TEACHING ENTREPRENEURSHIP IN THE ETHICAL-POLITICAL DIMENSIONS OF UNDERGRADUATE NURSING CURRICULA IN NORTHEASTERN BRAZIL

ABSTRACT

Objective:

to analyze the approach to content related to entrepreneurship in the ethical-political dimensions in curricular documents of undergraduate nursing courses.

Method:

documentary research, with a mixed approach and descriptive nature, from June 2021 to August 2022, with inspection of the Ministry of Education’s website, of the institutions offering Nursing courses in the Northeast region of Brazil. Content and quantitative evaluation using the T-test.

Results:

the majority of HEIs offered face-to-face courses (94.1%) and belonged to private institutions (64.7%). The subjects mainly covered theoretical topics (94.1%), highlighting the importance of entrepreneurship in the training of nurses. The lexicographic and similarity analysis highlighted the strong link between the words “Entrepreneur” and “Health”, highlighting the relevance of these concepts in the training of nurses.

Conclusion:

The curriculum documents highlight the importance of training nurses in their professional and entrepreneurial roles with competence, taking into account the principles of Bioethics, Morals, Science, and Philosophy.

DESCRIPTORS:
Entrepreneurship; Undergraduate Nursing Programs; Nursing Ethics; Health Policy.

RESUMO:

Objetivo:

analisar a abordagem dos conteúdos relacionados ao empreendedorismo nas dimensões ético-políticas em documentos curriculares dos cursos de graduação em Enfermagem.

Método:

pesquisa documental, com abordagem mista e natureza descritiva, de junho de 2021 a agosto de 2022, com verificação no site do Ministério da Educação, das instituições que ofertam cursos em Enfermagem na região Nordeste do Brasil. Avaliação de conteúdo e quantitativa pelo teste-T.

Resultados:

a maioria das IES oferecia cursos presenciais (94,1%) e pertencia a instituições privadas (64,7%). As disciplinas abordavam principalmente temas teóricos (94,1%), destacando a importância do empreendedorismo na formação de enfermeiros. A análise lexicográfica e de similitude destacou a forte ligação entre as palavras “Empreendedor” e “Saúde”, evidenciando a relevância desses conceitos na formação dos enfermeiros.

Conclusão:

os documentos curriculares destacam a importância de formar enfermeiros em seu papel profissional e empreendedor com competência, levando em consideração os princípios da Bioética, Moral, Ciência e Filosofia.

DESCRITORES:
Empreendedorismo; Programas de Graduação em Enfermagem; Ética em Enfermagem; Política de Saúde.

RESUMEN:

Objetivo:

analizar el abordaje de contenidos relacionados con el emprendimiento en dimensiones ético-políticas en documentos curriculares de cursos de graduación en Enfermería.

Método:

investigación documental, de enfoque mixto y de carácter descriptivo, de junio de 2021 a agosto de 2022, con verificación en el sitio web del Ministerio de Educación de las instituciones que ofrecen cursos de Enfermería en la región Noreste de Brasil. Evaluación de contenidos y cuantitativa mediante la prueba T.

Resultados:

la mayoría de las IES ofrecían carreras presenciales (94,1%) y pertenecían a instituciones privadas (64,7%). Los temas abordaron principalmente temas teóricos (94,1%), destacando la importancia del emprendimiento en la formación del enfermero. El análisis lexicográfico y de similitud destacó la fuerte conexión entre las palabras “Emprendedor” y “Salud”, destacando la relevancia de esos conceptos en la formación de enfermeros.

Conclusión:

los documentos curriculares resaltan la importancia de formar enfermeros en su rol profesional y empresarial con competencia, teniendo en cuenta los principios de la Bioética, la Moral, la Ciencia y la Filosofía.

DESCRIPTORES:
Emprendimiento; Programas de Pregrado en Enfermería; Ética de la Enfermería; Política de Salud.

HIGHLIGHTS

1. Entrepreneurship, growing knowledge in recent years at HEIs.

2. To train nurses who are aware of bioethics, morality, science, and philosophy.

3. Business vision and the role of the business planner.

4. A globalized and technological nurse, with innovative and creative practices.

INTRODUCTION

Historically, the nursing profession has been linked to direct patient care in different health contexts, such as hospitals, primary healthcare units, clinics, and homes. However, over the years, it has been identifying gaps and unmet needs within the health field, providing opportunities for entrepreneurship¹.

Entrepreneurship is the process of identifying opportunities, creating, developing, and managing a business or project with the aim of innovating, generating value, and achieving financial and/or social success². Florence Nightingale, considered the founder of modern nursing, was an entrepreneur in the 19th century, applying her knowledge of management and organization to improve the conditions of care in hospitals and promote reforms in the health system. Nightingale also contributed to the development of nursing as a field of knowledge, based on evidence and with a strong ethical foundation³.

Therefore, nurses are guaranteed their autonomy in the right to do business by Law No. 7,498/86, which regulates the Professional Practice of Nursing, as well as backed by Resolutions No. 358/19, No. 568/18 and No. 606/19 of the Federal Nursing Council (COFEN). These actions are intrinsically linked to the profession’s ethical principles, as they must consider the safety, dignity, and well-being of patients as priorities, ensuring that their initiatives are based on ethical values and in accordance with professional guidelines⁴.

Recognizing the importance of preparing future nurses for innovation and leadership in the healthcare field, Higher Education Institutions (HEIs) are implementing entrepreneurship as an important issue in the curricula of undergraduate nursing courses. This inclusion also aims to prepare students to face the challenges and demands of the job market, as it tends to stimulate critical thinking, creativity, resilience, adaptability, and the ability to identify opportunities and innovative solutions⁵.

Similarly, for nurses to carry out their activities in an ethical and political manner, they need a solid awareness of their rights and duties and an understanding of the ethical principles that guide the profession. This includes the adoption of values such as respect for patient autonomy, justice, beneficence, non-maleficence, and integrity, which must be applied both in direct patient care and in business management and entrepreneurial decision-making. In the political dimensions, there must be an understanding of the political, social, and economic context in which nursing practice takes place⁶.

Certainly, these dimensions tend to be understood during undergraduate studies, when students are prepared to act competently and responsibly as nurses, providing them with a solid base of theoretical knowledge, practical skills, and professional competencies necessary for practicing the profession⁶-⁷.

Understanding the need for a solid foundation on the subject in the training of nurses for their work in the entrepreneurial field, this question arose: how do the curricula of undergraduate nursing courses provide knowledge of the ethical-political dimensions within the scenario of entrepreneurship? Therefore, the general objective of this study is to analyze the approach to content related to entrepreneurship in the ethical-political dimensions in curricular documents of undergraduate nursing courses.

METHOD

This is documentary research, with a mixed approach and descriptive nature. Documentary research is defined as a technique that seeks, through the interpretation of data and information present in documents, to elucidate certain issues and serve as evidence for others, according to the researcher’s interest⁸.

The research began in June 2021 and ended in August 2022. Initially, it was checked on the Ministry of Education’s website - e-MEC (https://emec.mec.gov.br/), the electronic portal that allows users to follow the process of regulating HEIs in Brazil, and which institutions offer undergraduate courses in Nursing in the Northeast region of Brazil.

The Northeast is a geographically, culturally, and historically extremely diverse region of Brazil. Made up of nine states - Alagoas, Bahia, Ceará, Maranhão, Paraíba, Pernambuco, Piauí, Rio Grande do Norte, and Sergipe - Northeastern culture is marked by indigenous, African, and European influences, reflected in the music, cuisine and festivities that make the region unique. In addition, socio-economic challenges coexist with resilient strength and an entrepreneurial spirit, highlighting the region’s ability to overcome and its cultural richness⁹.

The selection included 412 HEIs with undergraduate nursing programs, out of the 705 registered in the Northeast region. Therefore, visits were made to the institutional websites in search of information on Political Pedagogical Projects (PPP), Course Pedagogical Projects (CPP), and/or course syllabuses for future download. In the search process, the following inclusion and exclusion criteria were adopted for the institutions taking part in this research.

The inclusion criteria were institutions with PPPs, CPPs, and/or course syllabuses available in electronic format (university website) and in the public domain. The exclusion criteria were those institutions that presented incomplete documents and documents for courses that had not yet started. After applying the established criteria, the institutions eligible for this research were selected and the aforementioned documents were downloaded. All the records were separated into folders, identifying the state of origin.

The next step was to read the course documents in order to identify the subjects/modules that addressed the topic of entrepreneurship and/or entrepreneurship in nursing in their statements and/or syllabuses. Those that did not provide information on the dimensions of this study’s objective were justified and excluded. It is worth noting that this process was carried out independently by two researchers and any disagreements were analyzed at a subsequent meeting.

Therefore, to present the flow of selection of institutions and documents, the instrument¹⁰ adapted for this research was used, dividing it into identification, selection, eligibility, and inclusion (Figure 1).

Figure 1
Flowchart for selecting the PPP/CPP and/or curricular menus for subjects. Crato (CE), Brazil, 2023

After identifying the PPP, CPP, and/or curricular menus, information was extracted to build the database. Therefore, information was captured on the following variables: state, modality, academic organization, administrative category, subjects covering the topic, and the modality of the subject. In the textual field, clippings were made and information was extracted regarding the ethical-political dimensions of nurse training within the entrepreneurial field.

The quantitative variables were analyzed using the Statistical Package for Social Science (SPSS®) software, and a one-sample t-test was carried out in terms of relative and absolute frequency, standard deviation, and confidence interval (90% CI). A significance level of p ≤0.05 was adopted for the study.

The texts were transcribed in the LibreOffice Writer program, version 5.4, and coded according to the command line indicated to enable analysis using the software Interface de R pour L Analyses Multidimensionnelles de Textes L de Questionnaires (IRAMUTEQ®), version 0.7 Alfa 2. The main aim of the software is to analyze the structure and organization of discourse, making it possible to find out the relationships between the lexical worlds that are most frequently enunciated in the research text¹¹.

Two textual analyses were carried out: (1) Classic Lexicographic Analysis to check the statistics on the number of Text Segments (TS), evocations and forms, whereby the higher the χ2, the more associated the word, and words with χ2 < 3.80 (p < 0.05) were disregarded; (2) Similitude Analysis, which is based on graph theory and makes it possible to identify co-occurrences and connections between words, and its results help to identify the structure of a textual corpus. In order to carry out the lexical analysis of the text corpus, the software cut every 40 characters, thus corresponding to the text segments analyzed.

Since no human beings were involved and the data was extracted from public domain websites, this research did not require approval from the Research Ethics Committee and the National Research Ethics Commission.

RESULTS

A total of 705 HEIs were found in the E-Mec system, of which 412 offered an undergraduate degree in Nursing; however, only 54 provided PPPs, CPPs, and/or syllabuses, and only 37 had these documents available in full in the public domain. Finally, the documents that presented the basics of entrepreneurship and/or enterprise in their subjects were selected, resulting in a total of 17 HEIs.

Of the nine states in the Northeast of Brazil, only six had HEIs that were eligible for this research and presented information that responded to the objective of this study. The state with the most HEIs was Ceará, followed by Bahia. As a result, 94.1% of the HEIs in the study offered face-to-face courses, and 5.9% offered distance learning or semi-presential courses. In terms of academic organization, 41.2% were University Centres, followed by 29.4% Universities, 23.5% Colleges, and 5.9% Federal Institutes. As for the administrative category, 64.7% were private institutions, and 35.3% were public. When the PPP, CPP, and/or syllabus were evaluated, the types of subjects that presented bases on entrepreneurship and/or enterprise were 94.1% theoretical and 5.9% practical. All the information is presented in detail in Table 1.

Table 1
Characterization of Higher Education Institution variables. Crato (CE), Brazil, 2023.

Variable		Frequency Absolute/Relative	Standard deviation	CI (95%)	p-value
State	Ceará	7/41.2	1.69341	1.7764 -3.5177	0.001
	Pernambuco	2/11.8
	Bahia	4/23.8
	Paraíba	1/5.9
	Rio Grande do Norte	2/11.8
	Sergipe	1/5.9
Modality	Face-to-face	16/94.1	0.24254	0.9341 - 1.1835	0.001
	EAD/Semipresencial	1/5.9
Academic Organization	College	4/23.5	0.88284	2.17647 -1.72264	0.001
	University Center	7/41.2
	University	5/29.4
	Federal Institute	1/5.9
Administrative Category	Public	6/35.3	0.49259	1.3938 - 1.9003	0.001
	Private	11/64.7
Subject Type	Theoretical	16/94.1	0.24254	1.8165 -2.0659	0.001
	Theoretical/Practical	1/5.9

Source: Elaborated by the authors (2023).

Therefore, subjects were identified in the PPP, CPP, and/or syllabus, which presented bases on entrepreneurship and/or enterprise:

• Administration and Management;

• Leadership and Entrepreneurship in Health;

• Entrepreneurship Applied to Nursing;

• Entrepreneurship and Innovation;

• Entrepreneurship in Nursing;

• Supervised Internship;

• Nursing Management;

• Management Applied to Health Services;

• Management and Entrepreneurship;

• Integrity of Care

The information on the ethical-political dimensions for the training of entrepreneurial nurses contained in the PPP, CPP, and/or syllabus, points to the aptitude objectives for these professionals which, according to the documents, are passed on during training:

[...] to train entrepreneurial professionals who are qualified to exercise their profession, aware of their professional actions in the promotion of health services, and based on the precepts of Bioethics, Morals, Science, Philosophy, and, above all, focused on the reality of the Brazilian population. (HEI 4)

[...]fundamental concepts of entrepreneurship in nursing/health, emphasizing the need to appropriate new management and/or care technologies for the technical-scientific improvement of the work process. (HEI 8)

Know the main behaviors and attitudes normally observed in successful entrepreneurs, cultural background, professional competence, ethical posture, leadership skills, ability to demand results, and a global vision of entrepreneurship. (HEI 6, HEI 15)

Knowing about business management, taking advantage of market opportunities by setting the right conditions for your business, defining the area you want to operate in, the audience you want to reach, and the type of work or service you want to offer. (HEI 3)

Therefore, the textual clippings show that political and ethical concepts are directly related to the aim of training nurses from an entrepreneurial perspective. The paragraphs highlight the importance of training nurses who are aware of their role, with professional competence, taking into account the principles of bioethics, morality, science, and philosophy. In addition, they are able to take initiative and manage and administer health resources.

The documents also point out the entrepreneurial attributions of nurses in their professional careers.

Entrepreneurship provides nursing with promising actions, generating business opportunities from the multiple directions and spaces available in the labor market. (HEI 3)

[...] act as a care entrepreneur in various nursing scenarios with a focus on the quality of home, outpatient, and hospital care, based on administrative models and nursing theoretical references. (HEI 8)

[...] introduction to entrepreneurial vision and the role of the business planner (HEI 9)

[...] running their own business, such as home care and consultancy services, which are on the rise in Brazil and other countries, promoting employability and home care for those who for some reason can’t or don’t want to travel to health facilities. (HEI 3)

[...] to work in the complex job market of the globalized and technological world, with an entrepreneurial spirit and innovative and creative practices. (HEI 14)

[...] professionals must be able to take initiatives, manage and administer both the workforce and physical, material, and information resources. (HEI 1, HEI 5, HEI 13, HEI 16, HEI 17)

The textual clippings emphasized acting as a care entrepreneur, focusing on the quality of care in different scenarios. Mention was made of the introduction of the entrepreneurial vision and the role of the business planner in nursing. This highlights the need to develop management and entrepreneurial skills so that professionals can act as business owners. It also highlights the importance of working in the globalized and technological market, with an entrepreneurial spirit and innovative and creative practices.

In order to better explore the materials collected, the texts were prepared into a general textual corpus comprising 17 texts for lexicographic analysis. The analysis therefore yielded an average of 114,760 word occurrences, distributed over 1,951 forms, with an average of 17 words each. The analysis was therefore considered valid given the good use made of the textual corpus. The words had a χ2 higher than the reference value and a p-value of <0.0001

In the similarity analysis conducted, two words were found to be strongly linked by a branch: “Entrepreneur” and “Health”. The nucleus that presents the word entrepreneur contains branches with a higher degree of contextuality, with the words: “leadership”, “training”, “development”, “competence”, “knowledge”, “attitude”, “capacity”, “action”, among others. The core of the word health is linked to branches such as: “planning”, “service”, “management”, “management”, “process”, “administration”, “activity”, “direction”, among other words. The branching between these nuclei reveals how the terms are strongly interconnected and convey the notion of political aspects for the training of nurses within the entrepreneurial field. Therefore, the need for these competencies and the presence of these contexts in university curricula is acknowledged, providing the acquisition of knowledge about the branches of health management and entrepreneurship, many of which are present in the analysis in Figure 2.

Figure 2
Analysis of the similarity between the words in the textual corpus. Crato (CE), Brazil, 2023.

DISCUSSION

The documents analyzed show the presence of concepts inherent to entrepreneurship, such as leadership, competence, and autonomy; as well as the objectives in training nurses to work in this area of knowledge, in public and private institutions in the Northeast of Brazil. Based on the concept that entrepreneurship in nursing is mainly linked to personal characteristics, it can be said that this study corroborates the literature, as the subjects’ syllabuses identified a concern with the formation of an entrepreneurial profile¹².

Therefore, the PPPs, CPPs, and/or syllabuses of the HEIs have incorporated subjects that address ethical and political issues, encourage critical thinking, the development of leadership skills, and stimulate entrepreneurship in the health area. However, specific technical knowledge alone is not enough; leadership skills need to be fostered in various scenarios during training, in order to encourage creativity, building strategic potential, and articulation¹².

However, during the extraction of data from the documents, it was observed that some HEIs still adopt outdated PPPs, CPPs, and/or syllabuses, using the same plan for more than ten years. Most of these are public institutions and do not provide any information on entrepreneurship in health or nursing. However, there is no absolute consensus on the exact timeframe for updating such documents, although it is suggested that there should be a review and update every three to five years, in order to guarantee the quality and relevance of the courses, keeping up with changes in social, technological and educational demands¹³.

It is known that entrepreneurship education is one of the fastest-growing subject areas in the world, but despite this, there is no consensus on “what” and “how” to teach it. One review pointed out that it is necessary to increase students’ theoretical knowledge of entrepreneurship and to stimulate innovation from an atmosphere in which they can write entrepreneurial projects and proposals¹⁴. Regarding teaching methods, the flipped classroom model has achieved positive results, such as improving learning, promoting practical knowledge, and the communication, collaboration, critical thinking, and problem-solving skills that are needed in the real-world business environment¹⁵.

Certainly, knowledge and skills in the field of Ethics are fundamental in the creation and development of businesses and innovations in health, as the positive social impact and sustainability of these initiatives depend on it. During their academic training, nursing students are exposed to subjects that deal with ethics and bioethics, exploring issues specific to the profession and developing decision-making skills. Thus, ethics in entrepreneurship in nursing education is intrinsically linked to the fundamental principles of the profession¹⁶.

Therefore, the documents analyzed indicate a commitment to training professionals who are committed to ethics and nursing philosophy. In addition, it is understood that nurses must consider the ethical implications of their decisions and actions, taking into account the well-being of patients, equity in access to care, and professional integrity¹⁷-¹⁸.

Understanding health policies, regulations, and legislation is also a fundamental action for nurses and disrespect for professional political aspects. Nurse entrepreneurs must be aware of current policies and understand how they influence their practice and business. Being a political nurse in professional practice broadens personal career horizons and makes it possible to improve access to and the quality of care¹⁹-²⁰.

In this context, research in the field of nursing has highlighted the importance of political dimensions in entrepreneurship and has shown that understanding health policies is fundamental to the creation and successful management of businesses, services, or projects in the field of nursing. Therefore, these dimensions should be highlighted at the academic level, preparing future professionals to deal with the needs of the market and to be politically engaged in health and entrepreneurship actions¹⁸,²¹.

The limitation of this study was the use of data that was only publicly available, which may have reduced the variability of the sample. However, an extensive analysis of the results was carried out.

FINAL CONSIDERATIONS

Presenting and arguing about the ethical-political dimensions of nurse training within the entrepreneurial field is an action that has been growing in recent years at HEIs. Therefore, the analysis of institutional documents made it possible to understand the institutions’ objectives in training entrepreneurial nurses and the qualities guaranteed in their professional segment.

The institutions’ objectives include training professionals who are aware of their role and are competent, taking into account the principles of bioethics, morality, science, and philosophy. The attributions of entrepreneurship for nurses in their professional field include the entrepreneurial vision and the role of company organizer, working in the globalized and technological market, with an entrepreneurial spirit and innovative and creative practices.

To date, there have been no previous studies analyzing the PPP, CPP, and/or syllabus in the ethical-political dimensions in the field of entrepreneurship in the Northeast region of Brazil. Therefore, new studies on the subject should be carried out as a way of encouraging the implementation of subjects focused on entrepreneurship in nursing, as well as the development of technologies to help teach these dimensions in undergraduate nursing courses..

ACKNOWLEDGMENTS

Funding: This study was carried out with the support of the Ceará Foundation for Scientific and Technological Development (FUNCAP) - Funding Code 001, with a Scientific Initiation grant..

• *
  Article extracted from the master’s: “Práticas do cuidado ao adolescente com obesidade na Atenção Primária à Saúde”, Universidade Federal do Rio Grande do Norte, Natal, RN, Brasil, 2022.

• COMO REFERENCIAR ESTE ARTIGO:

  Macedo LFR, Fernandes MNM, Albuquerque TR de, Pinto AGA, Matos TMGG de, Sales JKD de, et al. Teaching entrepreneurship in the ethical-political dimensions of undergraduate nursing curricula in Northeastern Brazil. Cogitare Enferm. [Internet]. 2024 [cited “insert year, month and day”]; 29. Available from: https://dx.doi.org/10.1590/ce.v29i0.94330.

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Edited by

Associate editor: Dr. Gilberto Tadeu Reis da Silva

Publication Dates

• Publication in this collection
  21 June 2024
• Date of issue
  2024

History

• Received
  26 July 2023
• Accepted
  19 Dec 2023