ORIGINAL ARTICLES

Nursing knowledge production on residence: a bibliometric study

Rosana Maria de Oliveira Silva1, Rebeca Santos do Amaral de Souza1, Luize da Silva Rezende da Mota1, Josicélia Dumêt Fernandes1, Carolina Souza-Machado1, Ana Lúcia Arcanjo Oliveira Cordeiro1

1Federal University of Bahia

ABSTRACT

Aim: characterize the production of nursing knowledge about multiprofessional residency and professional health area. Method: A bibliometric study was carried out from abstracts of articles, theses and dissertations of the nursing area on the subject, between 2005 and 2015. Results: 47% of the production on the theme comes from articles; 76% of the studies are concentrated in the South and Southeast regions, with higher productivity between 2009 and 2015; 75% of the studies are based on professional training for SUS. Discussion: Production is linked to the stricto sensu postgraduate and reflects its distributional disequilibrium, which focuses where the installed capacity of resources is greater. The need for a new professional profile for the SUS has also contributed to the increase of the discussions on the theme. Conclusion: Residence is a subject of relevance for the scientific production.

Descriptors: Internship, Nonmedical; Specialization; Nursing.

INTRODUCTION

The production of knowledge in Nursing facilitates the transformation of concepts considered hegemonic in the health and training process, changes in public and social policies and improvement in care practices, and it can also show weaknesses in the formation and process of health care. In this sense, nurses have sought, with the production of knowledge, to reaffirm nursing as a science, in order to make visible its constant scientific evolution(1).

Thinking about the production of knowledge in Nursing refers to the stricto sensu postgraduate programs that have driven research in this area of knowledge from Master's and Doctoral courses. These courses, aimed at producing knowledge, developing global leaderships and developing the profession, contribute to the training of qualified human resources, improvement of health systems and actions, promotion of technical and scientific advancement and strengthening of the educational scenario of Brazilian nursing(2,3).

Thus, since the creation of the first stricto sensu postgraduate courses in Nursing in Brazil, a master's degree in 1972 and a doctorate in 1981, the expansion and consolidation of scientific production through theses, dissertations, articles and books is evidenced(2). This growing and diversified knowledge production covers many themes, including training in health for work, which is among the health research priorities in Brazil(4).

The multiprofessional residency and professional health area that forms human resources for health work is recommended for new licensed professionals. This is because it complements and broadens training, favoring the qualified insertion of these professionals in the labor market, particularly in the priority areas of the Sistema Único de Saúde (SUS - Unified Health System), enables in-service training, with articulation between theoretical and practical knowledge, and allows the knowledge produced and learned to be applied, as well as it leads to the development of skills related to communication, leadership, management and teaching in specific areas(5,6,7).

Due to the expressive importance of these teaching programs for the training of human resources for the SUS, these are considered relevant research objects and, thus, the question is: what is the production of nursing knowledge on multiprofessional residency and in the professional health area? Based on this questioning, this study aims to characterize the production of nursing knowledge about multiprofessional residency and in the professional health area.

In developing this study, it is intended to provide support to researchers for the production of research to fill potential gaps in the literature, increasing the possibilities of building new perspectives and knowledge.

METHOD

This is a bibliometric study whose unit of analysis consisted of abstracts of articles, theses and dissertations of the nursing area on Multiprofessional Residency and Professional Health Area, from 2005 to 2015. The year 2005 was defined as the year in which the Interministerial Ordinance MS/MEC No. 2,117 was created, which establishes the Multiprofessional Residency in Health and the Residency in Professional Health Area.

Data collection took place from May 16 to 20, 2016 in the Virtual Health Library (VHL) via MEDLINE, LILACS, IBECS, BDENF, Brazilian Digital Library of Theses and Dissertations (BDTD) and the Bank of Theses and Dissertations of CAPES, using the search strategy (non-medical internship OR non-medical non-dental residency OR specialization OR areas of specialty OR specialist OR specialists OR specialties OR specialty) AND nursing, and the keywords "Multiprofessional residency in health", "Residency in occupational health area" and "Integrated residency in health", to broaden the search.

In order to obtain the data exclusively from the proposed theme, the following criteria were defined as inclusion criteria: articles, theses and dissertations from the nursing area that addressed the theme Multiprofessional Residency in Health and in the professional area of Health, from 2005 to 2015. As exclusion criterion: duplicates at the time of the search, documents that do not correspond to the nursing area and documents that do not correspond to the Brazilian Residency programs. The detailing of selections and exclusions can be seen in Figure 1.

After data collection, the data were systematized in spreadsheets in Microsoft Office Excel 2013® to fill in a previously prepared instrument. The instrument was composed of the following variables: title, year, language, origin, thematic category and level of education (masters or doctorate, to categorize theses and dissertations). With the duly completed instrument, statistical analysis was performed by absolute and relative frequencies, with tables and graphs presented for a better interpretation of the results.

There was no need for approval of the research by a Research Ethics Committee involving human beings, since the research has a bibliometric and documentary character.

Figure 1 – Flowchart of selection criteria for scientific productions – Salvador, BA – 2016.

Figure 1

Source: Research Data

RESULTS

From the reading and analysis of the abstracts, 21 studies of the nursing area on multiprofessional residency and in the professional health area were selected. Of these, 10 (47.61%) correspond to articles, three (14.28%) to Theses and nine (38.09%) to Dissertations. These studies are mainly from the South region, followed by the Southeast Region, according to figure 2, which portrays the publications by Brazilian geographic region.

Figure 2 - Distribution of publications by geographic region – Salvador, BA – 2016.

Figure 2

Source: Research Data

Figure 3 shows the year of publication of articles and the year of the defense of Theses and Dissertations. It is noteworthy that in 2015 four articles (19.04%) were published on the subject, representing the largest quantitative in temporal analysis.

Figure 3 - Distribution of articles, theses and dissertations according to year of publication / defense – Salvador, BA – 2016.

Figure 3

Source: Research Data

Regarding the thematic category of the studies, three articles (30%) and five theses and dissertations (45.45%) addressed the theme "Human Resources for the Health System". The thematic distribution of the other studies can be visualized in figure 4.

Figure 4 - Distribution of thematic categories by type of study – Salvador, BA - 2016

Figure 4

Source: Research Data

DISCUSSION

In this review on the production of nursing knowledge on multiprofessional residency and in the professional health area, it was verified that the theme is more approached in articles, mainly from the South and Southeast regions of Brazil. In the temporal analysis, the years of 2009 and 2015 stand out with greater quantitative of publications. Regarding the theme, the training of human resources for the health system was largely explained.

The production of articles on residence is greater when compared to the production of theses and dissertations on the subject. However, it is important to emphasize the linkage of these types of studies, since articles allow for the facilitated disclosure of investigations carried out for the elaboration of theses and dissertations of postgraduate students. In the present study, however, it was identified that only four of the articles found were thesis or dissertation clippings, which leads us to question what has been the product of the theses and dissertations developed in the postgraduate course in Brazilian nursing and how the disclosure of these works supposedly shelved occurs, since articles are not being produced to facilitate their disclosure.

Nonetheless, postgraduate programs and courses are the major responsible for the production and diffusion of scientific knowledge and identification of advances and setbacks in the different areas of knowledge(8,9,10).

Allied to the Graduate Programs and also knowledge boosters are the Research Groups (RG), which, in 2006, presented the quantitative of 331 in the field of Brazilian nursing. Of these, 14% worked with the theme of nursing education, which includes the production and dissemination of knowledge on multiprofessional residences and in the health professional area. It is noteworthy that 83% of these research groups on nursing education are located in the South and Southeast regions of Brazil(8).

The geographical distribution of these groups is similar to the distribution of Stricto Sensu postgraduate programs and courses, which are concentrated in the above mentioned regions and are insufficient in the North and Central-West regions, reflecting a distributive imbalance. This factor reflects in the academic productivity and can be observed in the present study, since the places of greatest production on the residence were the Regions South and Southeast of Brazil(3,11).

The distributive disequilibrium of Stricto Sensu postgraduate courses may be related to financial issues, such as the greater amount of public investments where the installed capacity of preexisting resources and infrastructure is already considerably high. This logic not only equates to the courses stricto sensu, but also to the lato sensu. Therefore, it is observed that in the proposals to incentive the Multiprofessional Residency there is a significant supply of scholarships in the Southeast Region, composed of metropolises such as São Paulo, where there is a larger Gross Domestic Product (GDP) and a greater number of courses, thus encompassing high investments(12).

These investments by the Ministries of Health and Education for the Multiprofessional Residency aim at strengthening this model of education in the country, and enable the rapid expansion of the number of programs, as occurred between 2005, the year of its implementation, and 2009. During this period, investments increased, reaching a total value of R$ 178 million between 2007 and 2009. It should be noted that in 2010 the Integrated Multiprofessional Health Residency Program of the Federal University Hospitals network was implemented. For these programs, 500 scholarships were made available at an estimated annual cost of R$ 11 million. In the following year, the number of scholarships for multiprofessional residency doubled, equivalent to 1,193, revealing the expansionist tendency of the programs. This expansion is expressed in the scientific production, observing the increase in the number of publications on the theme over the years(13,14).

Regarding the thematic category, most of the studies reveal that the Residence has gained notoriety in Brazilian production due to its ability to provide specialized human resources for health systems.

These discussions on the training of professionals reflect the concern about the supply of health needs and have been visible in recent decades in the partnership between the Ministries of Health and Education to manage the training of health workers with a view to reorienting education in this area and to bring it closer to the principles and guidelines of SUS(15).

One of the principles recommended is integrality, which aims to break with the reductionist and fragmented bases of care, so the proposals of specializations, such as multiprofessional residency programs, allow the formation of collaborative practices between different health professionals, through interprofessional education(16,17). This specificity was addressed in some studies that sought to understand the limits and potential of multiprofessional residences for interprofessional education, as well as the favorable development scenarios, with a view to reorienting professional training in health as an impact factor to achieve integrality and even contribute to the consolidation of the Brazilian health system(18).

In this sense, some studies found evaluate the results of the residency programs for the SUS and for the professional performance, through the analysis of the methodological strategies, the execution of the programs, the structures of the services and the resources offered. Other research that contributes to the evaluation of the programs, but that were little found in this review are the studies with graduates and preceptors. These studies make it possible to visualize the impact of the curriculum on the transformations of the students and the ways of DOIng of the preceptors, who need to adopt an educational model that surpasses the mere transmission of knowledge(19,20). Thus, this type of research could be more explored, as well as the other thematic categories, which, although relevant, were presented in a timely manner among the studies found.

In the process of elaborating this review, the absence of articles, theses and dissertations on Brazilian residence published in other countries and languages was denoted as a limitation, since the inclusion of such studies could enrich the discussion with the international perspective provided to the model of national residence. Nevertheless, the study is strengthened by highlighting gaps in the literature on the subject, and can support new research that fills the existing gaps.

CONCLUSION

The production of nursing knowledge on multiprofessional residency and in the professional health area is mostly from articles, which are not usually the product of theses and dissertations, which leads us to question how these studies are being disseminated. Nevertheless, production on the subject is linked to the stricto sensu postgraduate programs. These, in turn, are distributed unevenly throughout Brazil, which is also reflected in production, which is higher in the South and Southeast. This imbalance is the result of larger investments where the installed capacity of resources is high. Investments in residence follow this logic and are a factor of visibility of the subject, as observed in the time analysis related to the incentives. Another factor of visibility for the theme residence is its ability to train human resources for health, which is a condition for the consolidation of SUS.

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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 version 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