Knowing What the VHL is About Training, Care and Nursing

The first source of consultation that focused on was the Virtual Health Library. Initially, the search terms/words had to be adapted. This is because the scientific production in health relies on the Health Sciences Descriptors (Decs), which are requested by the journals when the authors submit the articles to them. Thus, the following Decs correspond to the terms previously elaborated: "Education in Nursing"; "Nursing Care"; "Bachelor’s Degree in Nursing". The findings obtained will now be described.

Initially, the following term was entered in the VHL: nursing education, being obtained 111,199 publications; another term was associated: nursing care, being 39,887 publications. Even so, there was still a large volume of articles, so the word Bachelor of Nursing was associated with the search, and 1,971 articles were obtained. From then on, the latter was refined, since this database has filters to refine/specify the research; we used the country of Brazil, with nine articles, which summaries were read and seven articles were selected, because they were related to the subject. Two were discarded because they relate to the nurse’s other work processes: managing and educating. It should be emphasized that this criterion of refinement per country was used in order to select articles dealing with the Brazilian reality.

Then, the expression was used: nurse training for care, obtaining 122 publications and refined from the region of Brazil, remaining 13 articles, whose reading of the abstracts identified three articles related to the subject studied. The others were rejected for dealing with the training in the scope of postgraduate (six) and residency (four).

The research was continued combining, now, the descriptors in Health Sciences: health institutions and nursing students, finding 59 articles. When refining the search for the subject: Bachelor’s degree in Nursing and country Brazil, no article was identified. Then, we combined the practical descriptors, health institutions and bachelor’s degree in nursing, being found 21 articles; after the refinement by the country Brazil, two articles remained, which, after reading the abstract, did not fit the theme of this research, because they also reported training at the level of residence and postgraduate.

By associating the terms: concept of care and nurse, twelve articles were identified, which, after reading the abstract, three were related to the study theme; the others were disregarded for dealing with the use of technologies in Nursing (five) or the carrying out of procedures in a specific area (four), and not a conception of care.

Later, the expressions were combined: concept of care and Nursing, being identified 107 articles, of which five were selected; the others dealt with the performance of care to specific pathologies (47); hospital procedures (23); the nurse’s managerial practice (21) or on the field of scientific research in Nursing (11).

After performing these searches in the VHL, a total of 18 articles were selected to integrate the Question State, being distributed in this way:

Chart 2, presents, in a systematic way, all the articles found:

Of the 18 articles selected to compose this State of the Question, most, i.e. 10 papers, deal with the nurse's training for Caregiving, from different perspectives: the relationship between professional user, knowledge approached in this formative process, the role of the teacher, among others.

^{Carvalho (2009}) begins to address this theme by explaining that Nursing should not be guided only by theoretical and scientific principles, but should be concerned with the conception of reality and the situations in which it intervenes. This process must begin with Nursing care, so that it does not have a merely technical conception, but rather values subjectivity, making the subject feel an integral part of the care it produces. And to constitute subjects of knowledge, capable of transforming reality, goes through the educational process.

^{Santos (2004}), in turn, when focusing on the training of the Brazilian nurse from a historical perspective, states that the rites and insignia are used to symbolize the transformation of women into nurses and that this training model, implemented in Brazil in the 1920s, was influenced by the United States. ^{Ayres (2012}), still in this historical perspective, deals with the training of the nurse in the early twentieth century, known as "visitor", highlighting the different conceptions that permeate the meaning of this profession, particularly that of the nurse subordinated to the doctor or, on the contrary, of that professional who should build her autonomy.

^{Barros et al. (2009}), addressing the teaching in the Nursing Course, highlights the insertion of students in the field of practice as one of the most significant strategies for the production of this care in Nursing and the teacher, in the meantime, is configured as a mediator of this process. Other studies also demonstrate (^{CARVALHO et al., 1999}; ^{MOSTARDEIRO; PEDRO, 2011}; ^{RODRIGUES; CULAU; NUNES, 2007}) that, for students to learn how to care, the teacher plays the important role of mediating their insertion in health institutions and the production of this knowledge.

It is interesting that, in this same sense, research conducted with nursing students has shown that the formative process focuses on care, understood beyond the technical procedure, but rather as the purpose of caring for another subject, in a planned and scientifically based manner, based on the bond established (^{FERREIRA; VALLE, 2005}).

Talking about training for care leads to the discussion of the curriculum, which, over time, has undergone several modifications to adapt to social transformations proposed by the Unified Health System (SUS), by the Curricular Guidelines for Nursing, in addition to the legal aspects arising from decision-making bodies. These changes lead to an improvement in training, which is indispensable, because it will only be possible to transform the reality of health services, producing an integral care, if these transformations begin in the training process (^{OLIVEIRA et al., 2007}; ^{PARANHOS; MENDES, 2010}; ^{SOUSA; BARROS, 1998}).

With regard to the concept of care, it was possible to realize that seven studies, which will be commented on below, point to the need to rethink the epistemological-philosophical basis, which has sustained Nursing since the early twentieth century, referring to objectivity, logic, and neutrality, which can no longer contemplate the current complex reality. To accomplish this, these studies propose different actions.

^{Silveira et al. (2013}) affirm that when Nursing relates to the clinic, it suffers influences from the biomedical model and the Cartesian perspective. From this tension, they believe it is possible to produce a clinical care that has the subject as the focus of the production of this care. ^{Monteiro and Curado (2016}), in turn, argue the importance of thinking about how technological innovations should translate into new perspectives for care. Particularly, academic training that should not be concerned only with teaching techniques, aiming at practical actions, however in reflecting how modern technologies can be inserted in the health field. ^{Backes et al. (2016}) propose the discussion of Nursing care from the perspective of Complexity, thinking of it as an expanded, complementary, antagonistic, and dynamic conception in the actions of nurses. ^{Oliveira et al. (2011}) state that basic human and health needs should guide the production of nursing care, which are captured from the insertion in the social context, both individually and collectively.

It is also observed, in the analysis of these articles, that there are theorists who report specifically to certain philosophers. ^{Schaurich and Crossetti (2008}) recommend thinking about care from the dialogical element of the ideas of Martin Bubber, emphasizing that dialogicity composes and intermediates the relations between the subjects. By bringing this premise to Nursing, the dialogue emerges as a strategy for the one who will care. ^{Queirós (2015}), from Plato, Sófocles, Higino, Boff and Heidegger, understands that care is inherent to the human being, constituting it, so it is necessary to understand what the meanings of caring present in the work of the nurse.

Finally, ^{Silva et al. (2005}) intend that nursing care should be guided by the thought of Leonardo Boff, who understands care from a philosophical, social, spiritual perspective, woven in relationships between people, which would enable the implementation of strategies in Nursing that would allow a resignification of the way of being human in the world.

Thus, the articles analyzed in this section point to a diversity in the conceptions about care, pointing out different nuclei of foundation: relationship between professional and user, knowledge that should permeate the training process and the role of the teacher in the process of teaching and learning, which shows how there is a complexity involved in what is thought and what is done in relation to nursing care.

The Reflections of the Dissertations and Theses on the Training of the Nurse for Care

In the database of dissertations and theses of CAPES, the search was started with the expression: "training of the nurse for care", soon 67 results appeared, however, after careful reading of the abstracts, five papers remained (four dissertations and one thesis). The others were discarded, because they dealt with the post-graduate level training (18), for the process of managing (14), researching (nine) or the nurse’s educational work (21).

Another expression was used: "Nursing undergraduate care", to search for papers in the Dissertations and Theses Database of CAPES. Sixteen results were found, however, after the analysis of the abstract, two papers related to the theme studied here, being the same already identified in previous search. The other studies were excluded because they addressed training in health residences (seven), for the process of managing (four) or researching (three).

Subsequently, the expression "concept of nursing care" was typed and 900,831 records were found. We refined the search by opting for those who had related to the concentration area in Nursing, leaving 248 records, but after reading the abstract, three papers were selected, being two dissertations and one thesis. The others were excluded because they refer to the care performed in health services (74), to techniques performed in certain areas or for specific pathologies (61) or related to the process of managing (66) or to the execution of health education activities (44).

After carrying out these searches in the Dissertations and Theses Bank of CAPES, eight papers were selected to integrate the State of the Question, distributed as follows: five papers dealing with the training of the nurse for care, being four dissertations and one thesis, as well as three works related to the concept of care, being two dissertations and one thesis. The main information about these studies: year of publication, author’s name, title, nature of the work, Post-graduation/University program and objective are listed in the following table:

Of the eight papers selected (six dissertations and two theses) to compose this State of the Question, five address the training of the nurse for care and the other three focus on the conception of nursing care. The works that deal with training for care focus on it from the proposal of the National Curricular Guidelines for Nursing; integrality and humanization in the care of the subject who seeks the health institution; the nurse’s work process and the student’s behavior when having contact with the patient’s body. It is interesting to note that all these five studies (^{CARBOGIM, 2012}; ^{COSSA, 2011}; ^{GUERREIRO, 2012}; ^{OLIVEIRA, 2011}; ^{RANGEL, 2011}) converge to the defense that the reality of health institutions can be modified, among other strategies, through transformations in the nurse training process. The following are detailed meaningful ideas of each work.

^{Carbogim (2012}), when conducting research with Nursing academics, found that students understand care as the founding nucleus of Nursing, going beyond the biological dimension, meaning a process of establishing relations with each other. It is interesting that in another similar investigation, carried out by ^{Rangel (2011}), students also affirmed to conceive integral care as the one in which one glimpses the subject who seeks the health institution considering its multiple dimensions: biological, social, cultural and historical.

In the same sense, ^{Cossa (2011}) argues that, through the systematization of nursing care, there is the possibility of producing an individualized care aimed at the patient’s needs. Thus, it is the role of the teacher to mediate the knowledge necessary for the construction of this care, which permeates, among others, the knowledge related to anamnesis and physical examination. For ^{Oliveira (2011}), another subject to be addressed in the training concerns the care of the patient’s body in a natural way. This is because, when the academic performs a nursing care, he deals with the sociocultural interdictions attributed to the body. As this theme is often not addressed in training, students feel uncomfortable in taking care of the other body.

In relation to the works that deal with the "concept of care", they point out that it is the foundation of Nursing, which goes beyond the technical dimension, producing itself in the relationship between the subjects. It is pertinent to highlight, then, the ideas of each study. Let’s start with ^{Venture (2013}), who, in order to understand the meanings of care intended by the Nursing team for people with cancer, verified that this care is permeated by doing and feeling. Doing as a result of the bureaucracy and the assistance that exists in the health service and feeling refers to the question of the finitude of life and, therefore, the sensitivity in relation to that moment.

Then, ^{Tôrres (2015}), when investigating the conception of care present in the reception by classification of risk performed by nurses, found the care restricted to the identification of the signs and symptoms that the subjects present, to, then, classify the severity of the case. Therefore, there is still a service focused only on the biological dimension, more restricted to procedures.

^{Ribeiro (2015}), aiming to understand how the intercultural care produced in an indigenous village, of the Terena people, in Mato Grosso do Sul, was carried out, using an anthropological and ethnographic reference, which allowed him to reflect that health care can be interdisciplinary, which is demonstrated by the junction of the traditional system, including the use of medicinal plants, rites and spirituality and the official, the one offered by the health services, wanted by the Indians when they can’t solve their health problems.

In this sense, one of the particularities that can be observed when analyzing the dissertations and theses in this section is that, when referring to the training in Nursing for Care, they seek from the NCD of Nursing, the principles of SUS, the nursing work processes, as well as the proposal of humanization and integrality of health care.

Care in Nursing Education: Perspectives From REBEn

In the Brazilian Journal of Nursing, the first search combined the following words: training and nurse and care, and no results were identified. Then, this combination was reformulated, instead of using nurse was used Nursing as follows: training and Nursing "and" care, obtaining 45 results, being four related to the subject studied; the others dealt with training for research (17) or management (14), or teaching-service (10).

When the terms "concept of care and nurse" were associated, as well as "concept of care and nursing" no results were obtained. Then, the expressions "care and nursing" were combined, and 2,226 articles were identified. To refine the search, the criterion was that these words were present in the abstract, so 386 records were available, of which, after careful reading of the abstracts seven were considered pertinent to the theme; however, three had already been identified previously when being performed in the VHL, therefore four new works were aggregated. The others were discarded because they dealt with the performance of hospital procedures (94), assistance to specific pathologies (87), techniques/methodologies to be used in the teaching-learning process (77), the conception of care for patients or companions (49), the performance of educational activities in health (38) and the managerial dimension of nursing care (34).

Subsequently, the terms "care and nurse" were combined, identifying 1451 records. When refining the search, so that these words were present in the abstract, 216 articles were selected. After reading the abstracts, six articles related to the subject under study, and three had already been identified in a previous search, so three more articles were added to the EQ. The other articles dealt with the assistance to specific pathologies (63); the performance of Nursing techniques (54); Nursing management (47) and health education activities (46).

After carrying out these searches in Reben, eleven articles were selected in all to integrate our State of the Question, with seven reporting on the conception of care and four addressing training for care. Table 4 provides the main information of these identified articles:

Of the 11 articles related to the subject studied, five deal with the training of the nurse for care, under different biases: the clinical experience, the perspective of integrality, the understanding of how the care worked and the difficulties to focus it. Thus, according to ^{Vale and Pagliuca (2011}), the training in Nursing needs to think about its conception of care, given that this understanding guides the whole process of teaching and learning. Thus, ^{Silva and Sena (2006}) identified that the nursing care that has been worked on in training aims to overcome the biomedical model, in order to glimpse the subject in all its dimensions and the reality in which it is inserted. In this sense, according to ^{Tanaka and Leite (2007}), when undertaking a study with nursing undergraduate students, they tried to understand how the learning about caring was done. The students brought several conceptions, emphasizing the need for teachers to approach more carefully the procedures to be performed by the nurse.

^{Souza et al. (2008}), in turn, based on a bibliographic study, identified that care in a humanized aspect has been more discussed, particularly in the formative process. The Guidelines emerge as a strategy that encourages the teaching of this humanized care, for both training has this responsibility, at the initial as well as permanent level. As for Souza et al. (2007), over time, the training of nurses for care evolved from a merely procedural aspect to a know-how, based on technical and scientific knowledge.

However, despite the reformulation of the Guidelines for Training in Nursing, there is still a deficit regarding the political-social dimension, which encompasses the role of nurses in society and, consequently, ends up placing him as a transforming agent of contexts (^{SILVA; SENA, 2006}). This situation occurs due to the limits of the formation itself (influences of the biomedical model, fragile links with the service and the training of the teachers who mediate this process) and the context of health institutions that do not provide the experience of a comprehensive care. To overcome these difficulties, ^{Landim, Silva and Batista (2011}) report that the experiences in health services in SUS are shown to be essential for the training of nurses, since it would allow articulating theory and practice, indispensable for the realization of nursing care.

Regarding the "concept of nursing care", ^{Pires (2013}) argues that Nursing needs to rethink the care that has been produced for the subjects, which should be guided both by their health needs, as well as the demand for adequate conditions to carry out the service, that is, both on a philosophical and material level. For ^{Waldow (2009}), care should be based on reflection in action. For this, it is important to stimulate this analysis still in training.

Rethinking the concept of care, ^{Ferreira (2006}) points out the need to conceive care from communication: verbal and non-verbal, which provide a relationship between professional and user, essential for the production of care. ^{Oliveira and Carraro (2011}) propose to think about nursing care from the philosopher Martin Heidegger, which raises the reflection that the actions between professional and patient presuppose a coexistence, a way of being in the world with each other. For ^{Silva, Damasceno and Moreira (2001}), Phenomenology can contribute to Nursing care by raising the understanding of the disease from the behaviors and attitudes of the subject, which translate a little of what he is experiencing; overcoming, thus, a merely biological vision and enabling a wider service.

The articles extracted from Reben, whose analysis was the focus of this section, demonstrate that there is also a multiplicity of conceptions about care, but that always intend to place care as the founding nucleus of Nursing. Therefore, in the formative process, the studies point out the need to think about how this care is worked, the inclusion of students in health services, integrality and the difficulties to experience it in training.