ORIGINAL ARTICLES

Technical visit carried out during the formation of nursing students: a descriptive study

Camila da Silva Marques Badaró¹, Angélica Conceição Oliveira Coelho Fabri¹, Raquel Líquer de Deus¹, Herica Silva Dutra¹

¹Federal University of Juiz de Fora

ABSTRACT
Aim: to identify, according to the perception of nursing students, whether the technical visits contribute to training and management in nursing.
Method: this is a descriptive study whose data has been obtained in semi-structured interviews with eleven (11) students of the nursing undergraduate course. After transcribing the interviews, we used content analysis.
Results: The technical visit is an effective tool in the teaching and learning of the nursing administration process. It assists scholars in the perception of the relation between theory and practice, provides the development of a critical and reflexive view in terms of reality and fosters awareness regarding the relation between management and nursing care/patient care.
Conclusion: The technical visit was considered an effective teaching tool to promote an approach to the reality of the labor market by decreasing the distance between theory and practice.
Descriptors: Nursing, Professional Qualification, Nursing Students, Nursing Services, Patient Care Management, Health Facility Administration.

INTRODUCTION

Due to the great advances in a world increasingly globalized and demanding in relation to the professionals who are being introduced to the labor market, it is the duty of educational institutions to follow the trends of the market and contribute to a quality professional education⁽¹⁾. For this to occur, we need to provide support and resources for future nurses to become professionals who are well beyond the technique⁽²⁾, using teaching-learning strategies to enhance dialogue and the exchange of ideas amongst the students themselves and with their professors⁽³⁾, and encouraging students to develop critical and reflective thinking regarding their reality⁽⁴⁾.

Nurses and their teams are responsible for providing care to patients in hospitals, sharing the care provided to the patient/family with various services⁽⁵⁾ of technical and administrative support, such as laundry, nutrition and dietetics, warehouse, reception, pharmacy and laboratory. These should have the common objective of ensuring quality and agility in the offering of developed services and reducing the cost of the institution.

It is considered of paramount importance to maintain a constant relationship of cooperation between nurses and those responsible for the sectors of technical and administrative support in order to ensure all necessary resources to care. Nurses are responsible for supervising the conditions of hospitality, maintaining the stock of the unit, ensuring the operation of equipment, coordinating and directing the procedures necessary to carry out additional tests, while understanding and meet the needs of the patient and a companion, all in order to provide satisfactory care⁽⁶⁾.

From this perspective, the discipline of Nursing Administration I, that I is offered to undergraduate students of the 6th term of the Federal University of Juiz de For a, has used the technical visit (TV) as a teaching tool. It allows one to know and to evaluate how a company or industry develops its activities, to observe their structure and the work carried out by the people responsible for the service. After observing and making a comparison, it is possible to exchange information, develop new practices, expand knowledge and improve the development of the service⁽⁷⁾.

Academically, TVs consist of an activity in which students are directed to a specific sector within an institution, led by the teacher and accompanied by a professional designated by the institution. Their purpose is the development of a particular set of learning resources, bringing together theory and practice⁽⁸⁾. In the nursing education context, it is important to identify and understand all the activities taking place in health care facilities (HCF), while one of the strategies is to carry out TVs to technical and administrative support services.

Thus, it is important to identify the perception of nursing students in regard to technical visits, that is, to determine if this strategy is perceived as a teaching methodology capable of contributing to their professional training, whether these students are able to identif the relationship between technical and administrative support services and nursing services in meeting the needs of patients. It is noteworthy that this approach has been little discussed in the teaching of Nursing and that it can contribute to the development of active teaching and learning strategies in the area and in other professions in the health field.

Thus, the following objective was set: to identify whether technical visits contribute to the training and the management in nursing, according to the perception of nursing students.

METHOD

This is a descriptive study, using a qualitative approach allowing the investigation of the perceptions of individuals in regard to a given reality. The research was developed in a public education institution in the state of Minas Gerais. The subjects were undergraduate students in nursing, regardless of gender, race or cultural issues. The inclusion criteria in the study were: age equal or above 18 years, being an academic regularly enrolled, attending the discipline Nursing Administration I, and having done TV in hospital support services. A semi-structured interview script was developed to allow the flexibility of responses during the interviews. A convenience sample was selected. After explaining to the students invited the objectives and data collection method, the interviews were scheduled, recorded in their entirety on digital recorder and transcribed by the researcher for further analysis. The number of interviews was not previously established and they were conducted until the recurrence of information occurred. Data was collected in August 2013 and the interviews lasted between 20 and 40 minutes.

In order to carry out the analysis of the collected data, we used content analysis in the thematic mode, involving three stages: pre-analysis, material exploration and processing and interpreting the results. The pre-analysis consisted of the organization of data aimed at systematizing the initial ideas. Later, we performed an exploration of the material in order to reach the core of the comprehension of the text. Finally, the processing of the results and their interpretation allowed the establishment of relations between the experienced reality and intuition/reflection⁽⁹⁾.

The survey data was collected after consideration and approval by the Ethics Committee in Research of the institution under opinion number 238,541. All ethical aspects were respected. In order to ensure confidentiality of the identity of the interviewees, the subjects were identified according to the inclusion order preceded by a sequential Arabic number of the abbreviation Acad (for academic).

RESULTS

Eleven nursing students were interviewed, including 10 women of a mean age of 25 years, ranging between 21 and 46 years.

Data analysis made it possible to list two thematic categories that allowed us to ascertain the views of respondents regarding the TVs: importance of the performance of TV in nursing for the training of nurses, and interface between the technical and administrative support services and nursing management.

The importance of conducting technical visits in nursing for the professional training of nurses

This category sought to identify the overall perception of nursing students regarding the performance of TV in support services of hospitals and their interface with the teaching-learning activities. Participants emphasized the importance of using the TV as a strategy to meet the support services in HCF and so permit a broader view of the institution, beyond the limits of patient care units.
] it makes us to have a more tangible sense in terms of how it will work in a team within a hospital institution. (Acad.1)

] The importance of the technical visit for me would be to know each sector [technical and administrative support services], to know what the sector does, what his utility in that service [HCF] is, and his relationship with nursing. (Acad.3)

] For you that will deal with patients in the hospital you already have an idea of what happens. (Acad.10)

The Technical Visit, a methodology chosen by discipline Nursing Administration I, will complement the discussions developed within the classroom and provide academics with an approximation of reality and with their professional future(10). TVs have allowed us to know a little about the hospital situation in which nurses may act in the future, as well as the services and/or technical and administrative sectors with which they will have to deal with during the development of assistance activities.

In addition, the speeches underlined the extent to which the activity carried out has allowed an approach to theory and practice, strengthening the appropriation of knowledge by students.
] This association [theory - practice] is extremely important because it is a way for us to understand it; what we saw in theory becomes more tangible; [...] the technical visit is the moment for you to see in practice what happens, what you see in theory. (Acad.5)

] Together they [theory and practice] are able to give an idea to students in terms of the nursing management inserted in the hospital context. (Acad.1)

Respondents also emphasized the importance of theory; that is, the study of laws, regulations and resolutions, being an opportunity to support their knowledge. The previous study furthers the TV in equipping the student adequately in regard to the reality to be investigated.
] This prior knowledge is very important so you do not get there uninformed. You need to have some theoretical basis to be able to practice it. (Acad.3)

] We can see in practice what we studied; if it was consistent or not, [...] we could see it in theory, in the laws, in the rules, what is being done there, whether it complies or not. (Acad.5)

] You can also check if they [HCF] are following or not the standard, what is correct. (Acad.9)

It was possible to identify in the statements of the scholars the need for the theory to work alongside the practice, with the intention of facilitating an understanding of the theoretical content and approach the academic reality, so enabling them to build critical and reflective thinking.

Interface between the technical and administrative support services and management in nursing

In this category, we sought to identify the perception of students in terms of the interface between the activities developed by nursing and the technical and administrative support services involved, as well as implications for nursing management. Scholars have reported interdependence between the different support services and nursing, insofar as the activities of each one, despite being distinct, are jointly responsible for successfully meeting the demands of patients and their families.

] The relationship between the technical and administrative support service and nursing is a relationship that needs to happen because you don’t do nursing without this support, without them being articulated. (Acad.6)

] The connection between the support service and nursing would be very important for the [nursing] sector, because without this support service it’s not possible to manage or provide patient care. (Acad.3)

The relationship between nursing services and the technical and administrative support must be determined in a collaborative and integrated way, while fashion and nurses must know how they work, where they are located, what activities they develop and who the professionals who work there are, making them partners in the provision of care.

] Nurses must understand the hospital as a whole, because this relationship [nursing service and technical and administrative support] is very b; that is why it is so important for us to know the background operation of these services [technical and administrative support]. [...] Because our service [nursing] [...] will influence theirs [technical and administrative support] so we have to understand this place [HCF] as a whole. (Acad.])

[...] It is important for nurses [...] to know how work the support services surrounding the work he carries out. (Acad.10)

The Technical Visit has provided academics with the possibility of articulation between care (nursing essence) and the activities developed by the technical and administrative support services in achieving complete care and excellence in quality terms.

[...] The great object of nursing is care. [...] When I think care [...] I need to have this technical and administrative support so I can provide such care, so that it can be effectively carried out. So I need to know these services [technical and administrative support], if they work well, so I can effectively perform my care duties [...] I think the support services are essential in this sense, to really get nursing to perform its full care. (Acad.8)

[...] After we made the technical visits, it became very clear that the support service and nursing are directly linked, because one depends on the other, because nursing depends directly on services [technical and administrative support], because each has some specificity, because each will act in a different way, will contribute in a different way in order to provide quality care. (Acad.9)

Some examples were cited by scholars to illustrate the relationship between nursing and support services.
[...] In the case of nutrition, which was the sector that I visited, along with nursing, it is extremely important in care because [...] nursing is responsible for giving an answer to them, in terms of how patient acceptance is; if patients like this diet or not [...]. (Acad.2)

[...] Generally, this link is very important, because how is it possible to provide assistance to patients who are bedridden, if the cleaning staff is not working with nurses in the ward cleaning, and disinfection of beds, for example? You got it? They need help. So I think the connection between the two services is very important. (Acad.3)

The speeches also revealed that the TV can be a tool in the development of nursing managerial activities because it allows a better understanding of the whole, which includes nursing care. Knowledge, here, should be understood in terms of the current reality and the activities of other sectors to favor the management of care and of the unit, thus integrating direct and indirect care to benefit patients.

So I think the technical visit, as a management tool, is important in assisting patients in each sector, to prioritize certain things in order to manage the service [nursing], not leaving the assistance aside, but also to manage the sector so that nothing is disconnected, always integrated. (Acad.3)

[...] It [TV] comes to help us in that, while graduate students, we have already begun to have an insight into which tools we could use on a daily professional practice, to provide quality care along with the whole staff, so that patients are always benefited. (Acad.1)

The technical and administrative support services and nursing are some of the services that operate in HCF and should be articulated efficiently with the aim of providing comprehensive, resolute, humanized and quality care.

DISCUSSION

The use of the TV allows students to gain knowledge of the various sectors involved in an HCF, the interdependent relationship between the professionals of these sectors and the relationship between the technical and administrative support services, the nurses and the nursing staff. This strategy has allowed scholars to develop a more reflective look on health services and their future performance as professionals^(11,12). The transitional process from the student status to the graduated nurse status allows future professionals to develop confidence and strengthen their clinical skills, as well as to develop positive work attitudes and professional qualities⁽¹²⁾. Thus, teaching-learning situations that promote student contact with the reality of the work environment, in this case the performance of TV, can be considered positive for the development of skills necessary for the fulfillment of their future role.

In this sense, the use of TV also contributes to the mediation between the academic and professional reality. It has allowed scholars to build an expanded concept in terms of the health service, beyond the boundaries of the professional practice of the nursing staff and the nursing care to be provided to patients/families. It has also allowed the observation of different aspects of the work process, including access to theoretical information and concrete practices in the work context⁽¹³⁾. Thus, the teaching-learning process can have its significance extended through the meeting of new elements of analysis, evaluation and creation.

The TV, as a teaching methodology, aims to complement the theoretical insight acquired in the classroom and provides an approximation of academics with reality/practice and their professional future⁽¹⁴⁾. In this conception, the TV can be considered a didactic and pedagogical resource, which translates into better educational outcomes, since the students not only listen, but they also observe and experience the practice of the institution, making the learning process more motivating and relevant. In addition, there is the possibility of a bonding construction between professional health services and higher education institutions⁽¹⁵⁾ for mutual partnerships in search of qualified training for the labor market. These partnerships facilitate the building of a network, give value to the knowledge and experience of professionals who are already in the labor market and increase the understanding and trust of students⁽²⁾ in relation to their learning.

The theory previously applied during the construction of the itinerary for the visit aims to direct what should be observed and investigated, which is extremely important in order for the TV to be successful, being that it provides a comparison and approach between theory and practice⁽¹⁶⁾. We can also add the opportunity to practice teamwork as a strategy for the development of skills and expertise for future professional practice⁽³⁾.

The link between theory and practice must be understood as an indivisible whole in which one complements the other⁽¹⁷⁾. Practice is necessary for the solidification of the theory, while is also needs to be grounded to remain innovative and compatible with teaching. This theory-practice interaction enables the transformation of subjects and teaching them how to learn⁽¹⁸⁾.

Nurses must have knowledge and skills that contribute to the provision of quality care based on evidence, and the ability to face the daily challenges of health services based on critical and reflective thinking⁽²⁾ for making clinical and managerial decisions. In nursing education, critical-reflective thinking should be considered an essential feature used in future professional practice and it depends on knowledge and experience. The development of critical and reflective thinking is linked to the acquisition of theoretical and practical knowledge⁽¹⁷⁾; thus, the TV is a teaching and learning strategy that can contribute to this.

In order to apply the knowledge acquired so that it can sustain nursing care and meet the needs of patients/family members, nursing students should feel confident in terms of their ability to act professionally and participate actively with other professionals in health services(2). Nurses should thus adopt a systemic view by dealing with patients throughout hospitalization and recognizing the fact that they are responsible for dealing with the various technical and administrative support services involved, in order to develop a model of comprehensive care according to patient needs.

The importance of carrying out effective communication with the various professionals working in the HCF is thus demonstrated. Moreover, despite the fact that nurses play a crucial role in maintaining quality care, this is only possible when there is the involvement of other actors in the process⁽⁶⁾. There is a level of interdependence between the work of the nursing team and the activities developed in the different technical and administrative support services, so that they influence each other and help each with their knowledge in order to promote quality and comprehensive care according to the needs of individuals.

Thus, it can be considered that TV is a strategy for the training of future nurses insofar as the practice of nursing occurs primarily from contact between humans and the relationship established between them, allowing the perception of the need for synergy between institution-nurse-patient.

A cost-effective performance and a variety of skills in terms of direct and indirect nursing care⁽¹⁵⁾are expected of the nursing professional future. These issues highlight the need for a greater expansion of training to include the experience of concrete situations. Nurses must be prepared to act as managers(5,6) while nursing schools have a duty to instrumentalize them. They must be able to manage physical, human, material and information resources⁽⁷⁾ to ensure comprehensive care to patients and their families, which does not happen independently of activities undertaken by various technical and administrative support services that are developed in the HCF.

Nurses’ knowledge and their approximation to technical and administrative support services also favor the development of managerial activities. Nurses may avail themselves of the TV as a management tool in different circumstances in order to identify and establish approach strategies and partnership with any of the technical and administrative support services. Thus, it is through consistent working relationships⁽⁶⁾ that the complex and varied processes permeating health care can be smoothly conducted towards the ultimate goal which is achieving a desirable quality of assistance and problem-solving.

It is worth highlighting the fusion between the management of care developed by nurses and direct nursing care. In this sense, the TV has helped students in building this perception, being that when one plans, organizes, evaluates and coordinates care delivery, one is seeking to achieve effective, high quality care⁽¹⁹⁾.

In order to achieve the desired professional profile for future nurses, it is important to incorporate teaching methods and strategies⁽²⁾, such as the TV, aimed to encourage the acquisition and application of knowledge in health care settings, so enabling the provision of an individualized and humanized care, promoting the necessary changes in health care, and contributing to the strengthening of nursing as a profession and as a science.

CONCLUSION

The interviewed scholars pointed out the importance of the TV performed in the practice of the discipline Nursing Administration I, as a tool for the process of teaching and learning in the training of future nurses. Moreover, being that the TVs are carried out in HCF technical and administrative support services, it is possible for students to know different aspects of a health institution and approach the reality of the chosen profession.

Amongst the advantages of carrying out TVs, we can highlight the rapprochement between theory and practice, so facilitating the fixing of the content through: the development of a critical and reflexive view in terms of the reality of their profession; the perception of the relationship between nursing management, the assistance/care provided to patients; and the magnified view of the organization of the HCF and the different services developed in it. By knowing the tool and demonstrating its advantages, students can avail themselves of their academic experience as a way to promote the development of different TVs in the future within their professional activity.

Insofar as they know the services developed within HCF and their relationship with nursing care, nurses can push the boundaries of the wards and, through an effective communication channel, facilitate the realization of comprehensive and quality care.

In terms of the limitations of this research, it can be highlighted the involvement of a small number of students of the same discipline in a single educational institution. Thus, the results reflect their perception in the period of data collection.

However, we believe that this research may contribute to the use of TV as a teaching and learning strategy in nursing in different realities. We suggest conducting further investigations that might discuss the perception of teachers regarding the TV and its applicability in other disciplines and to other backgrounds.

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All authors participated in the phases of this publication in one or more of the following steps, in According to the recommendations of the International Committee of Medical Journal Editors (ICMJE, 2013): (a) substantial involvement in the planning or preparation of the manuscript or in the collection, analysis or interpretation of data; (b) preparation of the manuscript or conducting critical revision of intellectual content; (c) approval of the versión submitted of this manuscript. All authors declare for the appropriate purposes that the responsibilities related to all aspects of the manuscript submitted to OBJN are yours. They ensure that issues related to the accuracy or integrity of any part of the article were properly investigated and resolved. Therefore, they exempt the OBJN of any participation whatsoever in any imbroglios concerning the content under consideration. All authors declare that they have no conflict of interest of financial or personal nature concerning this manuscript which may influence the writing and/or interpretation of the findings. This statement has been digitally signed by all authors as recommended by the ICMJE, whose model is available in http://www.objnursing.uff.br/normas/DUDE_eng_13-06-2013.pdf

Received: 03/06/2015
Revised: 02/02/2016
Approved: 02/15/2016