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ARTÍCULO ORIGINAL / ORIGINAL ARTICLE / ARTIGO ORIGINAL

 

From "being to the self" to "become to be": on development of autonomy construction in nursing students

 

Del "ser para sí" al "llegar a ser": sobre el desarrollo o la construcción de la autonomía del alumno de enfermería

 

Do "ser para si" ao "chegar a ser": sobre o desenvolvimento ou a construção da autonomia do aluno de enfermagem

 

 

Roberta Waterkemper1; Marta Lenise do Prado2; José Luis Medina-Moya3; Vânia Marli Schubert Backes4

 

1RN, Ph.D. Professor Universidade Federal de Ciências da Saúde de Porto Alegre -FCSPA-, Brazil. email: robswater@gmail.com.

2RN, Ph.D. Professor Universidade Federal de Santa Catarina –UFSC-, Brazil. email: mpradop@nfr.ufsc.br.

3RN, Ph.D. Professor Universitat de Barcelona, Spain. email: jlmedina@ub.edu.

4RN, Ph.D. Professor UFSC, Brazil. email: oivania@nfr.ufsc.

 

Receipt date: Feb 2, 2013. Approval date: Oct 7, 2013.

 

Article linked to research: Formação crítica e criativa em enfermagem: Um estudo de caso da disciplina de fundamentos para o cuidado profissional de enfermagem da Universidade Federal de Santa Catarina.

Subventions: Conselho Nacional de Tecnologia e Pesquisa (CNPq) e a Universidade Federal de Santa Catarina (UFSC).

Conflicts of interest: none.

How to cite this article: Waterkemper R, Prado ML, Moya-Medina JL, Backes VMS. From "being to the self" to "become to be": on development of autonomy construction in nursing students. Invest Educ Enferm. 2014;32(1): 33-40.

 

DOI: 10.17533/udea.iee.v32n1a04

 


ABSTRACT

Objective. To understand nursing student's self-consciousness and his/her autonomy in the discipline of fundamentals of professional care in the context of a liberating pedagogical proposal. Methodology. This qualitative, case-based research in the model of Ludke and André involved 14 students participating in the discipline. Data were collected by non-participatory observation and analysis of documents. Field observation was conducted from March to July 2010 and data were collected according to the proposal of Minayo: pre-analysis, exploration of material and treatment of results. Results. We constructed two thematic units of analysis: from "being to the self" and exercise of "become to be". Conclusion. When nursing students feel more liberty, they have the opportunity to substitute the scary prospect of learning something new material to something that motivates their curiosity and leads them to become more autonomous.

Key words: conscience; personal autonomy; students, nursing; education, higher.


RESUMEN

Objetivo. Comprender la consciencia de sí mismo (alumno de enfermería) y su autonomía en la asignatura de Fundamentos para el Cuidado Profesional (FCP), en el contexto de una propuesta pedagógica liberadora. Metodología. Investigación cualitativa en la modalidad de estudio de caso fundamentado en el modelo de Ludke y André. Participaron 14 alumnos de la asignatura FCP. Para la recolección de la información se utilizó la observación no participante y el análisis documental. La observación de campo fue realizada de marzo a julio de 2010 y la recolección de los portafolios fue en julio del mismo año. Se hizo el análisis de contenido de acuerdo con tres fases según la propuesta de Minayo: preanálisis, exploración del material y tratamiento de los resultados. Resultados. Fueron construidas dos unidades temáticas de análisis: del ser para sí y el ejercicio de llegar a ser. Conclusión. Los estudiantes de enfermería, en la medida en que se sienten libres, tienen la oportunidad de reemplaza la imagen atemorizante del nuevo aprendizaje por algo que motive su curiosidad, lo que los lleva a ser sujetos autónomos.

Palabras clave: conciencia; autonomía personal; estudiantes de enfermería; educación superior.


RESUMO

Objetivo. Compreender a consciência de si (aluno de enfermagem) e sua autonomia na matéria de Fundamentos para o Cuidado Profissional (FCP), no contexto de uma proposta pedagógica liberadora. Metodologia. Trata-se de uma investigação qualitativa na modalidade de estudo de caso fundamentado no modelo de Ludke e André. Participaram 14 alunos da matéria FCP. Para a recolha da informação se utilizou a observação não participante e a análise documentário. A observação de campo foi realizada de março a julho de 2010 e a recolha dos porta-fólios foi em julho do mesmo ano. Fez-se análise de conteúdo de acordo em três fases de acordo à proposta de Minayo: pré-análise, exploração do material e tratamento dos resultados. Resultados. Foram construídas duas unidades temáticas de análises: do ser para si e o exercício de chegar a ser. Conclusão. Os estudantes de enfermagem, na medida em que se sentem livres têm a oportunidade de substituem a imagem atemorizante da nova aprendizagem por algo que motiva sua curiosidade, o que os leva a ser sujeitos autônomos.

Palavras chaves: consciência; autonomia pessoal; estudantes de enfermagem; educação superior.


 

 

INTRODUCTION

The attitude or profile of a professional who wishes to build apart from the formal education level, which is presented in politic-pedagogical projects and National Curriculum Guidelines (NCG) in Brazil, is to educate students with critical attitude/profile that is translated by autonomy, ability of make decisions, solve problems, ability to communicate, to pursue interpersonal relationship, among other characteristics.1-3 The great challenge in education process consists of implementing pedagogical proposals that develop processes of teaching and learning that could stimulate construction and growth of such attitudes in students.

Among major methods of teaching emphasized in the literature focused on the development of critical attitude and critical thinking for autonomy action there is the clinical simulation environment associated with the use of information technology (IT), as well as the virtual learning environment-AVA.4,5 Innovative proposals and that represent a new context of teaching and learning show contribution for students' autonomy by decision making process.4 New teaching and learning proposals challenge both the student and the professor because they came from the conventional teaching model in which students and professors had different and specific roles, i.e., the professor teaches and the student learns, without the need of an interaction and cooperative participation between them.6-8 For this reason, to the student leaves his/her position from being a receptor of knowledge to become a protagonist constitutes a great challenge. Most of the times such fact restrain colleges to take risk because of the fear imposed by traditional college that requires success as synonymous of sure.9

To be a protagonist and exercises autonomy it is necessary liberty to enable the fulfillment of a space previously fulfilled by dependency, and which is based on responsibility that will be assumed.10,11 When the student feels free and perceives him/herself as free, i.e, to become self-consciousness in the college world, he/she develops the ability to make decisions in relation to what is experienced. This conscience appears from the epistemological conscience that man (man in a generic sense as Paulo Freire uses, to maintain reliability with Freire's writing) develops from his ingenuous conscience and by more centered perception. The man could be conscience in two forms: by ingenuous conscience and by epistemological conscience. The ingenuous conscience is natural to the man and it is part of a cognitive process. It is the way of perceiving the world without look deeply into himself and in his world. It is a perception of only one being. In the epistemological conscience the man perceives himself as a mutable subject in the world with possibility of changing him own actions that appear the need of act by his unfinished condition. 9-11

Since 2005, because of this need in educational world, professors of the discipline of fundamentals of professional care in nursing undergraduate program at Universidade Federal de Santa Catarina – UFSC have been developing a new pedagogical proposal based on critical pedagogy and adoption of active teaching methodologies. Professors sought to develop new ability in students using the following proposals: to learn how to learn by research and critical evaluate of data and information stimulation using books, journals, databases and personal source of information, including students' own experience; Successive approaches with high level of complexity; Learning by doing to develop psychomotor abilities and attitudes in the discipline articulated with knowledge production by action-reflection-action associated with practical scenarios and seek of information in a systematic and related manner. Professors believe that learning is part of the students' curiosity whom in a free space take decisions on him/her own learning. During the semester professors developed along with students three units of knowledge (UK) that aimed to address the theoretical program of the discipline. Each UK is developed by activities, such as: discussions in small groups (DSG), experiences in care setting (ECS), socializing, independent studies, simulation in the laboratory of clinical practice and development of a portfolio based on problems.

This study sought to analyze how autonomy of nursing students is developed in the knowledge process construction in the discipline of fundamentals of professional care (DFPC) in the context of liberating pedagogical proposal from students' self-consciousness about the world. The theoretical-philosophical support used to analyze this process was the Freire's thinking on liberating education. The theme of this study showed to be relevant to nursing education and education of the future nurses in order to emphasize the possibilities in the process of teaching and learning mainly from the student's perspective, which contribute to his/her own critical reflection related to the professor and construction of creative changes in the pedagogical practice.

 

METHODOLOGY

This qualitative, case-based research12 included 14 students of participating in the DFPC. To collect information we used the non-participatory observation and analysis of documents. The field of observation was conducted from March to July 2010. Subsequently, we collected portfolios. The analysis was based on content analysis proposed by Minayo(2010).12 This process is organized in three moments: pre-analysis, exploration of material and treatments of results. Information collected were transcribed using Microsoft word and then imported to Altas ti 5.0 program to organize and analyze qualitative data. This study was approved by Ethical and Research committee of the Universidade Federal de Santa Catarina (number 474 and protocol 305209/2009). Participants were informed on ethical principles presented in the resolution 19696 and on the consent form. All participants signed the consent form. Participants' reports were identified with letters P (portfolio) A (student) and a number, fragments of participants' observations with letters O (observation) A (student) and a number, and actions observed with letters O (observation) and a number.

 

RESULTS

Seeking of being to the self

Participants' portfolio presented their perceptions, ideas, concepts, reflections and attitudes stimulated by experiences in different learning settings in the discipline. Students revealed by writing their comprehension on what were experienced. The following registers contain the difficult of students to assume liberty in order to make choice of learning without the imposition of professor when they faced the new pedagogical proposal in the discipline: 1st week of classThis first day of class was very hard. […] the discipline includes an innovative proposal in relation to methodology. To be sincere at first, I was afraid […] because this methodology requires a self-confidence and higher independency from the student and, to be more confident with myself, it is a challenge that I'm trying to overcome […] (PA1); I admit that I'm was afraid about self-studies, especially on how to study, whether I have to study all topics or only those that will be teach in the next class. I have to find out more about this. (PA10); I'm also confused on what to do at independent studies and what to look for. I don't know if it is necessary to know everything in 1st unit or if we'll learn the unit during the semester. (PA7); The majority of students look to the blackboard, but they do not show enough interest. Other students not even raise their head because they "write down everything" showed in slides and told by the professor (O1- collective class).

In the following registers subjects revealed higher acceptance for the pedagogical proposal of DFPC, curiosity to experience and liberty to learn: 1st week of class - […] I believe that as time goes by I will be adapted to this teaching methodology. I loved the class today and I was more confident with the discipline. The good thing is that we could see theory and practice. I like this methodology. I believe we learn more and better. (PA7); [...] I was very excited especially for freedom that this method seems to give us at subjects approached, also enabling to widely open our viewing. For example, the types of references used and how to approach themes. (PA1); The same could be seen in records from field observation: An image is shown and the professor ask students "what do you guys think"? A1: "is it exchange of glances, smiles?; Professor: reinforces that during the interview is important the "eye to eye", to pay attention in the other, to interact. In second image the professor also asks "what about this one?" "what comes to your mind?" "are you liking it?". They mention about interaction and need of knowing how to do. In next slide the teacher says "Are you guy believe in this sentence?: "the nature of what is observed depend on the perspective from that we observe". "Is this sentence true?" The professor continues to give examples on situations of interaction and professional attitude that should be observed during the interview. The following example was given: In Carnaval my son's girlfriend will dress up as a nurse. "Could you imagine what professional image does she have?" A: Students did not show interest (O1).

When students begin to experience this way of learning, they highlight the self-management of learning that is related with search of "being to the self". It means a decision making of students on what he/she decides to be: 1st week of class - […] From now on I kept a phrase that I heard from the professor in the first day of college that perfectly represents my currently status: a nursing technician, students and future nurse professional: Take the responsibility of being excellent professionals. This is the responsibility that I want to always have with me, today, tomorrow and always. (PA27); I like to deal with people, I enjoy even more knowing that my attitudes, no matter smaller they seem, could completely help someone physically or mentally. Even better is to know that people will need me and I should be very attentive to address their needs. It is great to know that I could make a difference in life of one or more persons. In the end, I will be satisfied for what I've done. [...] (PA23); Such attitude could be observed in activity of discussions in small groups (DSG): "They said: "I'm more excited", "I want to be more dedicated". "I won't miss class anymore" (OA9).

Exercise of become to be

The autonomy exercise or the "being to the self" to "become to be" must occur by self-learning act of the student and in the decision making process that include where, how and what to study. In the discipline, the student has to have a time available in his/her schedule to manage studies according to his/her needs, and it was perceived in the following register: 1st week of exercise I don't have time to study at noon. Although the schedule includes a period of independent studies, I have to work during this period. I went to the university library at 9pm to search terms that raised my attention. I took two books to read at home. In addition, I searched about care (described in item 5.2) (PA7). The stimulus to read without be imposed by the professor enables the growth of student's curiosity and the exercise of reflection about what was read. 1st week of exerciseAfter several searches I ended up deciding to look for a scientific paper approaching a wider view instead of one simply reporting some technique for patient care, I decided to read (…) because the article reflection sought to understand the value of nursing care that requires a wider view, valorization of life itself and the respect of others in all aspects (PA27)".

The autonomy exercise experienced by subjects in the study is understood as a process to searching to him/herself. Before the student achieves this understand he/she waits for the professor to teach them. This perception could be seen in the following observations: discussions in small groups (DSG)A female student talks about her experience and reports a situation that she would questioned the professor, in the scenario of care experience whom said "so?; all the times". The professor did not answer. At a specific moment of training they had to conduct a search. "Now you understand what is to work with active methodologies". It is different. The student has to go after things. Now we understand" (OA5). When students begin to assume their liberty to decide, act and share thinking they built a self-perception about the world and him/herself inside the world, i.e., on be a nursing student, what he/she knows, do not know and what he/she should know: discussions in small groups (DSG) – A research on learning questions "[…] While we're answering one of the question, several others appear. But, I think it is a crucial point to construct our knowledge to life. Learning question impels us to seek more knowledge. I'm sure many of these questions will be answered during classes, practices and independent studies" (PA18).

During learning moments students observed themselves, the world and themselves inside the world as unfinished beings that need "to be more" because they perceive what they still unknown and what must be studied: Socialization – some classmates were afraid, others nervous, anxious, but I was fine, but off course with some anxiety, concerning to acceptation of our activities by professors and groups. […] I spent part of the day making the slides for the presentation. I wanted go beyond the practical field, to me, theory is important, although the activity was focused on practice. […] We received excellent comments that motivated us to be more involved in the discipline and let us to perceive how important is to introduce the theory into practice or vice-versa. (PA17); DSG – the professor asked "what could be add?". A10 suggested that "we should implement the bed bathing because the patient in the study was not assisted in this regard". A2 added that "to implement the things discussed about bandages, and cleaning of bed linen". When I came back I saw a student writing on the board the website she used during her surveys. Other students also shared things on the board (O5). The autonomy development is a process that happens in an articulated manner among liberty, curiosity and decision making. When the student, who ingenuous curiosity goes to epistemologic6-8, observes the object, actions of people he/she exercises the reflection that could generate an action from "be more" to "become to be". This act could be perceived in records of the portfolio Meeting with coordination - "[...] After a silence, a student in our tutorial group said crying everything she was feeling. After that student talking, a new silence. I interrupted the silence to say to other students and the Professor that I was not going to talk about our group tutorial, because we agreed before that everything in the group must be resolved among group members. I also supposed it was the reason of the silence of other group members. (PA2).

 

DISCUSSION

The autonomy development, i.e., the search from "being to the self" to "become to be" in DFCP begin from the liberty that students present in their choices both in studies and care. These choices are part of a rigorous presented in liberty and that implicates in adventure, risk and creativity.6 When the nurse professor stimulates the use of imagination, exposition of feelings, dreams and wishes to the exercise of creativity, they enable the student to take risks when interpreting and producing knowledge, which are fundamental to meanings development.11 Although subjects reports and observations are few indications that the experience of being accommodated4 , they show that students had conscience on the importance of their participation and it is an indication of what they are learning to be (DCN, 2001). Despite the introductory period in the discipline had presented the proposal that a student must be a protagonist in learning process, he/she interpret this message as one who acquire the knowledge "given" by the professor.4 The students commitment is to be attentive, to pay attention! Constructed ingenious conscience.

Liberty for those who did not experience it during his/her formal education process could not be perceived as something positive to learn, but as something that brings dissatisfaction by accommodation and conditioning4. The dissatisfaction must be because learning something not imposed and without transmission of contents by the professor in the discipline, requires the student to follow his/her own pathway, and takes decision on how to learn. In general, students from first semester of nursing undergraduate program demonstrate higher dependency of the professor than the those attending the last semester.4 This is a difficult that represents the accommodation taught in conventional teaching,13 and that maintain the student in passivity,11 subordination and ingenuous curiosity in the shadow of the world. However, during student's education, even with fear, this could be substitute by epistemological curiosity when pedagogical proposal conveyed by professor' actuation enables student "being to the self" and to show eagerness to learn.

The autonomy pedagogy is centered in experiences that stimulate decision making and responsibility. However, this centrality occurs only when these experiences respect the liberty of students to "be more" 15. It means, without oppression, authoritarianism or domination from those who educate. When the student feels free he/she has the possibility to act according to his/her believes and replaces the scary prospect of learning new lessons to something that motivates curiosity. Fragments revealed that a student beginning the experience in pedagogical proposal of DFCP showed acceptance to challenges, even without security.

We also perceived that such moment is the adaptation of students to novelty and liberty for searching. This enthusiasm could be interpreted as motivation based on Freire's ideas. For this student the enthusiasm found occurred when the discipline proposal was presented because in that moment he/she felt a kind of liberty. In this moment the motivation is showed by the student, but at the same time it is a trigger for reflection on act of learning. This is a motivation that could not occur, at any moment, out of the pedagogical practice, or before it9 because it is part of the practice. In this way, the student is motivated from the moment that he/she acts, in study act itself, of recognizing the importance that knowledge.

For this reason, this moment is a space to re-learning how to learn. It is a requirement of current pedagogical tendencies and recognized by UNESCO since 1998. Political-pedagogical projects based in emancipatory, critical and liberating pedagogy propose the student a new manner of learning and also of teaching. The professor does not transmit the knowledge, but share with the student who has autonomy to self-manage his/her learning.15 Because autonomy constitutes an attitude developed day-by-day based on experiences that someone has during life, it is conducted and learned, not taught, it requires discipline, that is why it needs to be offered as an opportunity. Autonomy is conquered by students when they assume and conduct it, which gives them strength against threatens exposed as temptations to other activities. To be disciplined a student should have body and mind pleasuring during the act of reading, because it is not possible to study without reading.11

Learning development involves: liberty, curiosity and decision making. However, to take decision the student must be free to, from his/her curiosity of what was observed, reflect and take decisions. It is a process that occurs in an articulated manner. The act of reflecting about an experience is a moment that provides the student time to read and re-read what is observed and construct his/her knowledge. In this exercise the student is able to analyze details of the situation by his/her conscience and make decision, assuming a responsibility that could be encouraged to solve conflicts and also contribute to control of infection by handing sanitization as in highlighted situations. These are examples of the process of autonomy development in which involves the context observation, reflection, decision making and action. It is a way to update exercise, simplify and improve what was done.8,9,15 It is act of construction of knowledge in a context in which generates new knowledge.16

Our results strengthen the conviction of the possibility to develop the students' autonomy by creating an environment of teaching where liberty is present. Liberty must exist as way to enable the student to act without fear and assume the responsibility to his/her own learning. Feeling free, the student could observe what stimulate his/her curiosity, questions, doubts, and actions to transform him/herself inside the world that he/she belongs. Students of this discipline were able to be perceived as persons and students in process of education, their difficulties, facilities and overcomes. They expressed decisions based on what was experienced in-class and decided how to act. This process reveals an autonomy apprehended by an unfinished state. Students learned to organize their studies, reading and writings dues and to communicate using activities of writing in portfolios, oral presentation in theoretical discussions and by experiences in care settings. High education has the aim to stimulate reflexive thinking to educate graduates in different areas of knowledge with competence to act in professional sectors assuming the responsibility by participations in development of the society and continuing education. To develop the society means to worry with it by development of scientific investigation, diffusion of cultural, scientific and technical knowledge as well as the provision of specialized services to the community.17

Hence, to develop a student with such competences related with autonomy is linked with the need to create teaching strategies that enable students to practice. Because it is a process, it must be trained in-class daily to become a permanent attitude and part of the student's character.

Classroom is not the only place that autonomy must be stimulated, but it should be extrapolated to environments outside the university, such as family, other formal education environments and workplace. This study strengths the nursing education research field, especially, concerning to the development of student's autonomy. The autonomy requires the student to decide to participate in learning process. To enable the decision making some organized teaching strategies with this objective must be encouraged and become concrete from the pedagogical process planned by nursing professor. Besides, it is evidenced by practice of experience that could contribute to reflection-action-reflection of nursing professors in teaching and learning process not only in Brazil, but also in other countries. Nursing professor plays an essential and irreplaceable role in this process. Therefore, they must be aware on the knowledge of pedagogical act and its relations, including, the different types of learning styles.

Universities as responsible for education of competent individuals to act in the society needs qualified educators to attend students' and society needs. The training of professor is important, and they must be involved and understand new tendencies of teaching and learning as a strategy of changing paradigms and leaving conventional attitudes that restrain an autonomous attitude from students. The critical teaching will be only part of history if exists and that is why it must be permanent in practice.

 

REFERENCES

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15. Ruiz IC. Autonomía en el aprendizaje: direcciones para el Desarrollo en la formación profesional. Revista Electrónica publicada por el Instituto de Investigación en Educación Universidad de Costa Rica. 2009; 9(2):1-22.

16. Waldow VR. Reflexões sobre Educação em Enfermagem: ênfase em um ensino centrado no cuidado. O Mundo da Saúde São Paulo. 2009; 33(2):182-188.

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