermagem está acompanhando as mudanças pedagógicas da educação superior na área da saúde.

DESCRITORES:
Educação Superior; Docentes de Enfermagem; Prática do docente de enfermagem; Gerência; Pesquisa em Administração de Enfermagem

RESUMEN

Objetivo:

analizar las estrategias didácticas utilizadas en el proceso de enseñanza y aprendizaje de la gestión en enfermería.

Método:

revisión integradora de la literatura en la base de datos Literatura Latino-Americano y del Caribe en Ciencias de la Salud y Scientific Electronic Library Online utilizándose los siguientes descriptores y palabras clave: enseñanza, enfermería, gestión, administración, gerenciamiento, educación en enfermería, organización y administración, educación a distancia y gestión en salud. La muestra incluyó 23 publicaciones.

Resultados:

las estrategias didácticas usadas en la enseñanza de gestión en enfermería están relacionadas, principalmente, con el método de trabajo independiente y, también, en grupo. Se destacaron las estrategias que hacen posible la articulação entre teoria y práctica, tales como: planeamiento estratégico situacional, metodología de la problematización con el método del Arco de Maguerez, seminarios, talleres y exposições dialogadas e interactivas.

Conclusión:

la enseñanza de la gestión en enfermería está acompañando los cambios pedagógicos de la educación superior, en el área de la salud.

DESCRIPTORES:
Educación superior; Docentes de enfermería; Práctica del docente de enfermería; Gerencia; Investigación en administración de enfermería

INTRODUCTION

Learning takes place in the interaction between people and their environment through the teaching process, from which the human being internalizes socially established knowledge. Therefore, it is not just a cumulative process of putting together isolated things. It is about joining a network or web of complex and dynamic interactions between teachers and students seeking knowledge development.^1-2 The effective direction of the teaching and learning process depends on systematized work by the teacher through their choosing of appropriate teaching methods and didactic strategies to the content learning.³

The teaching process involves external and internal aspects. External aspects correspond to teaching contents. Internal aspects are the mental and physical conditions of the students to assimilate the contents. Both relate to one another, since on the one hand there is the content to be taught in an assimilative form to the student, and on the other there is a student that needs to be “prepared” to assimilate the content. Thus, teaching methods can be classified into: the teacher exposition method, the method of relatively independent work by the student, the method of joint elaboration (or conversation) and the team/group work method.³

Regarding the teacher exposition method, knowledge, skills and tasks are presented, explained or demonstrated by the teacher. The independent working method consists of tasks explained and guided by the teacher so that the students can independently and creatively figure them out by themselves. The joint elaboration method is based on the active interaction between the teacher and the students aiming at obtaining new knowledge, skills and attitudes. The team work method consists of distributing study themes among groups of students with the purpose of obtaining cooperation by the students among themselves for accomplishing a task.³ According to the teaching method, the teacher defines the didactic strategies which correspond to the means and resources aimed at successfully teaching.⁴

In the health area, discussions on teaching methods and didactic strategies have intensified, especially since the 1990s with rising criticism of traditional pedagogy and the structuring of a new teaching model. In this context, the final report of the VIII National Health Conference of 1988 is considered one of the milestones in the movement to criticize the hegemony of the scientific medicine and traditional school models. This report emphasized the importance of training health professionals to act in the Brazilian social reality.⁵ In this historical moment the emergence of technological resources such as tools to improve teaching in health and nursing can also be highlighted.⁶

Due to these changes and the complexity of health problems in Brazil, higher education institutions have been building a pedagogical model that considers the social, economic and cultural dimensions of the population. In addition to the technical knowledge of each action area, future professionals need to be equipped to act in response to the population’s health needs in an interdisciplinary way in order to enable comprehensive care.⁷

In line with these paradigmatic changes, the National Education Guidelines and Bases Law (LDB) and the curricular guidelines for nursing undergraduate courses require universities to invest in the innovation and quality of their political-pedagogical projects through articulation between teaching, research and healthcare. Moreover, these guidelines suggest investments in didactic strategies that foster students’ critical and reflective capacity in society based on the problematization of everyday Nursing work situations.^1,7

The search for this new educational approach has consequent repercussions on the teaching and learning process of nursing management. Teaching nursing management requires a new approach, new technical-pedagogical tendencies, changes in strategies within the scope of the training process aiming at an emancipatory education that favors daily reflection, questioning and social modification.⁸

Based on the above, this study aimed to analyze the didactic strategies used in the teaching and learning process of nursing management.

METHOD

This is an integrative review of the literature.⁹ The research protocol was developed in order to answer the following question: which didactic strategies are used in the teaching and learning process of nursing management?

Data collection was carried out in September 2015 in the Latin American and Caribbean Literature on Health Sciences (LILACS) and the electronic library Scientific Electronic Library Online (SciELO) databases. The choice of these sources can be justified according to the researchers’ intention to identify the scientific production on the subject in Brazil. The descriptors and keywords in Portuguese adopted were: teaching, nursing, management, administration, management, nursing education, organization and administration, distance education and health management. Chart 1 presents the studies carried out for selecting the articles included in the study.

Chart 1
Search Descriptions for the selection of articles. Florianópolis, SC, 2015

Descriptors	Database	Articles found	Selected articles*	Included articles
Teaching and Nursing and Management	SciELO	45	4	4
Teaching and Nursing and Administration	SciELO	102	9	8
Teaching and Nursing and Managing	SciELO	40	2	1
Nursing Education and Management	LILACS	40	8	5
Teaching and Health Management and Nursing	LILACS	22	4	1
Nursing Education and Organization and Administration	LILACS	18	7	2
Distance Education and Nursing	LILACS	114	1	1
Distance Education and Nursing	SciELO	47	2	1
Total		428	37	23

• ^*
  Selected according to the title and abstract.

The inclusion criteria for the selection of articles were free articles published in full in journals available in the selected databases which were in accordance with the proposed objective and the descriptors and/or keywords listed in the previously validated protocol. This step was carried out by reading the abstract of each article, and by consulting the full article when necessary. Articles that were present in more than one database were considered duplicates and automatically excluded.

For data analysis and interpretation, a table according to the following columns was elaborated in the Excel^® program: study title, database, authors, journal, publication year, study locale/context, methodological design, didactic strategy, and the findings and reflections of the authors. The studies were critically analyzed by full readings. In this step, a classification system of evidence was also used: level 1: meta-analysis of multiple controlled and randomized clinical trials; level 2: individual studies with experimental design; level 3: quasi-experimental studies; level 4: descriptive studies (non-experimental) or qualitative approach; level 5: case or experience reports; and level 6: evidence based on expert opinion.¹⁰

Finally, a synthesis of the results of the selected studies was conducted and then organized into categories, observing the confluences and divergences of the findings. Category organization was carried out based on the type of teaching methods (teacher exposition, relatively independent work by the student, joint elaboration and team work)³ and according to the concept of educational technology applied to Nursing.⁴

RESULTS

The 23 selected articles^11-33 were published in 13 different journals, with emphasis on the Acta Paulista de Enfermagem, Revista Brasileira de Enfermagem, Revista Mineira de Enfermagem and the Revista Texto Contexto Enfermagem, each with three (13%) articles each. Regarding the publication year, articles published between 2002 and 2014 were included, with the years 2009 and 2011 concentrating five (21.6%) and four (17.3%) publications, respectively.

Regarding the origin of the studies, ten (43.4%) were conducted in the State of São Paulo (SP). Of this total, the University of São Paulo (USP) stood out with four (17.3%) articles. Regarding the academic level, 19 studies were carried out in undergraduate courses in nursing. Among the studies developed in the postgraduate context, two were from the Residency Program in Nursing Management at the State University of Londrina, and two from the Federal University of São Paulo, one from the Graduate Program in Nursing and one from the Specialization Course in Nursing management in the distance modality.

For the type of study, 15 (65.2%) experience reports were included, having an evidence level of 5. Among the original studies we can highlight the selection of six (26%) qualitative-based surveys classified as level of evidence 4.

Chart 2 synthesizes the characteristics of the selected articles regarding the title, publication year, journal and type of study.

Chart 2
Studies selected by the review. Florianópolis, SC, 2015

Title	Year	Journal	Study type
Ensino de administração em enfermagem: Experience report 16	2002	Acta Paulista de Enfermagem	Experience report
Abordagem metodológica diferenciada em aulas práticas de administração de enfermagem 32	2004	Revista Brasileira de Enfermagem	Experience report
O Strategic Situational Planning no ensino do gerenciamento em enfermagem 13	2005	Acta Paulista de Enfermagem	Documentary study
Percepção dos alunos de graduação sobre a disciplina de administração aplicada à enfermagem 28	2005	Revista Mineira de Enfermagem	Qualitative study
A inserção do tema Liderança nas disciplinas de Administração em Enfermagem de uma faculdade particular da cidade de São Paulo 1998 a 2004 24	2006	Escola Anna Nery	Qualitative study
A metodologia ativa na residência em gerência do curso de enfermagem da UEL 17	2007	Cogitare Enfermagem	Qualitative study
Diálogos entre a arte e a educação: uma experiência no ensino da disciplina de administração em saúde 21	2009	Texto Contexto Enfermagem	Experience report
O ensino de administração na graduação: percepção de enfermeiros egressos 18	2009	Texto & Contexto Enfermagem	Qualitative study
Tecnologia educacional: avaliação de um website sobre Escala de Pessoal de Enfermagem 29	2009	Revista da Escola de Enfermagem da USP	Qualitative study
Uso de metodologia ativa na disciplina gerenciamento de enfermagem em saúde coletiva da FEO/UFPEL 33	2009	Revista Eletrônica de Enfermagem	Experience report
Educação a distância na Disciplina de Legislação, Ética e Exercício de Enfermagem 30	2009	Revista Brasileira de Enfermagem	Experience report
Planejamento situacional na Estratégia Saúde da Família: atividade de integração ensino-serviço na enfermagem 12	2010	Revista Gaúcha de Enfermagem	Experience report
Avaliação no estágio curricular de administração em enfermagem: perspectiva dialética 14	2010	Revista Brasileira de Enfermagem	Experience report
O Strategic Situational Planning no ensino da gestão em saúde da família 11	2011	Texto & Contexto Enfermagem	Experience report
Ateliê de projetos físicos: estratégia para aprendizagem de administração de recursos físicos em enfermagem 26	2011	Revista Gaúcha de Enfermagem	Experience report
Seminars na perspectiva dialética: experiência na disciplina Administração em Enfermagem 25	2011	Acta Paulista de Enfermagem	Experience report
Reflective Portfolio como método de avaliação na residência de gerência de serviços de enfermagem 19	2011	Semina	Experience report
Avaliação dos estudantes de enfermagem sobre o ensino da gestão do sistema de saúde 27	2012	Revista Mineira de Enfermagem	Qualitative study
Problematization methodology aplicada a disciplina de administração em enfermagem 20	2012	Investigación y Educación en Enfermería	Experience report
Vivenciando situações de conflito no contexto da enfermagem: o esquete como estratégia de ensino-aprendizagem 22	2013	Escola Anna Nery	Experience report
Metodologias participativas no ensino da administração em Enfermagem 23	2013	Interface	Experience report
Diário de bordo: experiência de ensino-aprendizagem de gestão e gerenciamento em saúde e enfermagem 15	2013	Revista da Rede de Enfermagem do Nordeste	Experience report
Curso de especialização em gestão em enfermagem: propostas de melhorias segundo discentes 31	2014	Revista Mineira de Enfermagem	Quantitative study

Chart 3 presents the didactic strategies used for teaching Nursing management. Each of them is described below.

Chart 3
Didactic strategies for teaching nursing management. Florianópolis, SC, 2015

DIDACTIC STRATEGY	Independent work method
	• Strategic Situational Planning11-15 • Problematization Methodology using Maguerez' Arch16 • Practice Report17 • Case studies and problem-solving14,18 • Reflective Portfolio19
	Team work method
	• Student reflection workshops based on the Problematization methodology20 • Discussion Cycles21 • Theatrical technique (sketches)22 • Group work and role playing23 • Seminars13,24-25 • Workshop: "Ateliê de Projetos"26
	Exposition method and joint elaboration method
	• Expository lessons 24,27 • Dialogued and interactive classes26,28
	Educational Technologies
	• Website: Nursing Personnel Delegation Escala de Pessoal de Enfermagem29 • Virtual learning environment(links, texts, chats and forums)30 • Online classes (video classes)31

Independent work method

Strategic Situational Planning

Strategic Situational Planning (SSP) was identified as the teaching method in five studies.^11-15 It is based on a systematic process with four moments for organizing interventions and producing results on a given reality: explanatory, normative, strategic and tactical-operational.¹¹ SSP enables students to better align with professionals from the service and develop skills related to communication, leadership, decision-making, and management and administration. It also assisted the student in application of critical and reflexive thinking to problematize reality, describe the way to conceive and make proposed plans feasible in different scenarios, reducing the dichotomy between theory and practice.^11-15 Thus, this strategy stands out as it allows for expanding the vision of reality, in which the contingencies are usually poorly explored, often resulting in situations where the work developed by students are merely didactic exercises.^13-15

Problematization Methodology using Maguerez’ Arch

This is a methodological path that assists in developing students’ intellectual autonomy and critical-reflective thinking. It consists of five steps: observation of reality, key points, theorization, solution hypotheses and application to reality.^2,32 The use of this methodology allowed for greater reflection by the students to articulate theory and practice, enabling them to deal with professional practice, and acting intentionally to transform it. In addition, implementing actions in a reflexive, critical and cooperative manner facilitated the exercise of decision-making among students.¹⁶

Practice Report

This is an active learning methodology based on the discussion of a problem elicited by students within the health services practice, which is analyzed through a process of reflection and theorizing, seeking to find solutions. This strategy contributed to establishing links between theoretical education and health service practices, which generated greater motivation between teachers and students.¹⁷

Case studies and problem-solving

Case studies and problem-solving methods were adopted by two studies.^14,18 The case study is the objective and meticulous analysis of a real situation that is challenging and needs to be investigated by students.⁴ Similarly, problem solving consists of presenting a particular problem to the students, mobilizing them to seek a solution based on their critical, reflective, and creative thinking.⁴ In the studies included herein, the focus of these strategies were management, care, ethical, legal and educational issues related to the context of health and nursing work, thus allowing the student to learn about the interconnections of the content with social reality.^14,18

Reflective Portfolio

The Reflective Portfolio is a set of records made by students about their experiences in the teaching-learning process. Its use contributed to the personal and professional development of the students according to the development of their writing ability and reflections on their own routine. This strategy is based on the pedagogy of (asking) questions, since it stimulates intellectual autonomy and the development of questions among students, taking the central focus of learning away from the teacher. It is important to point out that this is not a classificatory or punitive evaluation, but rather a way to analyze the progress of the student in constructing the required knowledge in a given discipline.¹⁹

Team work method

Student reflection workshops, based on the Problematization methodology

The proposal for reflection workshops was developed through meetings between teachers and students guided by the Problematization methodology and by Maguerez’ Arch as an assessment strategy for the Supervised Internship in Nursing Administration course. A greater interaction between teachers and students and more effective participation by the students in constructing their teaching-learning process was verified from this through the development of critical and reflexive thinking.²⁰

Discussion Cycles

The activity entitled “Discussion Cycles: intermittence of death and SUS management: dialogue between Saramago and health policies” was an extra-curricular event developed with the objective of discussing the universality of SUS in the context of economic globalization and the importance of health policy management in professional training. It was made possible through a proposal that articulated content of administration in health and nursing with knowledge about cinema and literature. The purpose of this integration was to promote creativity and skills for developing abstraction, systematizing ideas and elaborating projects as requirements for health training.²¹

Theatrical technique (sketches)

Sketches are short presentations capable of promoting understanding and arouse humor based on a satire of reality. This technique was used to discuss managing conflicts in the professional practice of nurses and enabled an articulation between the theoretical content and the reality of health services through dramatizations organized by the students.²²

Group work and role playing

Role playing was used to consolidate knowledge and the exercise of managerial functions (planning, coordination, direction and evaluation). This proposal initially generated discomfort among the students; however in the end they highlighted its relevance for learning nurses’ managerial assignments. Group work and role playing also reinforced feelings of appreciation among students, highlighting the importance of constant knowledge development.²³

Seminars

Seminars present a theme or problem to a group with the purpose of putting it into discussion.⁴ This teaching method was adopted by three studies.^13,24-25 This strategy contributed to the theoretical deepening of content by the students, according to an encouragement for autonomy in constructing knowledge and motivation for learning through ‘hands-on’ learning. It contributed to developing competencies through problematizing and proposing creative solutions to problems evidenced in health services practice scenarios.²⁵

Workshop “Ateliê de Projetos”

The strategy “Ateliê de Projetos” was based on andragogy and dialectic methodology, seeking to integrate architecture and nursing contents. It allowed for developing nursing competencies for the design of physical projects of health care establishments.²⁶

Exposition method and joint elaboration method

Expository lessons

Two studies reported using expository lessons for teaching nursing administration.^24,27 However, the influence of the traditional teaching model was verified in one of the studies, as the teacher was identified as being the holder of knowledge and the person responsible for teaching the subject and for exposing the content.²⁷

Dialogued and interactive classes

The use of interactive dialogued classes as the strategy for teaching nursing management was reported in two other studies.^26,28 In this type of class, the main focus is the dialogue between teacher and student. Moreover, active participation by the student is valued while the teacher is speaking.^26,28

Educational Technologies

Website: Escala de Pessoal de Enfermagem

Computer science was used as a facilitating resource to develop the subject of the Nursing staff work schedules, which is considered difficult for students at a stage where they are not yet practicing the profession. Thus, a tool that assists in this task was developed and made available. It consists of a software program that allows the student to exercise and grasp acquired theoretical knowledge based on elaborating a monthly nursing work schedule on the legal parameters for personnel sizing. The use of this technology was valued by the students, as they have positively evaluated the website.²⁹

Virtual learning environment

The use of a virtual learning environment sought interactivity through the use of online learning resources such as: links, texts, chats and forums. Teachers and students involved in the activity evaluated it as a unique experience in this type of interactive configuration.^30-31

Online classes (video classes)

Video classes as didactic strategy are understood by students as a facilitator of learning. This may indicate that the majority of students preferentially assimilate verbal information, for example, due to greater experience with traditional teaching.³¹

DISCUSSION

The studies on didactic strategies in teaching nursing management in Brazil intensified throughout the years 2000, which coincides with the growth in the use of active methodologies in health education.³⁴ Another factor that may be associated with this growth is the promulgation of the National Curricular Guidelines for the Undergraduate Nursing Course in 2001, with a view to train competent professionals who are critical and committed to the health of the population.^34-35 These aspects may have motivated the search by teachers for new didactic resources for teaching nursing management.

The concentration of studies in the Southeast can be explained by the fact that almost half (48.6%) of the country’s higher education institutions are located in this region.³⁶ Moreover, most Brazilian postgraduate nursing programs are also located in the Southeast region,³⁷ which favors the development of scientific production in relation to the discussion and use of new teaching methods in nursing.

Regarding the study type, the main sources of evidence were experience reports, which have an evidence level of 5. This was expected considering that the focus of the present study was the description of using didactic strategies in teaching nursing management. However, it is important to develop empirical studies on the subject in question that can provide results based on scientific evidence.

From the analysis of the results of the selected studies, the predominance of the use of independent working methods and group work in teaching nursing management was verified. These methods allow students to develop autonomy, responsibility, creativity and communicative skills. Thus, the adoption of these methods favors learning of the expected competencies for the practice of nursing management and health.

We can say that teaching nursing management follows higher education pedagogical changes in the health area. Throughout the historical-pedagogical trajectory of health education, the traditional teaching model has been gradually replaced by new pedagogical tendencies. These tendencies emphasize the need for training critical-reflexive professionals, with potential for transforming the social reality.³⁴

In this changing context, the teacher-student relationship also acquires a differentiated configuration, as evidenced in the studies selected for review that highlight the importance of students’ proactivity in their learning process. This idea is in line with critical pedagogy, in which it is up to the teacher to awaken and stimulate students’ epistemological curiosity and to guide them in the search for knowledge.³⁴

The success in the use of active teaching methodologies requires participation and involvement of teachers and students. However, initial uncertainty or indecision is common prior to implementation of these changes in teaching methods, whether from teachers or students, since the adoption of new practices requires mobilizations and individual and collective change. It is also important to consider the available time of teachers for performing participative pedagogical practices, since teaching work involves research activities, extension and guidance in a postgraduate program, in addition to teaching.²³

The studies emphasized the commitment of the teachers to adopt didactic strategies that enabled articulation between theory and practice in teaching nursing administration, mainly through the SSP. The disconnection between theory and practice is a common problem faced by a practice-based course, as is the case with nursing. The search for integration between the two is important so that the students do not study theoretical content in the universities that cannot be applied in the practice, or that do not relate with the reality of professional practice.³⁴

To foster the relationship between theory and practice, it is also possible to invest in the use of educational technologies and simulation.^6,38 In this sense, considering that the increasing technological evolution brings possibilities of using new resources in healthcare and teaching practices,⁶ it is believed that greater investments are needed for implementing educational technologies in teaching nursing management. Only three studies were identified with this focus in this review.

Regarding the use of simulation, only one study adopted this didactic resource through role-play.²³ This type of simulation is configured as an experience-based learning method in which people assume the role of others to understand a phenomenon from a perspective different from their own.³⁸

Simulation is an active and widely-used methodology in teaching in the health and nursing areas. The types of simulators used in undergraduate nursing education are: “Patient Simulator (Dummy), Simulated Patients (people playing the role of patient, role-play), Virtual Learning Objects (educational game software programs, videos, audios, web technology) and mixed methods (use of more than one type of simulator)”.^38:495 The simulation allows for developing content related to medical-surgical care, care in acute situations, maternal and child health, psychosocial care, outpatient care, semiology, leadership and communication.³⁸ Thus, using simulation represents a possibility to be explored in teaching nursing management.

In terms of study limitations, it should be considered that the analysis scope of this review was mainly constituted by experience reports, which (as previously noted) do not have a high degree of evidence. However, the selected reports present successful strategies developed in teaching nursing management, and which demonstrate the commitment of teachers/researchers in the area with a differentiated teaching-learning process based on the use of active methodologies.

CONCLUSION

This study presented an integrative review on the didactic strategies used in the teaching-learning process of nursing management in Brazil. The predominance of using independent working methods and group/team work in teaching nursing management was verified through didactic strategies that made articulation between theory and practice possible, mainly from the Strategic Situational Planning methodology. Therefore, it can be said that teaching nursing management has been following the pedagogical changes of higher education in the health area.>

Thus, the study provides subsidies for teaching practice in the area of nursing management, as it indicates the main didactic strategies being used and it points out new possibilities to be explored in this area. Among these possibilities, we highlight the expanding use of educational technologies and simulation as an active methodology.

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Publication Dates

• Publication in this collection
  2018

History

• Received
  29 May 2016
• Accepted
  03 Feb 2017