Introduction

The school is no longer the only space for the development of teaching work, companies, welfare associations, hospitals, among others, are places that increasingly demand spaces for teaching. Thus, the diversity of these environments require pedagogical practices that take into account the needs and specificities of the public found them.

The educational care in hospitals, the object of this research, occurs in hospital classes and, depending on the physical conditions of the student / patient, may also occur in the beds.

This service is characterized as a teaching modality that aims at the continuity of the learning process of every child and adolescent who is in the schooling phase and who, due to illness, is hospitalized or undergoing health treatment, thus moving away from school routine.

Brazilian legislation supports and legitimizes the right to education for all children and adolescents, including those who are hospitalized or hospitalized. Among them, the following stand out:

All these laws guarantee hospitalized children and adolescents the right to continue their schooling and especially the interaction with education, guaranteeing them hospitalization in a more humane place, with games, studies and bonds of affection, making this space diverse, supportive and conducive to learning also.

Pedagogical Assistance in Hospital Environment is understood as a special education modality, as it assists children and adolescents with special educational needs in specific health conditions and limitations (BRASIL, 2002), which, as a result of hospitalizations and / or medical treatments, are temporarily prevented from attending regular school. Therefore, at this time it is considered a child or adolescent with special educational needs.

According to ^{Melo and Lima (2015}), one of the challenges that stands out in Hospital Pedagogy is the lack of qualified professionals to work in the Hospital Class. Because, according to the Ministry of Education (BRAZIL, 2002), the teacher who works in this area must be trained to work with human diversity, with different experiences, to propose didactic-pedagogical procedures and alternative practices necessary to the teaching and learning process of hospitalized students and to plan and develop structured and flexible activities, respecting the student's personal rhythm and clinical status.

In this sense, when attending a hospitalized child or adolescent, the pedagogical practice must differ from the school routine, and for that, it is necessary that there are trained and prepared professionals to work in this field. Thus, as a methodological approach, some questions were raised: Is the initial training course sufficient for the training of the professional who works in Pedagogical Care in a Hospital Environment? Are there really qualified and prepared professionals to develop pedagogical activities in this environment?

In view of this, a study that seeks to investigate these professionals is essential, in order to reflect on the role and challenges of teachers to develop a quality teaching practice in the Hospital Class; as well as contributing to this issue to be expanded, considering that there are academics and education professionals who are still unaware of the Pedagogical Service in the Hospital Environment.

For this, we investigated the formation and pedagogical practices of teachers who work in the Hospital of the University Hospital Class Maria Aparecida Pedrossian - HUMAP, the city of Campo Grande, Mato Grosso do Sul.

Pedagogical Assistance in Hospital Environment: A Pedagogical right

Faced with the need to provide continuity of schooling for children and teenagers hospitalized and/or for some reason of illness, they were removed from the formal scope of the school, the Pedagogical Service in the Hospital Environment appears.

The creation of school classes in hospitals is the result of the formal recognition that hospitalized children, regardless of the period of stay in the institution or any other factor, have educational needs and citizenship rights, which includes schooling (^{AMARAL, 2015}, p. 70).

Thus, the Hospital Classroom was created in order to ensure the continuity of regular teaching contents for hospitalized children and adolescents enabling a return to school after discharge, without jeopardizing their school education and thus seeking to recover the student's socialization through an inclusion process, giving continuity to their learning.

In this way, Pedagogical Care in Hospital Environment has the function of developing a unique pedagogical attention to children and school adolescents who are in hospital care, presenting alternatives that contribute to their learning and well-being, as it is evident the importance of continuing their schooling, so that there is no damage in their learning process and in their school formation.

According to ^{Fonseca (1999}), the first Hospital Class in Brazil appeared in 1950, at Hospital Municipal Jesus, in the city of Rio de Janeiro, it functioned without support and no link with the State and with the Department of Education and was considered nationally as the milestone of hospital pedagogy. However, in this period, students who went through illnesses that forced them to leave school, were submitted to the continuity of learning without the minimum conditions and opportunity, often resulting in failure, dropping out, or even sometimes in approvals without the necessary knowledge, which would be required in the next school year, thus significantly impairing the student's learning process.

According to ^{Matos (2014}), the second Hospital Class emerged in 1960, also in the city of Rio de Janeiro, but, like the first Hospital Class, this one also had no support and no link with the State and with the Department of Education. The health professionals observed the cognitive need that hospitalized children had for a long time and then began to carry out educational actions on their own, with the support of the hospital's management and staff.

Since then, the pedagogical assistance that occurs in favor of the right to education of hospitalized children and adolescents. From 1988 it became part of a process of redemocratization expressed in the Federal Constitution, which considers education as a right for all (BRAZIL, 1988). But even so, it took many years for the authorities constituted for the exercise of education were compelled to accept and standardize the Hospital Class.

Only in the 1990s, in Brazil, specific laws were created for the Hospital Class, among them the Child and Adolescent Statute, in particular, article nine, which deals with the right to education: “Right to enjoy in some way recreation, health education program” (emphasis added) (BRASIL, 1990).

In 1995, the Law on the Rights of Hospitalized Children and Adolescents was passed, through Resolution no. 41 of CONANDA - National Council for the Rights of Children and Adolescents and, thus, hospital educational action gains more strength and visibility, appearing on the national scene with the status of legislation, stipulating that the hospitalized student must receive psychological support, when necessary, and he must enjoy some form of recreation, health education programs and monitoring the school curriculum, according to the cognitive phase, during his hospitalization (BRASIL, 1995).

In 1996, the hospital class was inserted in the (Law of Guidelines and Bases of National Education (LDB) through law n. 9.394/1996 as special education, in a vision of inclusive education, as a modality of School Education, with specific resources and procedures for the teaching and learning process available to students with special needs, with respect for their differences, so that they have access to the curriculum and, consequently, achieve their social integration. Thus, in Article 58, paragraph 2: “Educational assistance will be provided in classes, schools or specialized services, whenever, due to the specific conditions of the students, it is not possible to integrate them into the regular classes of regular education” (BRASIL, 1996).

In 2001, the National Council of Education (CNE), dealt with the mandatory provision of Hospital Classes, in article 13 of Resolution no. 02, indicating that the education systems, through an integrated action with the health systems, should organize specialized educational assistance to students unable to attend classes, due to health treatment, which implies hospitalization or outpatient care (BRASIL, 2001).

In 2002, the Ministry of Education (MEC) published a document with the title Hospital Class and Pedagogical Home Care: strategies and guidelines. In this document, the principles, objectives and forms of organization and administrative and pedagogical functioning of the hospital classes and home pedagogical care are found (BRASIL, 2002). This document aims to encourage the creation of hospital and home pedagogical care, guaranteeing education for regular school students who are hospitalized as follows:

Hospital classes and home pedagogical care must develop strategies and guidelines to enable the pedagogical-educational monitoring of the process of development and construction of the knowledge of children, young people and adults enrolled or not in regular education systems, within the scope of basic education and that are unable to attend school, temporarily or permanently, and guarantee the maintenance of the link with schools through a flexible and / or adapted curriculum, favoring their entry, return or adequate integration with their corresponding school group, as part of the right to comprehensive care (BRASIL, 2002, p. 13).

It is understood, therefore, that the hospital class as the educational pedagogical assistance in health treatment environments for children and adolescents of school age who are hospitalized, hospitalized or not and who are unable to attend school. In this sense, the Hospital Class goes far beyond a simple classroom space inserted in the hospital environment. It is a type of service that is part of Special Education, as it deals with a differentiated pedagogical service, in which the role of the educator must both meet the educational needs of the child or adolescent as well as respect the personal rhythm and the clinical status of the same.

A survey carried out by the authors ^{Ohara, Borba and Carneiro (2008}), points out in a survey carried out, in 2005, on the functioning of hospital classes in Brazil, recorded that 99 hospitals had installed hospital classes, distributed as follows by region: Northern Region = 7; Northeast Region = 10; Center-west Region = 18; Southeast Region = 47 and South Region = 17.

More recently, in a study presented by ^{Fonseca (2015}), the author accounts for a total of 155 hospital classes in operation in Brazil, being distributed as follows: North Region = 10; Northeast Region = 26; Center-west Region = 26; Southeast Region = 64 and South Region = 29. As for enrollment in hospital environments, National Institute of Educational Studies and Research Anísio Teixeira (INEP) data reveal an evolution in the country between 2013 from 18% to 38.2% in 2017, being that of this total, 25.2% of enrollments were in Elementary School (Censo Escolar Mec, 2017).

From these surveys we saw that in our country there was a significant increase in the creation of Hospital Classes, but this number is still very small if we consider the immensity of the Brazilian territory. Pedagogical Assistance in Hospital Environments should exist in all hospitals that serve children and adolescents, because, according to the current legislation, it constitutes the right of every hospitalized student, prevented from attending regular school, and also, as previously mentioned , from the year 2001, the National Education Council (CNE) made it mandatory to offer Hospital Class in hospitals that attend school-age children and adolescents who are unable to attend school due to health treatment that implies hospitalization or outpatient care (BRASIL, 2001).

Both educational care in the hospital environment and home pedagogical care must be linked to education systems as a pedagogical work unit of the State Offices, Federal District and City Education Departments, as well as to the clinical directions of health systems and services in that are located (BRASIL, 2002). Articulated work for quality care that provides the hospitalized child/adolescent with the least possible damage to their learning process, enabling equal conditions for access to knowledge, as well as access to school and permanence in it (BRASIL, 2002).

The performance of the teacher and his pedagogical practice in Pedagogical Assistance in the Hospital Environment

The performance of the teacher and his pedagogical practice is not restricted only to the school environment, but also in other environments, such as in hospitals. In this environment, the teacher works in the Hospital Class, with students temporarily away from the regular school, due to hospitalizations and / or medical treatments and who are in a weak state of health and with special educational needs.

The performance of this professional and the pedagogical mediations performed by him, especially in the pedagogical monitoring of children and adolescents in situations of hospitalization or health treatment, differs from the pedagogical practice performed at school. In this sense, ^{Rodrigues (2012}) warns us that in the hospital environment:

We cannot just use the same strategies used in the regular classroom, this is not possible due to its peculiarities, which requires the teacher to have a flexible work posture and to be able to deal with diversity on a daily basis, to be able to evaluate in a short term, if the student at that time (regardless of age) has physical and psychological conditions to participate in educational pedagogical activities promoted by the teacher, thus respecting the learning time of each individual (^{RODRIGUES, 2012}, p. 88).

Therefore, the hospitalized student requires different treatment methods from regular education, making the Education professional who works with him take into account his hospitalization and act flexibly according to his needs and limitations.

According to ^{Matos and Mugiatti (2009}), educational assistance in the hospital environment requires, due to its specificity, qualified and competent professionals, thus launching a real challenge to Pedagogy courses and other degrees, to base their curricular proposals based on research and multidisciplinary, interdisciplinary and transdisciplinary scientific practices in hospital contexts.

^{Silva (2015}, p.51), points out that “reflecting on the role of educators in hospitals has been a very delicate issue in the recent past”, and to discuss it, is somewhat challenging and divergent, given the lack of a specific initial training for the professional to work in this area. In the perspective of ^{Custódio (2017}), for the Hospital Class service to continue to be carried out and consequently bring good results, it is necessary that, during the initial training, professionals have access to the knowledge inherent to educational care in the hospital environment and perceive it as a possible and necessary field of action.

The training in Hospital Pedagogy is, therefore, very necessary for the performance of this professional, as they are professionals who need to be prepared to perform functions in a different context from the school. In a study by ^{Barros (2007}), the author notes that the lack of training to prepare these professionals for entry into the hospital field is a negative issue for their permanence and/or satisfactory performance in this field.

The document entitled, "Hospital Class and home pedagogical care" (BRASIL, 2002) is an attempt to structure actions for organizing the educational care system outside the school context, proposing strategies and guidelines for pedagogical care and highlights that:

The teacher should have pedagogical training preferably in Special Education or in Pedagogy or undergraduate courses, be aware of the diseases and psychosocial conditions experienced by students and the characteristics arising from them, whether from a clinical point of view, or from an affective point of view. (BRASIL, 2002, p. 22).

Thus, to perform this role, the teacher must be able to deal with the constant changes in the plans, adapting them to each situation, and to each student, taking into account the affective, clinical and social moment that the child or adolescent is in, before insisting on carrying out any task. To this end, it is necessary to have creativity and sensitivity to face difficulties and find the necessary means to overcome them.

Thus, the performance and practice of the teacher in Pedagogical Care in a Hospital Environment are related to a humanistic view, which thinks of the student / patient as an integral being, with physical, psychological and social needs, thus, the teacher must develop a humanized work that meets the difficulties of these children and adolescents, providing the opportunity to carry out the educational process and, above all, it is necessary that the teacher knows the reality of the student, observes their performance and proposes activities that are consistent with their knowledge, in addition to stimulating, thus providing a meaningful learning to the internal students.

In this sense, consequently, it is necessary that the teacher of Pedagogical Assistance in a Hospital Environment be subjected to an appropriate training and psychological preparation, to carry out an educational work appropriate to the peculiar conditions of a hospitalized student. Thus, it is necessary that he also have access to prior information in relation to the health status of this student, as such information is fundamental considerations that will serve as a basis in the preparation of the planning and in the performance of his attendance.

Pedagogical Assistance in the Hospital Environment of the University Hospital Maria Aparecida Pedrossian

The Maria Aparecida Pedrossian University Hospital in the city of Campo Grande, was the pioneer in Hospital Class care, in the state of Mato Grosso do Sul, starting this service around 1989. At first, informally, in order to ease the idleness and suffering of those who were hospitalized there.

In 1994, a Group of Psychologists and Psychopedagogists, linked to the State Department of Education - SED/MS, began to develop a school attendance project, in a targeted manner. The service was aimed at elementary school students from the Initial Years, 1st to 4th grades, with an emphasis on literacy and learning through integration for inclusion. In 1997, this same group of professionals was being complemented with the arrival of new teachers for attendance, who together started to attend the Elementary School Early Years and Final Years, 1st to 8th grades.

In 2005, again, the group was complemented, this time with the arrival of Chemistry, Physics and Biology teachers, to attend high school. Today, educational assistance in the hospital environment is still linked to the State Department of Education - SED/MS, its teachers are based in the Vespasiano Martins State School, and follows pedagogical guidelines from the State Center for Special Inclusive Education (CEESPI) and assists all children in school age admitted to any wing of the Hospital, be it child education, elementary school, high school or youth and adult education.

At the Maria Aparecida Pedrossian University Hospital, the care of the Hospital Class is not restricted only to students in the capital, but to everyone of school age, regardless of where they live or study, since in the hospital individuals from all municipalities in the state of Mato Grosso do Sul, including from neighboring countries.

Methodological aspects of the research

This work is the result of a research developed in the Group of Studies and Research on Education and Human Development (GEPEDHI), of the Federal University of Mato Grosso do Sul. It was developed through the qualitative methodology, based on the socio-historical approach. ^{Bogdan and Biklen (1994}, p. 11) claim that qualitative research emerged from a field initially dominated by measurement practices, the development of tests of variable hypotheses etc., a field from which “[...] to contemplate an investigation methodology that emphasizes description, induction, grounded theory and the study of personal perceptions”.

Participants

Members of the GEPEDHI study and research group participated in the data collection work for this research, together with the guidance of the research coordinator. And, as subjects of the research, 3 teachers and 1 coordinator of the Hospital Class of the Hospital Universitário Maria Aparecida Pedrossian (HUMAP), from the city of Campo Grande, state of Mato Grosso do Sul, participated, with authorization from the Ethics Committee of Plataforma Brasil under CAEE nº 62205216.6.0000.0021, after signing the Informed Consent Form.

Material

The material used for the elaboration of this work was primarily bibliographic articles related to the research line: “Education, Health and Pedagogical Practices'', in the meetings of the Study and Research Group on Education and Human Development (GEPEDHI), which goes through the contributions of several authors , such as: ^{Ceccim (1999}), ^{Fonseca (1999} and 2015), ^{Matos (2014}), among others; what according to ^{Prodanov and Freitas (2013}) served, as a first step, to know in what state is the problem to which we refer; and subsequently a field investigation that began in October 2017, carried out in loco, together with the guidance of the coordinating research professor and collaboration of members of the study and research group - GEPEDHI, where systematic observations were used as research material, semi-structured interviews constituted with questions to the professors who work there and records in “logbooks'' (notebooks), which according to ^{Bogdan and Biklen (1994}, p. 150) serve for “[...] written account of that that the researcher hears, sees, experiences and thinks in the course of collecting reflecting on the data of a qualitative study”.

Procedure

The field investigation, carried out in loco, was divided in two moments. The first moment was carried out by 3 members of the study and research group - GEPEDHI, from October to December 2017. And the second moment, by 3 other members of the same group, from April to November 2018. All data collected, both in the first moment, and in the second moment they collaborate for the execution of this work.

Final considerations

This research made it possible to understand that teaching work in the hospital context is fundamental for the development of hospitalized children and adolescents, giving them the opportunity to continue their schooling, offering them a more human service and ensuring that the learning process, so important for our life, do not exclude yourself in the hospital context.

We saw that this work in hospital environments is a service that already has legal support, through legislation that legitimizes the right to education for all children and all adolescents, including those who are hospitalized.

The routine of a child or adolescent during a period of hospitalization certainly changes, and it is certainly not one of the most comfortable and pleasurable changes in the lives of these individuals, since there is a distance from their home, their family life, school, of friends. In this sense, the Pedagogical Service in a Hospital Environment has the function of filling a little of this need that affects them, and also directly benefiting the intellectual issue during hospitalization, providing the uninterrupted construction of their learning.

With the answers we obtained in the interview we conducted with the teachers, we concluded that only the initial training is not enough for the training of the professional who works in the hospital class, so much so that they seek training and specialization courses in the area, and one of the minimum requirements for them to work in the field is the specialization course in Special Education. That is, for quality care, teachers need to seek preparation that was not available in their initial training.

However, we note that there are qualified professionals prepared to work in Pedagogical Care in a Hospital Environment, proof of this are the Teachers of the Hospital Class of the Hospital Universitário Maria Aparecida Pedrossian, in Campo Grande/MS. We emphasize, however, that these are qualified and prepared because they sought and continued to study after their initial training.

In this sense, this research contributed not only to understand the role of the Hospital Class teacher, but also to reflect on the importance of further studies and research on the Hospital Class in the curricular structures of universities, as this is one of the possible and important fields teaching performance. And, the teacher is a fundamental element in the pursuit of teaching quality. However, it is necessary to be a professional with qualified training and who critically understands his role in the educational context; This context, as this study showed us, can be inserted in diverse environments, including in hospital institutions.

One of the elements that strongly contributes to a quality practice is theoretical knowledge, because as stated earlier¸ when we take ownership of theoretical foundations, we benefit from various points of view for decision making within a contextualized action, acquiring perspectives of judgment for understand the different contexts of everyday life. Thus, it is necessary that future professionals of Pedagogical Care in a Hospital Environment have access to the theoretical foundations of the Hospital Class since their initial training, since the hospital context presupposes that professionals are trained and that they understand the peculiarities of this environment. In this sense, teacher training universities must prepare themselves to train professionals for a more comprehensive scenario, as the teacher's performance has not only occurred in the school context, it extends beyond the school.

Thus, this work allowed us to reflect on how the education professional, "trained", "able" to work in his training area "faces" working in the Hospital Class: As a challenge!