Teaching the Nursing Process according to YouTube videos: a descriptive-exploratory study

Manacés dos Santos Bezerril1; Maria Eduarda Gonçalves da Costa1; Francisca Sánchez Ayllón2; Adriana Catarina de Souza Oliveira2; Alexsandra Rodrigues Feijão1; Viviane Euzébia Pereira Santos1

1 Federal University of Rio Grande do Norte, RN, Brazil

2 Catholic University of Murcia, Spain

ABSTRACT

Objective: To identify YouTube videos on the Nursing Process as a teaching theme in the national context. Method: A descriptive-exploratory and quanti-qualitative study, carried out with YouTube videos in November 2019, in which the main data identified were posting date and total views, author, video category, participant and content. Results: Among the 23 videos in the final sample, videos were identified in the period from 2016 to 2019, with predominance of the year 2018 (10; 43.9%), nursing professionals (17; 65.3%) as participants, and definition of the Nursing Process (12, 27.2%) as the content addressed. Discussion: Ease of access, existence of video sharing websites, the importance of the Nursing Process, and the development of partnerships between teaching and health organizations enhance the construction of audiovisual tools. Conclusion: The videos explain the concept of the Nursing Process and its stages and display the content through dialogical exposition. 

Descriptors: Nursing Process; Nursing; Teaching; Webcasts; Audiovisual Resources.

INTRODUCTION

The Nursing Process (NP) is a methodological instrument structured in five dynamic and interconnected stages (data collection, diagnosis, planning, interventions and Nursing assessment), which help nurses to develop the care provided to the patient in an organized manner, through critical thinking activities and the recording of essential information(1-4).

In addition, using the NP not only favors and encourages care continuity, but also means a Nursing care model that promotes recognition of the professional practice, optimizes the praxis performed in the services, and encourages the advancement of Nursing as a science(2,3 ).

However, in order for these perspectives to be achieved, it is important that the teaching environments provide the construction of knowledge about the NP in a precise, broad and interactive way, due to the multiple learning styles and for this work instrument to go beyond a work tool, as it encourages a humanistic approach, focusing on a horizontal patient-professional-family relationship, considering values, concerns and desires expressed by the individual to be cared for and the cost-benefit ratio with the activities performed(1,3,5).

Therefore, among the various teaching methods, Digital Information and Communication Technologies (DICTs) stand out, mainly after the popularization of the Internet, as it helps in the interaction between student and professor(2,5-7). 

In the midst of these technologies, videos have been widely used due to the ease of connecting to digital platforms, allowing users to manipulate them according to their time and space, having audiovisual elements that favor better assimilation of more agile knowledge, generate greater autonomy and student motivation, and bring the nuances of the educational-formative context closer to the cyberculture, due to the fact that many students opt for DICTs as opposed to books(6,7).

In this sense, the YouTube video sharing website is currently considered one of the content distribution services with the highest number of views per day, as it allows uploading, sharing, producing and publishing digital videos without the need for rigorous screening, in addition to being sources of research and studies by Nursing students and professionals, mainly due to the easy access to data(6-12).

Thus, it is indisputable to identify the materials that are conveyed by this media, especially those related to health and education, due to the fact that several products do not undergo a critical analysis with a deep theoretical basis and are idealized/constructed by lay people and/or not trained to transmit certain information; therefore, there is the probability of reflecting wrong actions/thoughts that may interfere negatively in the work performed by the Nursing professional and in the construction of knowledge(6-13).

Furthermore, it is important to emphasize that Nursing is the category of work in the health services with the largest contingent of workers, as it involves both nurses and nursing technicians, who, despite having some distinct attributions regarding the NP, need to be familiar with its meaning, objective and practice, in order to potentiate such tool in the different health-related areas, considering their complexity levels(2-4).

Such being the case, a screening of existing videos on YouTube about NP teaching becomes relevant in view of indicating possible inconsistencies that may replicate a deficient teaching-learning process, either at the mid/technical and/or higher level, and improve suggestions of contents on the NP with methodological rigor.

Therefore, this study seeks to answer the following guiding question: Which videos on YouTube address the Nursing Process as a teaching theme in the national context? And its objective is to identify YouTube videos that address the Nursing Process as a teaching theme in the national context.

METHOD

A descriptive-exploratory study with a quantitative and qualitative approach(14), carried out on the YouTube videos website (www.youtube.com) due to being a search and sharing site with considerable access among Internet users(9,10,13).

For the scope of the proposal, a research protocol was structured with the following stages: definition of the theme, objective and guiding question; search strategy; video analysis; data extraction and presentation of the main results(7,8,13,15) .

The search took place on November 28th, 2019 from the combination of the following Descriptors in Health Sciences (Descritores em Ciências da Saúde, DeCS): “teaching” and “nursing process”. Although YouTube is a social network, the choice of such terms to capture the material in evidence was due to the configuration of words that facilitated the identification of the videos.

In addition, despite the fact that there is an important issue in the national territory between the definition of the terms NP and Systematization of Nursing Care (SNC), the NP was chosen for being the focus of this research.

It is worth noting that there was no time frame and that no filter available on the research site (upload date, type, duration, characteristics and/or relevance) was applied, with the premise of covering the largest number of videos available.

Consequently, the links to the videos found were selected, and then they were organized in a Microsoft Excel 2016 spreadsheet for further analysis, considering the continuous addition of material in the investigated locus, in addition to allowing the researchers unrestricted access to view the same video several times, and at different times.

The sample of this study consisted of the videos selected on the YouTube audiovisual material sharing website according to the eligibility criteria. 

Videos that addressed the theme under study, in the Portuguese language, were included; because the focus is on NP teaching at the national level, regardless of their duration (short: less than four minutes, long: more than 20 minutes) and target-audience (mid/technical level students, undergraduate or graduate students, and/or Nursing professionals). Duplicates of no educational nature and those with commercial content were excluded (Figure 1).

Regarding the nature and/or quality of the videos, the principles adopted in similar research studies(11,12) were followed, since there is no specific tool for such evaluation.

Figure 1 – Process for searching and selecting videos about the Nursing Process on the YouTube website. Natal-RN, Brazil, 2019

Source: Research data, 2019

The videos were collected and analyzed individually by the research collaborators, who also filled in the checklist and, in case of disagreements, a third component carried out the evaluation. 

The material was analyzed according to the indicators found in a checklist developed by the researchers for data tabulation, adapted from instruments that were validated and used in research studies(7,8,10,13,15,16) of a similar nature in order to standardize the extraction of information. 

The elements that make up the checklist for data extraction are as follows: posting date and total views (indicated in the video description); video duration (in hours, minutes and seconds, as indicated by the time stamp); author (the party responsible for the posting: individual, company or agency); category (according to the YouTube classification: Education, People and Blogs, Entertainment, News and Politics, Games, Animation and Music); participant (individual who participated in the production of the video: nurse, teacher, student, among others); content approach (it describes all stages of the NP or just one, concept, historical aspects, relationship and/or dissociation of the SNC); and methodological characteristics (if there is indication and/or availability of the bibliographic sources, didactic-pedagogical techniques/tools used). 

The data were organized and tabulated in a simple descriptive manner, according to absolute and relative frequency. As it does not directly involve human beings and is material in the public domain, no Research Ethics Committee (Comitê de Ética em Pesquisa, CEP) appreciation was necessary.

RESULTS

The 23 (100.0%) videos composing the final sample obtained 888,418 views with a mean of 38,627, a total duration of six hours and nine minutes, and a mean of 15 minutes per video. As for the time dimension, they were published from 2016 to 2019, with predominance of the year 2018 (10; 43.9%), followed by 2019 (06; 26.0%), 2016 (03; 13.0%) and 2017 (03; 13.0%); it is noteworthy that, in one (04.1%) video, the posting date was not informed.

The Education category stood out (16; 65.2%), immediately followed by People and Blogs (05; 21.7%), Entertainment (01; 04.1%) and News and Politics (01; 04.1%). Among the authors responsible for the dissemination of media content, Physical Individual (19; 82.6%) and Entity (04; 17.4%) were evidenced and, in this last classification, institutions such as the Federal Nursing Council (Conselho Federal de Enfermagem, COFEN), the São Paulo Regional Nursing Council (Conselho Regional de Enfermagem de São Paulo, COREN-SP) and a partnership between the Nursing School of the Federal University of Minas Gerais (Universidade Federal de Minas Gerais, UFMG) and the Technical Nursing Vice-Directorate of the Clinical Hospital (Hospital das Clínicas, HC/MG) were identified.

With regard to the profile of the participants in the production of the videos, the presence of professionals (17; 65.3%), teachers (08; 30.7%) and students (01; 04.1%) was observed; it is worth noting that one person is present in more than one video. As for the content of the topic addressed (Table 1), six categories emerged, of which more than one was present in the same video; it is for this reason that the total number is greater than 23.

Table 1 – Contents addressed in the videos about the Nursing Process on the YouTube website. Natal-RN, Brazil, 2019

Source: Research data, 2019.

1Nursing Process; 2Systematization of Nursing Care.

Chart 1 displays the methodological characteristics of the videos selected for the final sample of the study regarding title, bibliographic source and teaching tools/techniques.

Chart 1 – Methodological characterization of the videos about the Nursing Process selected on YouTube. Natal-RN, Brazil, 2019

Source: Research data, 2019.

DISCUSSION

Ease of access to the information through the Internet and the existence of video sharing websites, added to the importance of the NP and the need for further study on this topic, are aspects that justify the high number of views regarding health/education content on the YouTube search site(5,6.10-12).

The fact that the publications comprehend the time frame from 2016 to 2019 reflects the fulfillment of the current profile of 3.0 students and their multiple ways of learning, which plays a more active role in their learning process and in a multidirectional way(16-18 ).

Given this perspective in the didactic-pedagogical process, the Education category was the most evidenced, indicating that, although YouTube offers several options to classify the video to be posted - which which has a direct repercussion on the consumption level of this material, since those related to Music, People and Blogs, Entertainment, Games, Cinema, Animation and Music are the most accessed - those responsible for the material are willing to spread knowledge(8,15,18).

In this sense, it is important that those responsible for making these media available and sharing them have a plausible understanding of what is produced and distributed as information to be apprehended and/or replicated by other people, especially with regard to data linked to health, due to directly involving the well-being of a particular individual or community(5,6,9,11,12,15,16,18-20).

Therefore, such notes are translated due to the fact that a Physical Individual is the main creator of the material, as well as the Nursing professionals are identified in the role of participants in the videos. 

Nevertheless, it is relevant to emphasize the existence of materials prepared by entities such as the labor class councils (COFEN and COREN-SP) and educational and assistance institutions (UFMG and HC/MG), which corroborates with a study(18) carried out in the United States of America (USA) when asserting that both professionals and health organizations show concern with the truth and quality of the messages transmitted on platforms such as YouTube.

Thus, it is perceived that these concerns about the characteristics of the videos have promoted steps to analyze this type of material, plan and build audiovisual content with topics of interest to health students and workers, as well as to patients and family members with some chronic disease, based on scientific evidence(6-9,11-13,15,16,18,20,21).

Amid the existing tools that enhance such an initiative is SQUIRE-EDU (Standards for QUality Improvement Reporting Excellence in Education), which stimulates the development and improvement of educational innovations, especially those directed to health professionals regarding clinical care, given the complexity of the care context that requires critical, reflective and systemic thinking(20).

Furthermore, it is indispensable to have partnerships between teaching/research centers and the health services, since the YouTube sharing website is the most known/accessed and the NP is one of the ways to meet one of the points set forth in the National Curricular Guidelines (Diretrizes Curriculares Nacionais, DCNs) for Nursing courses, with regard to the training of qualified and capable Nursing professionals to intervene in situations that promote the integral health of the patient in line with the principles of the Unified Health System (Sistema Único de Saúde, SUS)(2,3,22,23).

With regard to the content addressed in the selected videos, there was a significant number of explanations about the concept of the NP and the difference with the SNC, which can indicate doubts and/or disagreements regarding the real meaning of this term, although it is already defined in the literature as a structured methodological instrument that helps nurses to develop continuous patient care(1,2,4,5).

The description of the component stages of the NP constitutes something fundamental to indicate the correct structure, clarify the procedural dynamics and, therefore, allow continuous assistance. On YouTube, these aspects are worked on with a colloquial language, which encourages better assimilation of learning, but which can cause negative effects if scientific content is lost for not using the technical terms, for example(2-5,7-10,15).

When presented separately in some videos, the NP stages are discussed in more detail, focusing on each of their peculiarities, from how to execute them to which instruments can assist in their applicability (books, questionnaires, software programs).

In other cases, the NP stages are addressed independently, as they are a series of videos published by the same individual/user account at different moments, which, in addition to being common on the YouTube sharing website due to promoting expectation and maintaining the viewer's interest in the channel in question, they also enable the construction of a growing and knowledge-based understanding that can be expanded by other data sources, which can demonstrate the active interest of the subject who seeks this content, be it a student in training or even a professional who seeks to update their knowledge(9,10,13,16).

That said, it is evidenced that the disclosure of this information on YouTube, in its turn, allows sharing knowledge, perceptions and experiences from different geographical locations with specific characteristics that can assist in the insertion of the NP in the health services that do not yet have used it(1-3,5,6,8,11,12).

Given this setting, although few in numbers, the videos that reflect on the applicability of the NP are extremely important, as they raise discussions about the difficulties of its implementation and the benefits that its applicability can promote.

Among the weaknesses for carrying out the NP in the health organizations, the videos highlight lack of knowledge about the NP, its stages and objectives by the Nursing professionals; resistance by some individuals to its applicability in the practice, as they consider it another bureaucratic activity that can harm the assistance provided to the patient; absence of managerial support in educational actions to update/recycle knowledge and/or collaborate in implementing the NP in sectors of the institution in a horizontal and standardized manner, among others. 

In relation to the strengths, the videos highlight care continuity and uniformity in a safe and qualified way; the promotion of a unique, scientific language that promotes the visibility of Nursing as a profession and an an important field of science in the health area; they certify the actions performed by the Nursing team; and constitute a legal registration device in cases of legal/bureaucratic processes.

When worked within the scope of teaching-learning follow-up, such media can awaken expanded thinking in the students, in order to urge them to consider whether the NP is used in the health centers, how that happens, what the barriers are that prevent its use in full, and what strategies can be devised to change such situation(6-8,18,19,21).

Regarding the methodological characterization of the videos, it was verified that the majority used resolutions from the COFEN and/or CORENs to present the content of the NP in relation to the concepts, description of stages and attributions to the members of the Nursing team, in addition to the taxonomies used to list diagnoses, plan interventions and evaluate outcomes, through the North American Nursing Diagnosis Association (NANDA), Nursing Interventions Classification (NIC), and Nursing Outcomes Classification (NOC), respectively.

Thus, the importance of disclosing the references used in the production of the videos is emphasized, generally mentioned in the description, as it suggests that there was at least a theoretical basis for their production, directing the user to the information source in order to seek greater clarifications and, in case of disagreements, there is a field for comments to report questions and/or suggestions(11,12,15,18-20).

Amid the teaching techniques/tools applied for the explanation of the content, dialogical exposition was expressively identified, since many students seek in these audiovisual classes a way to advance and/or concretize the knowledge learned in the classroom, as an alternative way of understanding through a different language, which meets the profile of the 3.0 student(10,13,16,17).

The association of interactive illustrations, diagrams and mental maps with the exposures made in the videos was also perceived, in order to constitute a complement to the explanation of the NP, in the scope of meeting the needs and learning peculiarities of each individual who searches for this type of material because, for some, knowledge is better acquired from images and graphic elements(7,8,15,18).

The videos also displayed the resolution of clinical issues and cases as mechanisms to teach the NP, so it is suggested that there is stimulus in the student's clinical, critical and reflective reasoning, in addition to indicating to these subjects what the gaps are in understanding what they have and which needs are to be optimized, as well as preparing them for practical situations in the health services(1,6,9,10,16).

It is worth noting that, in some materials that compose the final sample, the video producer chose to address the NP subject matter through an informal conversation, in order to expose concerns, doubts and/or answer some questions made by third parties on their social networks, based on their personal experiences and perceptions, several times.

Therefore, the idea of the quality and source of the material available on YouTube is resumed since, as it is accessed by students in training and that, in most cases, these individuals have no scientific basis to carry out a critical analysis of the video, they take it for granted that all the reports transmitted are true, even when they are not consistent with the research theme(5,6,8,11,12,18-20).

In addition, the importance of widely using SQUIRE-EDU is noted, as this tool encourages improvements in scientific research in favor of the health professionals, on the premise of describing the educational gap of these individuals; consider the impacts of optimization on educational qualification; and be faithful in the description of the interventions(20).

Therefore, when considering such aspects, videos number 01, 02, 03, 10 and 20 are suggested as materials to be used in the educational follow-up of Nursing courses and/or indicated as supplementary content, in the scope of attending to the various learning profiles and addressing the NP in an assertive manner. The others present limitations of bibliographic and/or didactic-pedagogical sources that can negatively interfere in the students' training process. 

As limitations of the research, the impossibility of obtaining the exact number of videos available on the YouTube search site is pointed out by the absence of this information in the medium itself, since this number was manually counted by the researchers, in addition to the need to rethink about the available filters, in order to make not only a more precise selection feasible, but also greater control over the quality of the videos posted.

CONCLUSION

It became evident that the videos about NP teaching found on YouTube predominantly explain the concept and its stages, have the COFEN resolutions as their bibliographic source and present the content through dialogical exposition.

In addition, this study contributes to the reflection on the YouTube proposal of constituting itself as a social network with wide access and multimedia reach, in order to raise early and horizontal dialogs between Nursing professors and students in training about the indications of quality materials from that data source.

In addition to encouraging the construction and evaluation of educational innovations that can optimize teaching and learning not only in the training process but also in continuing/permanent education for health professionals working in health care services, in order to enhance the care provided with greater safety and quality. 

This is because, if there is no screening and criticality towards the authorship sources and the contents covered in these resources, there is the possibility of inconsistencies in the didactic-pedagogical follow-up in Nursing; therefore, they have direct repercussions in the activities developed in the practical fields of performance, whether as a student in training or as an active professional.

Therefore, the importance of studying and developing the NP is reinforced through various means, including videos, which require a more rigorous analysis from planning to posting. In addition, it is suggested to elaborate similar papers contemplating other educational themes and which, as the NP, have the scope of optimizing the care provided to the patients, in order to favor care continuity, safety and quality.

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AUTHORSHIP CONTRIBUTION

Conception of the study: Bezerril MS, Costa MEG.

Data collection: Bezerril MS, Costa MEG.

Data analysis and interpretation: Bezerril MS, Costa MEG, Feijão AR, Santos VEP.

Discussion of the results: Bezerril MS, Costa MEG.

Writing and/or critical review of the content: Ayllón FS, Oliveira ACS, Feijão AR, Santos VEP.

Review and final approval of the final version: Ayllón FS, Oliveira ACS, Feijão AR, Santos VEP.

Received: 12/19/2020

Revised: 02/18/2021

Approved: 03/18/2021