At the beginning of the 20 th century the first school exclusively run by nurses was established, with a strong hierarchical, disciplinary connotation along the lines of Florence Gerbera. There is, in this process of acknowledging nursing education prior to the curricular guidelines, a reinforcement of the perception of a hierarchical relationship on the part of the professor with the student.
The minimum curriculum and its implications for education were also acknowledged in the reports of professors and students: The professor as protagonist student being submissive, receiving information teaching was based on the need to evaluate knowledge. Therefore, all the nursing education processes follow this pattern up to about the mids when a re-discussion concerning the health model process in Brazil was initiated.
Up to the establishment of the national curricular guidelines for nursing graduate programs and this discussion concerning the implementation Invest Educ Enferm. The first landmark is related to the beginning of broad discussions concerning education in the health field that was strongly encouraged during the military dictatorship, during the movement of the sanitary reform, showing that the debate concerning education in general as well as within the profession has started long ago: It s not that, it s a development, an unfolding of events, of changes in the political, economic, socio-cultural spheres Lily.
Another important landmark noted by the participants in relation to redirecting nursing education refers to the national education bases and guidelines law: Other important events that took place later were mentioned in the this transition process as important elements that would support the coming transformations, as the cooperation established by the ministries of health and education and the establishment of a national system to assess higher education: In 98, 99 the discussion concerning the higher education national assessment system, SINAES, starts, concomitantly with the national teaching assessment Lily.
As relevant actions indicated by the participants, we highlight the creation of the Secretariat of Health Work and Education Management and all the programs and actions it coordinated, among them PRO-SAUDE in and PET-SAUDE in In summary, the participants show an understanding that links different elements in the context of Brazilian public policies to the process of the organization of the debate concerning nursing education, showing they understand it within a broader context and emphasizing the idea of transition as an expression of changes that have been designed, negotiated, gradually conquered and are in continuing redesign.
In regard to their understanding of the role played by the guidelines, there are perceptions there is a shift of focus and dynamics, showing a view that the national curricular guidelines are close to what is desired for health practices from the perspective of the SUS: Despite this context of a positive perception of the role the national curricular guidelines have to play, some barriers were observed in the consolidation process.
Among these, some testimonies make reference to the heterogeneity of Brazilian higher education with a strong presence of private education and weak control from the State, which generates a series of repercussions and distortions in the incorporation of guidelines, especially the relationship between teaching and quality. If we consider whether there are excellent programs, there are very serious institutions concerned Invest Educ Enferm. There is, however, a perception among the participants that this difficulty in incorporating guidelines to a greater or lesser extent, even if more evident in private schools, is not restricted to them but is also true in other institutions.
This issue of the SUS within schools is something that not everyone has understood; I don t think that is something the schools have already bought, I guess that private schools have a deficiency Wildflower. Regardless of the nature of the institution, there is an understanding that, in general, there are differences in investments in and understanding of the guidelines and the movement of professional reorientation on the part of schools and discrepancies that possibly hinder its consolidation.
One of these discrepancies refers to a view that the reorientation of education and the SUS passes through a teaching process mainly focused on PHC: It is important that we think from the perspective of education for the SUS as the country s unified health system and that it is not only PHC. It is composed of all the levels of care Lily. Another difficulty mentioned is related to the fact that the faculty does not know the program s political pedagogical project and often ignore the essence of the proposal to reorient education in the health field as expressed in the national curricular guidelines: You meet with the professors and they don t know the program has a project, let alone what the project is about Lily.
In this process, there are also difficulties from both the professors and students in dealing with these new proposals that encourage students autonomy and creativity, which reinforces the need for a space to qualify professors and enable discussions between students and professors to understand and engage in the process of educational change: I try to pay close attention and work with this way of bringing to the student, discussing with the student Orchid ; we wanted to have classes but didn t want the professor to go there, give us a text and discuss it, we d say: In addition to these points, though still related to the schools, the need for institutional support to implement changes was highlighted and exemplifies the need to establish a greater workload and the continuous education of the faculty to consolidate such changes: Where we are going This category reveals a positive perception of the study s participants in relation to the national curricular guidelines.
After highlighting persistent challenges, optimistic testimonies were presented, which can demonstrate the advancements already achieved with this new proposal of nursing education, both in relation to the understanding of education according to the SUS and to the professional profile of nurses: Narcissus When the participants express their idea of the future, they point out elements that refer to the profile and role of nurses in the collective context of health, indicating areas of practice, complex and joint competencies, in addition to values and principles that should regulate or guide such practice: They will be more active in classroom, and will be part of their own Invest Educ Enferm.
The participants reports express a desire that the guidelines and reorientation of nursing education be consolidated, including overcoming the elements they reported as being obstacles in this transition process: Nonetheless, for this to happen, the participants indicate more time is needed, as well as a collective disposition and commitment: More traditional, imposing education, so I guess it s a long way, but I believe that we are all willing to change this scenario Narcissus.
Discussion It is relevant, when considering the starting point of institutional nursing education in Brazilian schools, to take into account the understanding of the faculty and students concerning its landmarks.
It is believed that awareness of the circumstances that were present at the time of creating the first schools and the establishment of teaching models is important to assessing our strengths and weaknesses, and is one of the cornerstones for reflection based on the problematization of reality. In this sense, an important point to note, in addition to those expressed by the participants, is related to the fact that the emergence of the first school is concomitant with the creation of the first health departments and public health agencies in the Brazilian State, a result of an incipient recognition of State responsibility in providing health to the population, even though this perceived responsibility was limited to a perspective of sanitation and to the objectives of industrial development.
Also, due to a greater demand for nursing professionals, this Law also required every university center or medical school to offer a nursing program. Since then, nursing teaching has changed to follow the changes in the Brazilian educational legislation, but remains tied to the biomedical model.
According to the national education bases and guidelines law from , a minimum curriculum for undergraduate programs was incorporated by nursing education in through process No.
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The curriculum into effect since then proposed, among other aspects, that the program take place in the time span of three school years, that there will be no nursing courses in Public Health, or Human and Social sciences, and that nursing education would emphasize the biological sciences, disease, and healing measures.
The ABEn, aware this requirement was not sufficient, did not meet the interests of the profession and did not play its role in the context of health services, wrote an official letter No.
Such education would occur in a broader dimension, based on principles that currently underpin the SUS, such as universality and integrality, for instance. The concrete reorientation of nursing education has gained force within Brazil and in the international scenario as seen in Lily s testimony. The SUS has greatly strengthened this movement and the national education bases and guidelines law from provides a real opportunity to initiate transformations and discussions within the State, as acknowledged by the participants. As appropriately noted by Sunflower, there is momentum for discussions and actions to develop proposals capable of meeting a long repressed and crucial need.
These discussions develop both in internal forums and in committees cooperating in a partnership between the Ministries of Health and Education.
They show understanding that the curricular proposals and pedagogical models need to be understood, as they have meaning and intentionality, never detached from a conception of society and education and are, therefore, very significant for the curricular changes encouraged by the national curricular guidelines.
Hence, when the proposal of a minimum curriculum is considered outdated and disconnected from this intentionality, we start from this relatively shared historical and political bias that secures the demands for the effective reorientation of education. The process of constructing the national curricular guidelines has incorporated the need to organize education according to the SUS and brings with it the understanding that, in a country as diverse as Brazil, there is no space for a closed, predetermined type of education.
There should be a possibility to educate according to each regional reality. There were many discussions to achieve the document s final redaction, and there were many challenges after its publication because, even though there is no longer a demand to reach consensus, there is a demand to win over schools, promote understanding of the guidelines and implement them.
Nonetheless, even though professors and students have such an understanding, they point out the difficulties faced in this process that, at the same time, confer autonomy and flexibility, but which may hinder the implementation of the proposal. One of the perceived difficulties was the large expansion of private higher education, which resulted in a large expansion in the number of undergraduate nursing programs. There was a considerable increase in the number of private nursing schools in the s, especially in the wealthiest regions, such as the South and Southeast.
This study shows a greater demand for nursing professionals after the implementation of the SUS, which would result in the proliferation of schools.
There is currently a national system to assess higher education, the SINAES, which is transforming itself together with Brazilian education. The participants, however, recognize that despite private education s greater tendency of instability, there are positive aspects and weaknesses in both private and public universities. Hence, there is a need to be more flexible in relation to this rationale.
One study 5 suggests that private schools are ahead in terms of the programs curricula and conception, while public schools are ahead in terms of work regimen and faculty qualification. This is another issue noted by the participants as an element that hinders the consolidation of the reorientation of nursing education. Another important point related to the transition process concerns the professors pedagogical posture and their ability to more broadly focus on public policies at all levels of healthcare, not only in relation to PHC.
We understand that in order to qualify nurses to work in accordance with the SUS, schools need to take into account and enable students to have experiences in all these teaching spaces linking teaching, research and community services during the educational process, enabling students to work and understand the complexity of the health system and the integrality of care.
The testimonies also express the need to re-discuss pedagogical practices in elementary, middle and high schools so that teachers more easily accept active methodologies and more dialogical proposals and, then, these do not become difficult during undergraduate programs.
There is an acknowledgment that nursing education is in a moment of transition where some advancements had already been consolidated and others are still in process. The continuous process of change and reflection has the potential to mobilize more critical work aligned with professional policies of the education field and in the organization of the health field. The participants are optimistic because they believe that the path at hand enables glimpsing a promising future for professional practice precisely because changes are based on important shared values and commitments.
In spite of some barriers, there is a collective recognition concerning the need to reorient professional nursing education and that reorientation is already in progress. Despite the potential and actual advancement expressed by the national curricular guidelines for nursing undergraduate programs, it is important to note in this context that the guidelines will not enact the changes required in the educational system, professors and students, by themselves. These are an important tool but should be contextualized and modeled according to local specificity.
We believe that even though this has been a theme present in discussions and academic studies in recent years, it is important to further encourage discussions and analyses, and discuss the reality of the situation based on the historical process in the most diverse spaces and contexts to achieve the desired transformations and awaken, through reflection, a collaborative spirit among those involved, enabling these movements of change to be collectively constructed. Even though these movements do not mobilize everyone, they seem to manifest a common desire.
Perceiving the ongoing changes is also recognizing and questioning where they are going to lead, what future can already be envisioned, or even that not Invest Educ Enferm. To overcome ingrained teaching practices, the time of maturation and the consolidation of new projects is an essential and necessary condition for the profession to advance.
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